Down syndrome vs normal development

You can read more about antenatal tests for chromosomal abnormalities like Down syndrome.


Common features of Down syndrome

Children with Down syndrome share physical features with other children with Down syndrome, but they also look like their own family members.

Down syndrome is different for everyone affected, but all people with Down syndrome have some intellectual disability. It can range from quite mild to more severe.

For children with Down syndrome, intellectual disability means some delay in development and some learning difficulty.

People with Down syndrome might also have a range of medical and health conditions, so it’s important to have your child’s health checked regularly by health professionals.

Supporting your child with Down syndrome

You can expect that the key milestones – like walking, talking and crawling – will probably be slower to come for your child with Down syndrome.

But as with any other child, your love and stimulation are the most important influences on your child’s development. Children learn the most from the people who care for them and with whom they spend most of their time, so everyday play and communication can help your child a lot.

With family and community support, your child with Down syndrome can grow up to be just like anyone else – living in the community, holding down a job and having good relationships with friends and family.

Regular health and development checks will help to spot any issues for your child. Talking to health professionals like your child and family health nurse or GP is also a good way to work out what help you and your child need.

Early intervention services for children with Down syndrome

Although there’s no cure for Down syndrome, early intervention can make a difference. Through early intervention services, you can work with health professionals to choose therapy options to treat your child’s symptoms, support your child, improve outcomes for your child and help him reach his full potential.

The team of professionals involved in supporting you and your child might include paediatricians, physiotherapists, occupational therapists, speech pathologists, special education teachers and psychologists.

Financial support for children with Down syndrome

If your child has a confirmed diagnosis of Down syndrome, your child can get support under the National Disability Insurance Scheme (NDIS). The NDIS helps you get services and support in your community, and gives you funding for things like early intervention therapies or education support.

Looking after yourself and your family

Being told that your unborn or new baby has Down syndrome can be a big shock for you and your family and friends. If you need information and support, a good place to start is Down Syndrome Australia, which has branches in all states and territories.

Talking to other parents can also be a great way to get support for yourself. You can connect with other parents in similar situations by joining a face-to-face or an online support group.

If you have other children, these siblings of children with disability need to feel that they’re just as important to you – that you care about them and what they’re going through. It’s important to talk with them, spend time with them, and find the right support for them too.

What It’s Really Like Having a 2 1/2-Year-Old With Down Syndrome

My son is 2 1/2 years old. By the end of the day I am exhausted, worn out, pooped if you will. My son has Down syndrome. He has “special needs.” You might be thinking, “Wow, dealing with all those ‘special needs’ must wear you out, run you down.” Or, “I don’t know how you do it. I couldn’t handle it. You’re a superhero. God chose you for a reason.” And every night when it’s time for me to crawl into bed I am thoroughly exhausted. But I’m not a superhero. And God didn’t have some “special” plan for me.

I’m exhausted because I’m the mom of a 2 1/2- year-old little boy. I’m the mom of an every day, totally typical ball of chaos. I’m the mom of a toddler.

I’m exhausted because he just learned how to climb and that’s all he wants to do. I’m worn out because he loves making messes. I’m tired because we spend hours dancing and screaming and playing and racing cars and singing songs. By the end of the night I’m pooped because he didn’t want to get out of the bath and 20 minutes later the water has gone cold and each of his perfect little fingers and toes are wrinkled and I’m behind on my chores because I couldn’t help myself but watch him laugh and explore and play.

Oliver is an early bird. When he wakes up, he wakes up fast and hard, and he’s ready to take on the day. When he wakes up, there’s barely enough time for coffee before the terrible 2s commence. So we get up and have breakfast. We watch “The Secret Life of Pets” at least once and we will probably watch it again before the day is over. We get dressed and we run errands. He helps with the laundry by unfolding every piece I’ve just completed. We do all the hand gestures to the itsy-bitsy spider about 30 times in a row. Sometimes he just likes to walk back and forth across the room and laugh to himself because he finally figured out how to move his legs in an upright position.

