MONDAY, July 23 (HealthDay News) — As many as one in 20 children
may predominantly walk on their toes in early childhood. Youngsters who
have developmental delays or neuropsychiatric disorders, however, are more
likely to walk on their toes, according to a new study from Sweden.
Toe-walking is a condition where children walk on their toes instead of
using a typical gait. Certain conditions, such as cerebral palsy, can
cause toe-walking, according to background information in the study. But,
sometimes, toe-walking occurs in children who appear to be healthy
otherwise. This is called idiopathic, or habitual, toe-walking.
In the Swedish study, at 5.5 years old, more than 40 percent of
children with developmental delays or neuropsychiatric disorders, such as
an autism spectrum disorder, were currently or had been toe-walkers.
Although the number of children with “a neuropsychiatric disorder in
this study is too small for conclusions,” the authors reported, the study
“confirms earlier findings that toe-walking has a high prevalence among
children with a cognitive [or mental] disorder.”
And, they noted that toe-walking in otherwise healthy children often
resolves on its own. By 5.5 years, “more than half of the children have
spontaneously ceased to walk on their toes,” they concluded.
Results of the study were released online July 23, in advance of
publication in the August print issue of Pediatrics.
To get an idea of the prevalence of toe-walking, and the natural course
of the condition, Drs. Pahr Engstrom and Kristina Tedroff of the
Karolinska Institute in Stockholm reviewed data on 5.5-year-old children
living in Blekinge County, Sweden.
There were almost 1,500 youngsters included in the study, including 35
children who were seen at a clinic for children with special needs.
Seventeen of these children had developmental delays or neuropsychiatric
disorders.
Thirty (20 boys and 10 girls) of the otherwise healthy children were
current toe-walkers. That represented about 2 percent of all the children.
Another 40 children (22 boys and 18 girls) had previously walked on their
toes. That means about 5 percent of the county’s 5.5-year-old children had
a history of toe-walking.
Most of the children, but not all, started walking on their toes.
Eleven children developed toe-walking during their first year of walking,
according to the study.
Of the 17 children with developmental delays or neuropsychiatric
disorders, seven boys (41 percent) had a history of toe-walking. About
half of these children started walking on their toes. In two children,
toe-walking started during the first year of walking, and one youngster
started toe-walking during the second year of walking, the researchers
found.
Left untreated, toe-walking can cause damage to the structures in the
legs, ankles and heels. It can also create a social stigma, according to
the study authors.
Commenting on the study, Dr. Pete Richel, chief of pediatrics at
Northern Westchester Hospital in Mt. Kisco, N.Y., said: “Although many of
these cases are labeled idiopathic, which means without a known cause, as
clinicians and parents, I think we have to consider whether there is an
organic cause that may be so subtle it’s not always evident.” He said some
toe-walking children may have sensory issues that don’t meet the level for
diagnosis of an autism spectrum disorder, but still might benefit from
treatment.
Occupational therapist Chantell D’Avignon, from Ft. Lauderdale, Fla.,
added that “every child is different and every treatment is different, but
early intervention is key. The brain from zero to 3 years old is much more
pliable.”
Colleen Harper, a physical therapist and director of developmental,
rehabilitative and child life services at La Rabida Children’s Hospital in
Chicago, agreed that early treatment is important.
“Many issues are easy to fix at 18 months, but very hard at 5 years,”
said Harper.
For example, kids who walk on their toes often walk with their stomachs
forward, and part of treatment has to include moving that center of
gravity back. And, the longer that posture has been practiced, the longer
it will likely take to correct.
Harper noted that while the Swedish study didn’t address this cause, in
the United States, spending too much time in a baby walker is a common
source of toe-walking. She said that pediatricians and physical therapists
advise parents not to use these devices because they’re generally unsafe,
and toe-walking can be an unintended consequence.
All three experts advised parents to bring up toe-walking with their
child’s pediatrician, who can determine if further treatment is necessary.
And, Richel pointed out that while children with developmental delays and
neuropsychiatric disorders may have higher rates of toe-walking,
toe-walking on its own doesn’t necessarily mean your child has one of
these conditions.
Because while the study uncovered an association between toe-walking
and developmental delays or neuropsychiatric disorders, it did not prove a
cause-and-effect relationship.
More information
Learn more about toe-walking in children from the Seattle Children’s Hospital.
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