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Peirson Center for Children, 9820 E Burnside Street, Portland, OR (2026)

10/06/2026

Do expectations really matter that much to a child with Down syndrome? How much do the beliefs and behaviors of the adults around them influence their learning and development?

In honor of Down Syndrome Awareness Month Dr. Peirson explores these very questions in her new blog post, The Power of High Expectations for Children with Down Syndrome. 💛 💙

Learn about the Pygmalion and Golem effects and how high or low expectations can shape the opportunities, instruction, and support a child receives.

Read the post here:

https://www.peirsoncenter.com/articles/the-power-of-high-expecations-for-children-with-down-syndrome

10/01/2026

Two sisters. Both at the beginning of their lives. Both with personalities still emerging, interests to discover and so much ahead of them.

Yet the world may approach their futures very differently.

One is born with a diagnosis that can arrive with a list of expectations. Before she has had a chance to show anyone who she is, people may tell her parents what she will struggle with, what she won’t accomplish and how much help she will always need. Those predictions can follow her into classrooms, medical appointments and everyday interactions.

The other is given more room to become herself. People wonder what she’ll enjoy, where her interests will take her and what she might do someday. When she struggles, they are more likely to see something she can work through with time, teaching and support.

One child’s future is treated as something we already know. The other’s is something we’re waiting to discover.

What happens when children grow up surrounded by those different expectations?

Think about how much of childhood depends on someone offering an opportunity. Someone inviting you to join. A teacher giving you a challenging assignment and helping you understand it. An adult being patient while you find your words, instead of answering for you. Someone letting you try again after you make a mistake.

Those moments give children practice. They also send a message: your ideas are important, you can learn, and you belong here.

When we assume a child can’t do something, we may never offer the chance to find out if they can. We may step in before help is needed, speak for them before they can respond or choose an easier task before seeing what they can manage. What looks like kindness can sometimes take away the very experiences that help a child develop confidence and ability.

And when a child has had fewer opportunities to learn a skill, we need to be careful about interpreting that as proof that they could never learn it.

Down syndrome does affect development. Children have different learning needs, health concerns and levels of support. Recognizing those needs is important. So is recognizing how much we still don’t know about an individual child’s future.

A diagnosis cannot tell us how far a child will go with an education that fits them, appropriate medical care and people willing to keep working alongside them. It cannot tell us what they will love or which goals will be important to them.

High expectations mean taking those goals seriously and providing the support to pursue them. They mean allowing a child to struggle, learn at their own pace and experience the satisfaction of doing something for themselves.

We also need to ask whose definition of success we’re using. Our children’s worth does not depend on a diploma, a job or the ability to live independently. A child who needs substantial lifelong support deserves the same respect and opportunity to participate as anyone else.

A seat at the table means their presence is wanted. Their opinions are heard. They have a say in decisions about their own lives, however they communicate.

Look at these two sisters again.

We cannot predict either child’s future from a photograph. We should be curious about both. We should give both the chance to show us who they are.

Before deciding what a child is capable of, ask whether they have been given the opportunity, the time and the support to find out.

Their future is still unfolding. The way we treat them becomes part of it.

October is Down Syndrome Awareness Month. Let’s use this month to reconsider our assumptions and make room for children and adults with Down syndrome to show us who they are and what they want for their lives.

09/30/2026

It’s not often Dr. Peirson, Dr. Ast, and Dr. LaRosa get to be together in person! The MAPS conference gave them a chance to catch up, learn alongside one another, and take this photo.

During her lecture, Dr. Peirson presented two cases of Down syndrome regression, sharing each patient’s recovery and the care she provided along the way.

Dr. Peirson feels so blessed to have Dr. Ast and Dr. LaRosa on her team. They bring heart and compassion to their work with patients with Down syndrome and other neurodevelopmental conditions, along with the knowledge, critical thinking, and curiosity needed to work through complex medical concerns. They care deeply about the families they serve and keep asking questions about how to help.

That’s part of what makes MAPS such a special event. It brings colleagues together to learn, share clinical experience, and think through challenging cases. Getting to spend time together makes it even more meaningful. 💙

09/21/2026

What can an Organic Acid Test tell us about a child with Down syndrome? 🧪

Quite a lot, when it’s interpreted in the context of the individual child.

An Organic Acid Test (OAT) is a urine test that measures dozens of organic acids, which are metabolic byproducts produced as the body processes carbohydrates, fats, proteins, vitamins and other nutrients. Some are also produced or influenced by bacteria and yeast in the gut.

