Walker for my Baby?

Can we suggest a walker in babies with milestone delays as they have less lower back strength? 

This question is frequently asked to me by parents and fresh therapists alike. Walkers become an attractive toy for young parents because they offer mobility to a young child. 

  Walkers can vary in their design and therefore serve different purposes. This is one type of walker, an upright push-toy that my own kids used in the 90s. 

  Product Picture from Amazon

In contrast, the walker shown above has 4 wheels and a sling seat. Many parents use this walker because they feel that the baby will start to walk earlier. However, research looking into the walker conveys the opposite. Using a walker does not or may not help the baby to walk, but rather interferes with the development of important milestones. When this walker is used early on, starting around 7-8 months of age, muscles of the body do not get utilized the way they should be, as a part of development. And hence can sometimes have negative implications in the child’s future.

In my long experience as a pediatric physical therapist, I witnessed the time when these walkers (wheels and hammock seat) were banned in the USA in the late 80s. Much later in 2004, Canada placed a ban on all sales of these walkers including the used ones at yard sales. In the late 80s, I was working in New York city. At the time, in the world of pediatric physical & occupational therapy, there were discussions about the negative consequences of this walker.  Experienced therapists who worked with babies were quick to observe the drawbacks of using this walker. I do not remember how those walkers came back to the market, because I did not see them in the 90s when my own children were growing up in the USA.

There are many articles online that discuss the pros & cons of this walker. Some favorable arguments state that besides mobility, putting the child in the walker provides some respite to the mom. Others speak about the safety hazards when young children use the walker.

Being a pediatric physical therapist, I would like to speak about developmental concerns when an infant is placed in a walker for prolonged time periods.

When parents use the walker for a 9-10 months old child with  typical development, you are taking away the opportunities for tummy time, crawling,  tall-kneeling, and pull-to stand, all of which hold multiple benefits.  Frequently missed opportunities of these crucial movements result into compromised trunk muscle stability and core activation. Weight-bearing on the feet may not be adequate and can possibly lead to toe-walking. Furthermore, the muscle work that occurs numerous times during transitions between various body positions – lying to rolling over, sit-to-all fours, crawling to sitting, sit-to-kneel, pull-to-stand……that is so important for sensory & motor development…..is missed out. (Hence the importance of a moving infant spending time on the floor; today it is called as floor time. Traditionally, floor time was amply provided to babies so that they could roll over, come to sit, and progress to crawling that would lead to exploration of the environment).

Amongst children with developmental delays, prolonged use of this walker is likely to cause abnormal tightness in hip abductors, hip external rotators, and the tendo-achilles muscles. Other likely consequences would be decreased proprioception through the lower trunk and the lower extremities. Hence trunk strength, weight-bearing through the hands & upper body, cross crawling, trunk rotation, all do not develop adequately and lead to deficits in vision perception, vestibular processing, and reflex integration. All of this is sensorymotor development that occurs during the first 2 years of life. When the child has developmental delays, you are causing further deprivation of sensory-motor components by using a walker with wheels and hammock seat.

I am not trying to project that only after crawling, a child can walk. Rather, in early intervention session, I include many positions in parallel -- prone, all 4s positions, weight-bearing in supported standing if possible.  And gradually progress to walking with pushing a heavy chair (any chair with weights on it), while I facilitate the lower extremities as needed.

The consequences of using a walker may look different for different children, and are likely to be realized only after a few years. I have many children starting grade 1 in regular schools who have been referred to me for handwriting and attention. They have a history of not crawled or used the walker in early childhood. And now at 6 or 7 years of age while in grade school, they have poor core strength, weak hands and finger strength, thus leading to issues with handwriting and attention. I believe that young parents need to be educated about the role of tummy time and crawling and the value of transitioning between positions frequently as an infant. 

I absolutely agree that we need early mobility for our children with developmental delays, but not at the compromise of trunk stability and weight-bearing through various joints. The early mobility can be provided to the child in other ways.

Watch the following video; this walker was used more as a play item, months after the child has achieved independent walking. This child is using the push-toy walker just as if it was a cart. He steers it, pauses to bite on an apple while holding on to the walker, and uses the walker to run fast. This is a 22 months old child. He is learning how to steer the walker, turn it around, pull it and push it with the right force required. In the process he is learning so much  – body-spatial awareness, force gradation, and sense of direction.

There are Indian versions in wood material that children of my generation had used decades ago.

 

 

Product Picture from Amazon

However, we did enough crawling, prone, rolling, and pull-to-stand prior to using these. And that made all the difference in development as well as learning!

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