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Children with Down Syndrome and their Developmental Milestones typical child cognitive skills infant toddler child child with down syndrome -Comprehends less than 2-4 words -Notices when caregiver speaks

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Children 
with Down Syndrome and
their Developmental
Milestones

typical child

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cognitive skills

infant

toddler

child

child with down syndrome

-Comprehends less than 2-4 words -Notices when caregiver speaks, but does not yetunderstand simple reprimands such as “no”
-Comprehends approximately 10-15 words -Recognize familiar faces and sounds -Respond to environment with facial expressions  -Begins to understand object permanence (9-12months) -Enjoys looking through picture books
-Counting  -Identify familiar objects and people in books -Knows the difference between “me” and “you” -Sorting (shape, color, size) -Able to complete 3-4 piece puzzles -Manipulate lids and door handles -Can copy a circle -Builds 6+ block tower
-Motor-speech area of the brain not yet developedwhich can cause a delay in speech -Comprehends around 40-60 words -Use of gestures develops
-Begins asking “why” questions to better understandsomething -longer attention span (5-10 minutes) -Ability to tell someone where they live -Rhyming  -Can draw pictures of familiar places and things
-Engages in short (often 2-word) conversations -Recognizes familiar symbols (stop sign, restaurants,etc.)  -Counting to 10
Sensory and perceptual skills

infant

toddler

child

-Mature hearing  -Track objects with eyes  -Looks at hands -Responds to sounds and voices
-Visual problems  -Hearing loss (~? of children with Down Syndrome) -Sporadic reactions to sound
-Reacts to extreme temperature changes -Enjoys “messy” play -Copies sounds that are made -Recognizes common dangers (glass, hot objects,stairs)
-Starts to hold eye contact -Frequently watches other children
-Feeds self without difficulty  -Able to sit and pay attention for an extended periodof time -Most have 20/20 vision at this point
-Begin to visually recognize environmental cues andsymbols
Language skills

infant

toddler

child

-Baby will engage in ‘joint attention-baby will look atthe same thing caregiver is looking at purposefully -Caregiver engaging in play activities and bookreading with baby encourages them to speak faster -Reacts to sound -Turns head towards sound source -Babbles -Waves ‘bye’
-Usually does not babble until 10-12 months -Understands less than 2-4 words around 6-10months -Does not always turn head towards sound source -Their First oral word is usually between 11-15months
-produces 50 words -Says own name on request -Asks for ‘more’ -Answers to ‘where?’ and ‘what?’ questions -Listens to longer stories -Begins to use  adjectives
-Comprehends 100-125 words -Produces 3-6 oral words around age 2 -Follows one step commands -Initiates vocalizations to others -Imitates familiar sounds and actions -Produces animal noises -Acknowledges others with eye contact
-Follows instructions with 2-3 steps -Can name a majority of  objects -Can state their name, if they are a boy or girl, andtheir age -Can name their friends -Says words like ‘i’ ‘me’ and ‘you’ -Can carry on a conversation using 2 to 3 sentences
-Understands 250-400 words -Produces 90-150 words -Begins two word 'sentences' -Can name some colors -Can count some objects -Can carry out two stage commands -Pays attention  to longer stories
Gross motor skills

infant

toddler

child

-Turns their head towards colors that are bright -Pushes down on legs when feet are on hard surface -Can hold their head up and steady -Reaches for objects, can pick them up -Plays with their feet when laying on back
-Can have hypotonicity -Can hold head steady at 5 months
-Can move in and out of sitting -Pulling to stand and standing -Self-feeding -Release of objects -Eye-hand coordination
-Pushes self to stand -Stands unassisted -Walks with support
-Ability to navigate in the environmentindependently -Can walk on level, graded, or uneven surfaces -Can climb stairs
-Walks unassisted -Walks up steps with help
Eryn Lobo
Tori Hudgings
Emily Lawson
Jessica Kirk

Fine motor skills

infant

toddler

child

-Imitate adults using a cup or telephone -Wave bye-bye -Puts objects in a container -Pulls off shoes, socks, and mittens -Can point to a picture that you name in a book -Makes marks on paper with crayons -Feed themselves with a spoon to feed themselves(not necessarily neatly) -When playing with a book, turns pages, althoughmay turn two or three pages together -Can put on their shoes
-Grasp object -Hold bottle independently -Self feed with fingers -Scribble with crayons -Intentionally drop objects – Eat with spoon
-Reaches for objects and picks them up -Helps hold the bottle during feeding -Uses fingers to point at things
-Floppy not due to weakness -Clinodactyly
-Attempts to draw a person has a two-dimensionalbody (e.g a circle instead of a stick for a body) -Can print some letters (if taught) -Use fork, spoon and (sometimes) a table knife -Can dress and undress without help -When playing with a book, can turn one page at atime
-Drink with open cup -Eat with fork
Social/emotional skills and participation
infant

