As pediatric physical therapists, we are often asked, “my child has recently begun walking, what comes next?” This is a great question, because walking is the foundational basis for higher-level strength and balance skills contributing to future motor development.
When children begin walking, their gait is going to look a little shaky. Their arms are held up in the air, feet far apart, and hips wide. As they continue walking over the next 4-6 months, they gain strength and balance and their gait begins to change. Their feet will become closer together (shoulder-width apart), their arms will begin to swing at their side, and their heels will begin to hit first. During this time, it is important for new walkers to get lots of practice walking on different surfaces and over obstacles. With practice, children begin to gain the balance and strength to stand on one foot, a skill that translates to jumping, hopping, skipping, running, and ascending/descending stairs.
Here are some upcoming motor milestones for children based off a standardized assessment tool called the Peabody Developmental Motor Scale.
• Walking up stairs, placing two feet per step, with help from a rail, wall, or holding the hand of a caregiver
• Lifting foot to make contact with a ball
• Walking backwards 5 steps
• Walking down 4 steps, placing two feet per step, with help from a rail, wall or holding the hand of a caregiver
• Running forward 10 feet
• Walking sideways 10 feet
• Kicking a ball forward 3 feet
• Jumping forward 4 inches with two feet together
• Jumping up with two feet together
• Walking up stairs without help, placing one or two feet per step
• Walking down stairs without help, placing one or two feet per step
*Note; every child is unique and develops a little differently! The milestones described are for a child within typical development, walking between ages of 11-13 months. If your child began walking independently later than 13 months, then the subsequent motor milestones would then also be delayed by the same amount of months after 13 months. For example, if your child began walking independently at 15 months, then walking up stairs with the rail would not be expected until 17-18 months.
Activities and exercises to do with your new walker:
• Lots of barefoot play. This will further strengthen the muscles in your child’s feet.
• Hold your child’s hands at the level of his/her shoulder (not holding their arms above their head) and help them step up and down on a step stool or step. Make sure your child alternates leading with each leg.
• Encourage your child to kick a ball, balloon, empty box, or empty water bottle.
• Encourage your child to squat to the floor to pick up a toy and return to standing. Place objects on the floor and encourage your child to “clean them up” or “put them in a bucket” to encourage increased repetitions of squatting to floor and back up to standing for strengthening.
Another question we are commonly asked is regarding shoe recommendations for babies and toddlers.
Until your child is walking independently, shoes are not required. The main purpose of shoes at this age are for “warmth and protection”.Babies under the age of 10-12 months should wear a flexible, lightweight shoe such as a bootie.
New walkers are encouraged to be barefoot within their homes to further strengthen the muscles and give sensory input to their feet, as well as encourage continued development of their foot structure. However, once children are walking outside of the environment of their homes, the best type of shoe for them is a supportive shoe with a flat heel, and a rubber, non-skid sole.
The shoe should be durable enough to provide a stable base, but flexible enough to continue to promote and support ”natural foot development”.
If your child is wearing orthotics, the best type of shoe is an athletic shoe to provide support and hold the orthotic in place. Generally, your orthotist will recommend going one size up in order to accommodate for the space of the orthotic.
Lastly, once your child is walking, if your child is walking on his/her toes, with a limp, or
with one or both feet turned in, these could indicate an underlying musculoskeletal or
neurological condition.Contact a physical therapist for an evaluation or notify your
primary care physician for a physical therapy referral.
If you have questions about your child’s gait, foot position, or balance, contact Lumiere
Children’s Therapy for a physical therapy evaluation.
- Peabody Developmental Motor Scales Examiner Record Booklet. Second Edition.
- Sneha Gosalia, Dr. “Shoe Recommendations for Children”. DINOSAUR PHYSICAL
THERAPY. Web. 1 April 2017.
- Rebecca Talmud, Dr. “What A Difference a Shoes Makes”. DINOSAUR PHYSICAL
THERAPY. Web. 2 April 2017.