References/recommended reading

Down’s Syndrome. The Essential Guide. Antonia Chitty and Victoria

Dawson ISBN: 9-781861-440839 Need-2 Know series . Reviewed in the Association of Paediatric Chartered
APCP journal (Volume 2 Number 2 May 2011)
Physiotherapists
Children with Down Syndrome A Guide For Parents and Professionals.
Patricia C Winders. P.T. Woodbine House 1997 ISBN: 0-933149-81-6
Down’s Syndrome Association- www.downs-syndrome.org.uk

Down’s Syndrome Scotland- www.dsscotland.org.uk

Down Syndrome Education International– www.dseinternational.org

Down Syndrome
With thanks to Josie Carbin

The Chartered Society of Physiotherapy is the

professional, educational and trade union body for the
UK’s 50,000 chartered physiotherapists, physiotherapy
students and associates

APCP This leaflet has been produced

after an initial review of literature
https://apcp.csp.org.uk and where there is a lack of
Published: January 2016 evidence, a consensus of expert
opinion is agreed, correct at time
Review: January 2019
of publication
Although children with Down Syndrome (DS) will acquire motor skills more Ideas for pre-school children
slowly than a child without DS they will still master the basic gross motor
Tummy time: It is beneficial to start tummy time with young babies,
skills of rolling, sitting, walking, running and riding a tricycle. Many will also
encourage your child to lift its head and prop through its arms.
learn more complex skills such as swimming, dancing, riding and martial arts.
Developing sitting balance: Place toys to either side of your child to
Children with DS, like other children, develop their skills according to their
encourage them to reach out to get them. This can be made easier or
own timetable, some will be slower than others and some will be faster. In
harder by placing them in front, or behind to the sides, or further away. You
general though, specific physical and medical problems can delay the
can also play see-saw with your child to improve their sitting balance.
development of gross motor skills in a child with DS.
Standing Practice: Trying standing your child facing the sofa for support;
Hypotonia – children with DS have low muscle tone, also known as
place toys or games in front to distract them in this position. You may need
hypotonia (floppiness). This affects each child with DS differently – some
to help keep their knees straight and prompt them to ‘stand tall’.
children are affected very mildly, whereas in others it can be far more
noticeable. Footwear: Some children may benefit from ankle boots which are stiffer and
more supportive than shoes and can be purchased at your local shoe shop.
Increased flexibility of joints (hypermobility) – in children with DS the
Occasionally it may be felt that your child would benefit from being referred
ligaments that hold the bones together can be more lax than usual.
to the orthotist or podiatrist for further advice on insoles to promote a neutral
Decreased strength – children with DS have decreased strength in their foot posture.
muscles, but this can be improved through repetition and practice.
Activities for school age children
Short arms and legs – children with DS have shorter arms and legs in
relation to the length of their trunks. This can make sitting more challenging Although children with DS usually show hypermobile joints, there is a risk of
as they are unable to prop as easily and have further to go when falling muscle shortening at the hip flexors (the muscles at the front of the hips).
before they can save themselves. By encouraging lying on the tummy with the legs out straight behind (not
frogged out to the sides) it allows the front of the hip to be stretched out.
Medical issues – these can affect the child’s ability to engage in gross motor This is a great position to look at books together or play a game.
activities. Issues can include heart problems, stomach issues, chronic upper
respiratory infections and ear infections. They can lead to fatigue and All children benefit from regular exercise, but those with DS may feel that
decreased stamina. they struggle to keep up with peers in competitive sports. Consider trying
an individual sport where they compete against themselves by improving
Ways in which you can help their time or technique such as swimming, gymnastics, cycling. Some
children with DS may be advised against forward rolls in gymnastics.
Practice makes perfect when learning a new skill. It is thought that children
with DS require lots of repetition and encouragement at practising a task Check out local councils and charities for sports and activity groups which
before it is mastered, far more so than their peers. Many children can achieve are held in your local area. Regular exercise can be a useful way to promote
a high level of motor skills if given the opportunity. This is often best achieved cardio-vascular activity which we all benefit from, in addition to helping
through play activities. reduce the risk of becoming overweight or obese which can affect children
Typically children with DS learn best visually, or by watching others. Rather with DS as they get older and adopt sedentary lifestyles.
than just verbally encouraging your child, show them what you want them to It is important to remember that every child is in an individual. As such there
do at the same time. are no standard physiotherapy programmes which every child should follow.
Not every child with DS will need to be seen by a physiotherapist. If you
have any concerns please speak to your Paediatrican, Health Visitor or GP
for further advice.