Down's syndrome is a genetic condition that affects around one baby in every thousand. It occurs when the baby's cells contain an extra chromosome 21, but so far it is not known what causes this. What is known is that the condition affects children of all races and backgrounds and results in some level of learning disability, as well as a characteristic range of physical features which can include:
- 'floppiness' due to reduced muscle tone (hypotonia), which improves as they get older
- facial features like a flat facial profile and nasal bridge, a small nose, eyes that slant upwards and outwards, and a small mouth cavity which makes the tongue appear large
- a big space between the first and second toe (sandal gap)
- a single crease across the palm (palmar crease)
- below-average weight and length at birth.
Many children with Down's syndrome have associated healthcare needs, such as heart disorders (around 50 per cent), bowel abnormalities (around 10 per cent), hearing (over 75 per cent) and vision impairments or digestive problems and may have increased susceptibility to infections. But some may have no more medical problems than any other child. Children with Down's syndrome are also unique in their rates of progress. However, they tend to have a specific profile of strengths and weaknesses (see box).
IN PRACTICE
If you are caring for a child with Down's syndrome it is important to gain an understanding of the condition and, above all, as much information about the individual child from their parents as possible. You can then help maximise the child's learning by playing on their strengths and interests and supporting them through any weaknesses.
Often children with Down's syndrome can benefit from some extra support with their play. Help them find out what toys do and how to play with them by taking turns or modelling play - such children tend to be good visual learners. Patiently repeating tasks can also help.
Don't be surprised if at times the child appears to lose skills that they had mastered. An uneven pattern of development is characteristic of children with Down's syndrome, so there may also be times when they slow down in one area or have unexpected spurts in development.
Learning to sign while you speak can be a good way of helping children with delayed language to communicate and it can also help to reduce any frustration they may feel. Makaton and Signalong are most commonly used with Down's syndrome children.
It is important not to 'baby' the child, even though they may be less developmentally advanced than other children of their age in some areas. Instead, always encourage age-appropriate behaviour and support them to conform to routines. Just having the opportunity to interact with their peers will greatly benefit many children with Down's syndrome because they tend to be particularly good at learning by watching and imitating others.
The more a child with Down's syndrome is encouraged to grow in independence, such as feeding and dressing themselves, and learn as part of a group, sharing and taking turns, then the more chance they have of gaining in confidence and progressing socially and cognitively.
FURTHER INFORMATION
- The Down's Syndrome Association, www.downs-syndrome.org.uk
- Down Syndrome Online, www.down-syndrome.org
- Down's Heart Group, www.dhg.org.uk
The specific developmental profile associated with Down's syndrome
- Social development and social learning are strengths, right from infancy - the children enjoy and learn from social interaction with adults and peers.
- Motor development is usually delayed and may hold back progress in self-help skills, handling toys in play and in writing, though the use of gesture to communicate is a strength.
- Speech and language development is usually the children's area of most significant delay - it is more delayed than non-verbal abilities. Most children understand more than they can say and signing is an important bridge to speaking. Speech intelligibility is usually a difficulty. A high incidence of hearing difficulties is contributing to speech and language delay.
- Working memory development is specifically delayed relative to non-verbal abilities, particularly the verbal short-term memory component, so that learning from listening is difficult for the children. Working memory also supports thinking, problem solving and reasoning. Visual and spatial processing and memory are relative strengths, so the children learn effectively from visual information - they can be thought of as visual learners.
- The children have strengths in social skills and in developing age-appropriate social behaviour, if this is encouraged and expected. However, their good social understanding and empathy leads them to pick up on non-verbal emotional cues, such as those for anxiety or disapproval, very quickly. They are therefore sensitive to failure and may use behavioural strategies to avoid difficult situations.
Extract from 'An overview of the development of infants with Down syndrome (0-5 years)' published by Down Syndrome Education International and available to view at
www.down-syndrome.org/information/development/early/
CASE STUDY: MIGUEL, 22 MONTHS
Miguel has attended Greenfields Children's Centre in Southall, west London, since February for two and a half days a week, funded by Children in Need through the local authority. His parents particularly chose Greenfields because a special needs nursery had merged with a mainstream nursery, resulting in a mix of children of all abilities and staff trained to care for children with special needs - giving 'the best of both worlds'.
'The nursery felt just right when we visited. The staff engaged with Miguel and had him on the floor playing with toys and introduced him to the other children, which impressed us,' says Miguel's mother Vanessa de Guzman.
'Children with Down's Syndrome imitate quite a bit and learn through copying others, so we thought it would be good for him and for his development to be able to watch other children.'
Miguel had heart problems at birth, which were corrected by surgery when he was three months old. Physically he is developing slowly and he is not yet crawling although he can sit unsupported for long periods of time. Conversely, his speech is advanced and he happily uses words and makes connections. Mrs de Guzman was cautious about feeding Miguel because he had some problems swallowing and eating different textures, but the nursery staff have helped and he is now happy to try different foods.
It's a 40-minute round trip to Greenfields, which can be a challenge, especially as Miguel has an eight-month-old brother, but his physio, speech and occupational therapy sessions are now being conducted at the nursery. This has reduced the regular trips his parents were making to the health centre and is less disruptive.
Mrs de Guzman adds, 'He's a very sociable boy and was quick to settle in to nursery and make friends. The range of activities is great, from painting and playing in the sand to joining in story and singing times. He's loving it and actually seems sad to go home.'
