Tiptoeing - do I worry?

amother

Mon, Jul 23 2012, 12:35 am

DD (19 months) has been walking on tiptoes a lot over the last few days. Not always, but a lot. I never noticed her doing this before. I don't think it's a shoe problem because the first couple of days it started she was barely wearing shoes - it's summer, we're home mostly, she's been going barefoot at home and mostly in crocs to the park and such.

I don't want to be alarmist, I guess I'm a little hypervigilant over my special little girl, but I worry a little... I know this is something common to kids with Asperger's and autism... B"H she's had excellent development in all areas so far but hearing stories about regression freaks me out so when I see things like this I don't know what to think (she's also been lining things up... but she also plays functionally so I guess that's just regular toddler arranging her toys? But part of me wants her to stop it!)

Anon because I'm kind of embarrassed about my paranoia. Really I'm so rational and I am in the field myself so I know very well about signs of disorder vs. normal development, and I feel so sheepish that that isn't enough to stop me from panicking over some tiptoeing! But I guess despite all my textbook learning and experience with more clearly impaired people, I don't really know so much about shticks and funny things that regular babies do. Is it normal for a kid this age to prance around on tiptoes a majority of the time for about 4 days straight?! Suddenly out of the blue? Should I wait and see if it's a passing shtick or what?

amother

Mon, Jul 23 2012, 1:55 am

Ironically, your comment about how it cannot be the shoes because she's barefoot is what made me think that it sounds developmental. Around 18 months children learn to walk more on tiptoes, and the favorite place to practice is on wooden or tile floor. Not only is it a nice, clean, flat surface, but there are lines to practice stepping over.

My other thoughts are:
1) Do you wear heels? She might be imitating mommy
2) Crocs are not always supportive enough for playing at the park. She might need better supportive gym shoes

That being said, if she's not back on her 'flat foot' in the next few days, contact your pediatrician. It's possible she: 1) pulled a calf muscle, 2) has a mild form of CP 3) has a sensory processing issue

amother

Mon, Jul 23 2012, 2:07 am

Thanks for the analysis, amother. Sounds like you know a lot about this stuff!

We're carpeted mostly, but I haven't paid enough attention to notice whether she's doing it more or less on the carpet vs tile floors. Will look more closely tomorrow.

I never wear heels, and nobody else close to DD does either.

Interesting point about crocs not being supportive. I put them on her because the sprinkler is on all the time these days and I don't want her getting her shoes soaked. Also because it is definitely time to get her feet re-measured and probably get new/bigger shoes anyway, so just in case hers are too small (and because it's hot, and because I'm too lazy to chase after her with socks and shoes every morning...) I've been letting her go barefoot or in crocs.

Mild CP?! With no other CP symptoms in a year and a half? Confused

Is there any way to know if she pulled a muscle besides going to the pediatrician?

Sensory processing issues definitely come to mind because we have a little family history of that (unless it's so commonly diagnosed these days that every kid has cousins with something?) So it worries me and I would definitely want to nip it in the bud but I highly doubt she would qualify for therapy just for tiptoeing. She has some other slight sensory habits but nothing dramatic at all. She's B"H bli ayin hara so normal and well adjusted generally - she knows when she's dirty but doesn't freak out about it, has no strange eating habits, plays normally with play dough and other sensory types of things, doesn't like getting water in her face while hairwashing but nobody does... a little shy about things like water sprinklers but gets over it in a normal enough timeframe. Same for other playground equipment, took a little time to warm up to it but now climbs and plays on everything totally normally as far as I can tell. So whatever sensory self-stimulating she does is enough to worry me but probably not enough to get her any help.

amother

Mon, Jul 23 2012, 8:36 am

Amother again,
CP is not a progressive disorder. It is possible to have walking on tiptoes as the only symptom, but it isn't incredibly likely. I would be more suspicious if she never walked properly rather than suspecting it in a child that started walking strangely in the last four days.

