From the Guidelines
Most children should begin walking independently around 12 months of age, with a normal range being between 9 to 18 months, as indicated by the gross motor milestones outlined in the study by 1.
Key Developmental Milestones
When considering the development of walking in children, it's crucial to look at the broader context of gross motor skills development. According to the study published in Pediatrics 1, key milestones include:
- Rolling over prone to supine and supporting on elbows and wrists in prone by 4 months
- Sitting without support, pulling to stand, and coming to sit from lying by 9 months
- Walking independently by 12 months, on average, but with a range that can be considered normal up to 18 months
Factors Influencing Walking Development
Several factors can influence a child's development of walking, including prenatal, perinatal, and interval history, which should be reviewed at each screening visit 1. Additionally, the presence of risk or protective factors, such as socioeconomic status, can impact developmental timelines.
Surveillance and Screening
Developmental surveillance involves eliciting and attending to parents' concerns, documenting and maintaining a developmental history, making accurate observations, and identifying risk and protective factors 1. If concerns about motor development are raised, a standardized developmental test should be performed.
Recommendations for Parents
Parents can support their child's development by providing a safe environment for practice, offering appropriate support without forcing the skill, and ensuring the child has plenty of tummy time to build core strength. If a child isn't walking by 18 months or shows signs of developmental delay, such as asymmetry in movement, regression of skills, or other concerning signs, parents should consult with their pediatrician 1.
Clinical Considerations
Clinicians should carefully watch the child's posture, play, and spontaneous motor function without the stressful demands of performance under deliberate observation 1. In instances of prematurity, correcting for prematurity for at least the first 24 months of life is recommended when assessing developmental milestones.
From the Research
Age of Walking Onset
- The age at which a child starts walking independently can vary, with half of Norwegian children starting to walk at 13 months (median) 2.
- Twenty-five percent of children walked at 12 months, and 75% of the children walked at 14 months, with a mean age of onset of walking (AOW) of 13.1 months 2.
- Children who used crawling on hands and knees as a prewalking locomotor strategy started to walk unaided 0.9 months earlier than those who used other strategies, such as bottom shufflers 2.
Factors Influencing Walking Onset
- The age at onset of independent walking has been shown to be associated with physical activity and sedentary behavior in children, with later walkers spending more time in sedentary behavior 3.
- Moderate-to-vigorous physical activity (MVPA) has been found to mediate the association between age at onset of walking and sedentary behavior, suggesting that interventions to increase MVPA may be beneficial for children who start walking later 3.
Interventions for Children with Cerebral Palsy
- Various interventions, such as physical therapy, exercise, and functional training, have been shown to improve symptoms like balance, coordination, gait, and cardiovascular endurance in children with cerebral palsy 4, 5, 6.
- A systematic review of interventions for children with cerebral palsy found that 16% of outcomes were graded as "do it" (green light), 58% as "probably do it" (yellow light), and 6% as "do not do it" (red light) 5.