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Learning to walk/ Orthopedics

Concerns about pigeon toes, knock knees, pronation or other orthopedic questions for new walkers? Find a pediatric orthopedist (see info at the very bottom of this page)

Learning to Walk

It's an inevitable product of the progressive hardwiring of the brain that involves sophisticated coordination and diligent practice - and you thought those first steps were just about putting one foot in front of the other!

Some babies walk as early as nine months; other perfectly healthy children don't do it until 17 months. As excited as parents get about their baby's first steps, walking doesn't suddenly "turn on” thereafter. Toddling builds gradually, over the course of many weeks. Regardless of when she is finally able to walk independently, every baby goes through a similar learning process en route to mastering this most important of motor skills. How, then, does a baby start to walk? Is it all 'maturational', a fixed consequence of nerve and muscle development that allows each child, somewhere around his first birthday, to stand alone and toddle forth? Or is it a matter of learning, much as an adult masters a new motor skill, like typing or hitting a tennis ball - the product of hundreds of hours of diligent, highly-motivated practice?

Until fairly recently, researchers were convinced by the maturation explanation. The remarkable uniformity of movement milestones in babies from widely diverse cultures led scientists to conclude that motor development is an inevitable product of the progressive hard-wiring of the brain and muscles during early childhood. These studies, involving thousands of babies, produced the now familiar developmental charts that paediatricians consult in deciding whether a child is on-track or developmentally delayed. And, seeing what most parents see - that most babies achieve the same milestones at very similar ages, without any obvious training - they concluded that motor development is largely innate, preprogrammed into the normal maturing of the nervous system.

If confirmation were needed, it came in the early Thirties from an American psychologist, Myrtle McGraw, who carried out a famous training study with a set of identical twin boys. Although Johnny was put through many hours of motor practice each week, he walked no earlier than his twin brother, Jimmy, who spent the same hours playing with toys in his playpen. McGraw concluded, as scientists today agree, that brain and bodily maturity physically limit just how early a baby can hope to achieve a particular milestone.

For example, the long nerve tracts that control voluntary movement of the legs add their myelin (a critical white-matter sheath that dramatically speeds the flow of information from the brain to the muscles) relatively late in a child's first year oflife. These pathways also form the synapses (or connections) onto spinal cord motor neurons later than comparable fibres controlling voluntary movement of the face and upper body.

Bodily proportion also figures importantly in the onset of walking: until babies' legs grow long enough to balance the weight of their comparatively large heads, a high centre of gravity makes balancing on two feet virtually impossible in the first few months of life. While neuromuscular maturity clearly sets the lower boundary on what babies can do at a given age (which is why you'll never see a four-month-old walking independently), it is not the whole story in explaining the development of motor milestones.

Practice and exercise are equally critical. Skills like walking don't suddenly turn on, like a light when you flick a switch. They develop gradually, out of more basic skills, including standing, balancing and stepping. And walking is especially challenging because of our species' peculiar penchant for getting around on two legs.

Not only must a child figure out the complex alternation of muscle contractions in each leg, he must also master the ability to balance, however briefly, on one foot while the other swings through to begin its stride. Doing all of this successfully requires strength, balance, coordination... and weeks and weeks of diligent practice.

Researchers are now increasingly proving what parents have always known - that babies' movement experience does influence the emergence of various motor milestones. One widely publicised 1998 study showed that babies who sleep on their backs roll over and crawl about a month later than babies who sleep on their tummies. This found that back-sleepers are a little slower to master certain skills, such as crawling and pulling-to-stand, that depend on arm strength and co-ordination because they have less opportunity to exercise their upper body.

Of course, back-sleeping is still strongly recommended, because it dramatically reduces the risk of cot death. Moreover, babies who sleep on their backs are no slower to begin walking than babies who sleep on their tummies. Nevertheless, this study indicates that babies should be given plenty of "tummy time" while they are awake and playing to exercise their upper body .

Studies of baby-walkers have, ironically, produced further evidence tn link practice to motor milestones. These wheeled devices permit babies to propel themselves around a room while seated, with their legs dangling down to the floor. They do not, however, teach babies to walk, and are not recommended for safety reasons as they allow a baby to move easily before they have developed the necessary skills to control them.

Some studies also suggest walkers actually delay the onset of walking, along with independent sitting and crawling. The problem is that babies in walkers don't have to balance or support their own weight, so they have a harder time developing the strength and co-ordination needed to begin walking. Another problem is that babies in walkers can't see their feet, and so they lose the visual feedback that is important for learning how to control your two legs. Considering all these risks together, paediatricians are increasingly warning parents against the use of baby-walkers, and some countries are moving to ban them.

