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!

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10 responses to “On walking (and why you won’t see a physical therapist’s kid using a baby walker)”

  1. the busykids shop says :

    A very informative article thank you!

  2. Dan says :

    Kendra,

    I’m really enjoying reading your posts as well as your focus on practical advice and reviewing the evidence. I agree with you 100% on your take about W-sitting and offer the same advice in my own practice.

    I do take issue with your stance on baby walkers. You say that “baby walkers are bad for the development of walking.” In the very next sentence, you say “baby walkers don’t help babies learn to walk.” Those are two very different statements. I do agree with the latter; baby walkers don’t provide the kind of strength and balance building that is necessary for walking. They probably have no net effect on a baby’s ability to walk, though they do experience upright time, thus providing opportunity for social interaction at the height of walking and potentially increasing motivation to try to stand when out of the baby walker. But that’s just speculation.

    There’s no real evidence to support your first statement, that baby walkers are bad for the development of walking i.e., they adversely effect the attainment of the skill. In support of your point, you shared a BJM study that was able to show an association between the use of baby walkers and late motor milestones, but that doesn’t mean that the baby walker is cause of motor delay. It only means that there’s an association.

    Think about parents that might use baby walkers. Are they less apt to provide floor time? Do they have less time to provide opportunity for standing and other movement experiences? Are the homes more cluttered? Are the floors more cold? Possibly yes to all 4, but we don’t know because the BJM study didn’t consider those things. It could be that the baby walker is simply a red herring. Households that use baby walkers could, in general, offer less overall movement opportunity to their babies. In other words, it’s not the baby walker that’s the problem, it’s the environment that causes the baby walker to be necessary that’s the problem.

    You’re right to encourage more opportunity for ground based, gravity influenced movement opportunity, but to really find out if the baby walker itself has an adverse effect, you’d need to design a study where babies got an equal amount of floor-based movement opportunity with one group spending time in a baby walker and the other group not. Then look at milestones. Then you’d know more about the actual effect or non-effect of the baby walker.

    • patricia freeland says :

      Working in the early intervention program, I have seen many ill effects of using a walker. One so severe, the 15 month old could barely sit, let alone stand and take steps, even with assistance. The posture the walker promotes is horrible because they either lean forward, thrusting their hips forward and standing on toes, thereby throwing back their shoulders causing an unnatural arch, or leaning to one side and pushing off there by altering one side from the other, several other scenarios would take too long to type. Environment does usually resort to their use, but many times, in my experience, it is lazy parenting, or the parent is cognitively delayed and they leave the kids in the walker for hours at a time. “Bad” is a very appropriate word.

      • S says :

        Patricia, I am concerned by your statement that you work in an early intervention program. People look to you as an expert in early childhood development and rather than see the root cause of a problem, you’re quick to jump on a judgmental bandwagon. It sounds like the 15 month old was in the early intervention program because he or she had developmental delays caused by an underlying problem and to flippantly state that you worked with a 15 month old who had a variety of developmental delay issues that were all caused by the use of a walker is irresponsible and quite remiss of you.

  3. Dan says :

    Kendra,

    I’m really enjoying reading your posts as well as your focus on practical advice and reviewing the evidence. I agree with you 100% on your take about W-sitting and offer the same advice in my own practice.

    I do take issue with your stance on baby walkers. You say that “baby walkers are bad for the development of walking.” In the very next sentence, you say “baby walkers don’t help babies learn to walk.” Those are two very different statements. I do agree with the latter; baby walkers don’t provide the kind of strength and balance building that is necessary for walking. They probably have no net effect on a baby’s ability to walk, though they do experience upright time, thus providing opportunity for social interaction at the height of walking and potentially increasing motivation to try to stand when out of the baby walker. But that’s just speculation.

    There’s no real evidence to support your first statement, that baby walkers are bad for the development of walking i.e., they adversely effect the attainment of the skill. In support of your point, you shared a BJM study that was able to show an association between the use of baby walkers and late motor milestones, but that doesn’t mean that the baby walker is cause of motor delay. It only means that there’s an association.

