Pediatric Development

baby developmentRecently I have been treating a lot of pediatric patients with abnormal gait issues and flat feet. The parents are typically apprehensive about the situation and I do my best to explain what I expect to see at certain ages and if needed, what treatment should be rendered.

Below is an abbreviated list of the appropriate milestones to be expected for your child throughout the developmental years.

By the end of 2 months

  • The baby is able to hold up its head and can push up when lying on its stomach
  • Makes smoother movements with arms and legs
  • Looks at and tracks people and faces
  • Smiling
  • Coos and gurgling noises

By the end of 4 months

  • Reaching for objects such as toys
  • Facial recognition
  • Holds head steady and unsupported
  • Pushes down on hard surface with legs
  • Copying of sounds
  • Babbling

By the end of 6 months

  • Enjoys playing
  • Looks at self in the mirror
  • Responds to his/her name
  • Rolls over front to back and vice versa
  • Sits without support
  • When standing the legs support the weight and the baby may bounce
  • Rocks back and forth, sometimes crawling backward before moving forward

By the end of 9 months

  • Has a favorite toy or lovey
  • Making sounds almost word like
  • Uses fingers to point
  • Peek a boo is a favorite
  • Picks things up with thumb and forefinger
  • Stands (cruising)
  • Can get into sitting position
  • Sits without support
  • Crawls
  • Pulls to stand

By the end of 1 year1 year old birthday

  • Is shy with strangers
  • Says Mama or Dada
  • Mimics words
  • Copies gestures
  • Bangs things together
  • Sitting position without help
  • Cruising
  • Few steps without holding onto anything
  • May stand alone

By the end of 18 months

  • Walks alone
  • May be able to handle steps
  • Drinks from a cup
  • Uses a spoon
  • Pretends
  • Says several single words
  • Scribbles
  • Can follow simple commands

By the end of 2 years

  • Stands on tiptoe
  • Kicks a ball
  • Climbs up and down from furniture
  • Can handle stairs
  • Begins to run

By the end of 3 years

  • Climbs well
  • Runs easily
  • Pedals a tricycle
  • One foot on each step when using stairs

By the end of 4 years

  • Hops and stands on one foot
  • Catches a bounced ball
  • Cuts and mashes own food
  • Can sing songs
  • Remembers parts of stories
  • Plays board games

By the end of 5 years

  • Skipping
  • Somersault
  • Fork and spoon usage
  • Uses toilet on his/her own
  • Swings and climbs
  • Can print letters
  • Counts to 10 or more
  • Uses full sentences

baby feetThis is an abbreviated list and as always you should consult your pediatrician if you have any questions or concerns regarding the developmental milestones of your child. The milestones are there to give benchmarks so as to track the development of your child easily. They are an average of activities that the general population exhibits at those specific times. As a podiatrist I am mainly concerned with the shape of the lower extremity and the movement of the child. When I examine a pediatric patient and they are not of walking age I will generally check for any signs of hip dysplasia, I assess the neurological status of the lower extremity, and I attain a full history of the patient from the parents/guardian.

Typically I will see internal rotation of the legs and in-toeing of the patient when at rest. This is something that can be normal and that the child grows out of as they progress through development. The body undergoes many changes within the first few years of life and it involves rotation of the hips and legs bones. Sometimes in early development the “deformity” may appear severe but upon examination they are perfectly age appropriate. In certain developing countries there are severe deformities which are abnormal but they are not common in the United States. Talipes equino-varus or club foot is a type of foot deformity where the foot is rotated internally and the patient is walking on the outside of the foot. A podiatrist can easily spot this type of deformity and can render appropriate treatment.

Pediatric patients who are walking and have difficulty due to deformity or neurological issues is also a common experience in the office. For a beginning walker I analyze their gait first by their cadence. Cadence is the number of steps per minute when walking. There is an increased cadence in beginning walkers and therefore if this is seen in later years then this may be a concern. Steps length is also looked at which is the distance between steps of the same foot. Stride length is usually reduced since it is dependent on the the length of the legs.

child playingAs a beginning walker I will typically see a flat footed strike when walking with limited arm movements, elbows are flexed, and hips that are externally rotated so that they have a wider base of support. Small steps and a rapid cadence is also prevalent in beginning walkers.

At 12-18 months (Toddler Age) small steps, somewhat unsteady gait, running on toes, and less external rotation of the hips is noted during this time. From 18 months to 4 years the child will have reciprocal even arm movements when walking, cadence is slower, walking speed is higher but is still less than adult.

At 6 years old the velocity of the gait matches adult gait, decreased external rotation of the hips, and normal arm swing.

Most of the time the issues I see are not detrimental to the health and well being of the child. I could easily write a whole book on all the pediatric foot pathologies that are present in the world but the bottom line is that most the problems can be corrected with a combination of physical therapy, bracing, orthotics, and time.

If you have a question about your child’s development regarding the lower extremity please make an appointment today by calling (813) 875-0555. The doctors of Advanced Podiatry have successfully treated all types of pediatric foot ailments and will find the best solution for any problem.