What are the key developmental milestones I should monitor in a child with Down's Syndrome?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

When monitoring a child with Down's syndrome, key developmental areas and potential signs of concern should be carefully observed. It is important to discuss any developmental concerns with parents or carers and to evaluate and review them thoroughly .

  • Global Development and Learning: Monitor for signs of global developmental delay and learning disability (intellectual disability), which is characterised by deficits in general cognitive abilities and impaired adaptive function . Also, observe for executive function problems and potential special educational needs . Learning difficulties can also be a sign of concern .
  • Motor Development: Key motor milestones to monitor include sitting, crawling, and walking . Be alert for delayed motor milestones, unusual or absent fidgety movements, asymmetry or paucity of movement, and abnormalities of muscle tone, such as hypotonia (floppiness) or spasticity (stiffness) . Other signs of concern include persistent toe walking, waddling gait, enlarged muscle bulk, proximal muscle weakness, frequent falls or clumsiness, dyspraxia, coordination problems, or progressive incoordination ,. Any regression of motor developmental milestones at any age warrants referral .
  • Speech, Language, and Communication: Monitor for speech, language, and communication problems . Regression of language developmental milestones, especially in children under 3 years of age, is a significant concern . Delay or regression of speech and communication milestones should also be noted .
  • Social and Emotional Development: Observe for signs and symptoms of autism spectrum disorder . Regression of social developmental milestones, particularly in children under 3 years of age, should prompt referral . Emotional and behavioural problems should also be monitored .
  • Sensory Development: Regular checks for visual impairment and hearing impairment are important .
  • Other Areas: Monitor for feeding problems, sleep problems (including sleep apnoea), and problems with inattention, impulsivity, or hyperactivity .

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