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Feeding and Speech Issues in Children with Down Syndrome

Every parent worries about their child's development, especially during the first few years of life. When your child is diagnosed with Down syndrome, you may have many questions about what to expect and how to best help them grow and thrive. One issue that can cause particular concern is feeding and speech development. While Down syndrome does present some unique challenges in these areas, there are many ways you can help your child overcome any difficulties they may experience. This post will explore some of the common feeding and speech issues associated with Down syndrome, as well as strategies for overcoming them.

In this article we will discuss:

Speech disorder

What is Down Syndrome?

In every cell of our human body, there is a nucleus that carries our genes responsible for all our inherited traits. Normally, the nucleus of each cell contains 23 pairs of chromosomes. Half of the chromosomes are from the mother, and half are from the father. However, it occurs when an individual has a full or partial extra copy of chromosome 21.

One of the chromosomes does not fully separate. The fetus ends up with three copies, or an extra partial copy, of chromosome 21, instead of two. This extra chromosome causes problems as the brain and physical features develop. Down Syndrome is a lifelong condition. But with care and support from family members, children who have down syndrome can grow up to have healthy, happy, and productive lives.

Some common physical features of Down syndrome include:

  1. A flattened face, especially the bridge of the nose

  2. Almond-shaped eyes that slant up

  3. A short neck

  4. Small ears

  5. Tongue thrust, or tongue that tends to stick out of the mouth

  6. Tiny white spots on the iris (colored part) of the eye

  7. Small hands and feet

  8. A single line across the palm (palmar crease)

  9. Small pinky fingers that sometimes curve toward the thumb

  10. Poor muscle tone or loose joints

  11. Shorter in height as children and adults

Children with Down Syndrome need help from a speech therapist.

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Causes of Down Syndrome

What causes down syndrome depends on what type the child has. Generally, down syndrome is caused by an abnormal cell division in early embryo development. Normally, a person has 46 chromosomes. But most people with Down syndrome have 47 chromosomes.

Types of Down Syndrome

According to the National Down Syndrome Society (NDSS), about 1 in 700 babies in the United States is born with Down syndrome. It’s the most common genetic disorder in the United States. There are three types of down syndrome.


Down syndrome is usually caused by an error in cell division called “nondisjunction.” Nondisjunction results in an embryo with three copies of chromosome 21 instead of the usual two. Prior to or at conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate. As the embryo develops, the extra chromosome is replicated in every cell of the body. This type accounts for 95% of cases, is called trisomy 21.

down syndrome milestone chart


Mosaicism occurs when nondisjunction of chromosome 21 takes place in one – but not all – of the initial cell divisions after fertilization. When this occurs, there is a mixture of two types of cells, some containing the usual 46 chromosomes and others containing 47. Those cells with 47 chromosomes contain an extra chromosome 21. Mosaicism accounts for about 1% of all cases.

Research has indicated that individuals with mosaic Down syndrome may have fewer characteristics of Down syndrome than those with other types of Down syndrome. However, broad generalizations are not possible due to the wide range of abilities people with Down syndrome possess.


Translocation accounts for about 4% of all cases of Down syndrome. In translocation, part of chromosome 21 breaks off during cell division and attaches to another chromosome, typically chromosome 14. While the total numbers of chromosomes in the cells remain 46, the presence of an extra part of chromosome 21 causes the characteristics of Down syndrome

Risks of having a child with Down Syndrome

There is no cure for down syndrome. In order to prevent it, we have to be aware of the risk factors that can cause down syndrome. This includes:

  1. Getting pregnant at an older age. Risk increases for women who give birth at the age of 35 and above.

  2. You have a brother or a sister who has Down syndrome.

  3. You previously had a child with Down Syndrome.

Down syndrome milestone chart

Children with Down syndrome have a variety of physical and mental traits caused by their gene problem. Because of these problems associated with Down Syndrome, kids will most likely have delays in certain areas of development. Comparing their development to typically developing children is unfair. They achieve each milestone with their own down syndrome milestone chart. In monitoring their development, it is more important to look at the sequence of milestones achieved, rather than the age at which the milestone is reached.

