Early signs of autism are not universal as each child is a unique individual, but there are some behaviors that can signal parents to pay more attention to their child's development. While it doesn't always mean a child will be diagnosed with autism, toe-walking has been linked to language delays and autism for decades.
Is It Normal?
It is completely normal for children up to age two or three to walk on their tiptoes. Beyond this age, you should discuss toe-walking with your child's regular doctor to ensure there aren't other physical or developmental concerns. Dr. Thomas Lock, developmental pediatrician at Riley Children's Health says: "Some people with toe-walking will have autism. Some people with autism will not have toe-walking." That's why it's important to evaluate your child's total behavior before jumping to conclusions.
Kids who tiptoe could do so for a variety of reasons. If your child is able to vocalize why he or she is walking this way, it could be helpful in finding the cause. But, for many autistic children, it can be difficult to communicate the reasoning.
Toe-walking is associated with a lot of different developmental disorders, from cerebral palsy to muscular dystrophy, neurological disorders, autism, and ADHD. In some cases children may toe walk because of a short achilles tendon. Studies of kids with autism say that somewhere around a third of the kids walk on their toes. On the other hand, if you look at cases of extreme toe-walking, the children had a wide variety of disorders.
Sensory, motor, and processing all contribute to the behavior of toe-walking. Studies show toe-walking happens less on soft surfaces than on hard surfaces. Some kids may also tiptoe because a floor is too cold. In typical kids, the texture or temperature of what you're walking on is important. For kids with autism, those things are accentuated.
When to Be Concerned
Parents should be concerned when there are other problems along with the toe-walking that interfere with normal two or three-year-old behaviors. Ask yourself:
- Is my child having problems in other areas of life?
- What other behavioral concerns does your child exhibit beyond the toe-walking?
- Do these behaviors negatively impact my child's daily life?
Physical Development Is Impacted
When you can already see the behavior impacting your child's mobility and physical activity, it is cause for concern in the short and long-term. Toe-walking can lead to:
- Loss in range of motion in the ankles
- Decreased endurance for walking
- Postural issues
- Adult back pain
It Distracts From a Larger Concern
If you have toe-walking associated with another disorder, then missing out on getting that disorder getting treated is the bigger worry. Toe-walking can be the tip of an iceberg because it's easy to see. But, what's more important is the part of the iceberg that's under the surface. For some kids, it may autism, for other kids, it may be cerebral palsy or another disorder - and those concerns need to be addressed as a whole.
What Parents Can Do
You are your child's biggest resource and they depend on you for almost everything at this age. While you may not be able to correct the behavior or manage all your child's issues on your own, knowing when and where to get help can make all the difference.
Objectively Evaluate the Behavior
Take an honest look at your child's behavior over the course of a day and even a week. Document what you see so you'll remember and be able to accurately communicate the concern to your child's doctor.
- Is he/ she toe-walking most of the time?
- Is the toe-walking itself interfering with mobility (walking and climbing)?
- What other areas in life is he/she struggling with (behavior, communications, physical well-being)?
Consult Your Child's Doctor
Dr. Lock shares, "I can't say this enough, start with an appointment with the child's primary care physician." If you are seeing toe-walking, you need to consider all the other issues that can accompany it. Your primary care physician can help you work through whether the behavior is part of a larger concern, where and how you can find appropriate resources, and what you can do at home to help your child.
Address the Cause
If the child is truly autistic, parents need to address the autism. Your doctor could refer your child to an autism specialist if they believe that is the cause. If the toe-walking is significant, you might also be referred to a physical therapist.
Be Proactive About Your Child's Health
Parents are the best resource and advocates when it comes to their child's health and development. While you want to be careful of over-reacting, catching concerns while your child is young can have a big impact on their future development.