Your Baby's First Year

1. Growth During the First Year

Babies with Down syndrome often grow differently from other infants. This does not mean that slower growth is always expected or that poor weight gain should be overlooked.

Your pediatrician should measure weight, length, head circumference, and weight-for-length at routine visits and plot them on Down syndrome-specific growth charts.

Growth trends are more useful than any single measurement. A baby who begins falling away from their usual pattern may need evaluation for feeding difficulty, heart disease, thyroid problems, or other medical concerns.

2. Developmental Milestones

Your baby's development is a journey of individual progress, not a race against a calendar.

Many babies with Down syndrome take longer to develop head control, rolling, sitting, crawling, and early communication skills.

Low muscle tone, called hypotonia, and differences in muscle strength and coordination can influence how movement develops.

These are suggested areas for play and support, not deadlines for reaching milestones.

3. Early Intervention & Therapies

Early intervention is an important part of care for infants with Down syndrome.

Services are individualized and may involve physical therapy, occupational therapy, speech-language support, or feeding therapy.

Physical Therapy

Can help support movement, positioning, balance, strength, and motor skills.

Occupational Therapy

May support play, reaching, grasping, sensory-motor skills, feeding, and daily activities.

Speech-Language & Feeding Support

Can support early communication, interaction, and feeding or swallowing when indicated.

4. Feeding, Swallowing & Nutrition

Feeding needs can change during infancy. Some babies feed well from the beginning, while others need ongoing support with stamina, coordination, or swallowing.

Breast Milk or Formula

Breast milk or iron-fortified infant formula remains the main source of nutrition during the first year. Follow your pediatrician's guidance regarding vitamin D, iron, and other nutritional needs.

Starting Solid Foods

Complementary foods are generally introduced around 6 months when your baby shows appropriate readiness. Low muscle tone or swallowing difficulties may affect the timing and textures.

Your pediatrician or feeding therapist can help determine whether your baby is ready and whether texture modifications are needed.

Silent Aspiration

Some infants with Down syndrome aspirate milk or food into the airway without obvious coughing.

Recurrent respiratory symptoms, coughing or choking during feeding, noisy breathing with meals, prolonged feeding, or poor growth should prompt medical assessment.

When swallowing dysfunction is suspected, the medical team may recommend an instrumental swallow study.

Feeding Safety

Introduce foods in developmentally appropriate textures and avoid choking hazards. Keep your baby upright and supervised while eating.

Honey should not be given before 12 months. Whole cow's milk should not replace breast milk or formula as the main drink before 12 months.

5. Heart Health & Cardiology Follow-Up

The newborn echocardiogram establishes whether your baby has a congenital heart defect or other cardiac concerns.

If a heart defect was identified, your pediatric cardiologist will determine the schedule for examinations, echocardiograms, and possible treatment.

Some infants require surgery during the first year. Others need observation or medical management.

Infants with Down syndrome may also develop pulmonary hypertension, including in some cases without a structural heart defect.

6. Thyroid Function

Children with Down syndrome have an increased risk of thyroid dysfunction, including hypothyroidism.

Even if newborn thyroid screening was normal, the AAP recommends repeat TSH measurements at:

Testing may be needed sooner if symptoms or previous abnormal results suggest thyroid disease.

Abnormal results should be interpreted by the medical team, with pediatric endocrinology consultation when appropriate.

7. Hearing & Ear Health

Hearing evaluation is especially important because hearing loss can affect early communication and language development.

If your baby passed newborn hearing screening, the AAP recommends reassessment at 6 months.

If newborn screening was not passed, diagnostic audiology evaluation should not be delayed.

Middle-Ear Fluid

Babies with Down syndrome have an increased risk of middle-ear fluid and hearing problems. Narrow ear canals may also make ear examinations difficult.

Your pediatrician may refer your baby to an audiologist or pediatric ear, nose, and throat specialist for additional evaluation.

At 12 Months

Your audiologist may attempt age-appropriate behavioral hearing testing. If reliable testing cannot be completed, additional objective testing may be needed.

8. Vision & Eye Health

Your baby should have an examination by a pediatric ophthalmologist or an ophthalmologist experienced in caring for infants with Down syndrome within the first 6 months of life.

The examination looks for conditions such as cataracts, strabismus, refractive errors, nystagmus, glaucoma, and tear-duct problems.

Your pediatrician should also continue checking vision at routine visits.

9. Blood Counts & Iron Health

Adequate iron intake is important for brain development and growth.

Children with Down syndrome may have larger-than-average red blood cells, which can make iron deficiency harder to recognize from routine blood measurements alone.

Earlier testing may be needed when there are feeding concerns, poor growth, or other medical reasons.

If your baby had transient abnormal myelopoiesis (TAM) during the newborn period, continue the hematology follow-up plan provided by the specialist.

10. Sleep, Breathing & Safety

Babies with Down syndrome can have differences in upper-airway anatomy and muscle tone that increase the risk of breathing problems during sleep.

Tell your pediatrician about snoring, noisy breathing, breathing pauses, restless sleep, or other concerns.

A sleep specialist may recommend testing when symptoms suggest sleep-disordered breathing. The routine screening sleep study recommended later in childhood does not replace evaluating symptoms during infancy.

Safe Sleep

• Place your baby on their back for every sleep.
• Use a firm, flat, noninclined sleep surface.
• Keep loose blankets, pillows, bumpers, and soft objects out of the sleep space.
• Share a room, not a bed.
• Avoid weighted sleep products and inclined sleepers.

Neck & Positioning Safety

Support your baby's head and neck appropriately, as you would for any infant. Inform medical professionals of the Down syndrome diagnosis before procedures involving neck positioning.

Routine cervical spine X-rays are not recommended for an asymptomatic infant.

Routine Pediatric Care

Continue recommended immunizations and routine preventive care. Discuss any additional respiratory infection prevention or other individualized recommendations with your pediatrician.

11. Your Baby's First-Year Medical Timeline

This timeline summarizes important Down syndrome-specific care. It does not replace routine well-child visits, immunizations, or the individualized schedule recommended by your baby's clinicians.

12. When to Call & When to Seek Emergency Care

13. First-Year Parent Checklist

Use this checklist during your baby's medical appointments.

• Review all newborn screening results.
• Confirm the cardiology follow-up plan.
• Track growth using Down syndrome-specific charts.
• Review feeding and swallowing at each visit.
• Continue early intervention services.
• Schedule pediatric ophthalmology by 6 months.
• Complete hearing reassessment at 6 months.
• Complete TSH testing at 6 months.
• Discuss readiness and safety for solid foods.
• Review sleep and breathing concerns.
• Complete TSH testing at 12 months.
• Complete CBC and iron studies at 12 months.
• Arrange appropriate hearing follow-up at 12 months.
• Review the next stage of medical and developmental care.

14. Trusted Down Syndrome Organizations & Family Resources

These organizations provide information, advocacy, family connections, and resources throughout your child's development.