When should my baby walk? Late walking, walkers, shoes and flat feet

Most babies take their first independent steps around their first birthday, but healthy children can start walking anywhere from about 8 to 18 months.¹ If your child is not walking alone by 18 months, it is time to see your doctor.² Walkers do not help babies walk, and flat feet and bow legs are normal in toddlers.^3,4,5 Shoes early in childhood are linked with more flat feet.⁶

What age do babies start walking?

Most babies walk alone between about 12 and 14 months, but the healthy range is wide, from about 8 to nearly 18 months.^1,7

The WHO followed over 800 healthy children in five countries, including India. Walking alone appeared anywhere between 8.2 and 17.6 months. Walking alone and standing alone had the widest normal ranges of the six milestones studied.¹

A Norwegian study of over 47,000 children found that a quarter were walking by 12 months, half by 13 months and three quarters by 14 months.⁷ So if your neighbour's baby walked at 9 months and yours is still cruising at 14, both can be perfectly normal.

What are the steps before walking?

Most babies sit, then pull to stand, crawl, walk holding furniture, stand alone and finally walk alone, roughly in that order.¹

In the WHO study, about 90% of children went through these steps in a similar sequence. Around 4% never crawled on hands and knees at all.¹ Some babies roll or wriggle across the floor instead, and some go straight from sitting to standing.

Give your baby plenty of time on a clean floor or mat to practise. A busy lap or a cot all day gives little chance to build leg and trunk strength.

When is late walking a concern?

If your child is not walking without holding on by 18 months, see your doctor. Most children (75% or more) can do this by then.²

The CDC advises that if a child misses a milestone, parents should talk to the doctor, ask about a developmental screen, and not wait and see.² See a doctor earlier if your baby:

• Cannot sit without support by about 9 months¹
• Is very floppy or very stiff
• Uses one side of the body much more than the other
• Has lost skills she used to have
• Is also behind with talking, understanding or playing

Babies born early should be judged by their corrected age (age counted from the due date) in the first couple of years.

My baby bottom shuffles. Will she walk late?

Bottom shufflers (babies who scoot along on their bottom instead of crawling) often walk a little later than crawlers.⁷ In Dr Dutta's experience, most shufflers who are otherwise developing well are healthy.

In the Norwegian study, about 7% of children bottom shuffled. They walked on average about a month later than babies who crawled on hands and knees.⁷

If your shuffler is otherwise doing well, with good speech, play and hand skills, she will usually walk in her own time. If she is still not walking without holding on at 18 months, see your doctor.²

Are baby walkers safe?

No. Baby walkers cause many injuries, mainly from falls down stairs, and the AAP has called for them to be banned.^3,8

A US study counted over 230,000 children under 15 months treated in emergency departments for walker injuries over 25 years. About 9 in 10 injuries were to the head or neck, and about three quarters came from falling down stairs in the walker.⁸ Among children admitted to hospital, over a third had a skull fracture.⁸

The AAP says warning labels, supervision and stair gates have not been enough to prevent these injuries.³ In Indian homes, walkers also roll towards stoves, hot water, and open balcony doors.

Do baby walkers help babies walk earlier?

No. Walkers do not teach walking, and the AAP warns they may even slow a baby's motor and mental development.³

In a walker, the baby moves by pushing with her toes, without learning to balance or bear her own weight properly. She can also reach things she is not ready for.

If you want a place to put your baby while you cook, a stationary activity centre with no wheels is safer.³ Better still is the floor: tummy time, rolling, crawling, and pulling up on a low, sturdy sofa.

Does my baby need shoes to learn to walk?

No. Babies learn to walk best barefoot. Shoes are only needed to protect feet outdoors.

A study of 2,300 Indian children aged 4 to 13 found flat feet were about three times more common in children who wore shoes (8.6%) than in those who did not (2.8%).⁶ Closed shoes were linked with the most flat feet, sandals and slippers with fewer, and going barefoot with the fewest.⁶ The authors suggested that wearing shoes in early childhood may harm the development of the arch.⁶

Indoors at home, let your toddler go barefoot on a clean, dry floor. Gripping with the toes builds foot muscles and balance.

What kind of shoes should my toddler wear?

Choose light, soft, flexible shoes that protect the feet without holding them stiffly. Sandals or soft-soled shoes are usually best.

