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5 Tips from a Pediatric Occupational Therapist on Skill-Building for Children with Down Syndrome

2018-10-24 by Robbie Levy
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By Robbie Levy

Robbie Levy

Working with children with Down syndrome has been part of my experience as an Occupational Therapist and Child Development Specialist for 37 years. At Dynamic Kids in Westchester County, New York, where I am the Founder and Executive Director, and through my work as a national lecturer, we have positively influenced the lives of over 10,000 children with our therapies, interventions, practical advice, and enrichment groups.

While all children are unique, there are certain characteristics that are almost always present with Down syndrome and require attention. Low muscle tone is the most common and early intervention can be very powerful. Low muscle tone impacts gross and fine motor development as well as eating and drinking. Children can come across as lethargic or uninterested, however, this is often not the case as it can be a manifestation of their motor challenges.

Using play without screens to engage your child (at any age) is the single best way to address all areas of development including motor, language, social, and cognitive. Make sure early play includes as many sensory systems as possible. Pair systems together if you can for example movement (vestibular) with touch (tactile). Engage your child directly with eye contact. For infants, include their tummy and their backs and don’t rush to stand too early. Work on joint attention and when slightly older taking turns (reciprocity). Add in creativity, role playing and problem-solving as children grow. Quick, linear and unpredictable movement can add in helping muscle tone.

Some suggestions include:

  1. Hold your child up in the air and fly like an airplane.

    Airplane Game

    Have unexpected quick starts and stop. Support them appropriately based on their age and motor level. Make sounds while moving.

  2. Play hot potato with a favorite stuffed animal large enough to hold with two hands.

    Hot Potato Game

    Stop the music or your singing at different intervals. Pass to the left and then the right if in a circle. Then go in a line and pass it over the head and between the legs. Play in different positions (sitting, kneeling, standing).

  3. Play dress-up.

    Play Dress-Up

    You can stimulate sensory systems, work on motor planning and fine motor development and practice dressing all at the same time. Enhancing social skills and facilitating language always occurs with role-playing. Get into character, be creative, and have fun!

  4. Have your child crawl through a tunnel.

    Giddy Buggy Tunnel

    Meet them on the other side of the tunnel on your belly with a sensory puzzle (touch, sound). Expand on the play by talking about the artwork on the puzzle.

  5. Most importantly, enjoy playing with your child and helping their growth!


    Many national associations have resources to offer, including the National Down Syndrome Society (NDSS), National Association for Down Syndrome (NADS), and Association for Children and Adults with Down Syndrome (ACDS). Join a local chapter to find support and information in your area and to meet other families. There are countless books available, too. I like “Babies with Down Syndrome: A New Parents’ Guide,” by Susan J. Skallerup. In addition, these three books have activity suggestions to facilitate development:

    “Gross Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals,” by Patricia C. Winders

    “Fine Motor Skills for Children with Down Syndrome: A Guide for Parents and Professionals,” by Maryanne Bruni

    “Early Communication Skills for Children with Down Syndrome: A Guide for Parents and Professionals,” by Libby Kumin

    Here are some suggested skill-building toys that can be useful for children with Down syndrome:

    Play ideas to support cognitive development

    Play ideas to support letter and number skills

    Play ideas to support shape and color recognition

    Play ideas to support speech and language development

    Play ideas to support fine motor skill development

    Play ideas to support social and emotional skill development

Dynamic Kids


Robbie Levy

Robbie Levy is the founder and executive director of Dynamic Kids, one of the leading multi-disciplinary pediatric practices providing Occupational, Physical and Speech Therapy services to children from birth thru teens. The practice also provides enrichment groups such as music, art, yoga, self-regulation and handwriting. Robbie Levy has over three decades experience as a therapist and an influencer in her industry, and has built a practice founded on providing superior services to children and establishing open and trusting communication with parents, educators, and other professionals.

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