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Toddlers Weeble, Wobble and Fall Down – When Is It Cause for Concern?

Toddlers.  They weeble, they wobble and they fall down.  A lot!  The question is really, how often is too often?  Toddlers are still remarkably unstable and often over-8267455261_5f4b86336b_nconfident.  Two year olds are much more confident with their physical abilities but they don’t have a very good idea about when to stop.  They love to run, swing, climb, and ride on toys they can push with their feet, but they can easily get it wrong so bumps and minor falls are common. The average two-year-old falls 38 times a day.   It will take time before the toddler achieves the skills, strength, balance and rhythm of a secure walker.  In fact, pediatricians say it is normal for toddlers to fall, even on flat ground, until 4 years old.  Toddlers are learning how to coordinate their movements for this new skill of walking.  I like to remind my families that the first time they learned to ski or roller skate they fell a lot too!

In a study of 130 toddlers (12 and 19 months old), the researchers found that the toddlers fell on average 17 times an hour.  If they were new walkers, they fell an average of 69 times an hour.  The toddler’s height and flexibility make short falls relatively harmless.   Thankfully, most bumps require a kiss and maybe even some ice to make the boo-boo better.

There are several other reasons that a toddler can fall:

  1. Toddlers grow at a rapid rate, and shoes that fit one day may not fit the next.  If the toddler’s shoes are too small, he can suddenly start tripping, falling, or having other issues walking or running about.
  2. If a toddler has had a sudden growth spurt, he will need to find a new center of balance.  This might mean more spills as he figures out how to move his new, suddenly taller body.
  3. Most toddlers are farsighted and have trouble judging distances.4  If your toddler seems to constantly “over-step” stairs or misjudges picking up toys, he may need to be seen by an ophthalmologist, as these behaviors may indicate vision concerns.

Here a few ideas you can share with families to help decrease injuries while still allowing the toddler to explore their environment.

  1. Childproof with walking in mind.  Check for sharp corners on counters and coffee tables.  Check for unstable end tables and chairs.  Watch for dangling cords from electronics and blinds.  Keep drawers, doors and appliances closed when the toddler is moving.
  2. Avoid extra-hard surfaces.   Try to avoid surfaces like concrete, brick, tile, slate, and stone floors or hold your toddler’s hand while he walks over these harder surfaces.
  3. Bare feet!  Bare feet are preferred, especially when walking around the home.  If a toddler wears socks use nonslip bottoms.  If using shoes, make sure they fit properly and have good traction.
  4. Try not to overreact.  Avoid rushing to your child and making a big deal every time he falls.  It can make him unnecessarily fearful of falling and can discourage him from exploring.

As early interventionist, what other ways can you encourage families to let their toddlers safely explore their environment?  Have you ever provided a fall log to a family?

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References:

  1. Toddler Health: Bumps, Bruises, & How to Tell if it’s More Serious.  http://smartmomma.com/Toddler/bumps_and_bruises_toddler.htm
  2. Miller D.  (November 1999).  Toddler falls: When should you worry?  http://www.cnn.com/HEALTH/children/9911/10/head.falls.wmd/
  3. Adolph KE, Cole WG, Komati M, Garciaguirre JS, Badaly D, Lingeman JM, Chan G, and Sotsky RB.  n.d. How do you learn to walk? Thousands of steps and dozens of falls per day.  Psychological Science. 1-14.  http://www.psych.nyu.edu/adolph/publications/Adolph%20EtAl%20HowDoYouLearnToWalk.pdf
  4. Clumsiness (Frequent Falls & Bumps).  http://www.whattoexpect.com/toddler/behavior/clumsiness.aspx

This information is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.

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small_kimKim Lephart, PT, DPT, MBA, PCS is a dynamic pediatric physical therapist with nearly 20 years of experience.  She is board certified Pediatric Clinical Specialist.  She is a team player who enjoys the collaborative model of working with parents, teachers, occupational, speech and vision therapists to meet a child’s individual therapeutic needs.  She has worked with children in a variety of clinical settings including private clinics, school systems, home health, outpatient rehabilitation, aquatics, and early intervention programs.  She currently works for Rappahannock Rapidan’s Early Intervention Program.  Of all of Dr. Lephart’s accomplishments both professionally and personally, she is most proud of her four children.  She is a busy mother of children ranging in ages from high schooler to pre-schooler

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8 Comments to “Toddlers Weeble, Wobble and Fall Down – When Is It Cause for Concern?”

  1. Thank you, Kim, for a well written piece with useful statistics and good references for worried parents. I have indeed asked familes to keep a fall log! It is a very good measurement tool! I have also felt fine about devoting a home visit to childproofing, with permission, kindness and tact. Most new parents are grateful for another set of eyes.