Tongue Thrust

The range for Children with Down Syndrome

For Gross Motor Skills:

  1. At 6- 30 months, they learn how to sit alone.

  2. By 8-22 months, they develop the strength to crawl

  3. At 1-3.25 years old, children with down syndrome begin to stand

  4. By 1-4 years old, they can walk by themselves

For Language Skills:

  1. By 1-4 years old, they learn how to produce their first word

  2. At 2-7.5 years old, they begin producing two-word phrases.

For Social and Self-Help Skills:

  1. By 1.5 -5 months, children with down syndrome begin to smile responsively.

  2. At 10-24 months, they learn how to feed through their fingers.

  3. By 12-32 months, they learn how to drink from a cup without assistance.

  4. At 13-39 months, children with down syndrome begin to feed using a spoon.

  5. By 2-7 years old, they begin to learn how to address their bowel on their own.

  6. At 3.5-8.5 years old, children with down syndrome learn how to dress themselves on their own.

Communication skills of Children with Down Syndrome

Now that you read about Down syndrome milestone chart, it is best to learn the communication and feeding skills an of children with Down syndrome. They usually have speech disorders and language delays. This include:

  1. Expressive language skills present particular challenges and generally are more impaired than receptive skills in young individuals with Down syndrome.

  2. A consistent finding shows that children with Down syndrome have speech disorders characterized by poorer speech intelligibility than younger typically developing children of similar nonverbal mental age.

  3. Several studies using standardized assessments suggest that children and adolescents with Down syndrome comprehend spoken words at levels similar to mental age-matched typically developing children.

  4. Boys with Down syndrome produced fewer consonants correctly and more syllable structure phonological processes (e.g., cluster reduction, final consonant deletion) than younger typically developing boys of similar nonverbal mental age.

Feeding milestones of children with Down syndrome

One of the most common concerns of children with Down Syndrome is their persistent tongue thrust or protrusion. Let’s put it out there! Babies with Down syndrome do not have big tongues! They usually have small mouths and hypotonic, or low muscle tone, tongues. This causes them to have tongue thrust or tongue protrusion. It is because they have a big tongue! Muscle tone in the tongue will improve as muscle tone in the rest of the body improves as your baby learns to feed orally and use her mouth for oral play. Feeding problems, such as tongue thrust, associated with low muscle tone include:

  1. Difficulty latching on to the breast or teat.

  2. The mouth may be less alert or ready for feeding.

  3. Swallowing air leads to tummy cramps/discomfort during feeding.

  4. Loss of interest in feeding before finishing each feeding.

  5. Problems with moving on to spoon feeds and different food textures.

It’s important to identify and treat communication and feeding issues early to ensure your child with Down syndrome gets the most out of every conversation and meal.

Treating Down Syndrome

Down syndrome is a lifelong condition. Services early in life will often help babies and children with Down syndrome to improve their physical and intellectual abilities. Most of these services focus on helping children with Down syndrome develop to their full potential. These services include speech, occupational, and physical therapy. They are typically offered through early intervention programs in each state. Children with Down syndrome may also need extra help or attention in school. Although, many children are included in regular classes.

Speech Therapy

How can Speech Therapy help?

Children/adults with Down syndrome and speech therapists often come in contact. First, a proper evaluation of the patient is done by a speech-language pathologist. It is important the speech and language therapists work closely with the child’s parents/carers to provide support and advice regarding any problems the child may be experiencing. This is done to cater to the specific needs of a patient with down syndrome as they vary from one child to the next. This must be done so that we can have optimal results for treatment. The therapist will identify if the patient needs help with speech disorders, feeding difficulties, or both.

Different therapy techniques are used to target specific goals such as:

  1. Language stimulation

  2. Age-appropriate intervention plan & materials

  3. AAC (Augmentative or alternative communication (AAC) systems, such as sign language, visual schedules, pictures, object symbols, or computerized speech production devices, may improve the communicative competence of individuals with Down syndrome who are delayed in speech onset or have markedly reduced speech intelligibility)

  4. Conversational recasting is one method for helping children develop more complex syntax. (For example, if a child says “doggy sleep,” the communication partner could elaborate “the doggy is sleeping.”)

  5. Clinicians may also utilize books to target developmentally appropriate expressive vocabulary, taking into account age-appropriate themes, academic and social needs, and current interests of the child

  6. Strategies to increase elaborative language include using topics and materials of interest to the child, allowing additional processing time, and using open-ended questions

A child with Down syndrome must also work with speech with social words he is comfortable using. Transitioning from rehabilitation to after rehabilitation will be a lot smoother, and patients will be able to interact easier. Down syndrome speech therapy services can help an individual excel!

At Better Speech, we offer online speech therapy services for Down Syndrome, convenient for you and tailored to your child's individual needs. Our services are affordable and effective - get Better Speech now.


About the Author

Mikee Larrazabal

I am a Speech-Language Pathologist with 14 years of experience working with children and adults who have communication difficulties. I completed my Bachelor of Science degree in Health Science at Cebu Doctors' University and have been helping people overcome their communication challenges ever since.

I have worked with individuals of different ages, including toddlers, preschoolers, school-aged children, adults and seniors. I'm passionate about speech therapy and take great satisfaction in helping people overcome their communication challenges and improve their lives through better communication skills. In my spare time I like reading books, going hiking in nature and taking care of my dog Locas.



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