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12+ months: Walking PDF Print E-mail
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Tuesday, 17 January 2012 02:19

Greater than 12 months: Walking


Observe each step of child’s normal developmental progression to independent walking: pull up to stand, cruise holding on to furniture, stand alone, walk with one or both hands held, lower to sitting position from stand without falling; walk well.

What do the effects of weakness in gait look like?


Look at quality of posture and gait, in reference to how long child has been walking.

Tip: Evaluate whether the child has problems walking when carrying an object the size of a small shoebox that is held at midline against the chest.

Yellow flags

Pronation of feet and/or ankles when walking; mild lumbar lordosis/anterior pelvic tilt; increased width of base of support; lateral lean during stance (hip waddle); consistent toe walking


A child who does not walk well at 18 months, or shows regression in ability to walk, needs further evaluation.

Therapist Response to Red Flag

Communicate specific concerns about walking (in context of overall development and relevant environmental factors) to the family and referring provider. Provide evidence for weakness rather than poor coordination as a cause for the delay. Encourage a referral to a specialist (consider pediatric neurology) for a diagnostic evaluation.

Specialist Response to Red Flag

Draw a CK and refer for diagnostic workup.

Download a pdf of the Surveillance and Referral Aid for Therapists and Specialists. This Aid includes signs of weakness by age, red flags and warning signs for muscle weakness, and referral recommendations.
Last Updated on Tuesday, 04 September 2012 22:19

Did you know?

Signs of proximal muscle weakness include: abdominal breathing or accessory muscle use; a feeling of "slipping through hands" when held suspended by examiner under armpits; inability to voluntarily flex neck when supine or head lag when pulled to sit; difficulty rising from floor (including Gowers maneuver, full or modified)