The Wellness Roundup With Dr. Jill

Dr. Ruchi Mehta from All Star Pediatrics and Dr. Garripoli Pedalino from Healthy Kids Pediatrics Discuss Best Practices for their Practices

Dr. Jill Garripoli Pedalino, owner of Healthy Kids Pediatrics, along with HKP’s CEO, Marcello Pedalino, had a lovely brunch this morning with their friends from All Star Pediatrics and Sports Medicine.

Special thanks to Dr. Mehta and her awesome office manager, Arrika Noel, for their delightful hospitality and conversation at the Glen Ridge Country Club.

It’s always nice to network and team up with other exceptional practices from the area.

Thanks again and continued success!

-HKP 🙂

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Keeping Caregivers on Their Toes: Toe Walking in the Infant and Toddler

At Healthy Kids Pediatrics, we recently implemented the CHADIS program into our routine well visits. CHADIS (Child Health And Development Interactive System) questionnaires assess the development of our patients at the appropriate stages of growth. The results alert us to potential concerns whether they are physical (like gross or fine motor) or cognitive (like problem solving, communication, or personal-social). One of the biggest surprises is when parents tell me that after they had their child perform the activities on the questionnaire, they didn’t know their child could do so much on his or her own! However, one of the most frequent concerns of parents of infants and toddlers is that they answered “yes” to the toe walking question, but what does that mean and is there a problem with my child?  Toe walking, or walking on the balls of one’s feet, can be a source of anxiety for parents, especially when family members or friends say, “Isn’t that usually a sign of autism or some kind of neurologic problem?”. Let’s shed some light on toe walking and you will notice that it is quite common!

Walking is a huge developmental milestone for children.  It brings families a sense of pride and excitement (and often panic that the child is now mobile!), so when it doesn’t go exactly as expected it can make parents wonder if there is something wrong.  Common issues include toe walking, one foot turned in or out, and delayed independent walking. Since early walkers are trying different foot positions, toe walking may be one of these issues. By 2 years old, feet are usually flat and by 3 years old most children walk with a heel-toe pattern. Most children begin walking between 12 and 15 months old.  In some cases of idiopathic (without a known cause) toe walking, the child will not outgrow this behavior until 5 years old, so it can seem like a long time that they are walking on their toes.

Toe walking beyond the toddler years has been shown to be mostly out of habit and there may be a family member or two who are or have been toe walkers themselves. The prevalence of toe walking is unknown so there is no hard data on how common it really is. However, as long as your child is otherwise growing and developing normally there is no reason to worry that toe walking means anything serious. A Swedish study evaluated over 1400 children and found that by 5 years old more than half of the children spontaneously stopped toe walking and most of the children had absolutely no developmental or neuropsychiatric problems.

Toe walking, however, can be a sign of something else going on either musculoskeletally or neurologically. The signs that warrant further evaluation include not walking independently until after 18 months old, a complicated birth history or significant family history, toe walking on only one foot, and simultaneous abnormalities of the upper limbs. Other red flags include muscle stiffness, inability or refusal to bear weight or step on the foot when flat, loss of skills already achieved, late toe walking out of the blue, hyperactivity, autistic features like avoiding eye contact, spinning, and rocking, and very awkward walking, constant stumbling, and lack of coordination.  (Keep in mind that it is normal and expected in the first 6 months of walking to constantly stumble and lack coordination!) Toe walking in these situations could possibly be an indication of cerebral palsy, spinal cord problems, muscular dystrophy, peripheral neuropathies, autism, or ADHD.  There is also the possibility that a child could have a severe case of “foot equines” which is a tightness of the Achilles tendon that prevents the heel from touching the ground. While most children will outgrow their toe walking behavior, physical therapy and stretching can help the chronic toe walker. In cases of neuromuscular disorders, surgery and botox injections help relieve tendon stiffness in older children. Foot specialists like pediatric orthopedic surgeons as well as podiatrists are often consulted in these cases.

We all want our children to advance through their milestones easily and naturally and there will be plenty of times when variations in milestone achievement will cause us anxiety and worry. That’s why it is important to keep the lines of communication open and express your concerns since you are the expert on your own baby. Reassurance may be all that is required, but early detection and intervention will help give all our children the best chance at a full and productive life! Happy Spring!

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