He’s a daredevil, he’s messy, he’s a goofball, he’s a kid. He isn’t challenging or exhausting or a steep mountain to overcome because of Down syndrome — he is all those things despite it.

On Mondays our friend Michael comes and does physical therapy with us for one hour, and on Wednesdays our friend Florence comes and does speech therapy with us for one hour. We see the doctor regularly. Sometimes a little more than average. But most of our days are filled with laughter and messes and Oliver constantly trying to cheat death by falling off of things. I clean up the same toys at least 17 times a day. My most used phrase is, “don’t touch that.”

I’m not a superhero. I wasn’t chosen for anything “special.” There was no set path that God planned for me because I am a stronger person than the next. I’m just a mom raising a toddler, trying to keep him fed and clothed and maybe teach him some things along the way.

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Growth Charts for Children with Down Syndrome

Growth charts for children with Down syndrome in the United States are available for download below. These charts can help healthcare providers monitor growth among children with Down syndrome and assess how well a child with Down syndrome is growing when compared to peers with Down syndrome.

Clinical Growth Charts

The clinical charts are shown in metric units (kilograms and centimeters). Each chart is available for boys and girls. Each chart shows the 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. The available charts include the following:

For children from birth to 3 years of age:

  • Weight in kilograms*
  • Length/height in centimeters (length is measured unless the child can stand unsupported, in which case height is measured)
  • Head circumference (measurement around a child’s head in the largest area)
  • Weight-for-length

*Weight percentile curves start at age 0 months; other “birth to 3 years of age” growth curves start at 1 month of age.

For individuals aged 2-20 years:

  • Weight
  • Height
  • Head circumference

0-36 months


Weight in kilograms pdf icon

Length/height in centimeters pdf icon

Head circumference pdf icon

Weight in kilograms-for-length in centimeters pdf icon


Weight in kilograms pdf icon

Length/height in centimeters pdf icon

Head circumference pdf icon

Weight in kilograms-for-length in centimeters pdf icon

2-20 years1,2

Weight in kilograms pdf icon

Height in centimeters pdf icon

Head circumference pdf icon

Weight in kilograms pdf icon

Height in centimeters pdf icon

Head circumference pdf icon

1Body mass index (BMI) growth charts are available at
2Please see the publication by Zemel at al.external icon for body mass index (BMI) growth charts for a sample of children with Down syndrome

Methods and Development

For more information about the methods and development of the growth charts for children with Down syndrome, please see icon. For a summary of the paper, please read these key findings.


The information below is provided to help you read and interpret the growth charts for children with Down syndrome.

What is a percentile?
Percentiles are the most commonly used indicator to assess the size and growth patterns of individual children in the United States. Percentiles rank the position of an individual by indicating what percent of the reference population the individual would equal or exceed. The reference population is the group of individuals whose growth patterns were used to develop the growth charts.

What is a z-score?
A z-score is a measure of how an individual relates to the average value for the reference population. A z-score has a direct relationship to percentiles. For more technical information about these scores and how they are calculated, visit

My child is at or below the 5th percentile on a chart, what should I do?
If you are concerned about your child’s growth, talk with your child’s healthcare provider.

Are there considerations I should keep in mind when using these charts?
Specialized growth charts, like these new growth charts for children with Down syndrome, provide useful growth references for children with Down syndrome, but may have some limitations. For example, for this study the researchers took growth measurements from a group of 637 individuals with Down syndrome recruited from medical and community locations, mostly from the Philadelphia area. These children might not be representative of all children with Down syndrome in the United States. For more information about the methods and development of the growth charts for children with Down syndrome, please see icon.


The first years of life are a critical time in a child’s development. All young children go through the most rapid and developmentally significant changes during this time. During these early years, they achieve the basic physical, cognitive, language, social and self-help skills that lay the foundation for future progress, and these abilities are attained according to predictable developmental patterns. Children with Down syndrome typically face delays in certain areas of development, so early intervention is highly recommended. It can begin anytime after birth, but the sooner it starts, the better.

