Down Syndrome: A Physical Therapy Perspective
(AKA The Making of a Superbaby!!)
Babies with Down Syndrome have a special place in my heart. I think these kids are absolutely adorable! In my career, I have worked with many dozens of babies with Down Syndrome.
This article will help you navigate how to help your baby succeed at their gross motor skills and reach their milestones faster than babies with this diagnosis typically do. This approach works best when beginning as a newborn. The principles, though, can apply across the board.
This article will not explain what Down Syndrome is. For that, check out this link:
Why are babies with Down Syndrome so frequently delayed in their gross motor milestones?
There are a few reasons:
- Low muscle tone:
Muscle tone is like a setting in the brain. In typically developing children, muscle tone allows muscles to maintain a minimum tension threshold or tone in the muscle. This allows for readiness of muscle contraction and firing. When muscles are ready at a nanosecond’s notice, movements are able to be fluid, coordinated, and strong. When that muscle tone setting is turned down to low, as is generally the case with kids with D.S., it is harder to generate the necessary muscle firing for fluid, coordinated movements.
- Ligamentous Laxity:
Ligaments connect bones to other bones. They help keep our skeleton firmly connected so that no unnecessary shifting of bones occurs. When ligaments are loose, it makes the muscles have to work harder to stabilize joints. In short, when joints are not stable, stability is much more difficult.
- A Large head and a shortened neck (In many cases, but not all):
This is a difficult first hurdle for these babies. With neck weakness and a large head, head control can become significantly delayed.
- Cardiac Issues (In some, but not all):
Depending on the issue, this can be a small defect that barely affects development to more significant issues that not only require bigger surgeries, but their recuperation or long term effects can negatively impact endurance and other health concerns.
- Increased incidence of gross motor delays:
All genetic disorders can potentially carry risk for all sorts of delays: physical, speech, and cognitive. Down Syndrome is no different. However, just like any typical population, results vary from child to child.
It is not uncommon for kids with D.S. to exhibit a 50% gross motor delay throughout their first 3 years of life. These delays can be:
- Good head control at 8-10 months (typically 4-5 months)
- Crawling at 14-16 months (typically 7-8 months)
- Walking by 24-36 months (typically 12-18 months)
I want to change this norm. I believe that given the correct input, and with the right mindset, parents can help their kids achieve their milestones MUCH closer to the normal ranges.
I have 2 “clubs” when it comes to my D.S. babies. The 17 month club and the 18 month club.
I have had 3 kids with DS walk by 17 months, and MANY walk by 18 months!! (Even for those walking after 18 months have generally walked by 24 months, beating the average of around 30 months.)
Therefore, these kids all walked within the normal range for typically developing children!!
Why the big rush to get kids to walk on time, Jake?
Simple! Walking represents gross motor independence! Until a child can walk alone, they are dependent on their parents. And walking alone doesn’t just happen magically. It is the sum total of brain maturity, organizational skills, trunk control, strength throughout the body, safety awareness, and functionality of various neurological systems such as vestibular, sensory, and proprioceptive! It’s HUGE!!
Once a child, Down Syndrome or not, can ambulate independently, they are poised for future gross motor milestones that follow. But since they did it on time, they show up to the party with every advantage of the sum total just listed.
Some of the gross motor skills that follow walking are:
– walking with feet closer together and arms at their side
– walking on all surfaces without falling
– navigating obstacles in their path
– riding a bike
– playing organized sports
– all other gross motor feats any child or adult can do!!
So how do we get all this started?
We need to start as early as possible. Starting with your baby who is 3 months or younger will give you the best chances for success.
As a parent, you will need the correct mindset. There are 3 things you will need to focus on:
- Always try to provoke change, rather than help – Many parents will try to make things easier for their baby. This can include putting a Boppee or other supportive pillow under their chest while on their belly, putting them into different supportive “containers” like seats, exersaucers, and walkers, and holding them up in standing or any other developmental position with maximum support. While you may feel you are helping your baby right now, in the long run this will end up delaying your baby. Giving them the best chance at timely development must include the most natural positioning and support.
- Always work on the current skills AND the next skills- Gross motor skills and milestones follow a “blueprint” of development. There is an order and most kids follow that order at predictable intervals. However, when a child presents with risk factors for delay, we can give them an extra boost. This is done by stimulating the skills that are expected next. This stimulates the higher order skills in the motor cortex of the brain. When we work on current skills and the next milestone, we tap into the brain’s potential in a more profound and powerful way.