Think of these as metabolic footprints that can give us clues about what is happening inside the body’s biochemical pathways.

This is different from simply measuring how much of a vitamin is circulating in the blood. Patterns of organic acids can show us when a nutrient-dependent pathway may not be functioning optimally, even when a conventional blood test doesn't tell the whole story.

For example, depending on the overall pattern, an OAT may provide clues suggesting:

• Thiamine (vitamin B1) insufficiency or impaired utilization → elevations in pyruvic and lactic acids
• Riboflavin (vitamin B2) insufficiency or impaired utilization → elevations in markers such as glutaric acid
• Mitochondrial dysfunction → abnormalities in metabolites involved in cellular energy production
• Fatty-acid metabolism abnormalities
• Bacterial and yeast overgrowth/dysbiosis
• Malabsorption and digestive dysfunction
• Oxidative stress and antioxidant needs

So why can't we just order this through a conventional laboratory?

Conventional laboratories do perform urine organic acid testing, but these tests are generally designed to identify inborn errors of metabolism and other significant metabolic disorders. The specialty labs we use for OAT testing provide a much broader panel of metabolites that allows us to evaluate patterns involving nutrient-dependent pathways, mitochondrial function, fatty-acid metabolism, oxidative stress, microbial metabolism and gut health, including markers associated with bacterial and yeast overgrowth.

The value isn't simply whether an individual marker is high or low. It's understanding the pattern of metabolites and the biochemical pathways connecting them.

This can be especially useful in children with Down syndrome because we should not assume that every child with an extra copy of chromosome 21 has the same nutritional or metabolic needs.

In our practice, OAT results help us individualize supplementation rather than giving every child the same "Down syndrome protocol." They can help us determine which nutrients a particular child may need, how significant those needs may be and, importantly, WHY those deficiencies are occurring in the first place.

For example, if we see evidence suggesting vitamin deficiencies alongside patterns consistent with intestinal dysbiosis or impaired digestion and absorption, simply giving more vitamins may not solve the problem. We also need to ask:

Why isn't this child adequately absorbing or utilizing these nutrients?

For many of the children we see, malabsorption associated with bacterial and/or yeast overgrowth in the gut is an important part of that picture. Identifying and addressing the underlying cause is just as important as replacing the nutrients that are deficient.

An Organic Acid Test is not a diagnosis by itself, and it should never be interpreted in isolation. This is also why it is important to work with a physician who is trained in the use and interpretation of organic acid testing and who can correlate the findings with the child's clinical presentation, medical history, diet, symptoms and conventional laboratory results.

When used appropriately an OAT can provide valuable information about a child's biochemistry that we simply may not see with conventional testing alone.

And yes, there is published research supporting the clinical relevance of urinary organic acids and the metabolic pathways we evaluate. We've collected PubMed research and additional information here:

👉 https://www.peirsoncenter.com/organic-acid-testing.html

The goal isn't to give every child with Down syndrome more supplements. It's to better understand what each individual child needs, why they need it and what may be contributing to those needs in the first place.

www.peirsoncenter.com

09/18/2026

One of the things we talk about often is the importance of looking beyond the diagnosis of Down syndrome when a child has developmental or neurologic symptoms.

This 2024 review on thiamine (vitamin B1) and pediatric neurologic health describes the potential neurologic manifestations of thiamine deficiency:

“Neurological manifestations include abnormalities in gross, grapho-, and fine motor skills, ataxia, seizures or compromised neuromotor functions (including quadriplegia, and hemiparesis), compromised vision (ophthalmoplegia, nystagmus), swallowing disorders, aphonia, auditory neuropathy, cognitive deficits, and speech and learning disorders.”

Thiamine: An indispensable regulator of paediatric neuro-cardiovascular health and diseases
https://pmc.ncbi.nlm.nih.gov/articles/PMC11473601/

Some of the less familiar terms:

• Graphomotor difficulties - difficulty with the motor skills needed for drawing and writing
• Ataxia - problems with balance and coordination, including an unsteady gait
• Hemiparesis - weakness on one side of the body
• Ophthalmoplegia - weakness or paralysis of the muscles that move the eyes
• Nystagmus - involuntary, repetitive eye movements
• Aphonia - loss of voice or inability to produce speech sounds
• Auditory neuropathy - a hearing disorder in which sound reaches the inner ear, but the signal is not transmitted normally to the brain

Why is this so important in Down syndrome?

Because many of these symptoms are common in children with Down syndrome, and they can easily be dismissed as simply "normal for Down syndrome".

