At what age should babies start walking and when is a delay in walking considered a concern?

When Babies Should Start to Walk and When to Be Concerned

Most babies typically walk independently around 12-13 months of age, with 75% of children walking by 14 months. Absence of independent walking by 18 months warrants further evaluation. 1, 2

Normal Walking Development Timeline

• Babies develop walking skills progressively through several prerequisite motor milestones:

  • By 9 months: Rolling to both sides, sitting well without support, and demonstrating motor symmetry 1
  • By 12 months: Standing independently and taking first independent steps 1
  • By 13 months: 50% of children are walking independently (median age) 2
  • By 14 months: 75% of children are walking independently 2

• The American Academy of Pediatrics (AAP) identifies walking independently as a key milestone that should be achieved by the 18-month preventive care visit 1

Pre-Walking Motor Development

• Several important motor milestones precede walking:

  • 4 months: Rolling over (prone to supine), supporting on elbows and wrists in prone position 1
  • 9 months: Rolling over (supine to prone), sitting without support, pulling to stand, coming to sit from lying, crawling 1
  • Crawling on hands and knees (used by 84.5% of children) is associated with walking approximately 1 month earlier than other pre-walking strategies like bottom-shuffling 2, 3

• The pattern and timing of pre-walking milestones correlate with walking age:

  • Children who roll over at 4 months, sit and crawl at 9 months typically walk earlier 3
  • Different crawling patterns affect walking onset - typical crawlers walk earlier than "creepers" (1 month delay) or non-mobile infants (2 month delay) 3

When to Be Concerned

• Red flags that warrant further evaluation include:

  • Absence of independent walking by 18 months 1
  • Loss of previously attained motor skills at any age (may indicate a progressive disorder) 1
  • Asymmetry in motor movements or persistent use of only one side of the body 1
  • Atypical walking patterns such as toe-walking, waddling gait, or significant imbalance 4

• Special considerations for premature infants:

  • Preterm infants, especially those with very low birth weight (VLBW), typically achieve walking milestones later than term infants 5
  • When using corrected age (adjusting for prematurity), 50% of VLBW infants walk by 13 months 5
  • Even after age correction, preterm infants may show qualitatively different patterns of locomotion 4

Factors That May Affect Walking Timeline

• Several factors can influence the age of walking onset:

  • Prematurity and low birth weight 5
  • Growth restriction (small for gestational age) 4, 5
  • Environmental factors (institutional care vs. home-raised) 6
  • Neurological conditions like cerebral palsy 1
  • Bronchopulmonary dysplasia in premature infants 5

• Environmental influences:

  • Children raised in orphanages may walk significantly later (mean 15 months) compared to home-raised infants (mean 9.9 months) 6
  • Cultural practices and opportunities for motor exploration may influence walking onset 2

Evaluation Approach for Delayed Walking

• If walking is delayed beyond 18 months, a structured evaluation is recommended:

  • Review developmental history and achievement of earlier motor milestones 1
  • Assess for neurological signs including muscle tone, reflexes, and coordination 1
  • Evaluate for asymmetry or qualitative differences in movement patterns 1, 4
  • Consider standardized developmental screening tools 1

• For children with identified motor delays, referral for further evaluation is indicated:

  • Developmental pediatrics consultation 1
  • Physical therapy assessment 1
  • Consideration of neuroimaging in cases with significant concerns 1