Your Child's Early Years

1. Growth, Feeding & Nutrition

Growth patterns in children with Down syndrome differ from those of many other children. Your pediatrician should follow your child's growth over time using appropriate Down syndrome growth charts.

Before age 2, weight, length, and weight-for-length are important measurements. Beginning at age 2, body mass index (BMI) becomes part of growth monitoring.

A healthy eating pattern, physical activity, and attention to feeding skills can support growth and help prevent excess weight gain.

Feeding & Swallowing

Some children have difficulty chewing certain textures, coordinating swallowing, or moving from purees to family foods.

Coughing, choking, prolonged meals, recurrent respiratory symptoms, or poor growth should prompt evaluation for feeding and swallowing problems, including possible silent aspiration.

2. Development During the Toddler & Preschool Years

Every new skill matters, whether it arrives early, gradually, or with extra support.

Children with Down syndrome often develop motor, communication, and self-help skills at their own pace.

Your pediatrician should review development at every well-child visit and investigate a loss of skills or unexpected changes in functioning.

These are areas to support, not age-based deadlines. Your child's therapy team can help identify individualized developmental goals.

3. Speech, Language & Communication

Many children with Down syndrome understand more than they can express with spoken words.

Communication may include facial expressions, gestures, signs, pictures, spoken words, or assistive communication systems.

Supporting Communication

• Talk with your child during everyday activities.
• Read books and name familiar objects.
• Respond to gestures and communication attempts.
• Use songs, repetition, and playful interaction.
• Consider sign language or augmentative and alternative communication (AAC) when appropriate.

AAC does not need to wait until a child has failed to develop spoken language. A speech-language pathologist can help choose communication supports that fit your child's needs.

4. Early Intervention & Therapy Services

Physical therapy, occupational therapy, speech-language therapy, and feeding support may help children develop skills and participate in daily life.

Physical Therapy

Supports movement, strength, balance, posture, walking, and safe participation in play.

Occupational Therapy

Can help with fine motor skills, play, dressing, feeding, sensory needs, and daily routines.

Speech-Language Therapy

Supports understanding, expression, interaction, speech development, and alternative communication methods.

5. Hearing & Ear Health

Hearing loss is common in children with Down syndrome and can affect speech, language, learning, and behavior.

Middle-ear fluid, recurrent ear infections, and narrow ear canals can make hearing evaluation especially important.

If reliable behavioral testing cannot be completed, an audiologist may recommend objective tests such as otoacoustic emissions or auditory brainstem response testing.

Children with hearing loss or difficult-to-examine ear canals may need pediatric ENT care. Hearing should be reassessed after treatment of middle-ear disease.

6. Vision & Eye Health

Children with Down syndrome have increased risks of refractive errors, strabismus, amblyopia, and other eye conditions.

Your pediatrician should assess vision at every well-child visit using methods appropriate for your child's age and abilities.

Photoscreening is useful when available. Abnormal results require referral to an ophthalmologist.

Early identification and treatment of vision problems can help prevent avoidable visual impairment.

7. Thyroid, Blood Counts & Iron

Thyroid Testing

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

The AAP recommends measuring TSH every year, or sooner if symptoms suggest thyroid disease.

If antithyroid antibodies have previously been detected, TSH testing is recommended every 6 months.

Blood Count & Iron Status

Beginning at age 1, obtain a CBC with differential and iron assessment annually.

The recommended iron evaluation includes either ferritin with C-reactive protein (CRP), or serum iron with total iron-binding capacity (TIBC).

Iron deficiency can be missed if screening relies only on hemoglobin because children with Down syndrome may have larger red blood cells.

If your child previously had transient abnormal myelopoiesis (TAM), continue the follow-up plan recommended by pediatric hematology.

8. Sleep Apnea: An Essential Screening

This is one of the most important medical recommendations for preschool-aged children with Down syndrome.

Obstructive sleep apnea is common in children with Down syndrome. It can affect sleep quality, behavior, attention, growth, and overall health.

Symptoms may include snoring, heavy breathing, restless sleep, unusual sleeping positions, frequent awakening, or pauses in breathing.

A child with symptoms of sleep-disordered breathing should be evaluated earlier rather than waiting until age 3.

If sleep apnea is diagnosed, treatment depends on its cause and severity. Children treated surgically may need repeat polysomnography because sleep apnea can persist after adenotonsillectomy.

9. Neck & Cervical Spine Safety

Children with Down syndrome have an increased risk of cervical spine instability, including atlantoaxial instability.

Most children do not develop symptoms. The important approach is awareness of concerning changes and careful neck positioning during medical procedures.

Symptoms That Require Urgent Evaluation

• New neck pain or persistent head tilt
• New weakness or unusual stiffness
• Changes in walking or balance
• Changes in how the arms or hands are used
• New bowel or bladder dysfunction
• Unexpected loss of motor abilities

These symptoms warrant prompt medical evaluation. Significant or rapidly progressive neurologic symptoms require emergency assessment.

