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Baby Physical Growth: Delayed Crawling

Baby crawls forward

"What do you mean Fletcher's not crawling yet?"

I'd been waiting to put my son on the swings at Mommy & Me, and another mom had overheard me bemoaning his steadfast refusal to move under his own power. "He's 8 1/2 months and still not crawling?" she asked incredulously. I stood speechless. I was the bad mom whose kid didn't crawl, would never crawl, and thus would never get into a good college. Or at least that's how it played out in my new-mom neurotic mind.

"He's probably just content where he is," my pediatrician said, unconcerned when I brought it up at Fletcher's 9-month well-baby visit.

Basically, in my doctor's gentle way, she was telling me to relax. But how do you know when you're making a big deal out of nothing or if your concerns are spot-on? To help you decide, here's a guide to how babies go from facile kickers to speed walkers.

Before They Get Mobile

A baby's first few weeks are spent stretching out his arms and legs, basically "unfolding" from the scrunched up position he was in for so many months inside the womb. Within the first month or two, and certainly by month four, he should be actively lifting his hips and wriggling and kicking his legs. "The baby is beginning to test the waters to see what he can do with those legs," explains Charles Shubin, MD, assistant professor of pediatrics at Johns Hopkins University, in Baltimore.

If your baby's legs appear a bit bowed, don't be alarmed. Eventually, most infants' legs straighten out by themselves, adds Dr. Shubin. And don't be afraid to prop baby up on his feet. "The stresses of standing help straighten bones," he says.

Between 4 and 6 months, babies discover their chubby little feet, grabbing them and putting them in their mouths. They may also use their feet in the same way they use their hands, picking up toys and exploring the floor.

What to Watch For: You may notice that your baby's feet curve inward. In most cases, this is quite normal -- another result of being cramped in the womb. If the bones are flexible enough for your pediatrician to gently pull the feet into a straight position, there's no need to worry, says Kristin Hannibal, MD, clinic director of the Primary Care Center at the Children's Hospital of Pittsburgh. But if they seem rigid, you may be referred to a pediatric orthopedist.

Contact your pediatrician if by 3 to 6 months, your child isn't wriggling her legs, seems to flop in your arms, or she doesn't put her feet down when you try to support her in a standing position.

Sometime between 7 and 10 months babies get up on their hands and knees and begin to rock back and forth. This signals their readiness to start crawling. Of course, some kids find other ways to get around, such as scooting on their bottom.

Whether babies crawl or not may be simply a matter of temperament. "Some babies are more driven; other babies are more laid-back, happy to play with what's within their reach," says Dr. Hannibal. Indeed, some kids never crawl. It's usually nothing to stress over as long as they're meeting their other developmental milestones, such as pulling to stand, cruising on furniture, and using their hands properly, explains Dr. Hannibal.

What to Watch For: If your child can't support his body weight or doesn't have energy to move around, tell your pediatrician. Your baby may have low muscle tone (when the brain doesn't send nerve impulses to the muscles or the muscles don't receive them, which can lead to muscle weakness) or maybe he's not spending enough time on his tummy, says pediatric physical therapist Gay Girolami, executive director of the Pathways Center, in Glenview, Illinois.

Another potential red flag: Tell the pediatrician if your baby isn't scooting, rolling, or crawling at all by 1 year, or seems to favor one side, particularly if she's not meeting other developmental milestones, says Dr. Hannibal. This could be harmless, or it may indicate a neurological problem, such as cerebral palsy, which is diagnosed in about 8,000 babies annually.

Cruise Control

Around 9 or 10 months, kids' curiosity motivates them to pull themselves up for a better view of the world. And by 11 to 12 months, they're generally taking their first steps while holding on to the furniture -- known as cruising -- or your hands. During this period, you might also notice that her feet appear flat. That's partly because the arch hasn't entirely formed yet and because it's somewhat hidden by a fat pad, which disappears around age 2 or 3.

While low arches in young kids are normal, feet that remain flat may need shoes with arch supports to encourage the arch to take shape, says podiatrist Alan Woodle, DPM, of the Greenwood Foot and Ankle Center, in Seattle. Otherwise, baby shoes shouldn't have any support.

Your baby's feet may also turn in. Again, this is usually nothing to worry about and is likely the result of baby's position in the womb. Generally, both feet and legs straighten out by 18 months, and unless the in-toeing is totally rigid (which would require a visit to an orthopedist), causing pain or interfering with your child's ability to walk, most pediatricians allow children to outgrow it.

