Sunday, November 11, 2012

Down Syndrome and Therapy {a guest post by an OT}

Children with Down syndrome often receive occupational therapy to address motor delays. Today I’d like to share some physical characteristics of Down syndrome that may affect your child’s motor development and then I’ll share some easy activities you can do with your child with Down syndrome to promote development of motor skills.

Physical characteristics of Down syndrome that can affect motor development:

  • Hypotonia. This is a fancy medical term for low muscle tone. Babies with Down syndrome often feel very floppy when you hold them. This is due to the low muscle tone. The best way to imagine what it is like to have low muscle tone is to think of when you are exhausted and how much energy it takes to get your muscles to move. That is what it’s like all the time to have low muscle tone. It is good to remember that low muscle tone affects every muscle from head to toe.
  • A single transverse palmar crease (also known as the simian crease). Despite some beliefs that this is a primary physical characteristic of Down syndrome, only about half of children with Down syndrome have the single palmar crease. This may affect your child’s hand dexterity, but often the single palmar crease does not have a significant impact on hand skills.
  • Short fingers, especially 5th finger(pinky finger), which may appear slightly bent. Smaller fingers and hands may cause your child to have difficulty with tasks that require fine motor precision and dexterity, such as buttoning pants.

Activities for babies:
  • Tummy time. All babies need tummy time, but this will be especially important for your baby with Down syndrome. Lots of tummy time will help increase your babies strength and help your baby overcome the low muscle tone associated with Down syndrome.
  • To develop fine motor skills, encourage your baby to grasp onto toys such as rattle and rings. Since your baby may have smaller hands, make sure the toy is thin enough for your baby to get his or her hand around it.

Activities for toddlers:
  • Drink through a straw. Since low muscle tone affects every muscle from head to toe, drinking through a straw will help strengthen the muscles of your child’s mouth and face.
  • Further develop your child’s fine motor skills with simple, age-appropriate toys, such as duplo blocks, playdough, and wooden knob puzzles.
  • Walk, walk, walk! Toddlers with Down syndrome typically learn to walk around two years of age. The best way to promote their gross motor development is to let them practice their new skill of walking.

Activities for preschoolers:
  • This is a good age to start introducing oral motor games to further strengthen your child’s facial muscles. A simple oral motor game you can play with your child is to race cotton balls across the table by blowing through straws.
  • Develop early self-help skills by encouraging your child to put her shoes on and teach her how to manage the Velcro on her shoes. This promotes independence and fine motor skills at the same time!
  • Preschool is when children start developing pre-writing skills. Use broken crayon pieces to provide your child with small crayons for small hands. Encourage your child to imitate lines and circles. You and your child can also use your fingers to draw lines and circles in shaving cream, paint, or sand.
  • As your child’s gross motor skills develop, you can introduce more challenging activities requiring balance. Encourage balance by standing on one foot to kick a ball. Or place a two by four piece of wood on the floor to create a low balance beam.
  • To increase your preschooler’s overall strength, wheelbarrow walk with your child or have your child do animal walks (e.g. crab walk, bear walk).

Activities for school age children:
  • This is the age in which children begin to develop more independence in self-help skills. For your child with Down syndrome this will probably take a lot of practice and patience! Skills that require fine motor dexterity, like zipping a jacket, buttoning pants and tying shoes will require lots of repetition. It’s best to work on one new self-help skill at a time.
  • Developing scissor skills can require extra practice in children with Down syndrome due to their shorter fingers. Practice the open/close motion required for cutting by squeezing tongs and spray bottles. Promote the use of both hands together stringing beads or doing crafts that require tearing paper into small pieces.
  • As your child moves from pre-writing to writing letters and numbers, keep in mind pencil grip. Children with Down syndrome have shorter fingers, which can make it challenging to hold a pencil appropriately. To promote the use of a tripod grasp, encourage your child to hold a small toy or eraser against his palm with his pinky and ring fingers, while he holds onto his pencil with the remaining three fingers. Click here to see what that looks like.
  • As your child’s balance improves, keep introducing more challenging gross motor activities. Encourage your child to alternate feet when walking up the stairs or start riding a bike with training wheels. Get that two by four balance beam back out and practice jumping off of it!

The key to developing motor skills in children with Down syndrome is the same as in all children: go at your child’s pace and choose activities that are developmentally appropriate. I hope this list helps provide a guideline for promoting motor skills in your child with Down syndrome!

Recommended Reading:
Fine Motor Skills for Children With Down Syndrome by Maryanne Bruni
Gross Motor Skills in Children With Down Syndrome by Patricia Winders
Babies with Down Syndrome: A New Parents' Guide by Susan Skallerup

About the author:
Abby Brayton-Chung, MS, OTR/L is a pediatric occupational therapist with five years of experience evaluating and treating children ages birth to twenty-two, including children with Down syndrome. Her work experience includes school based practice, early intervention and feeding therapy. Abby recently moved from Southern California to New England, where she is enjoying the changing seasons. Abby currently specializes in providing occupational therapy services to students with language and learning disabilities. Abby blogs about her experiences as a pediatric occupational therapist at

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