Dr Katie Heathershaw is a Melbourne-based paediatrician and the Fisher-Price paediatric specialist who has been providing expert care to infants and children with different health needs for over 23 years. Here, she answers questions about the gross motor skill development of toddlers and preschoolers, including toe walking, jumping, riding a bike and being pigeon toed.
1. My four-year-old toe walks a lot, and has on and off since she was little. If we correct her she walks properly but if she gets distracted she goes back to it. Is it going to have any long term effects? Other people have suggested it could be a sign of something else but it's the only issue she seems to have.
Toe walking is quite common when children first start walking, but most grow out of it by about two years of age. As you have alluded to, if it persists beyond this age it can be a sign of other problems such as autism, cerebral palsy or muscular problems. In these cases there would be other symptoms: for example, children with an autism spectrum disorder would also have delayed social communication, repetitive behaviours, restricted interests and delayed imaginative play.
If there are no other symptoms, no tightness at the ankles or the Achilles tendon, and your daughter is able to walk with flat feet when reminded, then other conditions are unlikely; the diagnosis is likely to be 'idiopathic toe walking', which is not serious.
Walking up on toes is not as stable as regular walking so can result in more falls. It's also a good idea to have a check with your doctor to screen for underlying problems and see if any treatment such as stretches, physiotherapy or orthotics may be needed.
2. My daughter is almost 28 months old and finds it hard to jump. She tries so hard, but it's like a one-legged hop (quite cute but she really wants to jump both legs up!). Is there anything I can do to help her?
Jumping from a standing start is usually achieved between two and a half to three years of age. It's more difficult than hopping off a small step, so practice this simpler skill with your daughter first. When you're out walking look for very low walls or safe curbs; stand on it together holding hands, or stand in front of her holding both her hands, and encourage her to jump on '3'.
Bouncing together on a trampoline may be another way to give her the idea, or pretending to be frogs and leap frogging around (show her how to squat then leap).
Your daughter will eventually learn this fun skill, but if you have concerns about more persistent delays in motor development then a paediatric physiotherapist or occupational therapist may be able to help.
3. My four-year-old can't learn to ride a bike as she physically can't push the pedals. Should I be worried?
It's easy to forget that learning to ride a bike is quite a feat of bilateral coordination, motor planning, balance, direction and bravery! Most preschoolers will first learn the skill of pedaling on a tricycle where they don't have to deal with the balance issue, but even then it can be quite a knack to get the hang of alternating the pressure on first one pedal, then the other. Some children get the idea easily whilst others take longer or are not even particularly interested in this activity. It is a very variable milestone and not one you should worry about.
If your daughter is frustrated and really wants to learn you could help her by first of all demonstrating the cycling (pedaling) action off the trike. Get her to sit on a stool and take a hold of her feet in your hands to demonstrate the movement. Next, let your hand be the pedals and 'cup' each of her feet (with her still sitting on the stool/pretend trike seat), and get her to cycle by alternating and pushing down first one, then the other. You can give a little squeeze to the foot that should be pushing down. When you move to the real trike, you may start alongside her so you can tap her knee to remind her which foot should be pushing on the pedal. Eventually it will just 'click' and she will be away.
4. My two-year-old grandson is very pigeon toed. How do we stop it? I heard years ago an old wives tale to put their shoes on the wrong feet. Does this work?
Being pigeon toed or having an in-toed gait is very common in toddlers, and usually completely benign if there are no other medical or developmental issues.
The most common cause is tibial torsion (where the tibia - shinbone - tilts inwards) or metatarsus adducts (curvature of the foot). Both these conditions don't require any treatment - they'll usually improve as children get older and won't cause any long term problems. Putting the shoes on the wrong feet will certainly not help!
Make sure you visit your health nurse or doctor to discuss further should you have any concerns about your child's development.