But sometimes there is more to the story.

Thiamine is essential for mitochondrial energy production, particularly in the brain and nervous system. The body stores very little thiamine, and it must be continuously supplied and adequately absorbed through the gastrointestinal tract.

GI dysfunction is extremely common in Down syndrome. Slow intestinal motility can contribute to dysbiosis and small intestinal bacterial or yeast overgrowth, which can interfere with nutrient absorption.

We see biochemical patterns suggesting an increased need for thiamine VERY frequently when we perform organic acid testing in infants and toddlers with Down syndrome. Sometimes these are the same children struggling with hypotonia, delayed gross motor development, abnormal eye movements, feeding or swallowing difficulties, speech delays or other neurologic symptoms.

Organic acid testing does not diagnose thiamine deficiency, but it can provide important clues about how thiamine-dependent metabolic pathways are functioning.

This is why we shouldn't automatically attribute every developmental or neurologic challenge to just the presence of the extra chromosome.

www.peirsoncenter.com

08/29/2026

Low Neutrophil Count in Down Syndrome: Common Does Not Mean “Normal”

Children and adults with Down syndrome appear to have an increased tendency toward low neutrophil counts. However, a low neutrophil count should not automatically be dismissed as simply being “part of Down syndrome.” Neutropenia deserves further evaluation in every patient.

What are neutrophils?

Neutrophils are a type of white blood cell and an important part of the innate immune system, the body's rapid first-line defense against infection.

They are among the first immune cells recruited when bacteria or fungi invade the body. Neutrophils can engulf and destroy microorganisms, release antimicrobial substances, and help coordinate the inflammatory response that recruits other immune cells to an infection.

When evaluating neutrophils, the most useful measurement is the absolute neutrophil count (ANC) rather than simply the percentage of neutrophils reported on a CBC.

It is also important to use an age-appropriate reference range. Normal neutrophil counts change considerably throughout infancy and childhood.

Mayo Clinic Laboratories provides the following age- and gender-specific reference ranges:

MALES
• 0-14 days: 1.60-6.06 × 10⁹/L
• 15 days-4 weeks: 1.18–5.45 × 10⁹/L
• 5-7 weeks: 0.83-4.23 × 10⁹/L
• 8 weeks-5 months: 0.97-5.45 × 10⁹/L
• 6-23 months: 1.19-7.21 × 10⁹/L
• 24-35 months: 1.54-7.92 × 10⁹/L
• 3-5 years: 1.60-7.80 × 10⁹/L
• 6-16 years: 1.40-6.10 × 10⁹/L
• 17 years: 1.80-7.20 × 10⁹/L
• Adults: 1.56-6.45 × 10⁹/L

FEMALES
• 0-14 days: 1.73-6.75 × 10⁹/L
• 15 days-4 weeks: 1.23-4.80 × 10⁹/L
• 5-7 weeks: 1.00-4.68 × 10⁹/L
• 8 weeks–5 months: 1.04-7.20 × 10⁹/L
• 6-23 months: 1.27-7.18 × 10⁹/L
• 24-35 months: 1.60-8.29 × 10⁹/L
• 3-5 years: 1.60-7.80 × 10⁹/L
• 6-14 years: 1.5-6.50 × 10⁹/L
• 15-17 years: 2.00-7.40 × 10⁹/L
• Adults: 1.56-6.45 × 10⁹/L

https://www.mayocliniclabs.com/test-catalog/overview/9109/complete-blood-cell-count-cbc-with-differential-blood -and-interpretive

What can cause a low neutrophil count?

There are many possible causes of neutropenia. It may be temporary, particularly during or following a viral infection. Persistent neutropenia has a broader differential diagnosis that includes infections, medications, autoimmune conditions, immune disorders, congenital conditions, bone marrow disorders, and nutritional deficiencies.

Nutritional causes are particularly important not to overlook. In our clinical experience, nutritional insufficiencies are among the most common contributors we identify in our patients with Down syndrome and low neutrophil counts. Fortunately, they are also among the most easily addressed.

A review published in Seminars in Hematology states:
“Nutritional deficiencies of vitamin B12, folic acid or copper, or severe protein-calorie malnutrition can cause neutropenia.”
https://pmc.ncbi.nlm.nih.gov/articles/PMC3748385/

The authors note that nutritional deficiencies typically cause abnormalities in more than one blood-cell line rather than isolated neutropenia. Nevertheless, vitamin B12, folate, copper, and overall nutritional status should be considered when investigating chronic neutropenia.

