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  • Toddlers Weeble, Wobble and Fall Down – When Is It Cause for Concern?(current)

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-Man Helping Toddler Walkconfident.  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?


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 (PDF, New Window)
  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.


Kim SmilingKim 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

33 comments on “Toddlers Weeble, Wobble and Fall Down – When Is It Cause for Concern?

  • Cathie Cummins says:

    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.

    Reply
  • Kim says:

    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

    Reply
  • 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.

    Reply
  • Kim says:

    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

    Reply
  • nguyen says:

    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

    Reply
  • Kim says:

    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

    Reply
  • Tracy says:

    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?

    Reply
    • Kim Lephart says:

      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

      Reply
  • riva says:

    My 1 yr old fell from her swing yesturday and got hurt on her chest and coughed 2 ,3 times
    Is it something of a concern?

    Reply
  • Patty says:

    Our 30 month old grandson, just gout of his Potty seat and collapsed. Then @ one hour later he was standing and again collapsed and again @30 minutes later. What do think is going on?

    Reply
    • Hi Patty,
      It’s always hard to give advice without seeing a child in-person. The author of this post is out of town but she and I have touched base. What you describe does not sound like typical walking and falling, so we both recommend checking with your grandson’s pediatrician/primary care physician to discuss your observations and have the doctor assess your grandson’s falling. It’s always best to err on the side of caution when you observe something that worries you in a toddler. I hope everything is well with your grandson.

      Dana

      Reply
  • Jose says:

    Is there a reason why a toddler will keep falling after a sleep esp in the morning?

    Reply
    • Thanks for the question, Jose. The most likely reason I can think of is the child is still drowsy and is slow to wake up. If the child keeps falling after waking up from sleeping, I’d recommend that you (or the parent) bring it up at next pediatrician visit. Anytime you see a change in behavior like that, it’s a good idea to check with the doctor just to make sure everything is okay. Hope this helps.

      Reply
  • […] and falling down. That’s how it looks like for a toddler. The average two-year-old falls 38 times a day. However, the most important thing is to learn to get up and start running […]

    Reply
  • Shruthi says:

    Hi,
    My son had a fall a month ago and got 3 stitches on his forehead . The problem us he still running, jumping and climbing in every possible way .. I am trying to keep him busy with his toys and other things but all he wants to do is run around and jump … And he is very fast and very active .. I am getting paranoid as I can’t see him fall again .. it’s just been too much to handle.. please suggest what can be done … I have tried to calmly explain him that he might hurt himself running around but he still does all the stunts .. please help…

    Reply
    • I’m sorry to hear about your son’s fall, Shruthi. I can “hear” the worry in the words you wrote. It is so hard to keep a toddler calm and still – it’s just not really in their nature. It sounds like you’re doing what would be recommended – consistent supervision, distraction with toys and activities that don’t encourage climbing, etc. Since it sounds like your son really loves all of that movement (which is perfectly okay), one idea would be to create a safe space for climbing, like piling sofa cushions and pillows and perhaps making a soft obstacle course for him to climb over, under, and around. You would still need to supervise but he could exert his energy in a safe area. Be sure your home is child-proofed too. I once worked with a family who had an amazing climber and for a while, they had to turn book cases to face the wall, remove the coffee table, etc. That’s a more extreme example, but looking around your home and identifying anything you can child proof is always a good idea. Even with all of this, falls will happen so hang in there. 🙂

      Reply
  • Samantha says:

    Do toddlers ever fall intentionally because they think it is a kind of fun? Or attention-seeking? This is normal?

    Reply
  • Krystle says:

    I know I’m late to this but my baby girl has been walking for 2 months; possibly 2.5 months. Anyways she’s 13 months and she’s still very clumsy.
    We refer to her as a drunk baby.
    She’s suppose to be seen by a behavioral specialist but not for her walking. I’ve asked her doc about it but she doesn’t seem concerned.
    She said once she’s evaluated for possible autism and they think she doesn’t have it then she wants to have her seen by a neurologist.
    I haven’t put any shoes on her yet. She walks around in socks. I don’t feel she’s ready for shoes quite yet.

    Reply
    • Shoshana Rosen says:

      Hey my son who is 16 months and walking for 3 months lately had trouble balancing and of course it’s worrying me up the wall. What end up happening with your daughter

      Reply
  • Kim says:

    Krystle!
    Thank you for taking the time to reach out! I know what you mean!  Sometimes those little ones appear like they are looking for their “land legs” after being out to sea for awhile!  lol

    While it is normal for new walkers (even those who have been walking for a few months) to fall frequently, it sounds like you have concerns about your daughter’s walking.  I’m glad that you are connected to several specialists who will help determine if there is something else going on with your daughter’s walking; they will be a good resource for you.  In the meantime, I love having infants walk barefooted (instead of in slippery socks).  It helps them build up those arches in their feet!  You could also try having your daughter wear high top shoes.  Sometimes, having kiddos wear high top shoes gives them a little more support that they need and they may fall less.  I hope your little one finds her steady “land legs” soon! 
    Thanks for your comments!
    Kim

    Reply
  • […] achieve success, we must become resilient. An average two-year-old toddler falls 38 times per day. Knowing this, should we encourage kids not to take the risk of walking because they will fall? Of […]

    Reply
  • FA says:

    Would you be able to direct me to the source for the statement “The average two-year-old falls 38 times a day.”? I am very interested in references for this information. Thank you!

