Is It Okay For My Little One To Walk On Their Knees?
“Is occasional knee walking after learning to walk okay? ”
In most cases, YES, knee walking can be totally normal and a part of the pre-walking progression! In fact, it can actually be a great strengthening activity I even pull into therapy sessions at times!
But let’s talk about it….because you may be wondering what even IS knee walking? When is it ok to see? When does it become a concern? What can we do to help?
If you’re looking for knee walking answers, you’re in the right place!
First - what is knee walking?
Knee walking refers to a movement pattern where a child ‘walks’ through their environment while remaining in a tall kneeling position - aka, their bottom NOT resting on their heels.
Before we dig into more on knee walking, let’s quickly review average expected timelines of upright skills leading into independent walking.
A QUICK NOTE BEFORE YOU READ ON:
When looking at the expected average timelines for the skills listed below, please remember development is a range for a reason! Some children may master the skill sooner than average, some may be a bit later than average, some may need support to get there, and some may never do the skill in the ‘expected’ way. My hope is to empower you with the information you need to understand your child’s development, including what to expect, when to expect it, how to confidently support each stage, AND when to advocate for more support for your little one. As always, if you have ANY concerns about your child’s development, please be sure to bring them to your pediatrician or care team for further assessment!
Average Ranges for Pre-Walking & Walking Skills:
Pulling to stand with hand support: 9-10 months
Cruising along furniture with hand support: 10-11 months
Beginning to let go with one/both hands, transition between two items in standing (letting go briefly): 11-12 months
Taking steps with hand support or other external support (for example: using a pushwalker they stand behind *not referring to a sit in walker with wheels, which I actually do not recommend if you can avoid them, more on that HERE.
Independent Walking: 12-18 months
A note: As a pediatric physical therapist, I prefer the 16 month mark as the time to begin discussing a possible referral with your pediatrician for an individualized physical therapy evaluation IF your child is not progressing through the above pre-walking skills, which are strong signs walking is right on the horizon!
Now, back to knee walking!
Why do some children do knee walk and not others?
While we know milestones and ‘average’ ranges for acquisition of them follow a fairly predictable sequence, with the earlier ministones and milestones occurring in a specific way that lays a strong foundation for the next, higher level milestones to occur - the reality is, every child is unique and will have their own unique journey through milestones. Slight variations in ‘ministones’ and/or mastering skills on the earlier side or towards the later side absolutely happen, and many times they aren’t a major concern.
When it comes to pre-walking skills, knee walking is definitely one of those more common variations we can see. Where the typical progression from crawling to walking includes: crawling —> pulling to stand —> cruising along furniture with hand support —> beginning to explore letting to with one/both hands, assisted step taking, balance exploration —> walking, some children begin exploring knee walking thrown in BEFORE learning to walk independently.
In my opinion, when knee walking is NOT falling into the ‘concerning’ category (more on that below), there are generally 2 main reasons why it’s happening:
First, for stability! As compared to walking on feet, knee walking is a much more stable position. Not only are you lower to the ground when on knees, you’re also taking the lower leg & feet (which have LOTS of joints & muscles!!) out of the equation, which allows more stability & reliance on larger, stronger muscles & joints for support. Often times, when children are knee walking while working through the pre-walking ‘ministones’, they’re focusing in on targeting hip & bottom strengthening in a more isolated way, which often translates into more stability once standing on feet.
Second, when learning independent transitions into standing! Knee walking can also often be seen for little ones who have not yet mastered the ability to pull themselves into standing with hand support, and/or who are not yet able to transition into standing without hands yet. In this case, they will often knee walk towards a support surface for their hands when they’re attempting to rise onto feet.
In both of those situations, knee walking is NOT the primary or only way they are able to get around AND they’ll continue to demonstrate progression/ practicing of their pre-walking skills outlined above. If this sounds consistent with your little one, My top two tips that will help support the transition away from knee walking are outlined below - and there is TONS more in my Mastering Walking Milestone Class! Within the Walking Class, I lay out EVERYTHING in my expertise as a pediatric physical therapist with nearly 10 years of experience AND mom of 3 that gets it - including easy to implement daily activities, exercises, play space set ups, tips, tricks & so much more for every single stage of pre-walking through crawling, pulling to stand, cruising, and right up through those precious first steps (and beyond!). Check it out HERE!
We’ve covered when it’s NOT a concern, but when IS knee walking something to be concerned about?
*While the information below is not an exhaustive list, if you are seeing knee walking in conjunction with anything outlined below, I recommend discussing with your child’s pediatrician whether a potential physical therapy referral may be appropriate, as physical therapists will be able to fully evaluate and treat any individual musculoskeletal or sensori-motor concerns that may be contributing to persistent knee walking.
When SHOULD we be keeping a close eye on knee walking?
