Phonological awareness (PA) is the ability to hear and manipulate the smallest units of sound in our language. It is key to learning to read for typically developing children. Some have suggested that this is not true for children with Down syndrome (DS). The purpose of this review was to provide a better understanding of the role PA plays for children with DS as they learn to read and to provide guidance on whether phonics-based reading instruction is likely to benefit these students. Results from a review of 20 studies indicate that children with DS rely on PA skills in learning to read and suggest that phonics-based reading instruction may be beneficial for at least some of these children. (Contains 4 tables.)