Occupational Therapy Services for Infants and Children


An occupational therapist specializes in the development of fine-motor and self-care skills. Examples of such skills include: manipulating toys; using a pencil for writing, drinking from a bottle and cup, and eating from a spoon. Infants and children with Down syndrome are typically delayed in developing these skills and have common characteristics which affect their fine motor development and ability to eat.

Characteristics which can interfere with the development of fine motor skills are:

   1. Low "floppy" tone of the arms and hands.

   2. Extra flexibility of the arm and hand joints.

   3. Tendency for broad hands and short fingers.

Characteristics which can interfere with eating are:

   1. Low "floppy" tone of the face and mouth.

   2. Small mouth/enlarged tongue.

   3. Delayed eruption of teeth.

   4. Medical problems such as cardiac defects and swallowing dysfunction.

   5. Delayed eye-hand coordination and grasping for finger feeding and holding utensils/cup.

Occupational therapy provides treatment strategies to facilitate arm and hand development and feeding skills. It is recommended that an occupational therapy assessment be performed at approximately 8 months of age. This is an ideal time for evaluation since most infants are very "busy" with their hands and are eating some solid foods by this time. An evaluation may be performed prior to 8 months if issues requiring assessment/treatment arise at an earlier age, especially those related to feeding. Direct services can be provided as needed and will focus on the following:

   A. Oral-motor/feeding

         1. Management of food and liquids

         2. Progression of food textures

         3. Independence in cup drinking, finger feeding, and utensil use.

   B. Acquisition of fine motor skills

         1. Establishment of basic fine motor patterns of reaching, grasping, and releasing.

         2. Refinement of basic patterns for use in manipulating toys and objects. 

Services are also available for older children, which focus on further development of fine motor and feeding skills, as well as on the acquisition of additional self-care skills such as dressing. Specific treatment strategies are dependent on the infant’s or child's level of developmental readiness. Intervention emphasizes parent training with home activity suggestions provided. Ongoing services can be provided to monitor progress and update the home programs as necessary. Contact is made with the infant’s or child's community therapist as appropriate.

The two tables below provide milestones for fine motor development, as well as common feeding problems in children with Down syndrome. It is important to remember that the age range for acquiring these skills varies, as all children develop at a different rate.

Common Feeding Problems in Infants and Children with Down Syndrome

Range (months) Feeding Pattern
0-3 months
  • Weak suck on breast/bottle
  • Low endurance during breast or bottle feeding
3-6 months
  • Delay in placing hands on bottle
  • Difficulty accepting foods from spoon due to uncoordinated tongue movements and food loss
6-9 months
  • Delay in managing foods with texture due to lack of mature tongue movement
  • Delay in picking up foods with fingers
  • Weak biting
9-12 months
  • Immature chewing patterns
  • Delay in managing liquids from cup
12-15 months
  • Difficulty using spoon for scooping

Fine Motor Milestones in Infants and Children with Down Syndrome

Milestones Range (months)
Batting (Swiping at objects & toys) 2-5
Reaching (Purposefully reaching out for objects & toys) 5-8
Grasping (1" block cube using thumb & fingers) 5-8
Releasing (Transferring objects from one hand to another) 10-13
Pincer Grasp (Picking up small objects such as a raisin using a thumb and index finger) 20-23
Stacking (Two 1" cubes, one on top of the other) 24-27
Turning Pages (One at a time) 41-44
Holds a Crayon (Stabilizes with fingers in an adult fashion) 41-44
Imitates Circular Stroke (After demonstration) 53-56
Imitates Vertical and Horizontal Stroke (Without demonstration) 59-62


Curry, Jeanette, MS, OTR, Unpublished observations.

Share, Jack, & French, Ron. (1982). "Motor development of Down syndrome children," Birth to six years.

The article above is reproduced from the Down Syndrome Guide disseminated by the Down Syndrome Clinic at Kennedy Krieger Institute. In accordance with federal copyright restrictions, the contents of this booklet may not be reproduced by photocopying or any other means without written permission from the copyright holder. © 1999 George Capone, M.D.

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