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Multidisciplinary Programs

Down Syndrome.

Monkey Mouths Down Syndrome

Down Syndrome

When Monkey Mouths opened in 2003, 95% of our patients had a diagnosis of Down syndrome. What we learned in our early years of specialization was that while children with Down syndrome might have some commonality in delays or in anatomy, each child also looks very different. Over the last 20 years, we have focused on developing a treatment plan that looks at the whole child at all stages of development to design a treatment plan specific to the child and family. Early intervention and parental support are critical for the child’s progress and may include evaluation and treatment by a speech pathologist, lactation counselor, occupational therapist, and/or audiologist along with referrals to other specialists.

Monkey Mouths Down Syndrome

Speech Therapy Services

At Monkey Mouths, we believe that ALL people with Down syndrome can communicate successfully.

Speech Sound Development

Communication begins at birth with cooing and babbling, progresses towards beginning consonant and vowel combinations, and moves into harder sound combinations. Once a child masters multiple sound combinations, they can begin to form words and sentences.

While children with Down syndrome typically have hypotonia (low muscle tone), they can learn to compensate by working on precession of speech sounds and movements through repetition (practice, practice, practice!)

Programs that can be used in developing clear articulation include:

Language Development

Children with Down syndrome typically also have delayed receptive and expressive language. While speech articulation plays into language development, language skills also need to be enhanced for a child to listen and communicate most effectively. Research has shown that while learning to speak, children with Down syndrome may also receive help from a variety of programs to decrease frustration and increase success while learning to speak. Typical supports include:


Children with Down syndrome also show a higher frequency of voice disorders such as hypo and hypernasality and can receive help from voice therapy in coordination with their other speech therapy needs. Hyponsality may make the child sound like they are stuffed up and have a consistent cold. Hypernasality may make the child sound like sounds are coming through their nose when speaking. While both conditions can be related to anatomy and low muscle tone, speech therapy can address the voice concerns and, in many instances, avoid surgery.


The occurrence of fluency disorder (stuttering) in children with Down syndrome has been reported to be as high as 48% and can vary in intensity across the lifespan. Increasing language skills can decrease stuttering in some children. In other children, strategies such as breathing and pacing can decrease stuttering.

Feeding Therapy Services

At Monkey Mouths, we believe that all children can develop a safe and healthy diet that will in turn fuel their system for growth and development.

When an infant is born, they may accept the breast or bottle easily or there may be some difficulty with suck and/or swallow. At Monkey Mouths, we have lactation counselors, speech pathologists, and occupational therapists with advanced training in infant feeding and swallowing. We also offer Fiberoptic Endoscopic Evaluation of Swallow (FEES) for infants that may be showing signs of aspiration during breast or bottle feeding.

Monkey Mouths Down Syndrome
Monkey Mouths Down Syndrome

Just like speaking and moving, feeding skills have a typical order in which they develop. Once a child is around 6 months and begins transitioning from the breast or bottle to the spoon and cup, it is essential that they do not only consume the food and drink but do it safely and with the correct swallowing and patterns.

Once a child has mastered beginner feeding skills, speech pathologists help with transitioning to foods that require them to chew their food and move it from side to side. They also help a child accept a wide variety of food groups and food textures into their diet as healthy nutrition feeds the brain’s development. In addition, they work on developing a mature swallow with cup and straw drinking while providing strategies for safety.

Occupational Therapy Services.


Monkey Mouths occupational therapists are trained in developing a rehabilitative plan to strengthen the whole body. Gaining strength and motor control early will set an infant up for success in the later years ensuring a better path to achieve motor milestones. Age level fine and gross motor skills are taught and encouraged with all efforts made to keep the infant moving through typical developmental milestones. Our OT’s address neck and core strength to promote a solid foundation for oral motor skills of eating, drinking, swallowing and beginning language skills.


Learning to play and be a kid is an important part of OT with a child with DS. From walking to jumping and kicking to catching, engaging a child in fun and exciting motor activities keep their bodies moving and getting stronger.


Prior to starting kindergarten, a child with Down syndrome can learn all the necessary academic skills to function at school like learning to color, cut and write. The key to success is early exposure to these fine motor coordination tasks to allow enough time for repetition and learning before they start school. It is also a time for gaining independence in learning how to dress themselves, use eating utensils, and learning to follow rules and gaining understanding of social skills.

School Aged

Each child with Down syndrome will develop and grow at their own unique pace. Therapy services are tailored to meet the child where they are with skilled, individualized services that promote home programming and independence while continuing to focus on improving development to achieve all the skills for a functional life.

Young Adults

As a child with DS reaches the age of 18, they should have the skills necessary for independent living with or without a caregiver. Therapy services focus on adaptive living skills and training to the family for the transition into a possible vocation.

The generalized treatment plan of a child with Down syndrome includes:

Fine Motor Development
Gross Motor Development
Vision Assessment and Treatment of Visual Motor Delays
Strengthening / Body Work
Activities of Daily Living
Sensory Integration and Regulation
Recommendations for Community Integration
Weekly Home Programming

Monkey Mouths Down Syndrome

Audiology Services

It is estimated that 50-80% of people with Down syndrome have hearing issues that range from mild to profound. It is essential that children are assessed at birth, as well as regularly, and when common symptoms of a hearing disorder are present. When a child is under 5 months, Monkey Mouths audiologists can perform Auditory Brainstem Response Testing (ABR) without sedation to rule-out or confirm hearing loss. We can also test children in our sound booth–we have been told we have the only purple sound booth in the world:)

Monkey Mouths, Down Syndrome Hearing Aids

Conductive Hearing Loss

Most commonly, children with Down syndrome have Conductive Hearing Loss. Conductive Hearing Loss occurs when sound cannot get through the outer and middle ear. Conductive loss is usually temporary and fluctuating but recurring. The high occurrence in people with Down syndrome is due to anatomical differences and weaker immune systems that make it more likely for fluid to build in the ear. Treatment can include wax removal or softener, or with surgical intervention or medication from an ENT.

Overall rates of Sensorineural Hearing Loss are also higher in people with Down syndrome. Sensorineural Hearing Loss can occur at birth or occur with aging.

Treatment for Sensorineural Hearing Loss can include cochlear implants, hearing aids, or bone anchored hearing devices. We also assess the need for assistive listening devices for the school environment.

Common symptoms of a Hearing Disorder include: