Movement, Coordination & Your Baby

Whether your baby rises from a crawl with a shaky first step or a full-on sprint across the living room, chances are you’ll be on the edge of your seat. But remember — a child’s first steps usually aren’t picture perfect.

Learning to walk takes time and practice, and it’s common for kids to start walking with their toes and feet turned at an angle. When feet turn inward — a tendency referred to as walking “pigeon-toed” — doctors call it in-toeing. When feet point outward, it’s called out-toeing.

It can be upsetting to see your child develop an abnormal gait, but for most toddlers with in-toeing or out-toeing, it’s usually nothing to worry about. The conditions do not cause pain and usually improve as kids grow older.

Almost all healthy kids who toe-in or -out as toddlers learn to run, jump, and play sports as they grow up, just the same as kids without gait problems.

In-toeing and Out-toeing

Most toddlers toe-in or -out because of a slight rotation, or twist, of the upper or lower leg bones.

Tibial torsion, the most common cause of in-toeing, occurs when the lower leg bone (tibia) tilts inward. If the tibia tilts outward, a child will toe-out. When the thighbone, or femur, is tilted, the tibia will also turn and give the appearance of in-toeing or out-toeing. The medical term for this is femoral anteversion. In-toeing can also be caused by metatarsus adductus, a curvature of the foot that causes toes to point inward.

Why some kids develop gait abnormalities and others don’t is unclear, but many experts think that a family history of in-toeing or out-toeing plays a role. So, if you toed-in or -out as a child, there’s a chance that your child could develop the same tendency.

Also, being cramped in the womb during pregnancy can contribute to a child in-toeing or out-toeing. As a fetus grows, some of the bones have to rotate slightly to fit into the small space of the uterus. In many cases, these bones are still rotated to some degree for the first few years of life. Often this is most noticeable when a child learns to walk because if the tibia or femur tilt at an angle, the feet will too.

Does Walking Improve?

As most kids get older, their bones very gradually rotate to a normal angle. Walking, like other skills, improves with experience, so kids will become better able to control their muscles and foot position.

In-toeing and out-toeing gets better over time, but this happens very gradually and is hard to notice. So doctors often recommend using video clips to help parents track improvement. Parents can record their child walking, and then wait about a year to take another video. This usually makes it easy to see if the gait abnormality has improved over time. In most cases, it has. If not, parents should speak with their child’s doctor to discuss whether treatment is necessary.

In the past, special shoes and braces were used to treat gait abnormalities. But doctors found that these didn’t make in-toeing or out-toeing disappear any faster, so they’re rarely used now.

If Walking Does Not Improve

Speak with your doctor if you’re concerned about the way your child walks. For a small number of kids, gait abnormalities can be associated with other problems. For example, out-toeing could signal a neuromuscular condition in rare cases.

Have your child evaluated by a doctor if you notice:

• in-toeing or out-toeing that doesn’t improve by age 3
• limping or complaints of pain
• one foot that turns out more than the other
• developmental delays, such as not learning to talk as expected
• gait abnormalities that worsen instead of improve

The doctor can then decide if more specialized exams or testing should be done to make sure that your child gets the proper care.

Walking is the major achievement of kids this age and over the coming year they’ll get much better at it.

As kids’ mobility improves, so does their ability to investigate where they couldn’t before. Once again, take a look around your home from a kid’s vantage point and update childproofing measures to keep up with your child’s advancing skills.

How Is My Baby Moving?

Though some babies take their first steps before their first birthdays, most learn to walk well in the months after they turn 1.

Kids who are learning to walk are called “toddlers” because that’s exactly what they do — they toddle, keeping their legs wide apart and seeming to hesitate between each step, jerking from side to side as they move one foot forward, then the next.

About 6 months after taking their first steps, toddlers develop a more mature gait, holding their hands at their sides (rather than out in front for balance) and moving with their feet closer together. They also tend to move their feet in a way that looks more like walking — moving from the heel to the toe.

During these months of practice, most toddlers take a few spills, but this is part of learning to walk. You can’t protect your youngster from every fall, but you can reduce the risk of injury by keeping exploration in areas with soft carpeted surfaces and away from sharp corners of furniture.

To get back up from a fall, toddlers often place their hands out in front, lift up their bottom, and then pull their feet under. It may not look very graceful, but it works.

After walking for a couple of months, your child will begin to feel more confident about walking and take on new challenges — such as picking up and carrying objects, moving while pulling a toy behind, and climbing stairs.

By the middle of the second year, your child may learn to run, start to kick a ball, and even attempt to throw a ball. By 2 years, your child may jump in place.

As kids develop the ability to move, they’re also learning. You’ll notice that your child seems extremely interested in finding out how things work, so offer safe opportunities to do this.

Helping Your Child’s Development

Give your child lots of things to do and see in this new upright position. Take walks around your yard or through the neighborhood together or hold hands and climb up and down the stairs together. You can even make an obstacle course of pillows or boxes and encourage your child to walk, climb, and crawl through it. Buy a few balls for kicking and throwing.