- Expose your baby to gravity- Exposure to gravity is the main ingredient to trigger a neuromuscular response and help children succeed. When a child is routinely exposed to gravity, they learn to overcome it. This builds muscle strength, provokes milestones, and improves brain maturity.
One mom of a baby with D.S. told me, “Down Syndrome doesn’t mean your child is broken. It doesn’t mean delayed. All of the parts are there. We just have to press ‘GO’!!”
Now we are ready for actual treatment strategies!
In the first 3 months:
-Make tummy time your baby’s default position. Every time your baby is awake and alert, place your baby down for tummy time. Build up to 15-20 minutes of uninterrupted tummy time by adding a minute a day. Place your child on their belly at least 3 times per day.
– When your baby is in tummy time, get on his level, and stimulate him by playing and presenting toys
– In months 2 and 3, begin to hold your baby upright without supporting his head
– When holding your baby throughout the day, switch between holding your baby facing you, holding him under his tushy and facing away, holding him across his chest with his head free
– Practice visual tracking with age appropriate toys and by moving your face.
– Always speak to your baby throughout the day
-Look for your baby’s head to be less wobbly
Between 4-6 months:
- All above strategies, if goals not yet met
- Practice rolling with your baby. Start by moving them through the movement, then start and let him finish the movement
- Encourage your baby to prop up on his elbows and through his forearms.
- Closer to 6 months, look for him to push up on extended arms.
- Help your baby roll from his back to his belly. Bring his leg across midline. As he improves, help him less and finish the movement independently
- At 5 months, look for your baby to start making circles on the floor while on his belly.
- By 6 months, place your baby into a sitting position with his hands on the surface.
- Trunk control should be improving. When holding your baby facing you, make sure to hold your baby under his tushy
- While on his back, your baby should lift his head off the surface
By 7-9 Months
- All above strategies, if goals not yet met
- Your baby pushes backwards on his belly
Head control is perfect. Trunk control is good
- Sits without hand support
- Crawls forward
- When holding your baby in a standing position, makes stepping movements
- Gets into an all fours (quadruped) position
- Transitions from sitting to belly
- Crawls on all fours
By 10-14 Months
- All above strategies, if goals not yet met
- Kneels at surfaces
- Pulls to stand
- Moves well in sitting
- Cruises at furniture
- Stands for a few seconds
- Walks holding 1 hand
- Takes steps alone
By 12-14 months
- Walks alone
- Stoops down to pick up a toy and returns to a standing position.
- Please note something very important. These timelines are typical but are part of a range. It is normal for some kids to do these earlier and some later. Don’t get scared if your baby is a couple of months later than what is mentioned.
Another few points.
- You cannot hope to make this work by good intention alone. You will need to devote 20-45 minutes twice daily for best results.
- Knowing what comes next is extremely important, but you will still need the hands on skills to provoke your baby properly. Therefore, it is crucial that your baby receives physical therapy sessions at least twice a week.
- Make sure your PT is teaching you actual hands on strategies that you can practice daily.
- While I know that not every child with Down Syndrome will be able to achieve the goals laid out here, this pursuit will ensure your baby will be stronger and eventually move more efficiently than children who weren’t pushed in this way.
- If you don’t have access to PT or want to implement the DMI approach, reach out to me for a teletherapy session.
- How much time is enough? Try to do 2 “sessions” of exercises a day with your baby, when he is happy and alert. Cycle through the exercises you are currently working on. This way you are barraging your baby’s brain with positive gross motor information throughout the day.
One final disclaimer:
I use the Dynamic Movement Intervention (DMI) approach. It is a very powerful treatment modality that works to provoke neuromuscular changes by the use of less/distal support, exposure to gravity, and working on absent motor functions. I believe that the use of this powerful method has yielded the results mentioned in this article. After all, a plan is only as effective as how you can execute it.
If you want to try the DMI approach, check for a practitioner in your area here:
If there are no practitioners in your area, consider a teletherapy session with myself or someone else. Starting with concrete exercises and a game plan will get you and your baby closer to those awesome goals!!
In summary, helping your baby with Down Syndrome reach his milestones in a more timely manner takes hard work, consistency, and the right mindset. Doing so and reaching those goals will set your baby on a lifelong trajectory of greater strength, coordination, maturity, and gross motor achievements!