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Monday, May 2, 2016

Common Questions Regarding Walking by Trisha Robers

Question:  When should my baby start walking?

Answer:  The average age for walking is 11-13 months.  If your baby is older than 15 months and shows NO desire to stand, cruise (walk holding furniture), or walk with their hands held, you should talk with your child’s Pediatrician and ask for a referral to an Early Intervention Physical Therapist (one who specializes in working with children from birth to 3 years old).
When should baby walk?
Most Babies Walk before 14 Months

Question:  Should I start my baby walking barefoot or with shoes?

Barefoot Walking
Barefoot Part of the Time
Shoes on Baby
Shoes Part of the Time
Answer:  There are varying opinions on whether children should start walking barefoot or with shoes. Some therapists and experts say, “Barefoot all the time!”  I prefer to have children walk half the time with shoes and half without.  Walking barefoot gives more sensory input to the child and helps develop the small, intrinsic muscles of the foot as well as balance and coordination.  But we are a society that wears shoes!  A child needs to learn to walk with shoes!  I have had children start walking in the spring and their mothers have kept them barefoot all spring and summer long; when colder weather set in, it was a MAJOR BATTLE getting shoes on those children!  (Honestly, would you wear shoes if you didn’t have to?  I know that I wouldn’t!)

Question:  Does my baby need special walking shoes?

Answer:  No. A shoe needs to fit well so that the foot does not slide around.  I prefer shoes with laces, if you can find them in your child's size.  Laces allow you to snug the shoe tightly to your child's feet.  They are also less likely to be able to take them off in comparison to shoes with Velcro fasteners.  I prefer a normal, new tennis shoe—not high tops, not hard-bottomed shoes, not cloth-bottomed shoes, not used shoes, not shoes with a heel, and not sandals, Flip Flops, or Crocs.

Shoes need to fit well
Shoes Need to Fit Well

Not high tops because they give too much support and don’t allow the baby to develop good ankle control. (If your baby has very low muscle tone, her therapist may want to use high tops; this should be discussed with the therapist.)
Not hard-bottomed shoes because they are too rigid and are frequently made of a slippery surface that does give the baby a good grip on the floor.
Not cloth-bottomed shoes because they are really glorified socks and do not adequately serve as shoes; they can cause your baby to slip and fall, as they do not have tread on the soles.  They also tend to fit very loosely and slip off the foot when a baby tries to take steps. They are very cute and are great for young babies who are not yet getting to standing.  Once a baby is starting to stand, they should be put in a tennis shoe or other rubber-soled shoe.
Never put a baby or young child in a used shoe!  Each of us has a unique walking pattern that causes our shoes to wear in a particular pattern.  If you put a child in a pair of shoes that have been shaped and worn by another child, you are forcing your child’s feet to conform to the pattern of the previous owner.  One does not need to ‘break the bank’ and buy expensive shoes, but they should be new or previously unworn shoes.
Not Flip Flops, Sandals, or Crocs because they do not give enough support to the foot.  The heel is allowed to slide around too much on the shoe and leads to instability.  (For women reading this Blog—think about the first time you wore Stilettos or other High Heels!)  At five years old, after a child has been walking for several years, is an appropriate time to start using sandals or Flip Flops.

Question:  Is using a Push Toy or Walk Behind toy a good way to teach walking to my baby?

Answer:  Using a Walk Behind Toy or Push Toy can be useful in teaching a baby to walk, but selecting a good Push Toy is extremely important!  A Push Toy should have a wide base of support and be of sturdy construction.  The baby should be able to easily stand between the supporting arms of the Walk Behind Toy and take steps without hitting into any of the pieces of the toy. 

Baby Push Walker
Baby Walk Behind Push Toys Can Be Helpful If Used Correctly

 An adult should position the child behind the Walk and Roll Toy and place their hands firmly on the handle of the toy; a child will want to pull themselves to standing using the toy, which could result in the toy toppling onto them and the child falling.  When a child first starts walking behind a Push Toy, the tendency is to lean against the toy for support; this can lead to the toy moving forward so rapidly that the child can’t take steps quickly enough to keep up with the forward motion of the Push Toy and the child winds up falling. Most children will have success if a parent provides hand-over-hand assistance to keep the child’s hands on the toy and moving at a slow pace; the child will develop the ability to control the Walk Behind Toy independently with a little practice.  If the Push Toy is very light-weight it can sometimes be made more stable by affixing weights to the body of the toy or putting heavy items inside a storage compartment, if the toy has one.   Your child should have constant supervision with a Walk Behind Toy until your baby demonstrates the ability to use the toy properly.  Check out our great Kids Push Toy Here.

Question:  Should I use a walker with my baby?

Answer:  Absolutely NOT!  There are many incidents recorded of children toppling out of walkers and injuring themselves.  But, from a Physical Therapist’s point of view, the bigger concern is that using a walker can lead to the development of poor walking patterns.  First off, many parents and daycares put children in walkers long before they are ready to walk and when they should actually be on the floor learning to crawl!  Walker use often goes hand-in-hand with poor or absent crawling skills! (See our blog regarding the importance of crawling!)  Many children are placed in walkers at 4-5 months of age when they do not have good trunk control and depend on the walker for support while taking weight through their legs in a crouched standing position.  Children are using an abnormal posture to stand and will frequently  stiffen their legs (extension) and rise up on their toes in order to reach the floor; this can lead to toe walking, poor hip development, and other ambulation issues.

Question:  My baby walks with their legs apart.  My baby walks with their feet turned in. My baby walks with their feet turned out. My baby walks bow-legged. My baby walks pigeon-toed.  My baby walks flat-footed, etc.  Is this normal?

Answer:  When a baby begins walking it is usually with a wide base of support (legs apart) in order to give themselves more stability.  They begin walking with their feet flat and arms held up for balance (“high guard” position).  As they gain confidence and control, they will start to narrow their base of support and walk with their feet in line with their hips and knees. After several months of walking they will develop reciprocal arm swing and a normal heel-toe gait pattern.  If your baby has been walking several months and does not seem to be developing a more mature gait pattern or you are still concerned about your baby's feet or legs, you should have a discussion with your Pediatrician. 

Question:  My baby walks on her toes?  Is this normal?

Answer: When a baby begins walking they should walk with their feet flat.  As mentioned above, after several months of walking your baby will begin to develop a normal walking pattern of hitting the floor first with the heel of their foot (Heel Strike), moving to a position of the entire foot in contact with the floor (Foot Flat Phase) and then pushing off with their toes (Push Off Phase of Gait).  It is not normal to walk consistently on tip toes. 

Walking up on Tip Toes
Up on Tip Toes

Children generally develop the ability to walk on tip toes at about 3 years old, but they should always be able to get their feet flat on the floor at any age and should never be using Tip Toe walking as their primary method of locomotion. Walking consistently on tip toes can be an indication of a more serious problem and should be discussed with your Pediatrician.

Author:  Trisha Roberts

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1 comment:

  1. I will have to pass this along to the families I am currently working with in early intervention. Good info.