Experts recommend that toddlers should:

• get at least 30 minutes daily of structured (adult-led) physical activity like playing on the playground, going for a walk, or being in a parent-and-child tumbling class
• also have at least 1 hour of unstructured free play each day when they can explore and play with toys
• not be inactive for more than 1 hour at a time except when sleeping
• have indoor and outdoor areas that meet or exceed recommended safety standards for all of their activities

As their physical skills develop, toddlers also learn to use their hands more. Toys and objects that can encourage this include:

• paper and crayons
• sculpting dough
• simple stacking toys that kids can build up and knock down
• simple puzzles

When to Call the Doctor

Normal child development tends to follow a certain pattern. The skills that babies develop early serve as building blocks for future skills. Still, the time it takes to develop these skills can vary widely among kids.

Your doctor will talk to you during routine check-ups about your child’s progress. But if you have concerns before then, call your doctor, especially if your child does not:

• walk by 18 months
• walk in a more mature pattern after several months of practice
• walk any way but on the toes
• climb stairs while holding on

The reflexes they had just after birth start to disappear as babies this age gain more control over their movements and interact more with the people and things around them.

What Can My Baby Do?

During the first few months of life, infants start to develop the skills and the strength they need later for certain movements, like rolling over. At 1 month, infants struggle to lift their heads. But as neck and upper body strength improve, they’ll be able to lift their heads up while on their bellies and eventually prop themselves up on their arms, hold their heads up, and look around.

You also may notice your baby stretching and kicking his or her legs. This movement strengthens leg muscles, and your infant will need that strength to roll over, which will probably happen around 4 to 6 months of age. (But be careful: Even very young babies can roll over on occasion, so it’s important to never leave a baby unattended on a changing table, bed, or other high surface.)

Infants can grasp reflexively from birth, but during the first 3 months of life they’ll begin to open and shut their hands and start moving their hands to their mouths. Your baby may be able to shake a rattle or a toy that is placed in her or her hands — and drop it when no longer interested in it.

Vision will also start to improve as your little one develops the ability to follow a moving object with his or her eyes and reach out for nearby objects.

Encouraging Motor Development

Even infants need to practice their skills. While babies should never sleep on their stomachs, give your child supervised tummy time during waking hours. While lying on the belly, your little one can practice lifting his or her head and strengthening the neck, arm, and shoulder muscles.

Your baby may get fussy and frustrated in this position, so keep the first sessions of tummy time brief and gradually lengthen them. It’s important to keep an eye on your baby during tummy time.

Encourage the development of hand-eye coordination by letting your infant reach for favorite toys while sitting in your lap or by letting your baby swipe at colorful objects hanging from an infant gym.

When to Call the Doctor

Babies develop at their own pace, but most make certain movements by the time they’re 3 months old. Talk to your doctor if your infant isn’t making these movements by 3 months:

• opening and closing his or her hands
• grasping or holding objects in the hands
• supporting his or her own head
• lifting the head and chest when lying on his or her stomach

Normal child development tends to follow a certain pattern. The skills that babies develop early serve as building blocks for future skills. Still, the time it takes to develop these skills can vary widely among kids. If you’re concerned about your baby’s development, speak with your doctor.

From scooting to crawling to cruising, babies learn how to get around during these months. So now is the time to childproof your home, if you haven’t already. Be especially careful to gate staircases and block off rooms that you’d rather your baby didn’t explore.

How Is My Baby Moving?

By now your baby is sitting and using his or her hands every so often for support. Once comfortable in this position, your baby will learn to turn and reach for objects without falling over. Your baby will also get better at changing positions, and soon figure out how to get into a sitting position, then pull up to stand.

When on the stomach, your baby will learn to push up onto the hands and knees and rock back and forth. This little “exercise” is working the arm and leg muscles, getting your child ready to propel forward (or backward) in an attempt to get moving.

Some babies are better at crawling than others so don’t worry if your child has developed some novel ways of getting around, including rolling, scooting on his or her bottom, or creeping.

As long as your baby is using the arms and legs on both sides of the body and shows an interest in exploring surroundings, there’s usually no reason to be concerned.

Leg muscles have gotten stronger from standing, bouncing, and crawling. Now is the time for your baby to start taking steps while holding on to the couch, coffee table, or other pieces of furniture for balance. This is called “cruising.” You can encourage it by holding your baby’s hands while your little one takes a few steps.

Fine motor and hand-eye coordination also continue to improve during this period, and your baby will develop the ability to pick up very small things, including cereal, with dexterity. This coordination can range from an awkward raking grasp to a precise finger-to-thumb pincer grasp.

Encouraging Movement

Give your baby safe areas to practice moving and many chances to move — limit the time your baby spends in strollers, cribs, and other equipment that restricts movement.

Allow for tummy time so your baby is in the right position to practice crawling. Help your baby get onto his or her hands and knees, put a favorite toy out of reach, and encourage your baby to move toward the desired object.

Encourage walking by letting your baby cruise along the furniture (remove or pad furniture with sharp edges), holding your baby’s hands while he or she practices, or using a sturdy walking toy or wagon. Walking toys usually have a bar that extends to about chest height on a baby and is attached to a stable, weighted base with wheels. The baby holds the bar for support and pushes the toy for movement. You’ll need to supervise this process, of course, and make sure stairs are blocked off.

When to Call the Doctor

Call your doctor if your child does not:

• crawl, creep, or scoot around
• stand when supported
• use both sides of his or her body equally
• seem to have good control of his or her hands

Normal child development tends to follow a certain pattern. The skills that babies develop early serve as building blocks for future skills. Still, the time it takes to develop these skills can vary widely among kids. If you’re concerned about your baby’s development, speak with your doctor.