22q11.2 Deletion Syndrome

Introduction

The Questions and Answers that follow aim to provide an introduction to 22q11.2 deletion syndrome for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
More information about many topics relevant to children with 22q11.2 deletion syndrome and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our 22q11.2 Deletion Syndrome module.

What is 22q11.2 deletion syndrome?

22q11.2 deletion syndrome is a genetic disorder that may result in poor development of many body systems. It can affect every bodily function, and may affect people physically and mentally. Because of the wide variety of presentations, different subsets of the syndrome were given different names such as DiGeorge syndrome, velocardiofacial syndrome (VCFS), or Shprintzen syndrome (see other names at Synonyms for 22q11.2 Deletion Syndrome). However, these are all due to 22q11.2 deletion. Once thought to be an uncommon diagnosis, prevalence is now estimated at 1 in 4,000. [McDonald-McGinn: 2011]

What causes 22q11.2 deletion syndrome?

22q11.2 deletion syndrome is caused by the deletion of a small piece of chromosome 22. The deletion happens most often as a random event when reproductive cells (eggs or sperm) are formed or in early fetal development. It is important to know that parents did not do anything to cause their child to have the condition.
In about 10% of cases, a child inherits the deletion in chromosome 22 from a parent. In inherited cases, other family members may be affected.

What are the symptoms?

People with this syndrome may have a wide range of presentations, which may differ among affected members of the same family. No two cases are the same. Common presentations include:
  • learning problems
  • congenital heart disease (particularly conotruncal malformations)
  • palatal abnormalities
  • hypocalcemia
  • feeding problems
  • gastroesophageal reflux
  • chronic otitis media
  • developmental delay/cognitive problems (especially in the areas of expressive language)
  • dental problems due to enamel defects
  • characteristic facial features
  • immune dysfunction
  • renal problems
  • clubfoot
Less common symptoms may include:
  • skeletal problems
  • hearing loss
  • eye abnormalities
  • growth hormone deficiency
Other conditions such as autism, ADHD, and schizophrenia may co-occur with 22q11.2 deletion.

How is it diagnosed?

Clinical findings were previously used to make the diagnosis of the various conditions caused by 22q11.2 deletion. Now, the diagnosis is based on genetic testing.

What is the expected outcome?

22q11.2 is a lifelong condition. Outcomes will depend on what aspects of the condition are present in the affected person. Because there are many different presentations, some children may become fully independent as adults while others may need full-time care. Many therapies and medical treatments are available to help with symptoms. The earlier these symptoms are detected, the more doctors can do to help. Ask your child's primary care doctor for more information.

Will anyone else in the family get 22q11.2 deletion syndrome?

If a child with 22q11.2 deletion syndrome inherited the mutation, any future children of the same parents would have a 50% chance of also having 22q11.2 deletion syndrome. However, most cases are sporadic (they occur due to a rare, random mutation) and subsequent children have no increased risk. Ask your child's doctor or a genetic counselor for an individualized answer.

What is the treatment?

Treatment will depend on the clinical problems your child has. Often your primary care doctor will recommend involving specialists to help diagnose and treat specific problems. Specialists may include a:
  • pediatric geneticist
  • otolaryngologist
  • cardiologist
  • endocrinologist
  • ophthalmologist
  • psychologist
  • nephrologist
  • immunologist
It is important to work with doctors who are familiar with the condition and are able to recommend appropriate treatments.
An Early Intervention Part C Program would be particularly helpful for children from birth through age two who are at risk for, or are showing, developmental delays. Services may include visits by therapists (physical, occupational, speech, vision, etc.) and specific programming for a disability. Some children with 22q11.2 deletion syndrome may need to see an orthopedic specialist because clubfoot and scoliosis are common.
In addition to treatment, families can teach social skills to help their child develop positive peer relationships and self-esteem.

How will my family’s life be changed?

