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Delay in Walking

Introduction

Most children walk by their first birthday. In general, about 85% of children aged between 10-14 months are able to walk without assistance.

A child can be considered to have delayed in walking if he or she is still unable to walk independently at the age of 18 months old.

Milestones of Early Childhood Development

Walking is one of the most important key milestones in childhood development. It is a part of gross motor development, which is one of a few domains of childhood development as a whole.

There are other important milestones to watch during early period of your child’s development. These are:

Head control by age 3 months
Weight bearing age 4 months
Roll over age 6 months
Sit without assistance age 9 months
Stand without support age 12 months

What causes Delayed Walking?

A child who has delay in walking may or may not necessarily have underlying medical conditions. Following are some of the factors that may contribute towards walking delay in children:

  • Familial maturational delay: One or both parents may have history of delayed walking during early childhood period. In such cases, there is a possibility that some of their children may suffer from the same condition. This does not constitute a disease but rather a maturational delay due to some genetic or familial influence. There should not be any unnecessary concern, particularly if they started to walk by the age of 2 years.
  • Prematurity: A baby who was born prematurely is expected to have some degree of developmental delay, the extent of which may depend on the level of the prematurity. Therefore a delay of 2-3 months from the expected milestones including delay in walking may be tolerated as long as the affected baby is showing a good overall progress and does not demonstrate any abnormal muscle stiffness or posture.
  • Cerebral palsy:
    • Cerebral palsy may occur due to some damage to the brain during its early development. Many of the children who suffer from cerebral palsy can be detected early during infancy if they have the associated risk factors such as birth asphyxia, prematurity, head injury or infections such as meningitis. However, some of the children with cerebral palsy are only detected when they are assessed for walking delay during their second or third year of life.
    • Children with cerebral palsy always have problems with their movement and posture. For example, they may have difficulty to sit cross-legged and prefer to sit in ‘W’ position with legs curled backward. Some of them have abnormal crawl with leg-dragging.
  • Global developmental delay:
    • In this situation, the walking delay is simply a manifestation of more widespread developmental problems affecting other developmental domains such as speech, communication, social, fine motor and cognition.
    • Global developmental delay occurs in various medical conditions such as Down syndrome, previous brain injury and many other chronic diseases.
  • Muscular diseases:
    • This encompasses a few specific muscle diseases affecting young children such as muscular dystrophy, spinal muscular atrophy and congenital myopathy.
    • These children often demonstrated early signs such as reduced muscle tone, poor head control and weaknesses of arms and legs. They normally walk late due to the muscle weakness. In fact, many of these children are not even able to stand or walk.

When should I seek medical help if my child is delayed in walking?

Most babies in Malaysia are assessed around the age of twelve months during their routine immunisation visit. Any delay in walking or other developmental issue would be addressed by referring the babies to medical doctors for further assessment.

Should your child miss the visit or you have any concern at any other times, especially if your child is not able to stand alone at 1 year old and walk at 18 months old, then you should bring your child to see a doctor. He or she may be referred to paediatrician for further assessment. However this may not necessarily mean that your child has any underlying medical condition.

Last Reviewed : 20 September 2013
Writer : Dr. Nor Azni b. Yahaya