Tag Archive for: walkers

a guide to buying baby shoes

A Guide to Buying Baby’s First Shoes

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The seemingly exponential growth of the children’s shoe industry can overwhelm the even the most expert buyer. A quick search on Google for “Buying Baby Shoes” reveals over 40,000,000 hits. In this blog I’ve broken down the shoes requirements for each stage of walking to guide the consumer.

A Guide to Buying Baby’s First Shoes:

  • Pre-Walking – Shoes for children in this stage are used for protection from the elements. Due toA Guide to Buying Baby's First Shoes increase of floor time, shoes should be flexible enough to allow for ease of movement in this position. It should be noted that the best footwear for children in this motor phase is no-shoes at all.
  • New Walkers – As a child begins pulling up to stand and taking her first steps, her shoes should change to meet the increased demand. Shoes should continue to remain flexible, allowing for ease of transition between crawling and walking. It is also important that these shoes have some sort of grip associated with them to limit slipping.
  • Expert Walkers – These children use walking as the main, and usually only, means of locomotion. Crawling is no longer functional for them, but may be used in play. As children transition into this phase of walking, their shoe needs change as well. The shoe should have a semi-rigid sole, meaning the sole is made of hard plastic, but it can twist with a moderate amount of effort.

If your child has demonstrates any sort of gait abnormality (single foot turned out, walking on toes, excessive falls) or has not begun walking by 18 months, please come into NSPT for a free physical therapy screen.

north shore pediatric therapy physical therapy

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!

How to Encourage Baby’s First Steps

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As a physical therapist who works primarily with the 5 and under crowd, I have had the pleasure of witnessing many babies’ very first steps. Some of the proudest moments I’ve experienced on the job have involved children meeting their milestones for the first time.  Watching a child develop the confidence in his abilities to venture onto unfamiliar terrain on his own makes the months leading up to that moment so worthwhile.

I am sure that I do not have to talk about the importance of walking as part of typical development. What parents don’t realize are the components of human ambulation and the importance of each step.   For many new parents, I often reiterate the fact that weight-bearing through their feet is a great way for babies to learn. They learn how their bodies move, strengthen their muscles and bones, and receive the appropriate feedback from their environment to perform more and more challenging tasks, such as jumping, and running, and stairs.

Often, first time parents are unsure how to best encourage their child to take those first steps. So how do we facilitate and not hamper their exploration?

How best to help out a toddler learning to walk:

  1. Cruise is first: About a month after a baby first learns to pull to stand, he will start cruising along furniture.  At this time, he still relies on his hands a lot for standing and doesn’t yet have the full grasp of shifting his weight from foot to foot. Help him cruise along by placing toys just out of reach and he will slowly become more and more stable when all his weight is on one side. Cruising long distances increases baby’s standing stamina and strengthens those important hip and thigh muscles. Place toys on a low surface off to the side and behind him, and he will learn to let go with one hand and rotate in his trunk. Trunk rotation is an essential component of reciprocal walking later on. Click here to read more about cruising.
  2. Where to support: Contrary to popular practice, the best place to support a baby just learning to walk is actually at his trunk.  If you take an early walker (say, 9-10 months old) by both hands and try to lead him, he is most likely going to tilt his body forward and step really quickly to try to catch up with his center of gravity. This will not help him place weight throughout his whole feet. Instead, he may rise up on his toes. Weight-bearing through the heels during early walking is important. That impact from the ground helps build muscles and bones up the chain so babies’ thigh bones and hip joints can become strong and stable enough to support their growth. When assisting babies to walk, stay with them and let them lead, however slow each step may be. For more info about best ways to support a toddler learning to walk, click here.
  3. Slow them down: Children usually start to take steps on their own after they feel safe during independent standing. With each new step, babies will keep their feet wide apart so they can feel balanced.  Many parents I know like to give their babies a push-toy such as a doll stroller or shopping cart so they can speed walk around the house. While these toys may seem like a great way to get babies moving on their feet, if given to a baby in the early stages of walking, they also encourage poor postures and improper weight shifts.  If you have to use push-toys, weigh them down. When a baby takes each step slowly, he can experience the way his center of mass transfers over the entire surface of his feet. His foot muscles and his ankle joints need to experience the hard work required by each step in order to properly respond and develop the balance strategies he needs for later.
  4. No shoes or socks:  While I tell parents from early on that babies should experience their environment with only a diaper on, many parents think shoes are a necessary part of early walking.  Many pediatric therapists will tell you how important it is for babies to learn to walk barefoot. Why? Because babies rely on the feedback they feel from the ground to adjust their standing balance as needed. Standing and learning to walk on plush carpet, grassy terrain, or hardwood floor are all so different and our joints, muscles, and posture have to adjust accordingly. Taking that proprioceptive feedback away from babies just learning to walk by giving them shoes will make them unaware of the differences between surfaces.  Read here for information about the best footwear for babies.
  5. Importance of squatting: Squatting is a key play position for babies. Starting as early as 9-10 months, babies can lower themselves slowly from a standing position while holding onto furniture. So place some toys at his feet and try to get him to pick them up. That up and down motion, supported or unsupported, is great for strengthening hip and thigh muscles. Learning to safely transfer their weight during standing tasks will help them with walking skills. Eventually, around 15 months, a toddler is able to stand unsupported, pick up a toy from the floor, stand back up, and keep walking, all without any help from us. Now that is one independent baby on the move!