    Think about parents that might use baby walkers. Are they less apt to provide floor time? Do they have less time to provide opportunity for standing and other movement experiences? Are the homes more cluttered? Are the floors more cold? Possibly yes to all 4, but we don’t know because the BJM study didn’t consider those things. It could be that the baby walker is simply a red herring. Households that use baby walkers could, in general, offer less overall movement opportunity to their babies. In other words, it’s not the baby walker that’s the problem, it’s the environment that causes the baby walker to be necessary that’s the problem.

    You’re right to encourage more opportunity for ground based, gravity influenced movement opportunity, but to really find out if the baby walker itself has an adverse effect, you’d need to design a study where babies got an equal amount of floor-based movement opportunity with one group spending time in a baby walker and the other group not. Then look at milestones. Then you’d know more about the actual effect or non-effect of the baby walker.

  4. momknowsbest says :

    I must say, I am not a expert in child developement, however, I am a mother of 3 grown children, oldest 28, youngest is 16. I was shocked to hear my oldest daughter tell me she didn’t want a walker for my first grandchild because it was bad for the back, along with a swing, a floor boppy activity center and so on…I am here to say, each of my children used walkers, each of them also spent time on the floor learning muscle and coordination skills. This “walkers are dangerous and bad” business is for the birds. Everything a parent uses for a babysitter is potentially bad for a baby….The concern should be for the time a parent uses these things. One thing I thought was curious was the fact that a baby with barely any coordination is safer to pull itself up to a coffee table, a box, a grocery cart or a push toy and wheel around, not taking into account the many things a baby can fall on and crack it’s head, or take a nasty fall to the marble floor….this is just ridiculous state of the mind babble. There is no way my children were harmed by using a walker, they were all able to walk by their first birthday. All of them extremely coordinated, but we didn’t stick them in the walker and swing for hours at a time. We actually had play time together that involved muscle strengthening exercise. Parents need to take time to interact with their babies, but they also need to teach the children to entertain themselves too….every parent can not be 24/7 entertainer….Think for yourself parents, your babies are dependent on you, you should not allow every doctors opinion to muddy the thinking process….a hour or so in a upright position with out mommy poking and prodding is all a baby asks for ….geeeee wheeeezzzzz…..

    • meant2bquuen says :

      @ momknowsbest

      You are so right! 1 hour a day would probably be fine. They were safe when we used them etc. Agree.
      The problem is the new generation of parenting. They are not leaving them a “hour a day” they are not watching them (thus the danger). They are not bad parents, they are distracted parents.
      I work in early education and I can typically guess and confirm through casual conversations what babies are being left in bumbo seats, walkers, jumpers etc by their muscle tone, and body movements.
      These are great parents, educated, paying more for childcare (no contraptions used with us) than some pay for a mortgage a month. The demands on these parents is high. I have heard, “The baby loves it, what is the harm?”
      Be proud your daughter has done her research and is taking a much more challenging road of not using contraptions. Your grandchild will have opportunity for brain development that other infants wont’.

    • NancyPT says :

      It is also a case of “It’s not a problem unless it’s a problem” Having been a pediatric PT for more than 20 years, kids who are typically developing and also spend much of the day “out of the buckets”, i.e. baby walkers, swings, etc, most of them will not walk later nor earlier just by having spent time in a baby walker. Unfortunately, there are many children I see whose parents use the walkers as “baby sitters”, where they spend over an hour or more per day in “stuff”. As stated by others, this leads to a tip forward in objects where they are not really sitting, and not really standing either. I then see many children, some of whom are former preemies or at risk due to low or high muscle tone, “stand” in very atypical patterns: Up on tippy toes, tipped forward with tight hip flexors and weak trunk muscles, legs crossed, hips abducted or too wide. In addition, there are dangers baby walkers with wheels also lead to falls down staircases with disastrous results including head injury and death.
      Use of gated off areas with a few toys, playpens and some period of time in a high chair, where they can practice sitting, entertaining themselves, and “table manners’, as well as my standard “blanket on the floor” will all provide opportunities for babies to explore their environment and learn to have alone time.

  5. Babywalkerpro says :

    In my own opinion push walkers are good for development and also safe to use. Especially wooden ones are great and also good looking.

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