Normal Gait in Children

Development of gait (walking) in children

Parents often ask whether or not their child is walking “normally.”   In the vast majority of cases where there is concern about a child’s gait, their gait pattern will be within normal development with no reason for concern.  However, on occasion gait abnormalities are encountered which fall outside of what would be considered a ‘typical’ gait and may depend on the child’s age, medical history and family history. This is when specialist examination and gait assessment is essential to identify and diagnose gait dysfunction to ensure treatment is delivered early if required.

The components of typical gait in an older child (seven onwards) include:

• Musculoskeletal and neurological maturation

• Stability in standing

• Sufficient foot clearance

• Appropriate positioning of the foot for the initial contact of the next step

• Adequate step length

• Energy conservation

The above components of gait are very similar to those of an adult.  However, in the toddler and younger child there is a great amount of variation in gait.  What may be considered as abnormal may be a ‘typical’ gait pattern for a child of a certain age.

When your child reaches the milestone of walking it is quite an achievement!  However, a child is not a smaller version of an adult and as such you cannot expect them to walk like an adult after just a few months of being on their feet.   It takes years and lots of practice for a mature walking pattern to develop in a child.      Typically, adult gait is present in children by about seven to eight years of age.

The main factors essential for children when learning to walk and achieve a ‘typical’ gait pattern are co-ordination, an ability to learn and a ‘normal’ neurological and musculoskeletal system.   The components of typical gait in young children (onset of walking to seven years) will vary and are very different to that of an adult.  However, the majority of changes which include most gross motor skills are achieved by the age of seven in most children when there are no underlying factors that may impair the development of efficient gait.      

The following is a summary of ‘typical ‘gait development form the onset of walking to the age of seven:

Pre walking:

Typically, prior to walking your child will learn to sit up unassisted (6-8 months), crawl on hands and knees (9-11months), bottom shuffle (11-12 months), furniture walking (11-13 months).  Each child is an individual, so some children may not go through all of these stages.  However, they are important gross motor milestones which are the start of building strong muscles in preparation for the onset of walking.  Typically, children start independently walking between 12-14 months.

Onset of walking (12-14months):

When children are just learning to walk their arms are held up high to aid with balance, they walk really fast and may trip or fall down.  They rely on a wide base of support to maintain their stability and may appear bow legged because of this. They often put their feet down flat on the ground in full contact which and they do not spend as much time on each leg when clearing their feet for the next step.  Their foot position appears very flat and flexible and this is because of the presence of a fat pad on the bottom of the foot and the position of the heel bone.  Some children may not walk independently until the age of 18 months.  However, walking delay beyond 18 months needs investigation. 

Two years:

In the months between the onset of walking to the age of two, they will start to lower their arms and you might see their base of support become narrower.  They may still have a very flat, flexible foot strike.  Further development in their gross motor skills and coordination should include the ability to climb up and down stairs on their hands and feet.  They will still have some control over their velocity (how fast they move) however they may still appear quite un-coordinated and you may see them tip toeing during walking at this stage.

Three years:

By the age of three, most children have developed the strength, upright posture, and limb coordination to have a developed heel strike with some evidence of the toe pushing off which is similar to the adult heel-to-toe gait pattern.  A reciprocal arm swing may be evident.  In some children you may see their knees become ‘knocked’ which can occur between the ages of 3-6 years.  They may stand and walk with slightly different joint motions and positions than adults, but this is due to bony structural differences in the lower limb.  At this age some children can walk up and down stairs in some cases unaided.    As they continue to about the age of five years, you will see them develop the ability to hop, skip and run.  As their muscles and bones mature and their neurological system continues to develop, a child’s ambulatory ability will improve.

Five to seven years:

These are the ages at which a near mature, typical gait pattern will become established.   There will be good upper body posture and efficient balance, smooth pelvic movement, and the knee should be facing the front and there is will be a fully developed heel-to-toe gait pattern.  Most of the gross motor developmental milestones should be achieved.   Of course someone who is seven years old cannot walk with the same speed and step length that an adult can, but they will continue to develop as they grow older. 

All children attending The London Podiatry Centre undergo an extensive examination to determine whether or not there may be underlying factors that are affecting the development of your child’s gait.   Where necessary, the expertise or second opinion of other specialists such as Consultant Neurologists, Paediatricians and Paediatric Orthopods will be sought to ensure that your child is receiving the highest standards of care.

References:

Johnston L, Eastwood D, Jacobs B (2014) Variations in normal gait development, Symposium: Surgery and Orthopaedics, Paediatrics and Child Health Vol 24 (5), pp 204-207:

Sass P, Hassan G (2003) Lower extremity abnormalities in children. American Family Physician,36 (3) pp: 22-27.

Staheli L, & Song KM (2012) Paediatric Orthopaedic Secrets, 3rd Edition, Philadelphia,, USA: Elsevier.

Gait abnormalities in children: accessed 3.3.2016

http://patient.info/doctor/gait-abnormalities-in-children