Tell clinicians about your child's Down syndrome diagnosis before anesthesia, surgery, or procedures involving neck positioning.

Avoid trampoline use outside a structured, appropriately supervised therapeutic program. Discuss higher-risk sports with your child's medical team.

10. Digestive Health & Celiac Disease

Children with Down syndrome have an increased risk of constipation and certain digestive conditions, including celiac disease.

Constipation

Constipation can be influenced by diet, muscle tone, activity, thyroid dysfunction, or other conditions.

Persistent or severe constipation deserves evaluation, especially when accompanied by abdominal swelling, vomiting, or poor growth.

Celiac Disease

Celiac disease is more common in children with Down syndrome.

At every well-child visit, your pediatrician should review symptoms that may suggest celiac disease in a child eating gluten.

Symptoms can include chronic diarrhea, persistent constipation, abdominal pain, bloating, poor growth, anemia, or unexplained developmental or behavioral concerns.

11. Heart Health & Cardiology Follow-Up

If your child has a congenital heart defect, continued cardiology follow-up is important, even after surgical repair.

Follow-up may include assessment for residual or recurrent heart problems and pulmonary hypertension.

Your cardiologist will determine the appropriate visit and testing schedule.

12. Behavior, Emotions & Autism Screening

Toddlers and preschoolers with Down syndrome experience the same broad range of emotions as other children.

Communication challenges, sensory needs, changes in routines, poor sleep, or medical discomfort can affect behavior.

Consistent routines, positive reinforcement, clear communication, and developmentally appropriate expectations can help.

Autism Can Co-Occur with Down Syndrome

Having Down syndrome does not exclude a diagnosis of autism spectrum disorder.

Children with Down syndrome should receive routine autism screening at 18 and 24 months, as recommended for other children.

Concerns about social communication, repetitive behaviors, or developmental changes should prompt further evaluation.

Safety & Independence

Teach simple safety rules, support self-help skills, and plan for wandering or elopement risk when relevant.

Use accurate names for body parts, teach age-appropriate privacy and body boundaries, and explain examinations in a respectful, understandable way.

13. Dental Care, Skin & Everyday Health

Dental Development

Tooth eruption may occur later or in a different sequence in children with Down syndrome.

Some children have fewer permanent teeth or differences in tooth shape and spacing.

Establish a dental home by age 1 or within 6 months of the first tooth erupting.

Brush twice daily with fluoridated toothpaste in an age-appropriate amount and follow your dentist's advice.

Skin & Hair

Dry skin, keratosis pilaris, folliculitis, alopecia areata, and other skin conditions may occur more often in children with Down syndrome.

Persistent skin or hair changes should be discussed with your pediatrician. Some changes may also warrant thyroid evaluation.

Immunizations

Continue routine childhood immunizations, including annual influenza vaccination when age-appropriate.

Children with certain heart, lung, or other medical conditions may qualify for additional vaccines or preventive measures.

Ask your pediatrician to review the current immunization schedule and any condition-specific recommendations.

14. Preparing for Preschool & Learning

The transition from early intervention to preschool services is an important milestone for many families.

Families can contact their local public school district to request an evaluation for preschool special education services.

Educational planning should reflect your child's strengths, communication needs, developmental goals, and opportunities to learn alongside peers.

Helpful Questions for the School Team

• How will my child's communication needs be supported?
• What therapy services may be appropriate?
• How will learning goals be measured?
• What opportunities are available for inclusive activities?
• How will the school and family communicate?

CDC: Understanding Early Intervention and Preschool Services →

15. Your Child's Medical Timeline: Ages 1–5

Hearing and eye follow-up schedules may change based on testing results. Your child's medical team may recommend additional or earlier evaluations.

16. When to Call & When to Seek Emergency Care

17. Parent Checklist: Ages 1–5 Years

Keep this checklist available for pediatric and specialist visits.

• Continue regular pediatric well-child visits.
• Review growth on appropriate Down syndrome charts.
• Review feeding, nutrition, and swallowing safety.
• Complete hearing evaluations on schedule.
• Review vision screening and ophthalmology follow-up.
• Complete annual TSH testing.
• Complete annual CBC and iron assessment.
• Maintain cardiology follow-up when indicated.
• Review sleep symptoms at every visit.
• Arrange sleep study between ages 3 and 4.
• Review cervical spine warning signs.
• Discuss digestive symptoms and possible celiac disease.
• Continue developmental therapies as needed.
• Complete autism screening at 18 and 24 months.
• Plan transition to preschool services before age 3.
• Establish regular dental care.
• Review immunizations and preventive care.
• Ask about family and community support resources.

18. Trusted Down Syndrome Organizations & Family Resources

Reliable information and meaningful connections can make an important difference as your child grows.

These organizations offer educational resources, family support, advocacy, and connections to other families.