Lexical production in children with Down syndrome (DS) was investigated by examining spoken naming accuracy and the use of spontaneous gestures in a picture naming task. Fifteen children with DS (range 3.8-8.3 years) were compared to typically developing children (TD), matched for chronological age and developmental age (range 2.6-4.3 years). Relative to TD children, children with DS were less accurate in speech (producing a greater number of unintelligible answers), yet they produced more gestures overall and of these a significantly higher percentage of iconic gestures. Furthermore, the iconic gestures produced by children with DS accompanied by incorrect or no speech often expressed a concept similar to that of the target word, suggesting deeper conceptual knowledge relative to that expressed only in speech.