What is the approach to a child not walking at 18 months old?

From the Guidelines

If a child is not walking at 18 months old, you should consult with a pediatrician for evaluation, as this delay warrants medical attention and may indicate an underlying condition that requires early intervention. The pediatrician will likely conduct a developmental assessment, examining muscle tone, reflexes, and overall motor skills, as recommended by the American Academy of Pediatrics 1. They may refer you to specialists such as a pediatric neurologist or developmental pediatrician for further evaluation.

Some key points to consider in the evaluation of a child with motor delays include:

• The child's medical history, including any prenatal or perinatal complications
• The child's developmental history, including any delays or regressions in motor skills
• The results of physical examination, including muscle tone, reflexes, and overall motor skills
• The results of laboratory tests, such as thyroid function studies or genetic testing, if indicated

While waiting for the appointment, continue encouraging movement through supported standing, cruising along furniture, and floor play to strengthen muscles. Document any other developmental concerns like speech delays or difficulty with fine motor skills to share with the doctor. Developmental delays can have various causes, including normal variation in development, neurological conditions, muscle disorders, or other medical issues, as discussed in the literature 1. Early intervention is crucial, as therapy services can significantly improve outcomes. Many regions offer free early intervention programs that provide physical therapy, occupational therapy, or other services based on the child's needs.

It is essential to remember that developmental milestones occur along a spectrum, and some children simply develop at their own pace. However, if a child is not walking at 18 months old, it is crucial to seek medical attention to rule out any underlying conditions that may require early intervention. The pediatrician will work with you to develop a plan to support the child's development and address any underlying conditions that may be contributing to the delay.

From the Research

Approach to a Child Not Walking at 18 Months Old

• If a child is not walking at 18 months old, it is essential to evaluate the child's overall development and identify any potential underlying conditions that may be contributing to the delay 2.
• A comprehensive team evaluation, including a pediatric neurologist, developmental pediatrician, speech/language pathologist, occupational therapist, and physical therapist, can help identify any developmental delays or abnormalities 2.
• Treatment options may include physical and occupational therapy, oral medications, botulinum toxin and/or phenol injections, intrathecal baclofen, selective dorsal rhizotomy, and orthopedic surgery, depending on the underlying condition and the child's specific needs 3, 4.
• In some cases, non-invasive treatments such as serial casting may be effective in improving gait and ankle range of motion in children with idiopathic toe walking 5.
• Early intervention and treatment can help improve functional outcomes and reduce the need for later corrective surgery 3, 4, 5.

Specific Considerations

• Idiopathic toe walking, characterized by persistent toe walking in the absence of clinically diagnosed neuromuscular disease, may be a marker for developmental problems and should be evaluated further 2.
• Children with cerebral palsy may benefit from a staged multilevel intervention approach, which involves a combination of surgical procedures and therapies tailored to the individual child's needs and developmental stage 4.
• The use of botulinum toxin-A (BoNT-A) in combination with occupational therapy may improve outcomes in children with cerebral palsy, and further research is needed to determine the most effective type and amount of occupational therapy to use in conjunction with BoNT-A 6.