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.

When Should Early Intervention Start?

Early intervention should begin any time shortly after birth, and usually should continue until the child reaches age three. An amendment to IDEA in 2004 allows states to have early intervention programs that may continue until the child enters, or is eligible to enter, kindergarten. The sooner early intervention begins, the better, but it’s never too late to start.

How Can Early Intervention Benefit a Baby 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. Most children are expected to achieve each milestone at a designated time, also referred to as a “key age,” which can be calculated in terms of weeks, months or years. Because of specific challenges associated with Down syndrome, babies will likely experience delays in certain areas of development. However, they will achieve all 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.

What Are the Types of Early Intervention Therapies and How Does Each Type Address Specific Aspects of a Baby’s Development?

Physical therapy focuses on motor development. For example, during the first three to four months of life, an infant is expected to gain head control and the ability to pull to a sitting positions (with help) with no head lags and enough strength in the upper torso to maintain an erect posture. Appropriate physical therapy may assist a baby with Down syndrome, who may have low muscle tone, in achieving this milestone.

Before birth and in the first months of life, physical development remains the underlying foundation for all future progress. Babies learn through interaction with their environment. In order learn, therefore, an infant must have the ability to move freely and purposefully. An infant’s ability to explore his or her surroundings, reach and grasp toys, turn his or her head head while watching a moving object, roll over and crawl are all dependent upon gross as well as fine motor development. These physical, interactive activities foster understanding and mastery of the environment, stimulating cognitive, language and social development.

Another long term benefit of physical therapy is that it helps prevent compensatory movement patterns that individuals with Down syndrome are prone to developing. Such patterns can lead to orthopedic and functional problems if not corrected.

Speech and language therapy is a critical component of early intervention. Even though babies with Down syndrome may not say their first words until 2 or 3 years of age, there are many pre-speech and pre-language skills that they must aquire before they can learn to form words. These include the ability to imitate and echo sounds; turn taking skills (learned through games like “peek-a-boo”); visual skills (looking at the speaker and objects); auditory skills (listening to music, speech, or speech sounds for lengthening periods of time); tactile skills (learning about touch, exploring objects in the mouth); oral motor skills (using the tongue, moving the lips); and cognitive skills (understanding object permanence and cause and effect relationships).

A speech and language therapist can help with these and other skills, including breastfeeding. Because breastfeeding employs the same anatomical structures used for speech, it can help strengthen a baby’s jaw and facial muscles and lay the foundation for future communication skills.

Occupational therapy helps children develop and master skills for independence. Occupational therapy can help with abilities such as opening and closing things, picking up and releasing toys of various sizes and shapes, stacking and building, manipulating knobs and buttons, experimenting with crayons etc. Therapists also help children learn to feed and dress themselves and teach them skills for playing and interacting with other children.

Early intervention can also prevent a child with Down syndrome from reaching a plateau at some point in development. The overarching goal of early intervention programs is to enhance and accelerate development by building on a child’s strengths and by strengthening those skills that are weaker in all areas of development.

How Can Parents Benefit From Early Intervention Programs?

Programs of early intervention have a great deal to offer to parents in terms of support, encouragement and information. The programs teach parents how to interact with their infant or toddler, how to meet their child’s specific needs and how to enhance development.

How Do I Sign Up for Early Intervention Services?

Each state has its own set of laws governing early intervention services. Parents can get a referral from their baby’s doctor or find a local agency by visiting Once a referral has been made, the program staff must schedule and complete an initial evaluation within a specified time. Once the assessment is done, a caseworker is assigned to coordinate the various services for which the baby and family qualify. Early intervention services are individualized to meet the specific needs of each individual baby. The caseworker, therapists and family will determine areas of focus and set goals based on developmental milestones. These will be recorded in a document called the Individualized Family Service Plan (IFSP).

Who Pays for Early Intervention?