The impact of 22q11.2 deletion syndrome will depend on the ways and the degree to which your child is affected. Children who are more medically complex may need more appointments, therapies, and medications to manage the condition. Early in life, the focus tends to be on acute medical problems, including heart disease, feeding problems, and those associated with palatal dysfunction. Additionally, many children with 22q11.2 deletion syndrome are regularly seen by an immunologist during their first year. Monitoring by immunology may be vital because some children are born without a thymus gland or with a partial thymus gland. Those without a thymus gland cannot receive live vaccines.
Delays in reaching developmental milestones need identification and attention. After the child reaches school age, the focus shifts to cognitive and behavioral problems. Even children with mild clinical manifestations may need close developmental monitoring and increased support for education as they become older.
While a diagnosis may be scary and confusing, many parents report that caring for their child gets easier with time. One parent said that raising a child with 22q11.2 deletion syndrome has changed the way she looks at life, taught her a great deal, and helped her to appreciate life more.

I have a daughter with 22q11.2 deletion syndrome who has significant learning problems. She recently told me that she was pregnant. Will she have children with similar problems?

Talk with a geneticist or genetic counselor for more details. In general, children of an individual with this syndrome have a 50/50 chance of having the syndrome themselves, so doctors may want to follow her pregnancy more closely than is typical. Cardiovascular physiology changes significantly with pregnancy and women with 22q11.2 deletion syndrome may benefit from prenatal or early intrapartum consultation by cardiology. Prenatal echocardiograms may be needed on a regular basis.
Prenatal testing can determine if the child has the syndrome. If testing is positive, your daughter should be followed during her pregnancy by a perinatologist and a prenatal geneticist to enable health care providers to anticipate any problems that may arise. Your daughter's child might be born with a serious cardiac problem that could be anticipated with adequate prenatal ultrasound. Doctors will examine the ultrasound very closely to check for any medical problems that may be caused by 22q11.2 deletion syndrome .

Resources

Information & Support

Where can I go for further information?

For Parents and Patients

Support

22q11.2 Deletion Syndrome Foundation
Research, resources, and information for families with children who have 22q11.2 deletion syndrome.

Velo-Cardio-Facial Syndrome Education Foundation
An international, not-for-profit organization providing support and information to individuals who are affected by Velo-Cardio-Facial syndrome, their families, physicians, and other practitioners.

General

22q11.2 Deletion Syndrome (MedlinePlus)
Excellent, detailed review of condition for patients and families; National Library of Medicine and National Institutes of Health.

Velocardiofacial Syndrome (Genome.gov)
Medical information, educational materials, and a link to the genetic and rare disease information center; National Human Genome Research Institute.

Velocardiofacial Syndrome (OMIM)
Extensive review of 22q11.2 deletion syndrome with detailed information about the genetics of the condition; Online Mendelian Inheritance in Man.

22q11.2 Deletion Syndrome Educational Videos (MIND)
Videos about 22q11.2 deletion syndrome that cover early childhood and adolescence; University of California at Davis Medical Investigation of Neurodevelopmental Disorders Institute.

22q11.2 Deletion Syndrome (GARD)
Links to informational resources, scientific conferences, clinical trials, etc. A "Have Questions" link allows users to submit questions to scientific experts; Genetic and Rare Diseases Information Center.

Chromosome 22q11.2 Deletion Syndrome (NORD)
Overview of the syndrome and its symptoms, causes, and related disorders, along with a list of related organizations; National Organization for Rare Disorders.

22q11.2 Deletion Syndrome (GeneReviews)
An expert-authored, peer-reviewed, current disease description that applies genetic testing to diagnosis and management information; sponsored by the U.S. National Center for Biotechnology Information, U.S. National Library of Medicine.

International 22q11.2 Foundation
Extensive resources and support services for families and clinicians caring for those with 22q11.2 deletion syndrome.

Genetics in Primary Care Institute (AAP)
Contains health supervision guidelines and other useful resources for the care of children with genetic disorders; American Academy of Pediatrics.

Services for Patients & Families in Idaho (ID)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: October 2012; last update/revision: October 2020
Current Authors and Reviewers:
Author: Lynne M. Kerr, MD, PhD

Page Bibliography

McDonald-McGinn DM, Sullivan KE.
Chromosome 22q11.2 deletion syndrome (DiGeorge syndrome/velocardiofacial syndrome).
Medicine (Baltimore). 2011;90(1):1-18. PubMed abstract