Clinically reviewed by What is down syndrome
Down syndrome is caused by an extra copy of chromosome 21. For physiotherapy, the parts that matter are low muscle tone, loose joints and reduced strength, which together make every movement skill harder work to learn.
Children with Down syndrome reach their motor milestones later, and they do reach them. Sitting, standing, walking, running and sport all happen, on a longer timetable.
As a rough guide, most children with Down syndrome sit without support between eight and eleven months and walk somewhere between eighteen months and three years. Your own child's progress matters far more than any average.
Symptoms you might have
- A baby who feels floppy and settles into wide, flat positions
- Head control taking longer to arrive than in other babies
- Joints that move further than expected, especially hips, knees and ankles
- Sitting with a rounded back, and standing with the feet wide and the knees locked
- Flat feet that roll inwards once standing begins
- Sitting with the legs out in a W, which is comfortable and bad for the hips
- Tiring quickly, and skills needing rebuilding after an illness
Why it happens
- Low muscle tone, which means more effort is needed to hold any position
- Loose ligaments, so joints give way and the body looks for ways to lock itself steady
- Reduced strength, which follows from both of those
- Shorter arms and legs, which changes the leverage for crawling and climbing
- Heart conditions, present in a large minority of children, which limit stamina until treated
- Hearing and vision problems, which affect balance and learning by watching
- An underactive thyroid, which is common and slows energy and progress if untreated
When you should see a physiotherapist
Start early, ideally in the first months. Physiotherapy does not change the genetic condition, but it changes how your child learns to move, and it heads off the locked, compensating patterns that cause pain later.
The neck needs a doctor's clearance before certain activities. Some children with Down syndrome have extra looseness between the top two bones of the neck. Before somersaults, forward rolls, trampolining, diving or contact sport, and before any general anaesthetic, this should be assessed. Neck pain, a new head tilt, a change in walking, new clumsiness, weakness in the arms or legs, loss of a skill already gained, or a sudden change in muscle tone all need urgent medical review.
A paediatrician should also check the heart, thyroid, hearing and vision. All four affect how much your child can do.
Al-Shama Physiotherapy Clinic
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اپائنٹمنٹ کے بارے میں پوچھیںAppointment ke liye poochein
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How it is treated
The aim is not to make a child with Down syndrome move like a child without it. The aim is good quality movement, learned in patterns that will still work at ten and at twenty.
- Exercise therapy, strengthening the neck, trunk, hips and legs, which is the core of the work at every age
- Milestone practice in good patterns, sitting with a straight back rather than propped, standing with the feet under the hips rather than locked wide
- Balance and weight shifting work, which loose joints make genuinely difficult and genuinely trainable
- Insoles and supportive footwear for flat, inward-rolling feet, which make standing and walking steadier
- Gait, stair and running practice in older children, then sport, which is where the long-term fitness comes from
- Family training, since repetition at home is what turns a session into a skill
Stretching is used sparingly, because these joints are already loose and forcing range makes them less stable. There is no operation for low tone. Heart surgery, thyroid medicine and any neck imaging are doctors' decisions.
Exercises, and what to avoid
What helps
- Tummy time and side lying from the early weeks, building head and trunk control
- Sitting and standing with support at the hips, so the trunk muscles do the work
- Climbing, stairs with a rail, and pushing a weighted toy, all of which build real strength
- Swimming, dance and cycling later on, which build stamina and are usually enjoyed
What to avoid
- Somersaults, forward rolls, trampolining and diving until a doctor has assessed the neck
- Pulling or pushing hard on the neck, and any strong stretch of a loose joint
- W sitting and locked-knee standing, which feel stable and teach the muscles nothing
- Baby walkers and long periods in propped seats, which replace the work the body needs
What you can do at home
Short and frequent is the rule. Several five minute spells beat one long session, because a low tone child tires quickly and tired practice is poor practice.
Correct the sitting position every time you see the W. Legs crossed, legs forward, or sitting on a small stool are all better for the hips.
