• Signs of Weakness
  • Clinical Evaluation
  • Testing and Referral
  • Resources and Tools
About|Contact
Signs of Weakness: 12 months+ Gait PDF Print E-mail
Written by Administrator   
Wednesday, 22 June 2011 17:29

Milestone: Gait

Description

Watch child walk after parents report s/he can walk independently. Watch or ask about ability to run at 18-month and 24-month visits or until running is achieved. Ask about any concerns with walking, running, or frequent falls at all visits after milestone is achieved.

Surveillance & Next Steps

Walk

If a child does not walk at 15 months, consider referral for early intervention and physical therapy for developmental stimulation, taking into account overall motor development, and re-evaluate within 2-3 months. A child who does not walk well at 18 months, or shows regression in ability to walk, needs further evaluation: CK and referral.

Run

If a child does not run at 20 months, consider referral for early intervention and physical therapy for developmental stimulation, taking into account overall motor development, and re-evaluate within 2-3 months. Particularly note the quality of running, especially if there are other motor concerns. A child who does not run at 24 months, or shows regression in ability to run, needs further evaluation: CK and referral.

What do the effects of weakness in gait look like?

Developmental norms

Walking alone**: 50% by 12 months, 75% by 13.1 months, 90% by 14.4 months

Runs*: 50% by 16 months, 75% by 18.5 months, 90% by 21 months

*Source: Denver II

**Source: WHO Multicentre Growth Reference Study Group: WHO Motor Development Study

Download a pdf of the Surveillance and Referral Aid for Primary Care Providers. This Aid includes assessing weakness by age, clinical evaluation for muscle weakness, guidance on the use of CK testing, and the motor delay algorithm. These materials have been endorsed by the American Academy of Pediatrics.
Last Updated on Thursday, 30 August 2012 15:35
 

Did you know?

Red flags for prompt referral to a specialist (consider pediatric neurology) include: Tongue fasciculation; loss of motor milestones; CK>3 times normal
More Clinical Pearls MORE CLINICAL PEARLS