    Reply
  • Katherine says:

    My baby is 12 months old and seems to have a fear of falling. He has been pulling himself up to stand since 7 months but will only get down onto his knees, always very carefully. He appears to be scared to fall down on his bottom unless holding our hands. Is this normal behaviour? He has been cruising for months too.

    Reply
    • Hi Katherine – thanks for reaching out! Here is some guidance from Kim, the author of this post:

      It sounds like your little guy may be cautious. There are several reasons why a toddler is cautious. It could be it’s just part of their personality to be a little more cautious. It could be that they had a bad tumble and it scared them, so they learned to be a bit more cautious. Or it could be that they are gravitationally insecure. A child that struggles with gravitational insecurity is fearful and anxious about normal movement. They are uncomfortable in a position that is not upright and anxiety sets in when their feet are off the ground. A child that is gravitationally insecure would not like to fall on their bottom to get out of standing or cruising along furniture. The good news is that developmentally, it is more advanced when a child lowers themself to the floor instead of plopping to the floor.

      If you have concerns about your child, you may want to discuss it with your physician and see if a referral to an early intervention program is appropriate.

      We wish you and your baby all the best!

      Reply
  • Praveen Kumar says:

    Hello, Hope you are doing well.
    My kid is 14 months old now. He started walking when he was 11 months.
    Since 2 days while walking he is lifting right toes, not sure if he have hurtled or something. While he was slow it looks OK but if waking up fast or running toes are lifted up. He is doing lot of tumbling these days. Bit worried, can please let me know is it something serious to worry about?
    Sorry I have reported because above one was not fully written.
    Thanks.

    Reply
    • Hello Praveen! Here is the reply from Kim, the author of this post:
      Thank you for reaching out. I’m not sure I understand exactly what your son is doing with his toes. It sounds like he may be going up on his toes when he walks fast? Kiddos go up on their toes for so many reasons. It could be that he just discovered that this is a new skill and he’s playing with his balance when he walks on his toes. It could be that he did hurt his foot so he’s going up on his toes to compensate. The best advice I can give, especially not knowing your son or seeing exactly what he’s doing, is to speak to his pediatrician about your concerns. I hope your concerns for your son are addressed soon.
      Kim

      Reply
  • Praveen Kumar says:

    Thanks your replay, its other way i.e he is walking on foot and not using his toe. Because of which he is not getting balance.

    Reply
    • Thanks for the clarification. Since it’s hard to really address your concern without seeing your son, we’d still recommend that you talk to your pediatrician. We wish you and hand your son all the best!

      Reply
  • […] one of our earliest encounters with failure. In a study of 130 toddlers, researchers found that these brave adventures fell about 69 times an hour. […]

    Reply
  • Nat Ask says:

    Hello,
    I hope you are well? My daughter is currently 17 months old, she isn’t my first child. When I say she falls ALL the time, I genuinely mean she falls all the time. My other children used to fall, but this seems different if that makes sense.
    We try to keep her as bare foot as possible as we find it’s the best way to help her walk. She’s been walking since she was 10 months and 3 weeks old. When she wears shoes with every 2-3 steps she’s face planting the floor, it not that she’s tripping over, from observing her, it’s like one of her legs give way and she topples down. It’s hard to explain in writing, in all honesty. It’s genuinely like she’s off balanced all the time.
    When she walks, shes all over the place, genuinely like your Aunt Carol at Christmas after having one to many whiskeys. Any steps no matter the size, how long they’ve been there, you can guarantee she will fall over them. We have a small step in our kitchen and she will constantly fall over it, despite knowing it’s there. She’s had her eyes tested because we thought potentially there must be something wrong with her vision, not seeing steps, or when she does register a step, she either under/over steps for it and looses her balance on both instances. But her eye sight has come back ok, she’s still under for her eyes as she has a squint, but vision is perfect.
    If she’s stood still- not holding on to anything, for a while 5-10 minutes, again she will drop to the floor.
    When we are out and about she can’t walk very far with out becoming extremely tired and worn out and even more wobbly and off balanced that usual. She still can’t do anything with a slight incline and stairs are a big no. When she walks, one leg seems to not move aswell and her feet and inwards turned. She still has 2 naps a day and goes to bed at 7pm sleeping straight through to 7am. Do you think I have a right to be concerned and now’s the time to get her checked over by a paediatrician?

    Reply
    • Lisa Terry says:

      I think as a parent you always want to trust your gut. It sounds like there is a lot of concerns you have about your daughter’s gross motor skills. I would recommend contacting your local early intervention program. As a parent, you can start the referral process without a referral from the pediatrician. Please feel free to email info@veipd.org if you have trouble finding your local system. We can help connect you.

      Reply

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