toddler

child

-Respond to their parent’s voice -Becomes quiet in response to sound, especially tospeech -Makes sounds with expression as if trying to talk -Attempts to imitate sounds when engaged in vocalplay with parent -Lets you know if they are happy or sad
-On track with typical development -Play peek-a-boo and patty cake -Makes “ma-ma” or “da-da” sounds -Wave bye-bye -Points to things they want and tries to use words toask for things -Plays with other children for a few minutes -Demands a lot of your attention -Shows affection
-On track with typical development -More open display of feelings
-Fantasy play -Understand the concept of counting and may knowa few numbers (e.g understands ‘you can only haveone’)
-On track with typical development -Participate in sports by school age -High rates of provocative behavior -Low levels of aggression -Disobedient/ argumentative
ADL/iADL skills

infant

toddler

child

-Dependent for all hygiene -May begin to enjoy bathing -Begins to hold onto bottle -Can feed with fingers -Sucks on solid food rather than chewing
-Due to hypotonia and weakness of the muscles ofthe cheeks, tongue and lips, feeding is difficult forsome infants with Down syndrome. OTs suggestpositioning and feeding techniques.
-Sitting to look at a book independently -Unbuttoning large buttons -Tolerating a range of different textured foods -Distinguishing between urination and bowelmovements, and names correctly -Using a napkin to wipe face and hands -Feeding self simple meals using a fork or spoon -Taking shoes and socks off -Knowing where familiar items are kept -Attempting to brush teeth -Feeding self without difficulty -Tolerating different clothing textures, seams, tags -Independently packing items away -Using a napkin to wipe face and hands
-Can chew solid food and suck through a straw withassistance -Hold bottle independently -Self feed with fingers -Scribble with crayons
-Toileting independently -Brushing teeth independently -Dressing and undressing self (only requiringassistance with laces, buttons, and other fasteners inawkward places) -Begins brushing teeth and wiping nose -Combs/brushes hair
-Eat with spoon and fork -Drink with open cup -Toilet train -Dressing with assistance
Play skills

infant

toddler

child

-Can hold toys and shake them -Can swing at dangling toys -Play contently with family in the room -Plays give and take -Interacts briefly with other infants -Listens to stories
-Will engage with parent -May be able to blow bubbles
-Engaging in imaginative play -Enjoying/tolerating messy play -Taking Turns during play -Begins peer interaction -Imitative play -Can enjoy solitary play
-Will listen to simple stories and point at the pictures -Usually has a favorite toy and will seek or request itwith gestures -Brings objects to show others
-Works puzzles and blocks -Enjoys physical play -Prefers to play with other children  -Pretend play becomes more abstract and an objectcan be used to represent something else — a blockcan become a phone, a large box can become a car, aswing can become a space ship .-The young child’s motor skills are improving so theycan enjoy tricycles and throwing games.
-Can select their own story and may tell short stories

References

Batshaw, M., Roizen, N.J., ; Lotrecchiano, G.R. (Eds.). (2013). Children with disabilities  (7thed.).Baltimore, MD: Brookes.Centers for Disease Control.
(n.d.). Your Child at 3 Years. Retrieved from http://www.mychildwithoutlimits.org/wp-content/uploads/2012/11/Checklists_3yr-english.pdf

Center for disease control. (2017, October 25). Important milestones: Your baby by 4 months. Retrieved August 13, 2018, from
https://www.cdc.gov/ncbddd/actearly/milestones/milestones-4mo.html

Developmental Milestones. (n.d.). Retrieved August 13, 2018, from

https://www.luriechildrens.org/en/specialties-conditions/pediatric-occupational-therapy/developmental-milestones/play-developmental-
milestones/

Developmental Milestones. (2018). Retrieved August 12, 2018, from http://www.mychildwithoutlimits.org/understand/developmental-
milestones/

Cherry, K. (n.d.). Cognitive Developmental Milestones You Should Know. Retrieved August 13, 2018, from
https://www.verywellmind.com/cognitive-developmental-milestones-2795109

Self care development chart. (n.d.). Retrieved August 13, 2018, from https://childdevelopment.com.au/resources/child-development-charts/self-care-developmental-
cart/Play

Institute on disability and human development: University center for excellence for Illinois. (2016, May 12). Retrieved August 12, 2018, from

Layton, T. L. (n.d.). Developmental Scale for Children with Down Syndrome. Retrieved August 13, 2018, from
http://www.dsacc.org/downloads/parents/downsyndromedevelopmentalscale.pdf

National Down Syndrome Society. (2005). Early Intervention. Retrieved August 13, 2018, from https://www.ndss.org/resources/early-
intervention/

Occupational Therapy ; Down Syndrome. (n.d.). Retrieved August 13, 2018, from https://www.ndss.org/resources/occupational-therapy-down-
syndrome/

New York State Department of Health Division of Family Health Bureau of Early Intervention. (n.d.) Early intervention shaping futures: Down syndrome quick referenceguide for parents and professionals.  Retrieved August 13, 2018 from https://www.health.ny.gov/publications/4957.pdf
Sensory Processing Development Chart. (n.d.). Retrieved August 13, 2018, from https://childdevelopment.com.au/resources/child-
development-charts/sensory-processing-developmental-chart/

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