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Physical Therapy for Down Syndrome: A Parent's Guide

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Reviewed by Dr. Eva Lassey, PT, DPT · View full bio → · Last updated August 28, 2026 · How we write and who reviews it

Physical therapy for children with Down syndrome focuses on motor milestones, strength, postural control, and gait, with low muscle tone and joint laxity shaping the approach. Children with Down syndrome reach motor milestones in the usual sequence, generally later and often with more variation in how they get there — and physical therapy works on building stability and efficient movement patterns rather than simply accelerating milestones. Joint hypermobility means quality of movement matters as much as achievement: a child may find a way to walk that works short-term but places strain on joints over time. Physical therapy typically begins in infancy through early intervention, free in most states for children under three.

Key takeaways

  • Children with Down syndrome reach motor milestones in the usual sequence, generally later and often with more variation in how they get there.
  • Low muscle tone and joint laxity shape the whole approach.
  • Postural control and core stability is the foundation for everything else, so it comes before the milestone a family is waiting for.
  • Strength work is specifically against low tone, and joint stability matters because of hypermobility.
  • Gait and foot position are addressed with orthotics where useful, alongside endurance.
  • Physical activity and participation become the focus as children grow, rather than milestones alone.

This page covers what physical therapy does for Down syndrome. For the wider picture, including what commonly co-occurs, see Down syndrome.

What PT addresses here

Motor milestones in sequence · postural control and core stability — the foundation for everything · strength, particularly against low tone · joint stability, given hypermobility · gait and foot position, with orthotics where useful · endurance · physical activity and participation as children grow

The quality-over-speed point

Milestones matter less than how a child achieves them. A child with hypermobility may find a movement pattern that works now and creates strain later — walking with a wide base, locking joints for stability, or compensating in ways that become habits.

Good physical therapy attends to the pattern, not just the milestone. That's why "she's walking now, do we still need PT?" often has the answer yes.

Goals

Sits unsupported for five minutes while playing · Pulls to stand at furniture · Walks 20 meters without fatigue · Climbs stairs with alternating feet

On the cervical spine

Atlantoaxial instability affects a minority of people with Down syndrome. Guidance covers symptoms to watch for and considerations for certain activities, and it's part of the AAP health supervision schedule.2 Worth being aware of and worth asking your pediatrician about before contact sport.

Frequently Asked Questions

When will my child walk?
Later than average, with wide variation. The sequence is usually typical; the timeline isn't.1
Does my child still need PT after walking?
Often yes. Quality of movement, joint stability, and endurance continue to matter, and hypermobility means patterns established now have long-term consequences.
Why does joint hypermobility matter?
It affects stability, and children may adopt compensations that work short-term and cause strain later.
Is there anything to be careful about with sport?
Atlantoaxial instability affects a minority and is covered in the AAP health supervision guidance.2 Ask your pediatrician before contact sport.

Sources

  1. Palisano RJ, Walter SD, Russell DJ, et al. Gross motor function of children with Down syndrome: creation of motor growth curves. Archives of Physical Medicine and Rehabilitation. 2001;82(4):494–500. doi:10.1053/apmr.2001.21956 (PMID 11295010)
  2. Bull MJ, Trotter T, Santoro SL, Christensen C, Grout RW; Council on Genetics. Health supervision for children and adolescents with Down syndrome. Pediatrics. 2022;149(5):e2022057010. doi:10.1542/peds.2022-057010 (PMID 35490285)

Disclaimer. For general educational purposes; not medical advice, diagnosis, or treatment. Speak to a qualified clinician about your child.