What to Watch For: Does your child only use her arms to pull to stand, seem to have difficulty getting up because her legs are stiff, fall more than would be expected, or frequently fall to one side? These are red flags that could signal a range of problems, including joint disorders, spinal cord abnormalities, and cerebral palsy. Discuss the signs with your pediatrician.

Kids need balance, coordination, and confidence to take their first steps. That's why children reach this milestone at different ages. "My 18-month-old started cruising around 9 months, but he didn't walk until he was a year," says Robyn Kaminski, of Windermere, Florida. "On his birthday, he took three steps, then the next day a few more, and he was off and running." Meanwhile, my girlfriend Maria's daughter, Sofia, walked at 8 months, but my pal Jesse's daughter, Anjali, didn't walk until she was 15 months. "Most pediatricians aren't going to worry about a child who doesn't walk until 15 months if she appears to be neurologically normal in other ways," says Dr. Hannibal.

What to Watch For: If your child isn't walking independently by 15 months, his balance hasn't improved (he can't walk by himself or has an unsteady gait), he falls frequently, seems clumsy, lurches around, and takes very tiny steps, tell your doctor immediately. On the other hand, toe-walking by itself isn't a concern. Alarms start going off, say pediatricians, when a child never puts her feet flat on the floor, and the toe-walking continues past 2 1/2 years. Still, before you panic, have your child evaluated by a physical therapist or pediatric neurologist, because it's likely that constant toe-walking caused the foot muscles to shorten and tighten.

Low muscle tone could also account for difficulty walking. Joanna Hunter, a mom of two, of the Bronx, New York, thought her 17-month-old daughter, Julia, simply wasn't as active as her older son until a pediatric physical therapist diagnosed low muscle tone in her legs and torso. "She told us that at 17 months, Julia had the capacity of a 10-month-old," Hunter recalls. But within six months of twice-weekly physical therapy sessions, she was climbing stairs by herself.

Don't Sweat It

Some kids are early movers, some are late. As a guideline, remember this: "You can still wait two to three months beyond the milestone before you panic," says Michael Wasserman, MD, a pediatrician at Ochsner Health Systems, in New Orleans.

Even so, despite my own pediatrician's reassuring words, irrational thoughts got the better of me. And so, when Fletcher was six weeks shy of his first birthday, my husband and I did what all good parents do: We led by example and got on our hands and knees to crawl on the floor. That didn't work. Even standing at a coffee table, Fletcher was content to stay where he was, playing with whatever was easily within reach. Then we hit on it.

Apparently, the way to Fletcher's mobility was through his stomach. We planted his sippy cup at the far end of the coffee table, then watched as the boy who refused to crawl slowly sidestepped the length of the table in dogged pursuit of that cup. Call it thirst or pure bribery, but our boy was finally cruising.

Baby shoes are adorable, but don't be in a big hurry to put them on your child's feet. As children learn to walk, the best shoe is actually no shoe at all, says Charles Shubin, MD, assistant professor of pediatrics at Johns Hopkins University, in Baltimore, who recommends that his pediatric patients go barefoot or use socks. "Feet develop more naturally without the artificial support that shoes provide," he explains.

That said, there will come a time, such as when you go outside, when you'll need to cover your child's feet. Look for soft, flexible shoes with nonskid soles and no arch support, so your child can easily feel the ground. "You want less support because you want him to learn to use the muscles he has," says Dr. Shubin.

And remember that children outgrow shoes quickly, so check them every two to three months (four to six months for preschoolers) to be sure they still fit. Too-tight shoes can cause hammertoe (when toe joints curl under). There should be about a quarter inch between the big toe and the end of the shoe, says podiatrist Alan Woodle, DPM, in Seattle.

Here are exercises you can do with your kids to encourage movement:

Age Range

Exercises

Benefit
First 6 months and older Tummy time; playing in baby gyms, jumpers, and stationary activity centers Condition arm and leg muscles for pivoting, creeping on bellies, crawling, and walking
7 to 10 months Place a toy beyond her reach or put something against her feet to get her to push off. Encourages crawling and movement in general
9 to 10 months Stand baby next to a low table and put appealing items on it to get her to step sideways. Promotes coordination and at arm and leg strength that's necessary for standing and cruising
12 to 15 months Let baby push and pull wagons and similar toys; create an obstacle course with cushions Help and stimulate baby to become a more adept walker

 

Norine Dworkin-McDaniel, a frequent contributor, lives in Orlando.

Originally published in American Baby magazine, April 2007.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.