And how parents can get their infants walking
On average, infants with good development start to walk between the ages of 10-14 months. Infants with joint hypermobility, low muscle tone, Down syndrome and those born pre-term or at risk for autism often start to walk later.
The general rule is that if an infant is not walking by 18 months an assessment by a pediatric physical therapist or pediatrician is important to identify why the infant is not walking. This consultation should include an assessment of hip flexibility and stability.
Although the age of independent walking is not critical, it is important that infants who are late learning to walk have lots of experience with getting up into standing, standing with support and walking holding onto furniture (often called infant cruising).
These activities help to shape the hip joints, strengthen leg muscles, train balance and provide the infant with the visual experience that comes being upright.
Independent walking is linked to language development. Infants who have recently learned to walk independently often have a language growth spurt. an Infants who can communicate their needs, likes and dislikes have fewer emotion regulation difficulties, and less tantrums.
Some common reasons for late independent walking
Infants with global developmental delay and specific genetic disorders that affect motor control, may be delayed in reaching their motor milestones. The reasons for delayed walking are linked to underlying coordination difficulties associated with a particular condition, but are also influenced by motivation to move and explore, as well as joint laxity (hypermobility) and muscle tightness or weakness, often associated with joint laxity.
Pre-term infants often reach the sitting, standing and walking milestones 1-2 months later than usual, even when corrected age is used.
Infants with joint hypermobility, low muscle tone and Down syndrome may take time to reach the standing, cruising and independent walking milestones. The delay is linked to motivation to move, and the muscle weakness and tightness that are associated with joint hypermobility.
Hypermobile and low tones infants often have some weakness and tightness in the hip muscles that affect their ability pull up to standing. They often stand with their legs wide apart and their feet turned out.
Hypermobile infants may have weakness in the ankle muscles, especially if they tend to stand with the feet turned out.
Highly sensitive, very cautious infants are often reluctant explore new ways of doing things and move out of their comfort zone. They are often less active, and not motivated to pull themselves up into standing, challenge their balance by reaching for toys, step across gaps when cruising, or let go of hand support when standing.
The stages of learning to walk
Early supported standing
Infants with good motor development will extend their legs and take weight on their feet when they are held in the upright position, from the age of 5-6 months.
There are a group of infants who do not extend their legs when supported in the upright position. Instead they actively bend the hips and knees, and sometimes even hold the legs straight forwards.
If an infant is not taking weight on the legs when supported in the upright position by the age of 8-10 months, a physical therapy consultation is important to identify any motor control, strength and flexibility issues that need to be addressed.
Standing with support
Infants with good motor control, strength and flexibility start to stand with hand support from the age of 8-10 months. On average pre-term infant stand 1-2 months later, even when using corrected age.
This stage is important for developing strength, balance control and coordination.
Pulling up to standing strengthens the leg and trunk muscles and trains stability and balance control.
When infants first learn to stand with hand support their balance is poor and they easily topple over. But with practice they learn to lift one hand and reach for toys.
They are also able to twist and look behind themselves.
Infants with good balance and muscle strength are able to bend their knees and reach down for toys.
Infants who stand with their legs wide apart, lock their knees backwards and do not shift the weight from one foot to the other, often need to practice activities that encourage them to bend the knees to strengthen the leg muscles so that they are able to make the small adjustments in knee position needed for good balance.
Walking with support
Once infants have good balance standing with support, they start to takes steps sideways and walk holding onto furniture.
This early walking practice trains the infant to shift weight on to one leg and take a step with the other. With each step the infant is improving his/her ability to balance and support the trunk over one leg.
As their balance and confidence grows, infants start to reach across gaps and may even let go briefly.
Stretching out far to reach the next support provides the infant with another opportunity to hone balance skills.
Infants also enjoy pushing a chair or box forwards. This activity is another opportunity for the infant to improve balance and leg strength.
Standing without support
Infants will usually not start to walk without support before they are able to stand independently. This requires good balance and quite a bit of courage.
If a toddler is not willing to let go and stand alone, it helps to provide many opportunities for standing holding on to unstable supports and activities that encourage letting go because both hands are needed to achieve a desired goal.
Learning to fall well
It is important that toddler is able to bend the knees, reach out with the arms and hold the head up when he or she does fall.
Toddlers who have poor balance in standing and tend to keep the legs rigid to support themselves often topple over like a pole and bump their heads. If this happens it is important to train the toddler to bend the knees, sit down on the buttocks and keep the head up when falling backwards.
Help your child
Activities to encourage standing, cruising, walking
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Before you start
It is very important that your infant has been seen by a physician to check that the hips are healthy and that it is safe for your infant to engage in a program of exercises to strengthen the leg muscles for standing and walking.
If your infant has significant developmental delay, a referral for physical therapy is the ideal. However, if this is not available time spent training your infant can beneficial.
Gentle stretches for tight hip muscles
If your infant tends to sit, crawl or stand with the legs wide apart, you will need to spend some time working on increasing the flexibility of the hip muscles.
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Getting up into standing
Working on standing up from sitting strengthens the infant's leg muscles and trains coordination and control.
Improving balance in standing with support
Infants need to learn to balance in standing using one hand, and to shift their weight across the feet before they are able to take a step and start to crusie.
Standing with support and learning to balance
Some infants needs extra practice in order to learn to stand with support and reach in all directions.
Learning to bend the knees
Infants with developmental delay and joint hypermobility (low muscle tone) may need some extra help to strengthen their leg muscles and improve balance and coordination to get them ready for standing with support and cruising.
Stepping, cruising and walking with support
Once infants feel confident standing with support at a table, sofa or bed they start to step sideways holding onto whatever support they can find. .
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