This may be particularly relevant in Down syndrome because feeding difficulties, restricted diets, gastrointestinal disorders, and nutrient malabsorption can contribute to nutritional deficiencies.

Other important causes of low neutrophils include infection and bone marrow disorders. Neutrophil counts can temporarily fall during or after a viral infection because infection can suppress neutrophil production in the bone marrow and can also increase their use, destruction, or movement out of the circulating blood.

More serious bone marrow disorders, including leukemia, can also cause neutropenia when abnormal cells interfere with normal blood-cell production. Warning signs that warrant particular attention include persistent or recurrent fever or infections, unusual bruising or bleeding, petechiae, pallor, significant fatigue or weakness, bone or joint pain, unexplained weight loss, enlarged lymph nodes, or enlargement of the liver or spleen. Leukemia may also cause abnormalities in other blood-cell lines, such as a low red blood cell or platelet count.

A temporary decrease in circulating neutrophils can also occur following vaccination, most often within the first two weeks. This may reflect redistribution of neutrophils as part of the immune response and other transient immune effects. Although post-vaccination neutropenia often resolves on its own, a low neutrophil count still warrants follow-up to confirm that it returns to an appropriate range.
https://pmc.ncbi.nlm.nih.gov/articles/PMC4974007/

Evaluation should consider:

• The appropriate age- and gender-specific reference range
• Whether the ANC has been low on previous CBCs
• Whether the neutropenia is transient or persistent
• Whether other blood-cell lines are also abnormal
• Recent infections
• Medications
• Vitamin B12, folate, copper, and overall nutritional status
• Immune and autoimmune causes

In our practice, we follow up a low neutrophil count by checking serum vitamin B12, folate, copper, and zinc to evaluate for potentially correctable nutritional contributors. Depending on the degree and persistence of the neutropenia, the clinical history, and other CBC findings, additional evaluation and/or referral to hematology may also be appropriate.

A finding can occur more often in Down syndrome and still deserve investigation. A low neutrophil count should always prompt us to ask why, look for potentially correctable causes, and take action when appropriate.

References:

Newburger PE, Dale DC. Evaluation and Management of Patients with Isolated Neutropenia. Semin Hematol. 2013;50(3):198–206.

Mayo Clinic Laboratories. Complete Blood Cell Count (CBC) with Differential, Blood: Pediatric and Adult Reference Values.

Muturi-Kioi V, Lewis D, Launay O, et al. Neutropenia as an Adverse Event following Vaccination: Results from Randomized Clinical Trials in Healthy Adults and Systematic Review. PLoS One. 2016;11(8):e0157385.

08/25/2026

How much choline does a woman really need during pregnancy? 🧠

The current recommended intake of choline during pregnancy is 450 mg/day. But some fascinating research suggests that this may not be enough to optimally support fetal brain development.

In a randomized, controlled feeding study, researchers at Cornell University compared pregnant women consuming approximately the recommended amount of choline (480 mg/day) with women consuming about twice that amount (930 mg/day) during the third trimester.

The babies whose mothers consumed 930 mg/day had significantly faster information-processing speeds during their first year of life compared with babies whose mothers consumed 480 mg/day. Importantly, no adverse effects were reported at either intake level.

But here's the part we find especially interesting:

Researchers followed these children until 7 years of age.

Children whose mothers had consumed 930 mg/day during pregnancy performed significantly better on a test of sustained attention than children whose mothers consumed 480 mg/day. The researchers concluded that the higher prenatal choline intake produced lasting improvements in sustained attention.

Choline is critical for the developing brain. It's needed to make acetylcholine, an important neurotransmitter involved in attention and learning, as well as phosphatidylcholine and sphingomyelin, important components of cell membranes and myelin. Choline also contributes to methylation and regulation of gene expression.

And yet, most pregnant women aren't even reaching the current recommendation. The researchers note that average intake during pregnancy in North America is only around 350 mg/day, and many prenatal vitamins contain little or no choline.

These are just two examples from a growing body of research supporting the importance of adequate choline intake during pregnancy for fetal brain development and long-term neurodevelopmental outcomes. They raise an important question: Is the current choline recommendation during pregnancy high enough to optimally support a baby's developing brain?