The typically developing baby learns to walk around 11-15 months. He might not look stable and he may fall after a few steps, but he is doing what he should. He is trying. Every child is different in how and when he chooses to take that first independent step. Our job is to provide a safe and motivating environment for him.  If your baby is not making any attempts to stand by 12 months, or has been standing for a few months and seems to drag one side and trips often, or still has not walked by 16-18 months, it is a good time to bring up your concerns with your pediatrician and contact a physical therapist for an evaluation.

Toe Walkers Part 2: When You Should Seek Help | Pediatric Therapy Tv

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In today’s Webisode, a pediatric physical therapist discusses the intervention needed for a toe walking child.  For more on Toe walking, read this blog.

To Watch Part 1 of the Toe Walking Webisode, click here.

In this video you will learn:

  • How soon a toddler needs therapy intervention for toe walking
  • What is the maximum age  a child should stop toe walking

 Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide audience, this is Pediatric Therapy TV, where we provide experience and innovation to maximize your child’s potential. Now, your host, here’s Robyn.

Robyn: Hello and welcome to Pediatric Therapy TV. I’m your host, Robyn Ackerman. I’m stranding here today with pediatric physical therapist, Colleen Kearns. Colleen, when it comes to toe walking, when is intervention needed?

Colleen: Well, when it comes to toe walking, the earlier the intervention, the better, because toe walking can become such a strong habit in children. The longer that they do toe walk, the harder it is to break that habit. And then, also I mentioned before, when the muscles do become shorter, the more the child’s toe walking, the shorter the muscles will become. And then the longer that it goes, the harder it’s going to be to reverse that. So, if the child is over 2 years old and walking on the toes over 50% of the time, so the majority of the time that they’re walking, then it’s time to seek intervention.

Robyn: All right. Thank you so much, Colleen. Thank you to our viewers, and remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind to your family with the best in educational programming. To subscribe to our broadcast, read our blogs, or learn more, visit our website at LearnMore.me. That’s LearnMore.me.

Toe Walkers Part 1: What are Reasons Children Toe Walk | Pediatric Therapy Tv

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In today’s Webisode, a pediatric physical therapist explains why children may walk on their toes.

Learn more from this blog called “Is Toe Walking Normal?”

In this video you will learn:

  • How sensory input is related to toe walking
  • What is muscular dystrophy
  • What is idiopathic toe walking

Video Transcription:

Announcer: From Chicago’s leading experts in pediatrics to a worldwide audience, this is Pediatric Therapy TV, where we provide experience and innovation to maximize your child’s potential. Now, your host, here’s Robyn.

Robyn: Hello, and welcome to Pediatric Therapy TV. I’m your host, Robyn Ackerman, and I’m standing here today with Colleen Kearns, a Pediatric Physical Therapist. Colleen, can you give our viewers an explanation of why some children toe walk?

Colleen: Of course, Robyn. There are three main reasons why children may toe walk. The first one is related to sensory issues. Some children may actually be hypersensitive to certain textures on the floors that they are walking on, and the surfaces that they are walking on. So if that occurs, they may be more prone to walk on their toes to avoid those uncomfortable textures.

