Ignorance: It begins in the medical manuals.

90% of all prenatally diagnosed unborn children with Down syndrome are aborted. NINETY percent.


That leaves only 10 percent given the opportunity to take their first breaths.

Perhaps it has to do with the way the diagnosis  is delivered.

Misinformation begins early. Here is a page taken from a currently in use NURSING book published by Nursing Education Consultants, Inc.

Photobucket This is an actual page from a text book currently in use in many nursing schools.

The picture isn’t great and it’s hard to read what is written on it, so I’ve copied it below:

Down’s Syndrome

(btw, it is DOWN syndrome….NOT DOWN’s)

  • Eyes: inner epicanthal folds with short sparse lashes
  • Mouth: Protruding tongue  Arched palate
  • Hypotonic Muscles
  • Hands: Short, stubby fingers  Simian crease
  • Small Head
  • Flat Face Profile
  • Nose: Small with depressed bridge (Saddle nose)
  • Ears: Small, low set
  • Broad, Short Neck
  • Protruding Abdomen
  • Gen*talia: Small Pen*s  Cryptorchidism
  • Mental Retardation With Developmental Delays of Varying Degrees

Yes, these can all be signs of a child who has Down syndrome.  They can also be signs of kids without.  Parker has no Simian Crease.  Flat face profiles run in my family.  And Reed’s neck is about as broad and short as they come.

But that really isn’t the issue here.  The issue is the way the information is presented.  The degrading, insulting,  mocking manner in which Down syndrome is being addressed by the use of the picture depicting a person with Down syndrome.

I question the professionalism not only of the creators of the publication, but the nursing colleges that teach from it.  Remember, many colleges receive tax payer money.  YOUR money…..going to represent those living with Trisomy 21 in such an unprofessional and disgusting way.

This issue needs to be addressed.  I hope you do too.  Here is their contact information:

Nursing Education Consultants, Inc.

P.O. Box 644
Waxahachie, TX 75168
Phone: 1-800-933-PASS
Fax: 1-972-923-1938
Review Courses: info@nursinged.com
Books: books@nursinged.com

PS:  Down syndrome isn’t the only diagnosis mocked in this publication, bulimia, Alzheimer’s and others are presented in the same disturbing way.





About Tammy and Parker

Special Needs Blogger, and homeschooling Mom, heavily involved in advocacy for all kids with special needs in Utah.


  1. I gasped out loud when I saw that picture. I can’t believe that is used in a textbook. Unbelievable.
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  2. Cathy says:

    UNBELIEVABLE. The picture is not really clear on my screen. Please tell me that is not a tongue hanging out. Somehow I never noticed people with Down syndrome only have three fingers before. I also never noticed their feet/hands are as long as their legs. WTH???

    Is this so called “text book” being used at UVU?

    • Tammy and Parker says:

      Yup. Tongue. Hanging out. And three fingers. And all the rest. I don’t know if it is used at UVU or not, but I can certainly find out.

  3. Aimee says:

    Unbelievable!!! I have been reading your blog for forever, however have never commented. Love your blog, by the way! I just got finished sending an email to the fine folks at nursing ed. I have a nephew with Down syndrome who brings us so much joy! In my e-mail, I suggested that maybe they should actually sit down and spend some time with a child who has Down Syndrome, and just maybe they would be able to have a better description for their textbook. Thanks for bringing this to our attention.

    • Tammy and Parker says:

      Aimee, thanks for taking the time to comment! And thank you for sending off that email. Hope to have you jump in more often around here!

  4. Aimee says:

    Just me again! I got a reply:

    Hello Aimee
    Thank you for bringing this to our attention. This image is from an old edition of the Memory Notebook of Nursing, Volume 1. It is no longer in the current edition of the book

    • Tammy and Parker says:

      Aimee, that’s great.

      Now what about all the colleges that are still using this edition?
      Thanks for letting me know!

      • Aimee says:

        This was her response when I asked if it was still being used in colleges:

        Hello Aimee

        I cannot tell you whether or not colleges still have the old 2008 edition. Most schools purchase the new edition when it is available.
        JoAnn Zerwekh

        • Since when is 2008 OLD? My twins were born in 2008 and I don’t consider them old. My van is a 2005 and I don’t think of it as old, either. So we’ve gained enlightenment since 2008, have we?

  5. Renee

    This is inexcusable! Absolutely inexcusable!

  6. Constance says:

    Do you know the name of the book being used and the edition? I would bet that it is an outdated edition. I’ve been a RN for 25 years and have never seen anything even close to this.

    • Tammy and Parker says:

      Contance, you are right, this is from an older edition as per Aimee’s comment above. HOWEVER, this edition is STILL in use as I obtained this picture from a current nursing student.

