Tag Archive | development

On walking (and why you won’t see a physical therapist’s kid using a baby walker)

As my youngest son is just starting to stand on his own, cruise along the coffee table, and walk with a push toy on his own, I have been reminded once again how amazing and significant learning to walk really is.

As a physical therapist, one of the most common questions parents ask me is, “When will my child walk?” Walking is a developmental milestone that is extremely meaningful for children and families. For children, walking leads to independence, exploration and learning, as well as improved ability to socialize and participate in home and community life. For families, walking is a very visible sign that their child is developing and healthy, and relieves the physical burden of having to carry or wheel their child everywhere.

Although there are many different “normal” variations of learning to walk, walking is a very visible skill and it is hard for parents NOT to compare their child to others they see.  It is even harder to avoid listening to well-meaning friends, family, and even strangers ask questions and offer advice about walking, particularly if your child is a late walker (Is he walking yet?  No?  Well you just need to get him some hard-soled shoes!).  I’m here to set the record straight with a few fun facts about walking.

1. 90% of healthy, typically developing children will take their first steps sometime between 9 and 15 months of age. On average, a child will take his first steps right before his first birthday, but this can vary widely from child to child. This does not mean that something is wrong if you child doesn’t walk by 15 months. I have seen many typically-developing children walk at 15-18 months or later, and late walking is rarely a sign that anything is wrong. However, in rare cases, late walking can be associated with neurological or genetic conditions, so it is a good idea to talk to your pediatrician if your baby isn’t walking by 15-18 months of age.

2. Learning to walk involves multiple body systems. In order to take his first steps, a child must have sufficient strength to hold his body up and the ability to move his legs in a walking pattern. The brain must be able to send signals to the body to activate the correct muscles in the correct order, the sensory systems must send information back to the brain about how the environment looks and feels, and the child must be motivated to walk. Even body shape/size plays a role – infants have a very large head relative to the body and one of the most challenging aspects of walking is overcoming that top-heaviness and controlling the head over the body. Children who are smaller or shorter may walk earlier than children who are larger or taller or have relatively large heads.  The bottom line is this – no matter how “strong” or “smart” or “determined” your child is, he won’t take his first steps until all of his body systems are ready.

3. The best way to help a child learn to walk is: TUMMY TIME! It may seem counter-intuitive, but the best way to teach your baby to walk is to lay him on the floor on his tummy and let him learn to play, move, and explore.  When babies are born, they have been packaged in the womb for 9 months and their bodies are sort of stuck in a flexed or fetal position.  They have little to no ability to hold up their head, neck, and trunk.  In the first few months, tummy time is critical to help babies stretch out the muscles on the front of their bodies and strengthen the neck and upper back. By the middle of the first year, babies begin to push up on their arms and come to hands and knees, strengthening their lower back, pelvis, hips and legs.  All of these things are critical for learning to pull to stand, step, and walk.

4. Barefoot and soft-soled shoes are best for new and emerging walkers. See my previous post for more information on this.

5. Baby walkers are bad for development of walking. Apart from serious safety concerns (the American Academy of Pediatrics has called for a ban on baby walkers in the US and they have been banned in Canada for many years), baby walkers don’t help babies learn to walk. In fact, research shows that children who spend time in baby walkers actually tend to walk later than their peers who do not. Baby walkers put babies in an unnatural standing position, take away the ability to see the legs and feet during stepping, and deny opportunities for crawling and pulling up.  For parents who need to keep their baby contained for a few minutes, a playard or a gated baby-proofed room are much better solutions. And for learning to take first steps, a push toy allows baby to see his legs and feet and practice standing and stepping in a much more natural way. There are commercial push toys available, but most families have ordinary objects around the house that will work just fine – a play grocery cart or doll stroller, empty laundry basket, or large box are all perfect for holding on and pushing around the house.

6. Walking posture changes significantly in the first 3-4 years. Flat feet, walking on toes, or walking “bow-legged,” “knock-kneed,” or “pigeon-toed” can all be normal in the first few years of life.  Walking typically looks adult-like by age 6-7.  If you’re concerned about your child’s leg or foot posture during walking, you should talk to your pediatrician or physical therapist to find out if your child needs to see an orthopedic specialist or is a candidate for foot orthotics.  But, as long as what you are seeing looks the same on both sides and isn’t causing any pain or problems with function, there is a good chance that what you are seeing is one of the many variations of “normal.”

