A majority of my clientele are babies just learning to walk, toddlers who are delayed in their walking, or preschoolers who are showing an abnormal gait pattern. Years ago, when I worked in the rehabilitation and hospital settings, most of my patients were trying to regain their ambulatory abilities after an injury. Needless to say, walking is an important part of growth and locomotion. It is a complex task that requires musculoskeletal and neurological system maturation and cohesion.
Development of Gait:
The components of typical adult walking include 1) stability in stance, 2) sufficient foot clearance, 3) appropriate positioning of foot for initial contact of the next step, 4) adequate step length, and 5) energy conservation. Depending on the age or type of injury, a person’s walking ability might be impaired in any of these factors. Physical therapists work to address each component to encourage efficient and safe walking.
At age 1, children are just learning to walk and are still working on their standing stability. When they first start walking, their arms are held up high in protective guard, and they walk really fast so as not to lose their balance. They rely on a wide base of support to maintain their stability. They often put their feet down flat on the ground and they do not spend as much time on each leg when clearing their feet for the next step.
About 6 months later, children will often start walking with a more natural gait, with arms down in a reciprocal swing, and with heels hitting the ground first. Because of the structure of toddlers’ bones and joints, they still stand with a wider base of support than adults do, but are in the process of narrowing their stance.
In preparation for running efficiency and coordination, children who are two years old will have better ability to stand on one leg while clearing the other foot, and they are better at lifting their legs up and forward during walking. Base of support will continue to narrow during this stage.
By three years of age, children have gained the strength, upright posture, and limb coordination to walk similarly to adults. They might still stand and walk with different joint motions than adults, but this is more due to structural differences than anything else. As their muscles and bones mature, children’s ambulatory abilities will improve as the forces of gravity and daily activity slowly elongate and strengthen the structures needed to perform adult walking. Of course someone who is seven years old cannot walk with the same speed and step length that an adult can, but they come pretty close.
The orthopedic and neurological changes that occur in a baby to enable him or her to walk are complicated. It takes years and lots of practice for a mature walking pattern to develop in a child. Parents often ask whether or not their child is walking “normally.” That analysis depends on the child’s age, medical history, and family history. Studies have shown that adult gait is present in children by 7-8 years of age. A child can come into physical therapy with a variety of deviations (from flat feet, in-toeing, to toe-walking, to frequent falling). It is only through careful observation and assessment of their gait cycles that physical therapists can help these children achieve the optimal pattern.
Reference:
Stout, JL. Gait: Development and Analysis. In: Campbell SK, eds 3. Physical Therapy for Children. Philadelphia, Pa: WB Saunders Co,2004 :161-167.
Keen M. Early development and attainment of normal mature gait. Journal of Prosthetics and Orthotics 1993; Vol 5, Num 2, p 35. Available from: http://www.oandp.org/jpo/library/1993_02_035.asp; 2014 [accessed 31 March 2014]