    • Cathy says:

      The answer I got to one of my emails said it is from the “Memory Notebook of Nursing, Volume 1″. Here is the email response:

      Thank you for bringing this to our attention. This image is from an old edition of the Memory Notebook of Nursing, Volume 1. It is no longer in the current edition of the book.

      Nursing Education Consultants

      Too bad the old books are still out and about :( AND this should have NEVER been acceptable.

  7. Carolyn says:

    To tell the truth, when I first saw that picture I thought it was going to be yet another call to ban a degrading web page. I couldn’t believe it when you said it was from a textbook! I don’t know if it is used here in Australia, but it wouldn’t surprise me with a post diagnosis abortion rate of 98%!

  8. Jean P says:

    Hard to beleive that any school would be using that for the last 20 years. Another group that needs to get educated is the company that published this and evidently still lives in the ignorant dark ages.

  9. Did you see the one for bi-polar disorder? As someone who is diagnosed with this disorder this made me sick to my stomach to see!


  10. Colleen says:

    I doubt that any schools are using this book in their curriculum since it isn’t from a text book, but rather from an Illustrated Study Guide that uses mnenomic cartoons or illustrations to help the nursing student remember nursing concepts for a nursing exam. To further explain, here is a description of the book “Colorful illustrations and mnemonic cartoons clarify essential nursing concepts and offer a visual way for you to remember key facts for the NCLEX exam. Answers and rationales are provided for every practice question.” In other words, it may not be PC but the illustrations are exaggerated to help the student review and recall things that they have already learned.

    Here is a link to the Memory Notebook for Nursing Students Vol.1 2nd Edition – http://www.amazon.com/Memory-Notebook-Nursing-Joann-Zerwekh/dp/189215501X
    The cover features a female with Bipolar Disorder; the left side illustrates her manic side and the right illustrates her depressive side. I found this book without writing the publisher within two minutes of reading this post, and therefore was not offended because I took the time to understand the intent. Yes, if taken at face value only, it is offensive but they are not using the illustrations to belittle the patients (in my opinion) but to have a visual way for the nursing students remember what they’ve already learned so that they can review before their nursing exam. You all may disagree, but I do not find the illustration of the person with Ds offensive. Also, I did a reverse image search on Google and the only copy of this image on the internet is on Photobucket, presumably by this blogger.

    • Tammy and Parker says:


      So you are telling me that this is the only way that nurses can remember what they need to know about Down syndrome? A picture such as this? Nursing students aren’t smart enough to retain this information without using pictures that are as offensive to as many people as this one has been?

      Are you saying that I am lying when I say I received this picture from a current nursing student? What in the world would be my gain in doing that? The name of the school this picture is being used at has been given to an organization which is getting in contact with both the school and the publishing company. When I have more news I’ll share it on this blog.

      The publishing company has already said that yes, they did use this image in a previous edition, but are no longer using it in their most current editions. I wonder why? Could it have possibly been because it was so offensive?

      Have you ever taken the time to understand the intent of thousands of parents who are trying to reverse the perception of children with Down syndrome? Do you have a child with Down syndrome?

      And if that visual is a way for the nursing students to remember what they’ve learned, what exactly do you think comes to mind each time they see a person with Down syndrome?

      One reason I’m asking you these questions is because of a troll who has spent quite a bit of time leaving degrading comments on this blog about persons with Down syndrome. Thanks!

      • Looking Up says:

        Tammy, I’ve been a nurse for nearly 17 yrs now & I can assure you that I did not require offensive, degrading “cartoons” to help me retain the information that I needed to pass my NCLEX exam. In fact, I am happy to say that I have never seen anything remotely that ridiculous in my entire career. It is absolutely shocking to think that material like that was published as recently as 2008….the very year that my adorable son (who just happens to have DS) was born. What a disgrace!

    • JeanneDB says:

      Not that I have to, but I can back Tammy up on this. A nursing student who has a child with Down syndrome brought this to our attention via a private group for parents of children with Down syndrome on FaceBook. Therefore, the original image is not available to search engines.

      How nice that you are not offended. I’m not offended either – I’m angry. This is the image medical professionals will have in mind when seeing my son.

      I’m fortunate that my son’s pediatrician often has training nurses and doctors in her practice. I used to get upset that the training nurses and doctors would see Josh before the doctor so Josh had to go through vitals twice (he doesn’t like that) and I would have to answer questions twice. I won’t annoyed anymore. I’d rather they experience my son in their training than think back to that horrible image.

  11. Crystal says:

    are you kidding me these are children and humans not a stinkin’ cartoon. I swear if i ever saw an person who ever drew that i would slap them upside there head. they have no heart at all. who cares what is wrong medically with anyone. they are still here and we are to love them as we would love anyone else.

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