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Written by Dr. Katerina Vraka, MD, MRCPCH, Pediatric Neurologist, Associate of the Inter-Balkan Medical Center of Thessaloniki

Walking is one of the most important milestones in a child’s motor development and is often associated with intense parental anxiety. However, each child has his or her own rhythm.

An important goal of the Pediatric Neurologist Specialist is to help parents distinguish when a delay in walking is a normal variation and when specialized testing is needed.

When do we expect the child to walk?

Most children:

• They stand on their feet with help around 8–9 months.
• They stand up and hold on to furniture at 10–12 months.
• They take their first independent steps between 12–15 months.

There are children who may walk a little later (16–18 months) without any pathology. Not only age matters, but also the overall picture of motor and neurological development.

What factors affect walking?

Some common reasons for delayed walking are:

• Premature birth and low birth weight.
• Family history, e.g. parents who walked slowly.
• Child’s temperament, quieter or less mobile.
• Adherence to alternative forms of movement, such as crawling or dragging on the back.
• Previous health problems, hospitalizations or prolonged confinement in a crib/playpen.

In these cases we may see a mild delay, without necessarily being associated with neurological disease.

When should we worry?

We consult a pediatric neurologist when:

• The child does not support himself at all after 10–11 months.
• Does not try to stand up or stand with support after 12 months.
• Does not walk independently after 18 months.
• There is obvious asymmetry in the movement of the arms or legs.
• The child seems “relaxed” (hypotonia) or on the contrary very “tight” (hypertonia).
• It is accompanied by a delay in speech, contact, and reaction to stimuli.

These signs may indicate a neurological disorder, myopathy, or a developmental problem that needs to be investigated.

How is the pediatric neurological evaluation performed?

During the pediatric neurological examination:

• We take a detailed history of pregnancy, childbirth and early development.
• We examine muscle tone, strength, reflexes and posture.
• We evaluate fine and gross motor skills, balance and coordination.
• We also assess developmental milestones (speech, touch, play).

If necessary, additional tests may be requested (blood tests, imaging tests, genetic testing), always on an individual basis.

What can parents do?

Some simple practices that help:

• Give the child time on the floor for safe free play.
• Avoid prolonged use of a walker, which alters normal motor development.
• Encourage movement with toys at the child’s height and gentle support.

The most important thing is not to constantly compare the child with other children and to trust the specialist pediatric neurologist for personalized guidance.

When to make an appointment

If your child has not started walking by 18 months or if you notice any of the worrying signs mentioned, it is advisable to schedule a pediatric neurological evaluation. Early diagnosis allows the initiation of appropriate intervention (physical therapy, occupational therapy, further neurological examination) and significantly improves the prognosis.

In the pediatric neurology clinic, the child’s motor and neurological development is comprehensively evaluated, the parents’ concerns are discussed in detail, and an individualized monitoring and support plan is designed.

If you are concerned that your child is walking slowly, you can seek specialized advice and receive clear answers about his or her development.

Example from clinical practice: Many children who are examined for “slow walking” ultimately fall within the range of the normal variation and simply need monitoring and proper guidance. However, in a small percentage, conditions such as mild cerebral palsy or neuromuscular disorders are identified, where timely intervention can make a substantial difference in the child’s future functionality.

In any case, an evaluation by a specialized pediatric neurologist offers safety, a clear diagnosis, and an organized treatment plan tailored to the needs of your child.