How to Approach a Child with Delayed Walking

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How to Approach a Child with Delayed Walking
Ahmed Khamis Bamaga 6th year medical student
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Normal ranges

• Sit unsupported at 18 to 30 weeks of age.
• Pull self up to stand at 6 to 10 months.
• walk by holding on to furniture at 7 to 13
  months.
• walk alone at 11 to 18 months.

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History

• Was the child a full term normal delivery?
• Were there any problems in pregnancy?
• Did the child feed well from the outset?
• Was there deep jaundice?
• Has the child had any serious illnesses?

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History

• Are there any significant inherited conditions in
  the family?
• Has the mother been trying to get the baby to
  walk ?
• Are there any other aspects of development that
  have been a cause for concern?

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Examination

• Does the baby look well cared for?
• Does the child look normal?
• Does the child seem alert and attentive?
• What is the resting posture?
• How is muscle tone?

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Examination

• Try to get the child to walk.
• Test the plantar (Babinski) response.
• Check that the crease of the buttocks looks
  normal.

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D D

• First,
• The child reached all other milestones
  normally and seems on the way of achieving this
  one. Review in one month and if the child can
  walk that is fine. If not, refer.

Maturational lag
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D D

• Second,
• Walking seems to be the only significant
  delay. Referral to a community paediatrician may
  be in order for more detailed assessment.

Motor disorder
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D D

• Third,
• This seems to be part of global developmental
  delay. Refer to a community or general
  paediatrician. The cause of delay may be brain
  damage or unknown.

global developmentaldelay
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D D

• Fourth,
• This would appear to be part of a previously
  undiagnosed syndrome. Refer to a paediatrician
  for full diagnosis or exclusion.

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Causes

• Nutritional
• Protein calorie malnutrition
• Rickets
• Infectious
• Poliomyelitis
• Chromosomal
• Downs syndrome
• Werding Hoffmans disease
• Duchenne muscular dystrophy

• Neurological diseases
• Guillian Barre Syndrome
• Cerebral palsy
• Endocrine
• Cretinism
• Familial delayed walking

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Causes

• Brain
• Immaturity,
• variant of normal, lack initiative,
  
• control movements.

• Environment
• Lack of practice.
• Special Senses
• Interference with perception of the
  environment.

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Baby walkersDelay VS Accidents