The evaluation to determine whether your child is eligible for early intervention is free of charge if performed by a state authorized entity. No child deemed eligible can be denied services based on ability to pay, but insurance companies may be billed and/or a sliding scale payment may be required, depending on the state. Parents should check with their state’s early intervention center for information about authorized service providers and financial obligations. Frequently, there is little or no cost to parents for these services.

What Happens After Age 3?

The Individuals with Disabilities Education Act (IDEA), which regulates early intervention, also mandates that local school districts provide a free, appropriate, public education for preschool-age children with disabilities starting at the age of three, unless doing so would be inconsistent with state law or practice or the order of any court respecting the provision of public education to children between the ages of three and five.

Down Syndrome is a genetic disorder caused by the addition of an extra chromosome. People with Down Syndrome have 47 chromosomes in their cells instead of 46. The duplicate chromosome is chromosome 21, which is why Down Syndrome is also referred to as Trisomy 21. Down Syndrome occurs at conception and can affect both genders, people from all ethnic and social groups and to parents of all ages.

What are the common features of Down Syndrome?

People with Down Syndrome present with the following features:

Physical features:

  • Flattened nose
  • Small teeth
  • Stunted growth
  • Short neck
  • Shortened hands
  • Low set and rounded ears
  • Shortened extremities
  • Atypical fingerprints
  • Flexible ligaments
  • Smaller genitalia
  • Separation of the abdominal muscles

Developmental features:

  • Intellectual disability
  • Learning difficulties
  • Developmental delay
  • Speech and communication difficulties
  • Difficulty with coordination
  • Difficulty with fine and gross motor skills

Common difficulties often (but not always) experienced by the child with Down Syndrome:

  • Difficulty understanding the conventions of social interactions.
  • Poor articulation of sounds.
  • Difficulties with reading and writing.
  • Immature play skills/interests.
  • Resistance to change, very rigid in routine.
  • Can be impulsive or aggressive.
  • Difficulties understanding and using non-verbal communication.
  • Difficulties understanding instructions, questions or jokes.
  • Difficulties with fine and gross motor skills.
  • Difficulty accessing the school curriculum.

Management strategies that support the child with Down Syndrome (at preschool, school and/or home):

  • Set up an individualised plan with parents/carers that has small achievable goals to help develop the child’s skills.
  • Develop social stories to improve appropriate behaviour in social situations.
  • Positive encouragement
  • Provide opportunities to succeed by simplifying activities.
  • Teach new skills in a step by step manner and keep the environment as predictable as possible during teaching.
  • Introduce new skills or environments on an individual basis before introducing peers.
  • Use simple language and instructions.
  • Provide visual as well as verbal cues.
  • Provide extra time to complete tasks.
  • Recognise and reinforce the child’s strengths.
  • Appropriate set up for school desk.
  • Set realistic and achievable goals for all task performance and completion.
  • Make participation, not competition, the goal.
  • Liaison between health professionals and educational staff to provide information to be incorporated into an education plan and/or implementing ideas/suggestions/activities to help improve the child’s ability to access to the curriculum.

Occupational Therapy approaches and activities that can support the child with Down Syndrome and/or their carers include:

  • Expand abilities: Developing a broad range of skill areas.
  • Social stories: Providing ideas and education around social story development.
  • School transition: Advocating and professionally supporting the transition to school and liaising with teachers (as required).
  • Visual cues can be used to support routine and to introduce new activities, or a change in tasks.
  • Gross and fine motor skills: Determining the current age level of a child’s gross and fine motor abilities.
  • Devise goals: Setting functional and achievable goals in collaboration with the child, parents and teachers so that therapy has a common focus beneficial to everyone involved.
  • Educating parents, carers, teachers and others involved in the child’s care about Down Syndrome and the age appropriate skills a child should be demonstrating.
  • Management strategies: Providing management strategies/ideas to assist the child in the home, at school and in the community.
  • Direct skill teaching through a task based approach.
  • Task engagement: Providing alternative ways to encourage task engagement.
  • Underlying skills: Developing the underlying skills necessary to support whole body (gross motor) and hand dexterity (fine motor) skills, such as providing activities to support:
    • balance and coordination
    • strength and endurance
    • attention and alertness
    • body awareness
    • movement planning

