Eagerly anticipating your baby’s first steps is a parenting rite of passage, but for some parents, the path to that milestone takes a peculiar turn with their child starts walking on their knees instead of their feet. At first glance, you might think it’s just another waypoint between crawling and walking, but it’s more than that.
When babies walk on their knees long-term, it signals a cause for concern. Babies typically walk on their knees because of an inner ear imbalance caused by retained primitive reflexes or because of an orthopedic issue that makes upright walking uncomfortable or unstable. Alternatively, short-term knee walking simply reflects an additional step on the path to walking.
Read on to discover the most common causes of knee walking, causes for concern, and interventions to get your child on the path to normal walking.
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Why do babies walk on their knees?
Knee-walking refers to a type of movement where children get around on their knees. Unlike crawling, knee-walkers don’t place their hands on the ground.
The causes of knee walking can be lumped into two main types: physical issues with the legs or feet and issues with the vestibular system, which is the fluid in the inner ear that impacts our balance.
When do babies start knee-walking?
Chronic knee walking usually appears when your child is learning to walk. Most kids start walking at 12 months old, but anywhere from 9 months to 18 months is considered normal.
At around 9 to 12 months, babies start pulling to stand, standing without holding on to anything, and cruising, which is walking while holding onto furniture for support. These three things act as clues to parents that their child is preparing to walk.
Knee walking usually appears during this time. Instead of doing these activities on their feet, knee-walkers will do them on their knees. For some kids, knee-walking is just a stepping stone to walking on their feet, like cruising and pulling up. They might do it for a few days or weeks.
Other times, knee-walking is a chronic issue that needs intervention.
Causes of knee-walking
By identifying the cause of your child’s knee-walking, you’ll be able to implement the most effective solution sooner and get your baby on the path to upright walking. Besides your baby simply not being ready to walk yet, here are some other causes of knee-walking:
Retained Tonic Labyrinthine Reflex
Human infants are born with several primitive reflexes, which are intuitive responses to certain stimuli. We often talk about the sucking reflex for eating, rooting reflex for finding the breast, and Moro reflex which causes baby to startle. But less well-known is the tonic labyrinthine reflex (TLR).
The TLR helps babies navigate the birth canal, develop muscle tone, and stimulate the vestibular system. These reflexes also help your baby grow out of the curled-up fetal position that they’re born in.
When you’re watching your baby and see them arching their back and straightening their arms and legs in response to their held tilting forwards and backwards, you’re seeing their TLR at work.
All of the primitive reflexes go away as your baby gets older. The forward TLR (when the baby’s chin curls toward the body and the limbs clench toward the mindline) dissipates at around four months of age. The backward TLR starts disappearing at 6 months old but can stick around until the child is 4 years old.
When a baby’s TLR does not go away, it can lead to knee-walking. That’s because the baby’s body isn’t receiving accurate information between the eyes and muscles, and they don’t have an accurate sense of how their body is situated. You could compare this to experiencing vertigo – no wonder babies would be hesitant to stand on their feet and walk!
To try to narrow down whether retained TLR is the cause of your baby’s knee-walking, look for other symptoms of impaired vision and balance. Your child’s eyes might not track in coordination, they might have motion sickness or poor depth perception, or difficulty with figure and ground discrimination (inability to identify which objects are closer than others).
Other than retained TLR, orthopedic issues comprise the other primary source of chronic knee-walking. Orthopedic issues can make it uncomfortable–or even painful–for your baby to walk on their feet.
Bow legs, pigeon toes, flat feet, and knock knees all have cute names, but depending on the severity, can cause your baby real discomfort. Children often grow out of these conditions on their own, but if your baby is being deterred from walking because of one, intervention might be needed.
All of the things that can make it uncomfortable for us to walk as adults can impact children. Babies can even suffer from pediatric osteoarthritis, which can impact the joints in the legs, ankles, and feet.
Safety issues of walking on knees
Knee walking can be a clue that something else is happening with your child’s development and motor skills. For example, it is often seen in children who also have cerebral palsy.
Retained TLR is also related to delayed development in school-aged children, so even if you’re not worried about the knee-walking itself, it can be a sign of more concerning long-term issues. Retained TLR can impact sequencing, which is needed for both counting and reading.
If you think your child is knee walking too much or for too long, address it at your 12-month or 18-month well-child visit with your pediatrician. Of course, it doesn’t hurt to make an extra appointment if you have cause for concern outside the milestone check-ups.
Solutions for knee walking
The resolution of your baby’s knee walking will depend on the cause. Physical therapy, medical intervention, or just encouraging normal walking can be the solution.
Many providers offer physical therapy to target retained TLR depending on your child’s specific needs. The therapy implements simple physical movements to retrain the body and create the needed pathways between the brain and body.
You can help prevent retained TLR by ensuring that your baby has the recommended daily amount of tummy time and has adequate time for free movement where they’re not in a sling, swaddle, or swing.
Babies should have several tummy time sessions per day starting from birth.
Addressing underlying orthopedics issues
If your child suffers from an orthopedic issue that makes walking on their feet uncomfortable or painful, that condition will have to be addressed to support walking on their feet.
For example, bow legs often resolve on their own. However, they can be caused by being overweight, tumors, and even Ricketts Disease, which is a Vitamin D deficiency.
Encourage normal walking
Finally, if you think your child’s knee-walking isn’t caused by something more serious, you can help them move past this stage into the next.
Walking is a huge motor milestone, and it’s not something you have to rush. However, you can encourage your child to walk a number of ways. You might take them to new locations for a change of scenery, babyproof your house of sharp edges so they’re less afraid of falling, and engage in play and games where they need to be on their feet.
What can parents to do stop their baby from walking on their knees?
Anytime that your baby isn’t hitting recommend milestones, bring it to your pediatrician’s attention. They can help you identify whether there’s an underlying cause for concern or whether your child just needs a little extra support and encouragement from you.
Let your pediatrician know if your child isn’t making the following walking milestones:
- Taking a few steps alone by 15 months
- Walking without holding onto anything and climbing on the couch at 18 months
- Walking up stairs and running at 24 months.
In addition to encouraging normal walking as discussed above, you can also deter knee walking by making it difficult to knee walk. Keep their favorite toys at standing level and out-of-reach at knee level.
Infants and toddlers can have surprisingly complex relationships with peers. If they’re not in a daycare program, take them to a park or create other situations where they can imitate their peers. Peer imitation can play a huge role in teaching children new activities and giving them context for their world. And, toddlers interact through movement. Time with peers may be just what your child needs to get up on their feet
Products to help your baby walk on their feet
If you think your baby’s knee-walking isn’t caused by a more serious medical condition, you could try a number of products advertised to help encourage children to walk and improve their balance. As a reminder, these products shouldn’t be used as a Band-Aid to cover a more significant physiological or neurological condition.
- Walking harnesses allow the parent to provide some support and stability as their unsteady toddler learns to walk.
- Walking toys help babies get on their feet while leaning on a toy. The baby can then push the toy to walk.
- Baby walkers let babies push themselves around the house with their feet like the Flinstones. However, pediatricians caution against using these products over concerns that babies could fall down stairs or flip over in them.
- Baby jumpers position babies on their feet, and then babies can jump and jostle for fun. The jumpers can help build the muscles that your baby needs to walk.
- Soft corners blunt the sharp edges of furniture that can hurt your baby if they fall.
- Exercise mats can provide a soft place for hesitant babies to fall when they’re learning to walk and balance.