“Is my baby standing OK? It seems like he is up on his toes, and toe walking runs in my family”.
The answer to this question, of course, depends on how old the baby is and how long he or she has been on their feet. I teach in an infant mobility class every week and have the amazing opportunity to watch children pull to stand at the big drum in the middle of the room. How they love to pound on that drum! I love their joy and their success. However, as the class physical therapist, I’m also looking closely at how they are standing. Are they up on their tip toes and leaning into the drum, or are they standing with their hips a little behind their firmly planted feet?
At any age, proper biomechanics involves how you maintain your center of mass over your base of support. The base of support is defined as the area beneath a person that includes the point of contact with the floor. In this case, it is a circle around the edges of the baby’s feet. If they are leaning on the drum heavily with both hands, the base of support circle expands to include both feet and hands. The center of gravity is defined as the point where the mass of the body is equally balanced. I look closely at the alignment of the pelvis relative to the feet, and the rib cage relative to the pelvis. When everything is properly aligned, deep core muscles provide sustained posture and the ability to move fluidly while also remaining very stable. Under these circumstances, the baby starts drumming a lot because they are able to balance without holding on.
In my experience, the child learns very early (even before coming to stand) where they want to place their center of mass. This determines everything about their overall alignment and how they sit, stand and move. (If only I could see my toe walkers in their infancy, I truly believe I would see a strong bias toward extension in every position).
But I digress… getting back to the drum in the center of the room, what do I do when there is a little one leaning forward and up on the tips of their toes? I gently readjust their hips over or slightly behind their heels while engaging them fully in their play. Sometimes, they protest because it feels unstable or different. Sometimes a little support is needed because they truly do start to fall to a sitting position. At times, I place my leg just behind their bottom so they feel safe. First, the baby must adjust to the sensation of having their bottom behind their feet. Secondly, the baby must start to activate the quads and gluteus maximus and core muscles to control the position. This takes time and repetition if the drive to be on tip toes is very strong. All children are different. Often moms come in a few weeks later and the weight is back on the baby’s heels a bit more. In the ideal world, I like to think I have treated something that was never allowed to persist. In the real world, sometimes we are working on these concepts in the older years when it takes a bit longer to come together. Every child is unique and I have found that persistence usually pays off.