Speech Therapy approaches and activities that can support the child with Down Sydnrome and/or their carers include:

  • Speech and language assessment to help the family to understand how the child is processing, understanding, learning and using language and communication.
  • Communication strategies: Providing the family with strategies and techniques to increase and enhance communication with the child.
  • Daily activities: Helping the child to understand the environment, routines and language.
  • Developing language: Helping the child to understand and use richer language and to use language more spontaneously.
  • Conversation skills: Developing conversation skills (e.g. back and forth exchange, turn taking).
  • Concept skills: Developing concept skills, especially abstract concepts, such as time (e.g. yesterday, before, after).
  • Visuals can be used to help with understanding and the child’s ability to express their needs, wants, thoughts and ideas.
  • Social skills: Development of social skills (i.e. knowing when, how to use language in social situations).
  • Enhancing verbal and non-verbal communication including natural gestures, speech, signs, pictures and written words.
  • Visual strategies: Using visual information to help understand, organise and plan the routine for the day.
  • Liaising with educational staff regarding the nature of the difficulties and ways to help the child to access the curriculum.

Why should I seek therapy for my child with Down Syndrome?

Diagnosis alone is NOT the solution. It simply opens the door to getting the help that is needed by arming all involved with the relevant information.

The ‘help’ still needs to be provided. The help that is provided (at least from a therapy perspective) will reflect:

  • First and foremost what medical intervention is needed.
  • What the parents/teachers/carers biggest concerns are for the child (i.e. what are the most significant functional challenges).
  • The specific areas that are problematic to the child (which will vary even within children with the same diagnosis).
  • The capacity of the child’s environments to meet the child’s needs.

If left untreated, the child with Down Syndrome may have difficulties with:

  • Following instructions within the home, kindergarten or school environment.
  • Vocabulary whereby a child cannot clearly get their message across due to limited word knowledge.
  • Understanding jokes and figurative language during interactions with others, and when watching TV shows and movies and reading books.
  • Learning to talk, speech intelligibility and clarity.
  • Managing a full school day due to poor strength and endurance.
  • Participating in sporting activities leading to an inactive lifestyle, increasing the risks of other health related issues such as obesity, diabetes, cardiovascular disease or similar conditions.
  • Self esteem and confidence when they realise their skills do not match their peers.
  • Bullying when others become more aware of the child’s difficulties.
  • Fine motor skills (e.g. writing, drawing and cutting) due to poor core stability, meaning they do not have a strong base to support the use of their arms and hands.
  • Completing self-care tasks (e.g. doing up shoelaces, buttons, zips, using cutlery).
  • Self regulation and behaviour as the child is unable to regulate themselves appropriately to settle and attend to a task for extended periods of time.
  • Accessing the curriculum because they are unable to attend to tasks long enough to complete assessment criteria.
  • Sleep habits, impacting upon skill development due to fatigue.
  • Social isolation because they are unable to cope in group situations or busy environments, impacting on their ability to form and maintain friendships.
  • Reading/understanding social situations and being perceived as ‘rude’ by others.
  • Social communication, such as eye contact, appropriate distance when talking to someone, turn-taking within a conversation.
  • Academic performance: Developing literacy skills such as reading and writing and coping in the academic environment.

More specific implications of not seeking treatment will be influenced by the common difficulties that are most influencing your individual child.

For more information see the relevant fact sheets under areas of concern or refer to the other relevant resources section below.

What does the diagnosis of Down Syndrome really mean for the child?

Diagnoses are used to label a specific set of symptoms that are being experienced by a child.

This label then helps to narrow down and specifically tailor what:

  • Other issues commonly occur simultaneously.
  • Medication might be appropriate.
  • Therapies might help the child (e.g. Medical, Occupational Therapy, Speech Therapy, Psychology).
  • Course of intervention (medical and/or allied health) might be and what outcome might be expected (prognosis).
  • Can be done to help the child.

