We as physical therapist use functional measures of strength to assess strength in a child. Parents can use these same measures to assess whether their child is on track with gross motor skills, or to see if there is an underlying weakness. I have broken down the milestones for stair ascent and descent during the first 4 years of life, along with possible weaknesses and impairments associated with delayed skill.
Functional Strength Assessment Using a Staircase:
- 18 months – Children should be able to walk up and down 1 set of stairs in home or at the park, using one railing or one hand held assistance, and demonstrating any type of form. Children will usually place both feet on each step at this phase. Be aware of children who always lead with the same foot; this may be a sign of opposite side weakness. Delays to this milestone may indicate core weakness, lower extremity weakness, or balance impairments.
- 2 years – As children continue to practice this skill and strengthening their legs, their stair skills dramatically improve. First children will begin testing their stair skills by carrying objects up or down stairs and taking steps without holding onto the railing or holding a hand. Initially, they will place both feet on each step. By 2½ years old, children will begin using a more mature reciprocal form (one foot on each step), when going up stairs while using one handrail. Delays to reciprocal gait while going up stairs usually indicates weakness in the leg that does not step up.
- 3 years – A 3-year old should be able to ascend 1 set of stairs demonstrating reciprocal gait, without handrail support. This milestone may be delayed due to short stature, and subsequent shortened tibia length (shin bones) which make it harder to reach the stairs, but will be achieved prior to their 4th birthday. Delays to reciprocal gait without handrail support indicates lower extremity weakness in non-leading leg.
- <4 years – Prior to their 4th birthday, children should have mastered stairs. This includes walking up a set of stairs using reciprocal stepping, both with and without handrail use, as well as walking down a set of stairs using reciprocal stepping, both with and without handrail use. While handrail use will be dependent on situation, reciprocal gait will be the norm, used regardless. Delays to reciprocal gait while going down stairs may indicate eccentric weakness of quadriceps (inability to control limb with slow descent), impaired single limb balance, or core weakness.
Any child over the age of 4 who is unable to walk up and down 1 set of stairs without support, demonstrating a mature one-foot-one-each –step form, should come into NSPT for a free physical therapy screen to assess leg strength and balance.
NSPT offers services in Bucktown, Evanston, Highland Park, Lincolnwood, Glenview and Des Plaines. If you have questions or concerns about your child, we would love to help! Give us a call at (877) 486-4140 and speak to one of our Family Child Advocates today!