Learning to walk is no small task, and parents often have questions along the way. Should my toddler be walking by now? Should my toddler be falling this much? And should my toddler be walking on his toes? Most of the time, the answers are yes, yes, and yes. But for some children, toe walking does signal a problem. Fortunately, because children visit their pediatrician frequently during the first two years, it is absolutely appropriate to bring up these concerns. Let me fill in some details.

Most children begin walking around their first birthday. Some children who are born with low muscle tone may take longer to perform activities that require strength. In rare cases, a child has an inherited condition affecting the muscles or nervous system, which can lead to delays in gross motor milestones, including walking. Pediatricians use developmental checklists that usually identify these delays early.

Toe walking is often simply an intermediate stage of learning to walk and typically resolves by age two. If your toddler walks and the heels never touch the ground, that is toe walking. While some children without any identifiable condition may still toe walk at age five, it becomes more likely that a developmental delay is present.

You can do a simple check at home: ask your child to stand flat-footed. If he cannot walk heel-first, frequently falls, has pain in the heel area, or struggles to flex his foot upward to stretch the Achilles tendon—which connects the calf to the heel—an evaluation is recommended.

What developmental disorders are linked to toe walking? The most common are tight heel cords and cerebral palsy. Some muscle and nervous system disorders, such as muscular dystrophy, may also be involved. And — for reasons still unknown — many children with autism walk on their toes.

Treatment of toe walking may require an evaluation by a specialist and sessions with a physical therapist. Some children may temporarily need braces. But there are several home-based treatments you can try that are safe and effective. You can encourage heel-then-toe walking along a line, walking up a slight incline, squatting, and “bear walking” — walking on hands and feet with knees off the ground and heels touching. You should make these activities fun to encourage your child’s progress. Gentle daily calf stretches are helpful, too. Finally, hold your child’s hand as you both walk backward.

Remember, early toe walking is not abnormal. And we are fortunate to have the opportunity to get expert opinions and advice from our medical community if toe walking persists.

Robert B. Golenbock, MD, is currently retired. He has cared for children in the Danbury area for 43 years, including at the Center for Pediatric Medicine. The CPM is located at 107 Newtown Rd., #1D, Danbury, CT 06810. For more information, call (203) 790-0822 or visit https://centerforpediatricmedct.com.