Let your child be barefoot indoors and use firm, well fitting shoes outdoors. Flat feet usually do better with a little support.
Build strength into ordinary life: stairs rather than being carried, walking the last part of a journey, carrying his own bag.
Expect plateaus. Progress comes in steps with flat stretches between them, and the flat stretches are not failure.
How long it takes
This is long-term support rather than a course of treatment, but it is not constant. Many families attend weekly in the first two years, then monthly, then a few reviews a year.
Most children with Down syndrome sit without support between eight and eleven months, crawl around a year, and walk between eighteen months and three years. These are averages with a wide spread either side.
Each new skill usually takes longer to learn than it would in another child, and far more repetition. That repetition is the treatment.
What speeds it up is daily practice at home, treating the heart, thyroid, hearing and vision problems, and avoiding the equipment that does the work for the child.
Urdu / Roman Urdu
Choose your reading script / اپنی پسند کا رسم الخط منتخب کریں
اردوUrdu script
ڈاؤن سنڈروم میں بچے کے پٹھے ڈھیلے اور جوڑ زیادہ لچکدار ہوتے ہیں۔ اسی لیے بیٹھنا، کھڑا ہونا اور چلنا سیکھنے میں زیادہ وقت لگتا ہے۔ لیکن یہ سب آتا ہے، بس دیر سے۔
عام طور پر ایسے بچے آٹھ سے گیارہ مہینے میں بغیر سہارے بیٹھ جاتے ہیں، اور اٹھارہ مہینے سے تین سال میں چلنا شروع کرتے ہیں۔
ایک اہم احتیاط: کچھ بچوں کی گردن کی اوپری ہڈیوں میں زیادہ ڈھیلاپن ہوتا ہے۔ قلا بازی، ٹرامپولین، ڈائیونگ یا بے ہوشی کے آپریشن سے پہلے ڈاکٹر سے گردن چیک کروانا ضروری ہے۔
گردن میں درد، سر کا ٹیڑھا ہو جانا، چلنے میں تبدیلی، یا کوئی کام جو پہلے کرتا تھا چھوڑ دینا، ان پر فوراً ڈاکٹر کو دکھائیں۔ دل، تھائیرائڈ، کان اور آنکھوں کا چیک اپ بھی ضروری ہے۔
Roman Urdu
Down syndrome mein bachay ke pathay dheele aur jor zyada lachakdar hote hain. Isi liye baithna, khara hona aur chalna seekhne mein ziada waqt lagta hai. Lekin ye sab aata hai, bas der se.
Aam tor par aise bachay aath se gyarah mahine mein bina sahare baith jate hain, aur atharah mahine se teen saal mein chalna shuru karte hain.
Ek ahem ehtiyat: kuch bachon ki gardan ki oopri hadiyon mein ziada dheelapan hota hai. Qulabazi, trampoline, diving ya behoshi ke operation se pehle doctor se gardan check karwana zaroori hai.
Gardan mein dard, sar ka tedha ho jana, chalne mein tabdeeli, ya koi kaam jo pehle karta tha chhor dena, in par foran doctor ko dikhayen. Dil, thyroid, kaan aur aankhon ka check up bhi zaroori hai.
Treatment at the clinic, and online
INFORMATION → INDIVIDUAL CARE
A plan built around you.
Talk with Dr. Zahra Fatima, DPT. Understand your next steps, with guidance for your own symptoms and daily routine.
Talk it through
Discuss your symptoms, what you find difficult and what you want to get back to.
Understand your next steps
Use the consultation to discuss which care and exercises fit your situation.
Take your plan with you
Your online consultation includes a written plan you can refer to afterwards.
Questions people ask
Will physiotherapy make my child's development normal?
When will my child walk?
Why can't my child do somersaults at school?
Is W sitting really a problem?
Should my child wear special shoes?
Related conditions
- Cerebral palsy treatment and physiotherapy
- Torticollis in babies
- Child not walking
- Delayed developmental milestones
- Low muscle tone in babies