Your child doesnt walk yet
What you may notice
If your child continues to crawl, creep, or scoot on his bottom while other children his age are walking, you may be concerned about his motor development.
Not walking at 18 months could fall into the "unusual but possibly normal" category, says Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New York, but it could also signal that something is wrong.
What causes it
If your toddler is developing normally in other ways, it might be that she just hasn't had enough encouragement or opportunity.
"I always look at familial or environmental factors," says physical therapist Gay Girolami. "You might find you have a really busy family and the child spends a lot of time in a baby exerciser so she's learned to bounce around on her tiptoes. When she gets to the standing stage, she has trouble because her trunk and pelvic muscles have not been worked enough." (Some experts recommend against using baby exercisers for this reason.)
The same goes for baby walkers, which sound like they'll help a baby learn to walk but do the opposite and they're dangerous. The American Academy of Pediatrics advises parents not to use baby walkers because they're unsafe and don't help babies develop the muscles needed to master the skill of walking.
In addition, there are other environmental factors to consider. "Most kids desperately want to walk but a child who's carried everywhere in a backpack or car seat and handed everything she desires may not see much of a reason to exert herself," says Girolami.
You can find other ways to encourage your child to
develop his walking skills.
Both low muscle tone (hypotonia) and high muscle tone (hypertonia) can make walking difficult. If muscle tone is too low, a child will have a hard time gaining balance and control over gravity because her limbs are floppy. If her muscle tone is too high, or if certain muscle groups are overactive, she may have
stiff limbs and a hard time sustaining balance. In rare cases, doctors diagnose hip problems when a child doesn't walk on time.
Late walking can also be associated with developmental issues such as an intellectual disability.
What your doctor may recommend
If you're concerned that your child is late to start walking, the first step is a medical examination, including a neurological exam and an assessment of your child's reflexes, posture, and muscle tone. The doctor will also take into account other developmental issues including language, fine motor, and social skills.
"Late walking doesn't usually come out of the blue," Adesman says. "A child who walked late probably also sat late and crawled late it's probably not the first missed milestone you'd notice." For this reason, your doctor will probably look at your child's walking in the context of other skills and try to figure out where he is on the continuum of motor development.
If your child's doctor notices that your child has stiff or floppy limbs, she may refer you to a pediatric neurologist (a doctor who specializes in children's brain development). If there are delays in other areas, such as your child's language or fine motor skills, she may refer you to a developmental pediatrician. If a cause is identified, appropriate care could range from physical therapy to improve strength and flexibility or surgery to correct a physical problem.
If your child's doctor can't identify a reason your toddler's not walking, she may simply recommend some games and play periods that involve encouragement and practice and have you come back for a follow-up exam at a later date. She might also recommend physical therapy, which would allow a trained professional to closely monitor your toddler's progress.