This paper assesses the implications of advanced maternal age on children and adults with Down syndrome and their families. From national and Tennessee-based data, mothers continue to be (on average) 4–5 years older at the birth of newborns with (vs. without) Down syndrome, with more mothers giving birth above age 35, fewer during their teens and early-to-mid 20s. Increased maternal age relates to higher levels of formal education, to more often being married at childbirth, and to less often divorcing. In population studies, more educated mothers also more often work outside the home, have husbands who actively participate in childrearing, and have families that provide their offspring greater financial and social resources. Though rarely examined, maternal-age correlates should also apply to persons with Down syndrome and their families. During childhood, more often having older, more educated parents—and less often having younger, less educated parents—should relate to more accurate caregiver assessments of the child's development; increased access to available services; and enhanced abilities to benefit from services. But once adults with Down syndrome reach their mid-40s, having parents who are 30+ years older may result in simultaneous health declines for these adults and for their parents, causing a pile-up of caregiving challenges for the family's adult siblings. Maternal age has much to do with offspring, parent, and sibling functioning during the offspring with Down syndrome's childhood and adult years.