The developing brain and body are truly remarkable, and the journey to walking is different for every child.  My own sons are a perfect example of this.  My oldest didn’t take a step until he was over 13 months old and didn’t walk well until he was nearly 15 months. It took him several more months to be comfortable walking on uneven terrain such as grass and gravel. My middle son took his first steps at 11 months and never looked back. By his first birthday, he was practically running everywhere – in the house, across the yard, and at the park. My youngest is now 9 months old and is already beginning to stand on his own.  I suspect he’ll take his first steps within the next few weeks.  All three of my boys developed their walking skills completely differently and on their own timetables.  But you know what?  They’re all absolutely typical and equally awesome!

Walk on, my little friends!

What do babies do in the first year? A lot!

During the spring semester, I get to introduce second-year DPT students to “normal” motor development as part of their Control of Human Movement course. I created this 5-minute video (starring my three boys: Max, Charlie, and Bobby) for my students as a quick review of motor milestones in the first year.

As I note in the video, motor development is a complex and individual process influenced by individual differences, environment, and even culture. What I present here is meant to be a quick review, and is certainly based on the study of motor development in WEIRD cultures. Do you know any children who developed differently than what is presented in the video? Or who may have even skipped one (or more) of the milestones discussed?

Primitive reflexes (or, cool party tricks you can do with your newborn)

I’ve taken a several-month hiatus from blogging, but with good reason. In December, I welcomed this little guy to my family.

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Look at those cheeks!

The fatigue of late pregnancy and the early newborn weeks – combined with a busy work schedule, my two older boys and husband, and a host of other “real-life” obligations – left me little time for blogging over the past several months. But I’m ready to re-enter the blogosphere. And, since I’m living with a newborn and will be teaching physical therapy students about infant development later this spring, it makes perfect sense to create a series of posts on newborn development. Today’s post is on primitive reflexes.

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Primary standing & stepping

When most people think about reflexes, they think about sitting on the table in the doctor’s office getting hit on the knee with a rubber hammer. Those types of reflexes are called deep tendon reflexes and are completely different than the primitive reflexes I’m writing about today.

Primitive reflexes are a set of involuntary movements that are typically seen in the newborn infant. These reflexes originate in the lower, more primitive parts of the central nervous system (hence the name primitive reflexes). Parents are often surprised and sometimes even entertained when I show them primitive reflexes in their baby – because they are involuntary, they can be elicited in a newborn baby almost any time and are often times quite strong. But primitive reflexes are more than cool newborn party tricks (Look, Grandma! I’m 2 weeks old and I can stand!). They give healthcare providers important information about a baby’s neurological function.

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Asymmetrical tonic neck reflex

When a baby is born, the higher centers of the central nervous system – areas that allow for voluntary movement – are not fully developed. This means that lower areas of the brain are in control and primitive reflexes dominate movement. In the first few months of life, the presence of primitive reflexes tells us that the lower portions of the central nervous system are functioning as they should. If primitive reflexes are absent or otherwise abnormal (weak or asymmetrical), we may suspect neurological injury or dysfunction in these lower areas of the central nervous system.

By 6-12 months of age, the higher, more sophisticated areas of the brain mature and voluntary movements dominate. In older babies, we expect primitive reflexes to integrate or “disappear” as more purposeful movements emerge. If we continue to see primitive reflexes in the older infant, we suspect that the higher centers of the brain may not be developing normally. Persistence of primitive reflexes can inhibit future development, making it difficult for the baby to learn to roll over, creep and crawl, reach and grasp, stand, and walk. Of course, primitive reflexes never really disappear – they continue to “live” in the lower brain and spinal cord and are simply masked by more mature brain function. This is why primitive reflexes may also be assessed in an older child or adult with neurological disease or injury – the reappearance of primitive reflexes may indicate damage to higher centers of the brain.

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Plantar grasp

The following primitive reflexes are frequently tested by physicians, nurses, and physical and occupational therapists as part of a newborn neurological exam:

  • Asymmetrical tonic neck reflex (also known as the “fencing” reflex) – When baby’s head is turned to the side, he assumes a “fencing” posture by extending one arm in front of his face and bending the other arm behind his head.
  • Rooting/sucking – When the skin next to baby’s lips is stroked, she turns her head to find the stimulus and attempts to “latch” on and suck.
  • Palmar and plantar grasp – Pressing into the palm of the hand or ball of the foot causes the baby to grasp with his fingers/toes.
  • Primary standing and stepping – When held in a supported standing position, the newborn “stands” and even takes some steps.
  • Galant reflex – Stroking along the side of the baby’s spine causes the spine to curve toward that side.
  • Moro reflex – When the baby’s head is dropped backward, it elicits a “startle” (he quickly extends both arms), recovery (arms back to midline), and a cry.

For more information or to see primitive reflexes in action, check out the video:

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