On the other hand, they may also be seeking extrasensory input. Maybe, some kids need a little bit more of the sensory input, and by walking on their toes they are locking their ankles and knees, and by doing that, they are actually getting more input from their joints. So that’s also why children with autism will walk on their toes, to get that extrasensory input.

The second main reason that children toe walk is due to an underlying diagnosis. Muscular dystrophy is a big one. That’s a genetic disorder where the muscle tissue is destroyed and it’s actually replaced by fat, and the calf muscles are often the first ones to be involved with that. So children with muscular dystrophy will toe walk in an effort to stabilize, due to the decreased strength. Any condition that results in an abnormal increase in muscle tone will also result in toe walking. A common one with that would be cerebral palsy.

The third reason why kids may toe walk is actually unknown. Some children, who don’t have an underlying diagnosis and don’t have sensory issues, just prefer to walk on their toes, and that’s what we call idiopathic toe walking, which means we just don’t know. Unfortunately, they can get into a very strong habit of doing it, and when they do that it results in a shortening of the muscles in their calf, and that actually makes it harder for the child to be able to get their foot flat on the ground. And when that happens, it’s kind of like a vicious cycle. They are more likely to be walking on their toes because they have a strong habit, then their muscles get shorter, then it’s harder for them to walk on their flat feet, so then they are even more prone to walking on their toes.

Robyn: All right. Well, thank you so much, and thank you to our viewers. And remember, keep on blossoming.

Announcer: This has been Pediatric Therapy TV, where we bring peace of mind to your family with the best in educational programming. To subscribe to our broadcast, read our blogs, or learn more, visit our website at learnmore.me. That’s Learnmore.me.

Is it okay for a Baby to Waddle with Feet Outward? What is “Toeing Out”?

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In my continued effort to expedite information for parents, it is ok for your baby to waddle with their feet outwards up to the age of 2, or until the child has been walking for 4-6 months. Toeing out in new walkers is very typical up to the age of about 2, or once they have become proficient walkers.Waddling Baby

And here is why toeing out is normal in toddlers who have been walking for 4-6 months…

Babies walk in this pattern for several reasons, primarily because they are trying to maintain their balance by keeping a wide base of support due to their nervous system and their overall architecture.

New walkers are working with immature nervous systems so they need repetitive practice to build the nerve pathways.  In addition, they are learning what to do with the sensory input that they are receiving from their vestibular system (inner ear), as well as the somatosensory proprioception (feeling where their body is in space).  There are motor development theories that say that children walk not when the stepping pattern is mature, but when the balance control system matures.

Structurally, at the time children begin to walk, their center of mass is around the base of their ribs.  As they grow (and the head to body ratio changes) that center of mass lowers to around their belly button.  This high center of mass early on makes it more difficult to balance, leading to the need for an increased base of support to avoid falling.

New walkers often fire a lot of their hip muscles in order to stabilize themselves as they learn to balance on two feet.  EMG (neuromuscular studies) of children with 6 months of walking experience have also shown that they will fire their outer hip muscles (specifically the muscles that outwardly rotate their legs, and that move their legs apart) for stability.  In doing so, the hip outward rotators over-power the inward rotators, which brings their feet and legs out.

The anatomy of the feet of new walkers also facilitates their out-toeing gait pattern.  Newer walkers have large fat pads on the bottom of their feet and do not have the muscle strength or ligament stability to create a stable structure.  This capability of stabilizing at the foot typically comes with practice and age.

Since new walkers have had little weight-bearing through their legs, the shape of the thigh bone promotes a wide stance.  As the child bears weight on their legs, the shape of the bone begins to more closely resemble the mature alignment.

New walkers will often keep their arms at either chest or shoulder height to help with their balance.  This wide balance reinforces toddlers’ wide stance.  Once these children begin to swing their arms when they walk, then each step begins to promote a more narrow foot placement.

If you ever have concerns about how your child is walking, address it with your pediatrician.  If your child has been walking for 6 months or more and they continue to walk with a wide foot placement and arms at shoulder height, you may have legitimate concerns that could be addressed.

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