A Five Star Occupational Therapy Guide for Children With Down Syndrome

Down Syndrome is a genetic disorder caused by the addition of an extra chromosome in a child. Instead of 46 chromosomes children with Down Syndrome have 47 chromosomes. Down Syndrome can also be referred to as Trisomy 21. Trisomy being the medical term for having a duplicate chromosome and the duplicate chromosome being chromosome 21.

Effects of a Duplicate Chromosome 21 in a Child with Down Syndrome

Extra cheese on a pizza is good, an extra serving of Ice cream or our favorite dessert is super good but an extra chromosome has a different effect. The extra chromosome can causes the child with Down Syndrome to present with physical features such as:

  • Flattened facial profile and nose.
  • Short neck, with excess skin at the back of the neck.
  • Decreased or poor muscle tone.
  • Small head, ears and mouth.
  • Wide, short hands with short fingers.
  • Separation of abdominal muscles.
  • A single, deep, crease across the palm of the hand.
  • Upward slanting eyes, often with a skin fold that comes out from the upper eyelid and covers the inner corner of the eyes.
  • Flexible ligaments.
  • Misshaped bone in the upper part of the spine.
Cognitive difficulties in down syndrome

Apart from the physical characteristics, the child with Down Syndrome can have cognitive and developmental difficulties such as:

  • Learning difficulties.
  • Speech and communication difficulties and delays.
  • Developmental delays.
  • Difficulties with coordination.

Some children with Down Syndrome might have heart defects, vision problems, hearing loss, hypothyroidism, blood disorders, disrupted sleep patterns and sleep disorders, gum disease and dental problems, epilepsy, digestive problems and Celiac disease.

The Role of the Occupational Therapist in Managing Down Syndrome

Occupational therapists are part of the team that works with children with Down Syndrome to enable them thrive and function in their life. This team may have all or some of the following team members; Developmental Pediatrician, physiotherapist, speech and language therapist and a child psychologist.

When dealing with Down Syndrome, the occupational therapist focuses on five areas which include:

  1. Fine Motor Skills
  2. Self Care Skills
  3. Attention and Concentration Span
  4. Social Skills
  5. Self Esteem

Focus 1:

Fine Motor Skills

The fine motor skills enable children with Down Syndrome to do activities using small muscles of the hand. Activities such as buttoning require use of the small hand muscles. The occupational therapist uses various fun activities to develop age appropriate fine motor skills.

For the school going children the Occupational Therapist shall work on hand writing development by use of various hand writing programs such as Hand Writing Without Tears.

In addition fun pen and paper activities shall be done to aid the school going child to have great handwriting. Mazes, Dot-to-dots, crafts and artwork are some of the activities used. Twinkl has such amazing resources that are age based.

The occupational therapist will also advise on what classroom adaptations and accommodations are required to enable this child flourish. Some of the adaptations required in school are pencil grips, slant boards, sitting wedges just to name but a few. (See our shop for more)

Focus 2:

Self Care Skills

Dressing and Undressing

Due to the decreased or poor muscle tone the infant may not actively aid the parent/caregiver in dressing and undressing. The occupational therapist will teach the various techniques that can be used to dress and facilitate better muscle tone in the infant.

As all toddlers, the children with Down Syndrome would love to dress themselves. The occupational therapist will work on buttoning skills, tying of shoelaces and generally organizational skills required to plan the dressing process.


When the baby is born he/she might struggle with suckling. The occupational therapist will suggest positions and feeding techniques to the parents that will enable the little one to feed well. As the baby grows and is ready to self-feed, the occupational therapist works on the child’s fine motor skills so as they are able to grasp cutlery and use them effectively.

The Occupational Therapist will do various bilateral coordination activities (activities that will involve use of the right and left side of the body at the same time) during the sessions. The purpose of these activities is to enable the toddler to use both hands well during feeding.

The occupational therapist will also recommend various feeding adaptations that will enable the toddler to effectively and independently feed. The therapist will advise the parents/caregiver on supportive seating for the toddlers and explain the benefits of this.


When the toddler and the parent/caregiver are ready, the occupational therapist can create a visual schedule for the family and additionally give suggestions on various reinforcements to encourage development of toileting skills.

Focus 3:

Attention and Concentration Span

To be able to learn and play, age appropriate attention and concentration span is required. Through games, stories and activities children increase their attention span.

Sensory diet activities such as jumping jacks, wheelbarrow walking can be done both at school and at home just before classwork or homework to prepare the child to focus. Brain gym exercises are also great for “waking up the brain”.

When a child’s attention and concentration improves, they will be less anxious, have better workout put, access the curriculum and their self-confidence will for sure grow.

Focus 4:

Social Skills

Children interact with their peers, caretakers, teachers and people in the community. Great social skills is a plus to any child and an Occupational Therapist will use role play, videos and social stories to facilitate great social and life skills. Kelly Bear is an awesome resource for parents, teachers, children and practitioners.

Focus 5:

Self Esteem

Children with special needs constantly face different barriers in the school and community and this affects their self-esteem and self-confidence. The occupational therapist sprinkles some of the confidence building activities in the sessions. The activities will encourage and allow the child to share their feelings. The activities will also allow the student to be able to accept and love themselves.

In Conclusion

Children with Down Syndrome truly benefit from early intervention, more so by occupational therapists. This intervention based on the focus points mentioned enables them to blossom into great and influential youth and adolescents.

We would love to get your feedback as a parent, guardian, or therapist. Feel free to ask any relevant question or leave a comment or even a compliment. We will be happy to answer your question and reply to your comments.

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