Content area
Full Text
THE BASlCS
Difficulty with walking in children is a worrying presentation for parents, says Dr Keith Barnard
0.5 CPD CREDITS
For 30 minutes of learning activity and reflection based on this article
Take a test and claim your I CÏTIB certificate for this article - ? at: myCME.com/gp
Before considering abnormal gait in children, it is essential to know the normal milestones. There is some variation, so a child falling just outside these parameters should not immediately be classed as abnormal unless the margins are wide or other factors point towards pathology.
A child normally begins to walk between 12 and 14 months, climb stairs on hands and knees by about 15 months and run awkwardly by 16 months. Climbing downstairs is not usually achieved until 20 to 24 months.
Walking up stairs using alternate feet occurs at about three years, hopping by four and skipping by five, and balancing on one foot for about 20 seconds by six to seven years.
1 Variations of normal gait
Initially children usually have externally rotated legs with some bowing, and use a broad base with their arms out to aid balance.
They usually have flat feet and take high steps. By about 15 to 18 months the heel starts to strike the ground first, and they swing their arms. By the time they are two they can run quite well and change direction easily.
Some variations occur quite commonly, and most resolve spontaneously by the age shown in brackets: genu varus...