As the child with Down syndrome enters the second decade of life, some of the original medical issues, such as cardiac, vision, and hearing problems, continue to concern parents. Dermatologic and podiatric problems may become particularly bothersome. Although the child may be doing well, monitoring for thyroid and celiac disease continues to be needed. Continued vigilance is needed for arthritis, diabetes, leukemia, neck subluxation, and seizures. Prevention and treatment of dental and obesity problems are important. Psychiatric and behavioral problems may compromise the adolescent's opportunities. Sexuality and the associated issues of abuse, pregnancy, and menstrual hygiene must be addressed.