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Summary of Clinical Practice Guideline

New York State Department of Health, Early Intervention Program; U.S. Department of Education 
Clinical Practice Guideline: Report of the Recommendations. Down Syndrome, Assessment and Intervention for Young Children (Age 0-3 Years)
New York State Department of Health, Early Intervention Program. (2006).
Albany (NY): NYS Department of Health, Publication No. 4959, 292 pages. 
AGREE Rating: Highly Recommended
This guideline provides recommendations pertaining to the assessment and intervention of young children with Down syndrome. The intended audiences for this guideline include families and professionals. Of particular importance to speech-language pathologists and audiologists are recommendations regarding assessment and management of communication, cognition, social relationships, oral-motor feeding, and hearing. The recommendations are classified A, B, C, D1 or D2, based on the strength and quality of evidence. Level A recommendations are considered “strong evidence” based on high quality evidence from two or more efficacy studies. Level B recommendations are considered “moderate evidence" and based on evidence from at least one high quality efficacy study. Level C recommendations are "limited evidence" and based on evidence from at least one efficacy study with moderate quality or applicability to the topic.  Level D1 and D2 are consensus recommendations. Level D1 recommendations are consensus panel opinion based on information not meeting criteria for evidence in systematic reviews and Level D2 recommendations are based on information where a systematic review has not been done.


  • Assessment/Diagnosis

Assessment Areas


Children with Down syndrome should be assessed for oral sensorimotor and feeding problems. Assessment should include:

  • "Physical examination and thorough medical and feeding history;
  • Observation of interaction patterns between child and primary feeders, including observation of trial feeding, body posture and positioning effects;
  • Oral-motor examination, including:
    • Presence/absence of oral reflexes
    • Structure and praxis of lips, tongue, palate
    • Oral sensation
    • Laryngeal function (voice production)
    • Control of oral secretions
    • Respiratory control
    • Swallowing function (including effect on nutrition intake and need for measures to prevent aspiration)
    • Oral postural control;
  • Parents knowledge about the progression of introducing solid foods to the child’s diet;
  • Indications for specialized studies (such as videofluoroscopy)" (Level D2)

Assessment Instruments


  • Oral Motor/Feeding - The following assessment tests may aid in assessing oral-motor and feeding:
    • The Neonatal Oral-Motor Feeding Scale
    • The Pre-Speech Assessment Scale
    • Schedule for Oral-Motor Assessment  (Level D2)
  • Treatment


Behavioral Interventions

Interventions for oral motor and feeding problems may include:

  • [B]ehavioral interventions "to improve tongue posture and encourage appropriate development of jaw, lip, and tongue movements used in eating, drinking, and speaking" (Level C).
  • Parent-child groups and parent-parent training to facilitate feeding (Level D2).

Prosthetic Interventions - Interventions for oral motor and feeding problems may include palatal plate therapy (Level B).

Down Syndrome