Supporting optimal brain development begins before birth, and choline is emerging as a particularly important piece of that picture.🧠💚

Bahnfleth CL, et al. Prenatal choline supplementation improves child sustained attention: A 7-year follow-up of a randomized controlled feeding trial. FASEB J. 2022.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9303951/

Caudill MA, et al. Maternal choline supplementation during the third trimester of pregnancy improves infant information processing speed: a randomized, double-blind, controlled feeding study. FASEB J. 2018.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6988845/

08/19/2026

The MAPS Parent Conference is back this fall in Philadelphia!

Created specifically for parents navigating complex chronic and developmental conditions, this is a space to learn directly from MAPS clinicians, ask questions, connect with other families, and leave with deeper understanding and practical support.

Join us in person for expert education, parent-focused conversations, and the connection that made our first Parent Conference so special.

Dr. Peirson will also be speaking at the MAPS conference in the physician track that weekend!

📅 September 13, 2026
📍 Philadelphia, PA
💻 Virtual option available

Learn more + register:

➡️ https://www.medmaps.org/events/fall2026-parent-conference/

08/18/2026

Down syndrome results from approximately 0.75% additional genetic material.

So here's a question worth asking:

Should your child's treatment and supplement regimen be based on that 0.75% alone?

That extra copy of chromosome 21 is important. It can have widespread effects on development, metabolism, immune function, thyroid physiology, neurological function, and much more.

But it isn't the whole story.

The other 99.25% of their genetics matters too.

But genetics is only part of what makes each person unique.

Every person with Down syndrome has a different medical history, diet, nutritional status, environment, medication exposure, microbiome, gut health, immune history, sleep patterns, activity level, and countless other influences that shape how their body functions.

Even two people with the same diagnosis can have remarkably different biochemistry and very different needs.

This is why we believe supplement recommendations for people with Down syndrome are most helpful when we consider the individual as a whole, not simply the diagnosis.

Chromosome 21 should inform our understanding of a person. It shouldn't become our entire understanding of them.

Look at the whole person. Ask questions. Test when appropriate. Consider their history, symptoms, diet, environment, and individual biochemistry.

Because a person with Down syndrome is so much more than their extra chromosome.

www.peirsoncenter.com

07/25/2026

Concerns About Long-Term Miralax Use in Children

🧠 Behavioral and neurologic concerns

The FDA has received reports from families describing behavioral and neuropsychiatric changes in children taking PEG 3350, including anxiety, aggression, mood changes, obsessive-compulsive behaviors, tics, and sleep disturbances. Importantly, these reports do not prove that Miralax caused these symptoms, and studies have not established a causal relationship. However, the reports were significant enough that the FDA called for additional research into the long-term safety of PEG 3350 in children.

FDA Briefing Document on Polyethylene Glycol (PEG 3350) Safety:
https://www.accessdata.fda.gov/drugsatfda_docs/nda/2013/203595Orig1s000OtherR.pdf (opens as PDF)

🛡️ It may temporarily disrupt the gut's protective mucosal layer and have lasting effects on the microbiome

Animal studies have shown that PEG treatment can temporarily disrupt the intestine's protective mucus barrier, resulting in a thinner mucus layer, sometimes with areas of complete mucus loss, and allowing bacteria to come into direct contact with the intestinal epithelium. In these studies, the mucus layer recovered within a few days after PEG was discontinued, but the findings demonstrate that PEG can transiently alter the intestinal environment rather than acting as a completely inert stool softener.

Transient osmotic perturbation causes long-term alteration to the gut microbiota
https://pmc.ncbi.nlm.nih.gov/articles/PMC6061967/

🔍 It doesn't address the root cause

Miralax softens stool, but it does not correct why constipation developed in the first place. If a child requires Miralax daily for months or even years, it's worth asking what is preventing normal bowel function.

Some of the most common contributors to chronic constipation include:

• Thyroid dysfunction
• Nutrient deficiencies (especially magnesium, vitamin B1, B2, and B6)
• Gut dysbiosis or methane-producing organisms that slow intestinal motility
• Food sensitivities (especially dairy) or chronic intestinal inflammation
• Low muscle tone
• Inadequate hydration or poor dietary fiber intake

Rather than simply making stools softer, the best long-term approach is to identify and address the underlying cause of impaired gut motility. Depending on the child, this may include optimizing thyroid function, correcting nutritional deficiencies, restoring a healthy gut microbiome, treating intestinal dysbiosis when present, improving diet and hydration, and supporting the body's natural motility mechanisms.

Get help for your child here: www.peirsoncenter.com

This post is for educational purposes only and is not medical advice. Never stop or change a prescribed medication without discussing it with your child's healthcare provider.

Peirson Center for Children

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