A diagnosis helps the child and their carers (parents, teachers, health professionals, carers) to:

  • Access information about the relevant cluster of symptoms.
  • Communicate the salient features of the child’s challenges to all people involved in the child’s care.
  • Possibly interpret certain behaviours differently in light of the diagnosis.
  • Obtain information about what can be done to help the child.
  • Determine specifically where and how to help the child.
  • Access funding or services that might not otherwise be accessible.


Development Timetable

Children with Down syndrome generally follow the same pattern of development as typically developing children, but at a slower rate. There is a great deal of individual variation in the age different skills are developed by children with Down syndrome, just as there is with all children. Children with Down syndrome face challenges in all the areas of development –

  • Language and Communication
  • Cognitive
  • Social and Emotional
  • Gross Motor
  • Fine Motor
  • Self-Help

Because children with Down syndrome also have some degree of intellectual disability they often have the most difficulty with more abstract language based concepts.

Articles and Information

Down Syndrome Child Development Charts

An Overview of the Development of Children with Down Syndrome (5-11 years)

Bruni, Maryanne Fine Motor Skills in Children with Down Syndrome : A Guide for Parents and Teachers

Hanson, Marci Teaching Your Down’s Syndrome Infant : A Guide for Parents

HELP : Hawaii Early Learning Profile – Activity Guide

Winders, Patricia Gross Motor Skills in Children with Down Syndrome : A Guide for Parents and Teachers

Early Communication video produced by Down Syndrome WA –
Toilet training video produced by Down Syndrome WA –

Self-Help Skills

Social Development for Individuals with Down Syndrome : an overview – Independence and Self Help Skills

Motor Development and Self-Help Skills Milestones to view click on > milestones, then > motor & self-help

Clothing Optional by Rachael Smith

Bruni, Maryanne Fine Motor Skills in Children with Down Syndrome : A Guide for Parents and Teachers

Hanson, Marci Teaching Your Down’s Syndrome Infant : A Guide for Parents

HELP : Hawaii Early Learning Profile – Activity Guide

Therapy Focus Inc Self Care Skills Moving on Up : Helping Children Move from Primary to High School

Winders, Patricia Gross Motor Skills in Children with Down Syndrome : A Guide for Parents and Teachers


Independent Living Centre

River Abilities

Toilet Training Children With Down syndrome by Jane Orville

reproduced with permission from

Most parents wonder how their children with Down syndrome will learn to become toilet trained. This is understandably an anxious time for a parent, as you might be thinking about sending your child to a preschool program and wonder if he will ever be out of diapers. Teaching any child to use the toilet can be a frustrating time for parents, and the child, but if you relax and remember that you cannot “make” him learn before he is ready, he will leave those diapers behind some day.

One professional suggests taking a few days to document your child’s voiding schedule. Check his diaper every twenty to thirty minutes to see when he is going and what (urine, bowel movement). When data is taken for a few days and you can see some semblance of a pattern, you will want to schedule toilet times for those specific times of the day.

One suggestion is to give your child some fluids to drink about 15-20 minutes before you plan on toileting him. Tell your child he is going to use the toilet, and if needed, use the sign for it and help him make the sign.

Make his toileting experience pleasant. Have books available for looking at during this time, and keep toileting time short, about 7 or 8 minutes at the most. If your child does not void during this time, don’t force it or use an unpleasant or frustrated tone. Have him get off and then try again at the next scheduled time.

A lot of praise is necessary when toilet training your child, especially for a child who has Down syndrome. Giving an edible reinforcement might be tried, but this can lead to the child expecting something to eat every time he has success on the the toilet. Since children with Down syndrome already may struggle with weight issues, it is recommended that reinforcements such as verbal praise, hugs, high fives be used instead.

Some parents may have`expectations for their child in the area of toilet training that`are too high. Remember that not only is your child delayed intellectually, he also may lack the proper muscle control at the average age that a typical child is toilet trained. He will eventually learn this too; it will be on his own individual timetable.

