Speech Therapy & Down syndrome: When & Why

I've been blogging everyday in October for the 31 for 21 challenge- where bloggers write each day in October for Down syndrome awareness month. Today, I'm sharing a popular post from earlier this year. Because my daughter has Down syndrome and I'm a pediatric speech-language pathologist, today's topic is near and dear to my heart. So, let's discuss:

When should speech therapy be started for babies/toddlers with Down syndrome? And why?

With all the research that has been made over the years, it is indisputable that early intervention for babies and toddlers who are at risk for developmental delays helps the child. The question becomes when should certain therapies begin. 

But it really isn't a simple question to answer. Most articles regarding speech therapy and Down syndrome that I have read suggested an evaluation by or at 1 year of age. However, it is rare to find an article to state a specific age that all children with Down syndrome need to be evaluated by a speech-language pathologist. I believe this is because we know that the language of a child with Down syndrome will most likely be delayed whenever testing is completed. But, each child has their own family structure, health history, strengths, weaknesses, and motor abilities to take into consideration. That's why this is somewhat of a individualized decision.

First...What would speech therapy look like anyway in babies and toddlers?

If your baby with Down syndrome is under the age of 1, then most likely the treatment will primarily (or only) focus on feeding and oral-motor abilities. There are babies, like my daughter, that struggle to suck, eat from a spoon, accept a variety of textures, or drink from a straw. These types of issues can be addressed with early speech-language intervention. There are some babies that nurse or drink from bottles without any concerns who wouldn't need this type of intervention.

Still, there may be concerns with the baby's low muscle tone and tongue protrusion that would warrant early speech therapy. A speech-language pathologist who has taken courses with Talk Tools, for example, will know some of these strategies that can assist with these oral and feeding concerns.

If feeding and oral motor is the focus, the family and therapist may decide how much and how many sessions are appropriate. Some therapists do intensive, short term therapy to build skills. Others may do weekly or monthly visits with the focus on training the family to complete activities at home. Again, these are decisions that are made individually.

Speech therapy that begins after age 1 may start to address language delays. This may include building the child's ability to use gestures, introducing sign language, encouraging vocalizations or words, helping them understand familiar words, and following directions.

Libby Kumin has written many great books and articles on the development of language and treatment strategies for those with Down syndrome. You can click here for one example.

Deciding when to Begin:

While I believe early intervention is key, I do feel that there are several factors to consider when deciding what is best for a child with Down syndrome. Some of these are:

• Family priorities: What are the main concerns for the family? In early intervention, we as professionals are told this is the guiding force that helps us make decisions. Even if the child may show big delays in language, we aren't suppose to push for speech therapy if the mom is mainly concerned about motor delays. The priorities and concerns of the family is a one thing to consider.
• Health & Medical Status: For babies with feeding issues, any digestive health issues need to be considered. Reflux and constipation, for example, need to be addressed medically and may affect progress in feeding therapy. Cardiac conditions may affect feeding as well and the energy level of the baby or toddler. This may be an important factor to consider if the child is getting multiple therapies in one day.
• Hearing: Ear infections and related conductive hearing loss are common with Down syndrome. A child's hearing history or concerns is a factor when considering if/when speech therapy should begin. Hearing loss or ear infections would put the child more at risk, and therefore may suggest therapy is indicated.  
• Other delays: Global delays in development are usually found with children with Down syndrome. When deciding on starting speech services, the team and family need to look at all delays present and consider how one may impact another. Fine motor delays may impact the toddler's ability to mimic sign language. Gross motor delays in babies will affect the speech-language pathologist's decision on positioning for feeding, for example. Therefore, speech can rarely be considered in isolation. The baby/toddler's overall development needs to be considered when deciding to begin speech therapy.
• Age: The child's age is always key. Sometimes there are agency rules, state guidelines, or program rules that state when speech-language therapy should or can begin. Some may consider 12 months too young to benefit from speech therapy that only focuses on language development as motor skills are still developing and attention spans are short. Some programs will not allow evaluations that are for language only to be completed for children under 18 months. Eighteen months is a common age to see speech therapy evaluations take place in any child without Down syndrome, since this is often the age when delays become noticeable and walking is established. It is important for parents and professionals to know the guidelines and rules that apply to them.

The take away

Every child with Down syndrome is unique. Each baby and toddler with Down syndrome needs to be evaluated while considering all the multiple factors that come in to play in order to determine when services should start. The earlier speech-language therapy starts, the better. However, therapy may be more productive when certain skills and milestones are met. It is my belief that every child with Down syndrome should receive a speech-language evaluation around 18 months of age and earlier if feeding issues (gagging, poor sucking, only eating pureed foods) are present.

This information is for educational purposes only and not intended as therapeutic advice.