Developing standing and stepping

You can hold your child supported in a standing position from an early age. This allows them to experience the feeling of their body weight through their feet. They may bounce up and down, which develops the strength in their leg muscles.

You can stand your child in many different ways, for example on your lap when you’re sitting in a chair, in front of a coffee table or sofa, or on the sofa cushion next to you with their back against the back cushions.

As they get stronger, they’ll need less support from you and start to use their hands on the furniture to support themselves more. When they can stand briefly without holding on, they’re ready to learn to step along the furniture or ‘cruise’.

Babies pull themselves to standing at furniture to prepare for standing without holding on and eventually walking. 

A child may start to pull to stand as early as nine months of age or as late as 18 months. Children who bottom shuffle rather than crawl are often later in pulling to stand. At first they’ll be unable to get back down to sitting in a controlled way, and will ‘plop’ back onto their bottom.

• Kneel-sit on the floor in front of a sturdy coffee table or low sofa. Place toys on the furniture
  
• Sit your child on your knee with their feet on the floor
  
• Encourage your child to reach forward and hold onto the furniture
  
• Put your hands around their hips and help them into a standing position by moving their hips forwards as they straighten their legs
  
• You could also start by placing your child in a kneeling position

It’s important for your child to spend lots of time every day on the floor playing in different positions.

The Association of Paediatric Chartered Physiotherapists doesn’t recommend the use of baby walkers and door bouncers. Baby bouncers and baby walkers can actually delay a child’s ability to learn to pull to stand and to stand without help. 

This is because they support the child in a position they’re not developmentally ready for and don’t allow the child the opportunity to develop strength in the right muscles. 

Because you have to lift them in and out of the equipment they can’t learn how to move in and out of standing for themselves. 

Once your child is confident in standing, they’ll be keen to explore by taking steps. They will usually side step along furniture first.

As they stand at a coffee table or sofa, place a toy just out of their reach. This will encourage them to try and step sideways along the furniture towards it. Walking along furniture helps them develop strength and balance.

As their confidence increases, they’ll hold on with one hand only and eventually let go. You can walk along with your child holding their hands until they’re ready to let go.

Push-along toys can be fun as a child moves from cruising to walking independently. Heavier wooden trolley style toys give them more stability than lighter plastic ones.

Walking patterns vary from one child to another. It’s easy to feel concerned about the following things, but they’re all normal variations that don’t need checking by a physiotherapist:

• Flat feet: All children are born with flat feet; the arch of the foot develops gradually over the first 10 years of life, and 20% of six year olds still have flat feet. There’s no evidence that insoles will help an arch to develop, but they may be useful if a child is experiencing foot and ankle pain when they walk.
• Intoeing: This is where the knee and foot turn inwards when a child stands. It’s common, and happens to girls more than boys. Often children who intoe sit in a W kneeling position to play. Intoeing tends to improve gradually up to the age of around eight, and in many cases will resolve completely without treatment. The child doesn’t need to be seen by a physiotherapist unless they’re having difficulty walking or running. Encourage them to sit cross legged rather than in a W, and to take part in sports. Don’t ask them to try and correct the way they walk
• Bow legs: This is when there’s a larger gap between the knees than the ankles when the child stands. This usually corrects naturally by the time the child is three. They don’t need to be assessed by a physiotherapist unless one leg appears bowed while the other one is straight
• Knock knees: This is when there’s a larger gap between the ankles than the knees when the child stands, and it’s common in children between the ages of three and eight. This usually improves over time without treatment. They don’t need to be assessed by a physiotherapist unless one leg appears more bent than the other, or if the gap is very large
• Curled toes: This is when the toes are not straight and is common in young children and often runs in families. No treatment is needed unless there’s pain, or a change in the skin or nail
• Toe walking: This is when a child walks on their tiptoes. There are many different reasons why this might happen, and it often runs in families. If it interferes with the child’s daily activities please ask our CYPIT Team for advice

If at around six months when lying or standing they either hold their legs in a stiff position or in a very relaxed ‘froglike’ position, or by nine months they lift their legs up when you place them in a standing position, please speak to your health visitor.

If by twelve months of age If they find it difficult to pull up into a standing position because their legs are stiff or they walk on tiptoes, please speak to your health visitor.

If they can’t stand from the floor without using furniture for support by two years old, please speak to your health visitor or GP.