Spina Bifida Association of Wa Inc run an incontinence pad scheme supported by Lotteries Commission. If your child is aged between 3 and 15 and lives at home with you full time you may be eligible to purchase nappies at a discounted price. For more information phone (08) 9346 7520.

Continence Aids Assistance Scheme provides an annual subsidy of up to $479.40 each year to eligible families of children aged 5 and above. For more information visit

Toilet Training your child with Down Syndrome by Donna Heerensperger

Toilet training made semi-easy by Kent Moreno

Toilet training by Darlene Devenny

Green, Dr Christopher Toddler Taming : Children with Disabilities volume 6

Toilet training children with Autism and other developmental delays

Explaining Down Syndrome To Your DS Child

Let’s Talk About Down Syndrome – a brochure created to help inform people with an intellectual disability about Down Syndrome

I have Down’s Syndrome – but don’t feel sorry for me by Anya Souza

Living with Down syndrome

Types of Developmental Delays in Children

Often, developmental delays affect more than one area of a child’s development. When a child has delays in many or all of these areas, it is called global developmental delay.

Some developmental delays have an identifiable cause. However, for many children, the cause of the delay, or multiple delays, is not clear.

Cognitive Delays

Cognitive delays may affect a child’s intellectual functioning, interfering with awareness and causing learning difficulties that often become apparent after a child begins school. Children with cognitive delays may also have difficulty communicating and playing with others.

This type of delay may occur in children who have experienced a brain injury due to an infection, such as meningitis, which can cause swelling in the brain known as encephalitis. Shaken baby syndrome, seizure disorders, and chromosomal disorders that affect intellectual development, such as Down syndrome, may also increase the risk of a cognitive delay. In most cases, however, it is not possible to identify a clear reason for this type of delay.

Motor Delays

Delays in motor skills interfere with a child’s ability to coordinate large muscle groups, such as those in the arms and legs, and smaller muscles, such as those in the hands. Infants with gross motor delays may have difficulty rolling over or crawling; older children with this type of delay may seem clumsy or have trouble walking up and down stairs. Those with fine motor delays may have difficulty holding onto small objects, such as toys, or doing tasks such as tying shoes or brushing teeth.

Some motor delays result from genetic conditions, such as achondroplasia, which causes shortening of the limbs, and conditions that affect the muscles, such as cerebral palsy or muscular dystrophy. They may also be caused by structural problems, such as a discrepancy in limb length.

Social, Emotional, and Behavioral Delays

Children with developmental delays, including those with related neurobehavioral disorders such as autism spectrum disorder and attention deficit hyperactivity disorder, often also have social, emotional, or behavioral delays. Due to differences in brain development, they may process information or react to their environment differently than children of the same age. These delays can have an impact on a child’s ability to learn, communicate, and interact with others.

It is common for children with developmental delays to have difficulty with social and emotional skills. For example, they may have trouble understanding social cues, initiating communication with others, or carrying on two-way conversations. They may also have difficulty dealing with frustration or coping with change. When the environment becomes too socially or emotionally demanding, children with developmental delays may have prolonged tantrums and take longer than other children to calm down. This behavior can be a signal that the child needs more support by modifying his or her environment or learning skills to cope with social and emotional challenges.

Speech Delays

Some speech delays are receptive language disorders, in which a child has difficulty understanding words or concepts. Children with this type of speech delay may have trouble identifying colors, body parts, or shapes. Others are expressive language disorders, in which a child has a reduced vocabulary of words and complex sentences for his or her age. A child with this type of speech delay may be slow to babble, talk, and create sentences. Often, a child with a speech delay has a combination of receptive and expressive delays.

Children with an oral motor problem—such as weakness in the muscles of the mouth or difficulty moving the tongue or jaw—that interferes with speech production have what is known as a speech production disorder.

Children may have speech delays due to physiological causes, such as brain damage, genetic syndromes, or hearing loss. Other speech delays are caused by environmental factors, such as a lack of stimulation. In many instances, however, the cause of a child’s speech delay is unknown.

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