Phonological awareness (PA) is the knowledge and understanding of the sound structure of language and is believed to be an important skill for the development of reading. This study explored PA skills in children with Down syndrome and matched typically developing (TD) controls using a dual approach: a meta-analysis of the existing international literature and a longitudinal empirical study. The results from both the meta-analysis and the empirical study showed that the children with Down syndrome initially had weaker PA skills compared to the controls; in particular, the awareness of rhyme was delayed. The longitudinal empirical data indicated that, as a result of formal education, the children with Down syndrome exhibited greater improvement on all PA measures compared with the controls who had not yet entered school. The results reach significance for rhyme awareness. With respect to dimensionality, the performance of the children with Down syndrome loaded on 1 factor, whereas the performance of the younger TD controls was multidimensional. In sum, these findings underline the need for studies that compare interventions designed especially to stimulate development of PA in this group of children and to provide insight into the underlying causes of the developmental profile of children with Down syndrome.