The rationale for the use of walkers appears to be primarily as a child-care device. Every parent knows well the inquisitive mind of the crawling infant. Once infants start to crawl, they are able to thoroughly investigate their previously inaccessible world: exploring every available inch of floor space, and on their journey testing every found morsel in their path to see if it is food. For this reason, and perhaps with a desire to see their child reach the walking milestone, parents are placing their infants in what is now considered to be a very dangerous piece of childhood equipment.
The use of walkers and any other apparatus designed to prematurely assist infants to assume erect posture, should be discouraged both as a potential cause of trauma and of frequent finger amputation. Walkers are obviously designed for use on level surfaces and pose a significant threat to the infant when used in homes with unprotected stairways and ramps. In a study of infants who experienced trauma from the use of baby walkers, 88 percent of the injuries were caused by a fall down stairs.2 In another US study, an estimated 27,804 injuries requiring treatment resulted from the use of baby walkers in a one year period, with most of the victims being under two.3 Another study of the mechanisms of walker-related injuries reported stairway falls as being the most common cause of injury (71 percent), with tip-overs (21 percent), falls from a porch (three percent), and burns (five percent) also being cited. In this same study, the authors also reported that 29 percent of infants who used walkers suffered significant injuries which included skull fractures, concussion, intra-cranial hemorrhage, c-spine fracture and death.4 When infants are placed in a baby walker, they are able to establish erect posture and mobility, but in doing so, they are placed at significant risk for trauma from falls and for the development of faulty walking patterns.
Some parents may incorrectly think that the use of a walker will help their child learn to walk. This notion has been shown by research to be incorrect. In fact, studies indicate that infants who use these devices may actually develop locomotor problems due to the establishment of a faulty walking pattern.5 In one study using electromyography, it was demonstrated that the use of infant walkers alters the mechanics of locomotion, thereby inducing substantial mechanical errors in the walking process.6 The conclusion from this study suggests that it may be deleterious to the eventual development of a normal gait pattern to prematurely train infants to walk by using these devices.
Spinal development may be affected by prematurely forcing a child to assume the erect posture and to walk with the assistance of a walker. Because a young child has not yet developed the appropriate bone strength and the necessary muscular coordination to maintain erect posture, prematurely encouraging such activities may be inappropriate.
The use of baby walkers has yet another potential problem. An infant who is placed in a walker during the crawling phase of motor development may be missing out on an important developmental skill. Studies of childhood development indicate that an early infant crawling experience is positively reflected in later motor skill development. A study by McEwan et al., showed that infants who did not crawl scored lower average performance scores on pre-school assessment tests.7 These findings would appear to support the hypothesis that early crawling experience is important for the development of the body's sensory and motor systems and for general motor skill development.
The use of baby walkers has been criticized from several perspectives. The most consistent criticism has been of the trauma caused by tip-overs and falls down stairs. Canada has already banned the use of baby walkers. The American Academy of Pediatrics has issued a recommendation to parents that baby walkers should not be used. Within a year, the US Consumer Product Safety Commission is expected to set-up mandatory standards. Other less obvious childhood problems which are posed by the use of walkers, e.g., integration and development of the neuromusculoskeletal system, may prove to be a much more serious indictment to the use of these devices.
References
- Mayr J, et al. Baby walkers -- an underestimated hazard for our children. Eur J Pediatr, 153(7):531-4, 1994.
- Rieder M, Schwartz C, Newman J. Patterns of walker use and walker injury. In Pediatrics, 78(3):488-93, 1986.
- Trinkoff A, Parkes PL. Prevention strategies for infant walker-related injuries. Public Health Rep, 108 (6):784-8, 1993.
- Chiaviello CT, Christoph RA, Bond GR. Infant walker-related injuries: a prospective study of severity and incidence. Pediatrics, 93 (6, part 1):974-6, 1994.
- Crouchman M. The effects of babywalkers on early locomotor development. Dev Med Child Neurol, 28(6):757-61, 1986.
- Kauffman IB, Ridenour M. Influence of an infant walker on onset and quality of walking pattern of locomotion. Percept Motor Skills, 45 (3, part 2):323-9, 1977.
- McEwan MH, Dihoff RE, Brosvic GM. Early infant crawling experience is reflected in later motor skill development. Percept Motor Skills, 72(1):75-9, 1991.
Peter Fysh, DC
San Jose, California
Editor's Note: Dr. Fysh is currently conducting pediatric seminars. He may be contacted at 1-800-999-7337.
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