• A sole that bends easily at the front
• Room to wiggle the toes
• Breathable material, which matters in the Kolkata heat and monsoon
• A grip on the sole so she does not slip
• No need for high ankles, arch supports or "corrective" shoes

Shoe inserts do not help a child develop an arch.⁴ Check the fit every couple of months, since toddler feet grow fast. Hand-me-down shoes that have moulded to another child's foot are best avoided.

Are flat feet normal in toddlers?

Yes. Babies and toddlers almost always look flat footed, and most develop an arch by about 6 years.⁴

A toddler's foot has a fat pad on the inner side and very flexible joints, so the arch is hidden when she stands.⁴ In an Austrian study of 3 to 6 year olds, 54% of 3-year-olds had flat feet, falling to 24% by age 6. Fewer than 1% had a true problem.⁹ Boys and overweight children were more likely to have flat feet.⁹

Flexible flat feet do not need treatment unless the foot is stiff or painful.⁴ The same study found that over 90% of treatments being used, such as arch supports, were unnecessary.⁹

When are flat feet a problem?

See a doctor if the flat foot is stiff or painful.⁴ Dr Dutta also likes to check a flat foot that affects only one side.

A simple home test: ask your child to stand on tiptoe. In normal flexible flat feet, an arch appears.⁴ Warning signs that need a check include:⁴

• Foot pain
• Sore or red patches along the inside edge of the foot
• A stiff foot that does not move well side to side or up and down

A tight heel cord (the Achilles tendon) can also cause a flat foot, and this is usually treated with stretching exercises.⁴

Are bow legs and knock knees normal in toddlers?

Yes. Many children are bow legged until about 2 years, then knock kneed until about 6, and the legs usually straighten by themselves.⁵

Some children do not have fully straight legs until 9 or 10 years.⁵ Braces, special shoes and exercises rarely help and are not needed for normal bowing.⁵

Signs that need a doctor's check:⁵

• Very severe curving
• Only one leg affected
• Bow legs getting worse after 2 years
• Knock knees lasting past 7 years
• A child who is also unusually short

Rickets (soft bones from lack of vitamin D or calcium) is one cause of abnormal bowing, and your doctor may check for it.⁵

Why does my toddler walk on tiptoes?

Many toddlers walk on their toes for a while as they learn, and most stop on their own. Toe walking that continues needs a check.¹⁰

In a Swedish study of over 1,400 children aged 5 and a half, about 5% had walked on their toes at some point with no medical cause. More than half of them had already stopped by that age.¹⁰ Toe walking was much more common in children with developmental delay or a neuropsychiatric diagnosis.¹⁰

See your doctor if your child cannot stand with heels flat on the floor, toe walks on one side only, keeps toe walking well past the toddler years, or also has delays in speech or social skills.

My toddler falls a lot. Is that normal?

Yes. New walkers fall many times a day as they learn balance. Most falls cause nothing more than tears.

Make the house safer instead of keeping her still:

• Put safety gates on every staircase, at both ends.
• Keep balcony and terrace doors locked, and move furniture away from windows and railings.
• Pad sharp table corners.
• Wipe up water on marble or tiled floors.
• Keep her out of the kitchen while you cook.

Get medical help after a fall if she loses consciousness, vomits more than once, is unusually sleepy, or has a swelling on the head that keeps growing.

Will my child grow out of a delay in walking?

Many late walkers do catch up, especially when everything else is on track. But you cannot assume this. The CDC advises acting early and asking about developmental screening rather than waiting.²

Walking late with normal speech, understanding and play is usually a variation of normal. Walking late with delays in other areas, or with stiff or floppy muscles, is more likely to need help. Help such as physiotherapy works best when it starts early, and an assessment does no harm if all turns out well.

When should I see a doctor about my child's walking or legs?

See your doctor if:

• Your child is not walking alone by 18 months²
• She has lost walking or other skills she had²
• She limps, or refuses to walk or stand
• One leg or foot looks or moves differently from the other⁵
• Bow legs get worse after 2, or knock knees last past 7⁵
• Her feet are stiff or painful⁴
• She toe walks all the time, or toe walks with speech or social delays¹⁰
• She is very floppy or very stiff, or falls far more than other children her age