Clearly, movement experience is critical for learning how to walk, but the good news is that babies are naturally inclined to get all the exercise they need. It all begins with the newborn "stepping reflex", a highly co-ordinated neural program, that allows babies, even as young as three mor;ths premature, to "walk" when held upright, with their bare feet touching a flat surface. This reflex is controlled by the stepping circuit, which sits in the spinal cord - below the level of our conscious awareness - and programs the alternate flexion and extension of each leg. Paediatricians sometimes use this reflex as a way of assessing the integrity of the nervous system in very young babies.

It's an amazing skill to witness: babies who are otherwise completely helpless 'marching' in place when held up in the right way. But it doesn't last long. Newborns typically step for only the first six to eight weeks of life. Chubby babies lose the reflex earlier than lighter babies, as their legs get heavier faster than their muscles grow - meaning they are no longer strong grow strong enough to lift them.

However, some studies have found that babies whose stepping reflex is exercised more frequently tend to retain this reflex longer, and even walk independently a few weeks earlier as a consequence. Daily practice works the best, so if your baby enjoys it, you should let her exercise this neural circuit for a few minutes each day.

If, on the other hand, you have a baby who doesn't like to perform this little party trick, don't worry. It turns out that babies use exactly the same motor circuit when they practice rhythmic kicking, a common pastime of young babies while they are awake and lying on their back. Kicking begins at about three months and peaks between four to seven months. It's obviously a lot easier than stepping - babies can do it all by themselves and don't have to bother supporting their legs against gravity. But researchers believe it is every bit as useful for honing the muscle patterns and neural pathways for later independent walking.

Every healthy baby kicks a lot, just as all eventually sit, stand, cruise around the furniture and finally, walk independently. Learning to walk is not easy but it couldn't be more natural.

As long as they have the freedom to move, babies will instinctively exercise their muscles, practice their balance and hone their rapidly maturing neural circuits into bodies that walk smoothly, efficiently... and most happily. Your job? To provide encourage, praise - and be on hand to offer comfort after the occasional, and inevitable, tumbles.

WALK THlS WAY: STEP BY STEP TO WALKlNG

The good news about motor development is that it tends to take care of itself. Babies are incredibly motlvated to practice thelr budding skills, whether it is reaching for an enticing new rattle or cruising around the coffee table. However, there are ways to promote walking:

VESTlBULAR STlMULATlON Any kind of movement or postural change activates your baby's vestibular system, that begins in the inner-ear and is processed in brain areas mostly below our conscious awareness. The vestibular system matures before birth and is closely tied to the motor and postural reflexes necessaly for head control, standing and walking. Babies love vestibular stimulation, such as rocking, swinging and jiggling. They get bored with lying in one position but stop fussing when they are repositioned, especially if they get to be held upright, looking over your shoulder. Some studies have found that babies who receive additional vestibular stimulation (such as spinning in a swivel chair while seated on an adult's lap) stand and walk a few weeks earlier than babies not treated to such fun experimentation. So, pick up your baby and dance!

AVOlD 'PARKING' YOUR BABY IN A CARSEAT OR STROLLER By the same token, babies who spend much of their day in infant carriers or strollers miss out on a lot of movement opportunities. Such seats support a baby's body too well, robbing her of the chance to strengthen her neck and abdominal muscles. Babies in pre-industrial cultures, without all the fancy contraptions for holding them, are known to reach their motor milestones earlier.

BABYPROOF EARLY AND OFTEN Why wait until your child is already toddling to tie up the blind cords and secure your floor lamps? Creating a safe environment early on encourages your baby to explore, withaut hearing "No" at every attempt to stretch his motor repertoire.

HOLD HANDS AND WALK TOGETHER This classic method still works. Hold both your baby's hands and help him practice stepping across the room. The easiest way to do this is to stand behind your child, holding his hands above his head. However, it will be easier for your baby to balance if he holds his hands out in front of him, while you walk backwards. This way, he can also see your excited face. Pre-walkers will love 'walking' on your feet - just for the fun of it!

BABY PING-PONG Here's a game for babies just on the cusp of walking: sit with your partner facing each other on the floor, a few feet apart. Support your child into standing up and then coax her into taking a few steps toward the other parent. Babies love this game and with two parents encouraging them, get twice the reinforcement to egg them on!

BREASTFEEDING Many studies have found that breastfed babies reach developmental milestones, including walking, significantly earlier than formula-fed babies. While some of this advantage may be due to the different parenting styles of breast- and bottlefeeding mothers, most experts believe that the nutrients in breast milk are superior to those in manufactured formula milk for boosting brain and cognitive development.

L. Eliot
Junior Jan 2003


Concerns about pigeon toes, knock knees, pronation or other orthopedic questions?

Start with your pediatrician, or find a pediatric orthopedist at
http://www.aaos.org/

Click on “Find an orthopedist”

The direct link is
http://63.141.36.80/memdir/public/memdir.cfm

Put in your state, or zip code, or country, and also the “pediatric” specialty below, then “submit”.



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More about learning to walk: WhatToExpect.com

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