Diagnosis Discussion- Down Syndrome Part 2

Now onto Part 2 of my Diagnosis Discussion regarding Down Syndrome.  You can read Part 1 here.

Part 3 will have :  

What you DON’T say to a parent of a child with Down Syndrome

Great blogs from parents of a child with Down Syndrome

sorry I couldn’t fit it all in 1 post!


Physical Therapy and Down Syndrome

For general information regarding various therapies for children with Down Syndrome (DS), here is a link from NDSS.org 

Onto the physical therapy part.  There are a few characteristics that children with Down Syndrome have that influence how we plan our physical therapy interventions.  Here are the main ones:

  • Hypotonia, aka low muscle tone– what is that?? It’s pretty hard to explain, but our muscles are tightened to an optimal point that helps us do all the movements that we do.  In children w/ Down Syndrome, they’re muscles are not tied as tightly, which makes it more challenging to increase strength and build powerful movements.  Children w/ hypotonia tend to feel a little floppier than children with typical muscle tone.  One way hypotonia is noticeable is when you pick a child up from their shoulders, where their body slips a little when you hold them from the shoulders.
  • Ligament laxity– Children with DS tend to have looser ligaments, which means they are very very flexible in most of their joints.  Ligaments help to hold our joints together, so when you have loose ligaments, you tend to have decreased stability, which makes it harder to progress through gross motor milestones.




Patricia Winders, PT has written a detailed book for parents and clinicians about physical therapy for children with Down Syndrome.  She presents a good summary of a PT’s goal for treatment for children with DS:

The goal of physical therapy for these children is not to accelerate the rate of their development, as is often presumed, but to facilitate the development of optimal movement patterns. This means that over the long term, you want to help the child develop good posture, proper foot alignment, an efficient walking pattern, and a good physical foundation for exercise throughout life.

You can find more info regarding her book and how she guides her treatments for children with DS here.  

Children with DS typically begin physical therapy early on around 4-6 months.  In addition to receiving physical therapy, they also receive other services, which can include occupational therapy, and speech therapy.

Another valuable service that can help children with DS is called Early Intervention.   NDSS.org has a great resource that explain early intervention and how it helps children with DS.    Early intervention involves all the above therapies and can also involve 2-3 hour class that mixes all 3 in 1 session.  Early Intervention usually is provided from 0-3 years of age.

Here are some excerpts from their site about Early Intervention:

What is early intervention?

  • Early intervention is a systematic program of therapy, exercises and activities designed to address developmental delays that may be experienced by children with Down syndrome or other disabilities.
  • These services are mandated by a federal law called the Individuals with Disabilities Education Act (IDEA).
  • The law requires that states provide early intervention services for all children who qualify, with the goal of enhancing the development of infants and toddlers and helping families understand and meet the needs of their children.
  • The most common early intervention services for babies with Down syndrome are physical therapy, speech and language therapy, and occupational therapy.

How can early intervention benefit a child with Down Syndrome?

  • Development is a continuous process that begins at conception and proceeds stage by stage in an orderly sequence. There are specific milestones in each of the four areas of development (gross and fine motor abilities, language skills, social development and self-help skills) that serve as prerequisites for the stages that follow.
  • Because of specific challenges associated with Down syndrome, babies will likely experience delays in certain areas of development. However, they will achieve each of the same milestones as other children, just on their own timetable. In monitoring the development of a child with Down syndrome, it is more useful to look at the sequence of milestones achieved, rather than the age at which the milestone is reached.

Estimated gross motor milestones in children with Down Syndrome

These have a wide range of months similar to the ranges for milestones for all children, so just wanted to share for anyone wondering about when children with Down Syndrome achieve certain milestones.

These are from NDSS.org:

Here are range from a study that looked at the gross motor milestones for children with DS:

Gross Motor Function of Children With Down Syndrome: Creation of Motor Growth Curves
Robert J. Palisano, ScD, MCP, Stephen D. Walter, PhD, Dianne J. Russell, MSc, Peter L. Rosenbaum, MD, FRCP(c), Maryan G~mus, MSc, Barbara E. Galuppi, BA, Larry Cunningham, B
Arch Phys Med Rehabil Vol 82, April 2001

  • Rolling: 6 months
  • Sitting by themselves: 8-12 months
  • Crawling: 15-18 months
  • Standing at a support: 15-18 months
  • Walking: this has a very wide range but generally 18-24 months, and sometimes closer to 24 months or older depending on if they receive physical therapy early on.
  • Running: 48-60 months
  • Jumping: 60-72 months

Treadmill training is commonly done with children with DS to help them learn the proper mechanics of gait more quickly.  There are a number of studies that have shown the benefits of treadmill training for children with DS.

Next week I will share things you DON’T say to parents of a child with DS and great blogs from parents with children with Down Syndrome.

Categories: Child Development, Diagnosis Discussion

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1 reply


  1. Developmental Milestones Checklist | My Blog

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