Down syndrome and the development of Gross and Fine motor skills

Each child with Down syndrome develops gross & fine motor skills at their own pace, and has their own individual strengths and needs. In general, however, there are a variety of characteristics associated with Down syndrome that can affect gross and fine motor skill development. These include physical characteristics such as hypotonia, medical problems, and cognitive delays.

Occupational Therapy can help a child with Down syndrome to develop gross and fine motor function more normally and achieve better performance in areas such as hand writing, balance and playing sports.

Hypotonia

Hypotonia or low muscle tone is lower than normal tension in the muscles. Our muscles always have some degree of contraction, even if we are not moving, as they hold our bones upright. Children with Down syndrome have varying degrees of low muscle tone. This makes them appear floppy, and delays the development of head and body control. When we pick them up as infants, they may feel like wet spaghetti slipping through our hands.

Any child with hypotonia has difficulty with the first developmental motor challenge of learning to move into upright positions. Holding up their head, propping up on their arms, lifting their hands and feet into the air, sitting, etc. - all these skills are slower to develop because the infant can't activate enough tone in their muscles to move into a more upright position, and, if they are placed upright, to hold that position.

In children with Down syndrome, hypotonia affects all the muscles of the body. Thus, children will have low muscle tone in their tongue and face, fingers and ands, as well as in their torso, arms, and legs. Just as low muscle tone affects their gross motor development, so too does it affect their fine motor development. A child who is struggling to keep their balance in sitting because of low muscle tone in their body will be less able to reach out and pick up toys. Low muscle tone in the shoulder and upper back area also impair the baby's ability to reach and grasp.  Likewise, low muscle tone in the lower arm and hand makes it difficult for the child to position his finger joints to hold an object such as a pencil without his joints "collapsing.

It may be particularly difficult for the child to push with his fingers, such as when pushing a button on a pop-up toy or pushing a thumbtack into a bulletin board. The muscles in the hand may not have enough tone to stabilize the joints.

Generally, the literature suggests that hypotonia in children with Down syn­drome decreases with age. The problem is that by then, they may have developed ways of moving that may be detrimental in the stages of motor development that follow. For example, a child with Down syndrome who dislikes being on his stom­ach may eventually learn to move himself around the room on his back or his bottom by pushing and pulling with his feet. If he never has the experience of leaning, pushing, and pulling himself on the floor with his arms, his arms will be weak and it will likely be harder for him to pull himself up to standing and to eventually learn to do things such as eating soup or printing.

See the Role of Occupational Therapy for more information on how OT can help your child.