The authors examine the reading profile in children with Down syndrome by comparing the nonword decoding skills in children with Down syndrome and typically developing children matched for word recognition level. Journal articles published before 04.05.2010 were identified by using the keyword Down* cross-referenced to "reading", "literacy", "decoding", and "reading comprehension" were selected. A total of eight papers met the criteria for inclusion. Each study was reviewed and coded on both inclusion criteria and coding protocol before the analysis was performed. Children with Down syndrome had equivalent nonword decoding skills to typically developing children matched for word recognition level, but showed deficits on measures of two important underlying skills, vocabulary and phonological awareness. Differences in vocabulary, but not phonological awareness, were predictive of differences in nonword decoding skills. The practical and theoretical implications of these findings are discussed. (Contains 3 figures and 1 table.)