QUESTION: My 2 ½ -year-old daughter walks on her toes much of the time. Is this normal?
TARA’S ANSWER: Since your daughter is still quite young, toe-walking in and of itself is not a reason for concern. It is not uncommon for young children to walk on their toes, especially when they are in the early stages of walking.
Toe-walking is the noticeable absence of the use of heel when someone walks, known as a heel-strike pattern. Medical professionals often refer to this as idiopathic toe-walking. The term idiopathicis used when there doesn’t seem to be any type of physical or medical condition to cause the issue.
With that said, some children will continue to walk on their toes. Sometimes children do this out of habit. Chronic and continued toe-walking may be a sign of underlying problems or difficulties. It can be as minor as tight muscles or a condition that is more involved such as mild cerebral palsy.
If you child is doing it off and on, especially when they are playing, this may require only simple reminders to walk flat footed by saying, “Heel-toe, heel-toe “ while demonstrating heel-to-toe walking. Along with verbal reminders to walk, heel-toe also remind them to walk using big steps because it is difficult to walk on your toes when you are taking large steps.
If you notice that your daughter is having difficulty keeping her feet flat this could be related to a shortened Achilles tendon or muscular weakness. If, in addition to toe-walking, you notice that your daughter also has fine motor difficulties (buttoning, using a crayon) or poor balance, you should talk to your doctor about having an evaluation conducted by a pediatric occupational or physical therapist.
Children who have sensory processing difficulties may also exhibit toe-walking. It is usually for short periods of time and primarily when there is a lot of sensory input and the child feels overwhelmed. On the other hand, when toe-walking is linked to language delays or social impairment this may be a sign of autism.
Just remember to give your child the verbal cues–“heel-toe”–and then watch for her to grow out of toe-walking around 3 to 3 ½ years old, except if she has her sites sets on being a ballerina.
Tara Delaney is a nationally known child development expert who specializes in sensory processing, autism spectrum disorders, and social/behavioral issues. She is the author of two books: The Sensory Processing Disorder Answer Book (Sourcebooks) and 101 Games and Activities for Children with Autism, Asperger’s and Sensory Processing Disorders (McGraw-Hill). An active occupational therapist, Tara is also the Founder/Executive Director of Baby Steps Therapy, a nonprofit clinical practice focused on helping every child achieve his or her greatest potential in the classroom and beyond. Visit her web site at www.taradelaney.com.