As discussed above, knee walking is often NOT a major concern, acting as a normal variation in pre-walking ‘ministone’ development. However, there ARE times where it warrants further investigation, especially when present in conjunction with other concerns. This is because knee walking naturally puts the lower back into more of a lordotic position, which can change the way muscles fire, impact finding balance once in standing, put undue strain on the low back and hips, and can reduce abdominal (core) muscle activation (think - like when toddlers have that little protruding belly until those core muscles get really strong!). In my opinion, If you’re seeing your child relying on knee walking more than 50-60% of the time, NOT making consistent progress through pre-walking skills, NOT willing/demonstrating practice of pre-walking skills each day OR in conjunction with any of the following, it’s worth keeping a close eye on.
When general low or high muscle tone is present
When too little (hypomobility) OR excessive range of motion (hypermobility) is seen at joints
When joint instability is present - especially through the knees, ankle & feet, as knee walking takes those joints out of the equation, providing added stability.
When moderate to severe flattening of the inner arch of the foot is present. *The arches of the feet are not fully developed until 6+ years of age, and appearing ‘flat footed’ during that time in development is *often* within normal limits, however, if a child’s foot alignment is significantly outside of ‘normal’, it can contribute to delays in upright skills and walking, potentially resulting in persistent knee walking as a means of moving through their environment.
When there is a history of ear infections, fluid in the ears, or vestibular/sensory concerns. Our vestibular system, located primarily within the inner ear, aids in maintaining balance, maintaining an upright position against gravity, understanding where our head is in space, and so much more. It is influenced greatly by fluid within the inner AND head position, making it common to see children with chronic ear infections or excess fluid within their ears to be resistant to movement in general, but especially movement that involves the head AND that brings them further from the floor (ie: walking on feet!). If you can imagine feeling unstable in standing on your feet as a NORMAL part of the learning to walk process, you can likely imagine adding in atypical vestibular system functioning could contribute to wanting to remain in a more stable position lower to the ground - ie: knee walking! *If you’re seeing knee walking AFTER a child begins walking independently - I always recommend having your pediatrician check out their ears, just to be sure!
For more about the connection between chronic ear infections/fluid & motor skill development, check this blog out.
Though there is not currently very strong evidence to support theories around retained primitive reflexes and the potential impact on milestone acquisition, anecdotally, many of the exercises and activities used to address possibly retained reflexes are not harmful and in general, have benefits to strength, coordination & mobility. Related to persistent knee walking, there is one reflex that is thought to potentially contribute if retained, known as the tonic labyrinthine reflex (TLR). This reflex is present at birth and aids in passage through the birth canal. It should be fully integrated (no longer present) by 2-3 years of age. Once born, the TLR reflex helps to support the development of functional movement patterns, first by creating automatic patterns of movement that are then taken over by voluntary, intentional movements. Specific to persistent knee (or toe!) walking, some believe addressing the TLR in extension can be helpful. Typically, a pediatric occupational therapist is most experienced in evaluating and addressing any potential retained primitive reflex concerns, though other professionals including physical therapists may have experience as well.
How to Encourage The Transition From Knee Walking To Independent Walking
Now that we’ve got the WHEN & WHY covered, let’s talk about HOW! If they are seeming ‘stuck’ in the progression above from pre-walking to those independent steps here are two of my top tips for intervening - and remember, for TONS more, be sure to check out my Mastering Walking class!
First & foremost - This is where environment set up is HUGE! ...Are you sick of hearing me say that yet?! 😂
But seriously - oftentimes when knee walking becomes a preferred mode of getting around, it’s because they are QUICK…which means they get where they want, when they want and that is MOTIVATING! So, our goal is to tap into that motivation in another, strategic way - namely by using things they LOVE and intentionally setting up their play space using those things. For knee walkers, the key to environment set up is to raise EVERYTHING YOU CAN onto higher surfaces, the more motivating the item is, the better! Think - place those motivating toys onto the couch, a bench, even a diaper box flipped on the side works!
We want everything off the floor and in places they can still get to (because remember, success drives motivation!) BUT that they have to rise into standing and/or work through those pre-walking skills above in order to get to!
It’s a small but mighty hack, and I promise, once implemented - you’ll start to see changes SO soon.
Second - ALL THE CLIMBING. For pre-walkers AND post-walkers, climbing has SO many benefits. And when it comes to knee walking, that is no different! Climbing allows them to gain sensory input to the feet, encourages weight bearing through their full legs, provides opportunity for strengthening, gentle stretching, motor planning, and so much more. You can’t miss with climbing play, especially when it comes to knee walkers!
Again, for LOTS more on supporting steps, don’t forget to check out my Mastering Walking Class, where I lay out EVERYTHING for you from my expertise as a pediatric physical therapist with nearly 10 years of experience AND mom of 3 that gets it - including easy to implement daily activities, exercises, play space set ups, tips, tricks & so much more for every single stage of pre-walking through crawling, pulling to stand, cruising, and right up through those precious first steps (and beyond!). Check it out HERE!
And if you’re looking for some seriously awesome toys that are not only FUN but also foster development and pre-walking through walking skills, check out my ‘Encouraging Walking Faves’ list here.
Hope this helps!
Looking for More Milestone Support?
Learn how milestones that are mastered before independent standing work to lay a strong foundation for walking, and when to expect pre-walking milestones & simple tips to encourage walking. You will also get quick tips for encouraging getting in/out of standing independently and encouraging balance & letting go in standing!
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