Toddlers thrive on routine. Lining up toys and playing them in order is a routine. Not only that but toddlers frequently exhibit OCD-like behavior. The key here is that it is temporary. All of these things should go away. However, if you are seeing other things that make you suspicious, speak with your pediatrician.

With regards to a processing disorder, in all honesty, everyone has sensory quirks. I need my cup of coffee in the morning in order to function. DH hates the taste of coffee and insists on a mug of caffeine free tea. I love control top panty hose. My sister hates them. I love long sleeves. My mother will only wear 3/4 length. I hate wearing sleeveless shells. There are women who love them. My DC hasn't napped in years and needs to be active all day in order to go to sleep at 7:30 PM. A friend of mine had three kids who conked out at noon even if they did done nothing more strenuous than read books. The issue is when the quirks get extreme and begin to get in the way of daily living. So a child that likes to chew on the back of erasers is also biting little Sam in preschool. A child will not every walk on grass. A child will never eat anything other than a "tan" diet of bland singularly textured food. A child covers their ears and screams every time the bell rings for recess.

An OT can help sort out and divide out quirks vs. possible problems and help plan an intervention.

The important differences between a natural sensory/behavioral quirk and one that needs intervention is that
1) It must bother you or your family's routine -- ex: you can never go to the grocery store without DD pitching a fit and screaming for two hours. If she does it once, you blame the age. If she does it consistently every time she walks through the double doors of Target, that's something more concerning.
2) It must bother or frustrate DD -- ex: if she cannot make her wishes known verbally, she might benefit from speech therapy to teach her methods of communication or assist in language development
3) It must be a physical problem that can be helped/cured with assistive devices, medication, or therapy -- ex: a special orthotic shoe for the child who limps or stands on tiptoe, giving glasses to a child that cannot see, etc.

BusyBeeMommy

Mon, Jul 23 2012, 9:21 am

My DS tiptoed at that age as well. He did it until he was almost 3 from time to time, and I had similar worries to you about the spectrum, G-d forbid. At almost 4, thank G-d he has great development in the speech, social-emotional and physical areas but he does have sensory processing issues and behavioral issues that he sees an OT for in a sensory gym. He gets destructive at times, needs to jump a lot and needs a lot of sensory input. He gets hyper regularly and/or gets under a "spell" at times where he carries on in a tantrum without reasoning or hearing anyone or anything.

I don't think you should worry about ASD if your DD's speech and social development is age appropriate, just because she tiptoes, but you should watch out for other sensory/behavioral issues if she's showing other signs. In my case we weren't able to get OT for DS through EI because he was only showing signs of delay in behavior - not physical development. If your DD has other signs however, it would be helpful to have a private OT eval, or through your health insurance. If the signs are minimal, or the tiptoeing is an isolated thing that doesn't interfere with her normal functioning, then just keep an eye out and don't worry.

amother

Mon, Jul 23 2012, 9:38 am

As a mother of a child that walked on his toes and still does years later I would say discuss it with your peditrician and have it checked out.
It can either be a light form of CP, ADHD, Autisim or just sensory.
My son was diagnosed at 2 years old for ADHD by a neurologist even though we couldn't treat him for it. We have met several orthopedists and after reviewing x-rays they all concluded that it was ADHD. One doctor took a blood test (I don't recall the name of it) to see if it was something wrong with his bones or muscles.
Most therapists say to have your child walk in sand or rice. You can also massage the foot or have her walk or jump on bubble wrap. My son loved doing it.

amother

Sun, Jul 29 2012, 6:43 pm

So for a few days she was tiptoeing much less and now she seems to be doing it more again... definitely doing it more on carpet than on regular floors but she's doing it a little all over... and she's also doing other "stimming" kind of things like shaking her head back and forth very vigorously and vocalizing, though she's still doing all her normal socially appropriate behaviors as well B"H. So I will definitely have to talk to the pediatrician about this, but not sure what kind of therapy or whatever to do for a kid who is developing 100% normally but just doing weird things in addition... Confused