  2. Hello Cathie!

    I appreciate your comments! I have found fall logs can be great tools to see if there is a pattern to falls (i.e. early in the morning, just before nap times, etc.) I have also found that the fall logs help families quantify their little one’s falls to see if they are close to the norm or truly are falling more than the average toddler.
    I think having more eyes to help child-proof a home is a great idea!
    Do you have many families concerned about the amount of falling their child does? Or have you seen an increase in the number of families concerned about toddlers falling?
    Thanks again for your comments!
    Kim

  3. These are great suggestions, Kim! I really like how you addressed having the child walk in bare feet. I’ve seen many families feel like their toddlers should be wearing shoes all the time, especially in the colder months. A PT I used to work with would recommend buying the most flexible shoes possible, which tended to be from stores like Target or Payless rather than more expensive stores like Striderite. She used to show families how the sole of the shoe should bend and be flexible, rather than stiff. I thought that having flexible shoes was a great tip for when the child couldn’t be in bare feet.

  4. Great suggestion to use flexible soled shoes!

    I also have families who insist on having their kiddos wear just socks, especially when it’s cold out. I encourage the families to have their kiddo wear either flexible soled shoes or socks that have those grippy bottoms so the kiddos have traction and are less likely to slip.

    Thank you for sharing Dana!
    Kim

  5. Thanks Kim for your great suggestions.

    Still, could you recommend us the documents to back up this line “The toddler’s height and flexibility make short falls relatively harmless”. Because the above study http://www.psych.nyu.edu/adolph/publications/Adolph%20EtAl%20HowDoYouLearnToWalk.pdf won’t clearly say that.

    Thanks Kim.

    N

  6. Hello Nguyen!

    I’m glad you found the suggestions helpful. You asked a great question. Here are a few references that answer your query:

    “Overall, the risk of severe or life-threatening injury in short-distance household falls is low.” P.iv
    “Serious injuries resulting from pediatric short household falls are rare. Less than 3% of the cases seen in this study were classified as a serious injury (MAIS 3), and no severe or life-threatening injuries were seen. Seventy-six percent (76%) of the cases in this study had no injuries or only minor injuries.” P.51
    “Children with moderate or serious injuries tended to have fallen from greater heights, had greater impact velocities, and had a lower BMI than those with minor or no injuries. “ p. 57
    “The extra soft tissue in children with higher BMI values likely has a cushioning or protective effect.” P.148
    Thompson, Angela Knight, “Biomechanics and injury assessment of household falls in children : clinical, anthropomorphic surrogate, and computer simulation studies.” (2011). Electronic Theses and Dissertations. Paper 1435.
    http://dx.doi.org/10.18297/etd/1435

    “…tendency of toddlers to fall less and less with months of walking experience.”
    Bisi M, Riva F, Stagni R. Measures of Gait Stability: Performance on Adults and Toddlers at the Beginning of Independent Walking. Journal of Neuroengineering & Rehab. 2014 (11):131
    DOI: 10.1186/1743-0003-11-131

    “Whether your child is an active athlete or just a toddler jumping on the bed, there’s a good possibility that he or she will take a spill at home or on the field or court at some time. These falls are usually harmless…”
    http://www.rushortho.com/ot_arm.cfm;

    “…falling down is a fact of life for new walkers. Sometimes these falls happen headfirst, which can be scary for both child and parent. Fortunately, most head bangs are minor…”
    Miller D. Toddler falls: when should you worry? 1999. http://www.CNN.com
    http://www.cnn.com/HEALTH/children/9911/10/head.falls.wmd/index.html?_s=PM:HEALTH

    “Most falls are not serious. Kids are very resilient. Most falls seem worse than they really are, and usually do not require a call to your doctor or a trip to the ER.”
    http://www.askdrsears.com/topics/health-concerns/childhood-illnesses/fallsrolls-and-bumps

    I hope that helps!
    Kim

  7. My 14 month old started walking 2-3 steps 2 months ago, but is still only at 2-3 steps. I know it is normal to start walking later, but is it normal for progression to be this slow?

    • Hello Tracy!

      Thank you for sharing your concern. Without knowing your kiddo and their specifics it’s difficult to say if it’s normal for them or not. Clinically I have found that whatever they did with crawling they will do with walking. For instance, if it took a kiddo a long time to get crawling down, they typically have a long time getting walking down. If they quickly learned how to crawl, I find that they quickly learn how to walk too. If it took your kiddo a while to learn how to crawl proficiently, then it may be typical for them to progress with walking at a slower pace too. However, if your Mommy instincts are telling you that something’s not quite right, then talk to your pediatrician about your concerns. Your local early intervention program is also a great resource.
      I hope to hear your toddler is up and walking very soon!
      Kim

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