Health Awareness blog

Delay walking is one of the common examples of developmental delay. 50% of child is walking by 12 months and 90% by 15 months. Those who still not walking by 18 months need further assessment. Many of these kids will be normal late walkers but some of them will have underlying problem.

Causes of delay walking

Normal variants:

• Familial
• “Bottom shuffler”
• “Commando crawler”

Organic causes:

• Cerebral palsy
• Congenital dislocation of the hip
• Duchenne Muscular Dystrophy (affected boys)

Physical examination

• Neurological examination: Check for tone, power, tendon reflexes on all limbs.
• Hips examination: Look for any signs of hip dislocation like waddling gait, leg legth discrepency, limited abduction, etc.
• Locomotion problem: “commando crawler” or “bottom shuffler”
• Gowers sign-This test is used to check for proximal muscle weakness, the child will be asked to stand from lying supine. A normal child will sit then stand while child with Duchenne muscular dystrophy will have to roll over onto their front and then climbed up using their legs.

Investigations

• Usually not necessary
• For some cases imaging of the hips and spine will be useful
• Creatine kinase is indicated if there is any suspicion of Duchenne muscular dystrophy

Management

Management for normal late walkers is only supportive. For others, you need to refer to the specific problem.

Related:

• Warning signs for developmental delay
• Developmental milestones

Reference:

1. Bhakthavalsala et al/ Crash Course Paediatrics. 3rd edition. 2008. Mosby Elsevier.
2. Alan Cade et al. Short Cases in Paediatrics. GMM. 2000.

1. Breast feed your child. There is no need for me to explain further on this.
2. Add the right amount of water during milk preparation. Too diluted or too thick is not advisable.
3. Drink plenty of water may help to prevent constipation.
4. Add high fiber foods into diet at least 2 servings of fruit and 3 servings of vegetables a day. In infant less than 6 months, most probably breast milk alone is enough.
5. Include source of prebiotic and probiotic (live good bacteria) into diet. Probiotic diet is usually expensive. Don’t get cheated by the advertisement. Perhaps it is wise to ask you physician before you buy one. No matter what, breast milk is still the best. There are components of probiotic in breast milk as well!