My child is walking on his toes. Is that normal?
Toe walking is when an individual walking on tip toes, with heels off the ground. Toe walking can be a normal part of the development and children may do this as they started learning to walk, specifically around 10 to 18 months old (NHS). As they grow older and become more fluent in walking and running, most children outgrow toe walking around the age or 2 or 3 years old. However, in some children, toe walking may persist.
What causes toe walking?
Other than being learning process for children to walk, toe walking might be a symptom of some muscular condition (e.g., muscular dystrophy, cerebral palsy), although sometimes the reason is not known (i.e., this condition is called idiopathic toe walking). Idiopathic toe walking can be referred to as habitual or behavioral toe walking, as children who have been evaluated by medical professional and there was no medical explanation for this behavior. Meaning that these children are healthy and physically they are able to walk on their both flat feet.
What are some interventions for toe walking?
To date, medical and behavioral interventions have been evaluated to address toe walking. Medical intervention may include serial casting and surgery (Williams et al., 2020), while behavioral intervention may include the use of antecedent-based and /or consequence-based interventions (Marcus et al., 2010; Hodges, Wilder, & Ertel, 2018; Wilder et al., 2020).
What do I need to know about to walking as a parent?
- Toe walking is a normal part of child’s development until the age of 2 or 3 years old.
- If toe walking persists above the age of 3, consult to your medical professional for the possible underlying cause of the behavior. Plus, it is recommended by medical professional to address toe walking early on the development before it further persists.
- Persistent and prolonged toe walking behavior can cause physical problems like musculoskeletal contracture (i.e., tightening of muscle, tendons, ligaments, or skin).
As a parent to a child with autism, what else should I know?
- While typically in general toe walking may resolve at around the age of 3 years old, in children with autism, data that toe walking may resolve by the age of 6 to 9 years old.
- Data suggests that children with autism who engage in toe walking tend to require more intervention compared to typically developing children.
- Specifically for children with autism, it is recommended for the evaluation conducted by pediatric orthopedists familiar with ASD.
Tiara Putri, MS., BCBA.
BehaviorPALS
References:
Helms, A. S. (Ed.). (2020, May). Toe Walking. KidsHealth. Retrieved March 12, 2022, from https://kidshealth.org/en/parents/toe-walking.html
Hodges, A. C., Wilder, D. A., & Ertel, H. (2018). The use of a multiple schedule to decrease toe walking in a child with autism. Behavioral Interventions, 33(4), 440-447.
Leyden, J., Fung, L., & Frick, S. (2019). Autism and toe-walking: are they related? Trends and treatment patterns between 2005 and 2016. Journal of children's orthopaedics, 13(4), 340–345. https://doi.org/10.1302/1863-2548.13.180160
Marcus, A., Sinnott, B., Bradley, S., & Grey, I. (2010). Treatment of idiopathic toe-walking in children with autism using GaitSpot auditory speakers and simplified habit reversal. Research in Autism Spectrum Disorders, 4(2), 260-267.
Oxford Health NHS Foundation Trust. (n.d.). Toe walking in children (walking on tip toes). Podiatry Service. Retrieved March 12, 2022, from https://www.oxfordhealth.nhs.uk/podiatry/wp-content/uploads/2013/12/Toe-walking-in-children.pdf
Wilder, D. A., Ertel, H., Hodges, A. C., Thomas, R., & Luong, N. (2020). The use of auditory feedback and edible reinforcement to decrease toe walking among children with autism. Journal of Applied Behavior Analysis, 53(1), 554-562.
Williams, C. M., Gray, K., Davies, N., Barkocy, M., Fahey, M., Simmonds, J., Accardo, P., Eastwood, D., & Pacey, V. (2020). Exploring health professionals' understanding of evidence-based treatment for idiopathic toe walking. Child: care, health and development, 46(3), 310–319. https://doi.org/10.1111/cch.12745
toe walking, walking, children, toddler, autism
Pre-school 2 Years - 4 Years / 2 Tahun - 4 Tahun (Balita) / General Health / Kesehatan Umum / Health / Kesehatan / My child is walking on his toes. Is that normal?
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Personalized book to trigger the imagination and curiosity to discover the wonders of our wonderful Indonesia. The food, music, fashion, language, landscape and the culture. They all never fail to amaze us. What better legacy can we pass on for Indonesia than by instilling nationalism to the future generation of this part of the planet called heaven on earth.
