How physical therapy can help children with Down syndrome

Pediatric physical therapists are movement specialists who work with children of all ages and all medical conditions. One of our main overarching goals is to help progress a child’s motor development in order to improve their independence and safety with activities of daily living and to increase their participation in client-specific activities. A physical therapist (PT) provides hands-on care with individualized exercises and incorporates client-specific goals into treatment sessions. If you are wondering how physical therapy can help children with Down syndrome improve their quality of life, independence, and participation, then read along!


Children with Down syndrome have several musculoskeletal differences contributing to a delay in motor development. The most significant difference is due to hypotonia (low muscle tone) and ligament laxity (looseness), characteristic of Down syndrome. Hypotonia is distributed to all major muscle groups, including the neck, trunk, and all four extremities.

The following lists some common neuromuscular impairments in Down syndrome and how each impairment can limit a child functionally:

1. Hypotonia and low force production  →Low muscle tone has been highly correlated with a delay of gross and fine motor skills and in other areas such as speech acquisition and cognitive development. Low muscle tone can lead to decreased interest in movement activities and decreased overall fitness.

2. Joint hypermobility → Can cause anxiety with movement and feeling unstable while holding static positions (like standing on one leg). Ligament laxity can result in flat feet, knee cap instability, a curvature of the spine called scoliosis, and atlantoaxial (A-A) instability. A-A instability is caused by laxity of a ligament in the upper neck joints and is present in 10 to 20% of children with Down Syndrome. The laxity results in excessive motion of the first two cervical vertebrae. Only 1-2 % have symptomatic A-A instability and will need medical attention.

3. Slow automatic postural reactions → Can cause balance limitations, slow reaction time, and decreased task completion speed.


Children with Down Syndrome can receive physical therapy intervention across the lifespan. For example, physical therapists can help with the following:

(1) an infant to achieve motor milestones such as sitting up and crawling.
(2) a toddler to walk independently and later on to safely go up and down the stairs
(3) a teenager to work on specific motor skills and improve fitness needed for community, vocational or recreational activities.
Physical therapists do not directly treat medical impairments such as hypotonia or joint hypermobility. Instead, we treat the child as a whole to address the functional limitations. For example, PTs can help a child improve their joint stability by strengthening the muscles around the joints and practicing activities that will enhance proprioception, which is the awareness of a common position in space.

In addition, physical therapists can help a child with Down syndrome by:

• teaching caregivers appropriate positioning and handling activities for their infant or child to promote postural control and weight bearing.
• designing activities to encourage the development of antigravity muscle strength in all positions.
• encouraging dynamic rather than static exploration of movement.
• collaborating with other interdisciplinary team members to enhance cognition, language, and socialization development.
• teaching family members and other team members activities and position choices that will enhance the child’s overall development.


If you feel that physical therapy will benefit your child or are unsure if your child would help, I highly recommend setting up an evaluation with a pediatric PT! Please get in touch with a local pediatric physical therapy clinic, or ask your child’s pediatrician to make a referral for a PT evaluation. At Child and Family Development, we also offer a 30-minute motor development readiness check from our physical therapists; no referral is needed. Please get in touch with either of our offices if you have any questions relating to your child’s development.

Scott Harvey, MPT
Physical Therapist

Campbell, S. K., Palisano, M. N., Orlin, M. N., & Schreiber, J. (2017). Campbell’s physical therapy for Children |physical therapy for Children. Elsevier.