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What should for slow walking development in a child?

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General Surgeon
Practicing since : 2002
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Hi... My son is almost two years old and he is still not walking. I became concerned about his development at 5 months old. He was diagnosed with club feet at two months old. He was in cast for a total of six weeks. He did not sit up on his own until after he was a year old and that was with therapy. He began therapy at 11 months old. He began crawling at 9 months old but would keep his left armed tucked underneath his body and drag his left side. With therapy he began crawling up on his hands and knees. The therapist feel like he should be walking by now. He can walk with a walker but seems to tire pretty easily. He can walk around furniture and as long as he has something to help balance him, he is fine. The only thing that showed up on his blood work was low Vitamin D. Normal Vitamin D range is 20.0-58.6 and his was 23.0. As a mom, I know that something just isn't right. I feel that there is something keeping him from walking. He tries really hard and is not lazy. He is also small in size. He will be two years old in about a month and a half and he only weighs 21 pounds. We are scheduled to see a doctor at LeBonheur Children's hospital in Memphis in February. I was curious if anyone here had any clues as to what may be going on. I took Bactrim for a staff infection on my leg while I was pregnant with him. Other than that, I had no other issues during my pregnancy and he was a healthy 8'13 oz baby boy. Thank you so much!
Posted Sat, 1 Feb 2014 in Child Health
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: To rule out plantar arch abnormality Detailed Answer: Hi Welcome to Healthcare-Magic Greetings of the day Dear Ms I do understand the your concern about your kid and agony which you may going through. If his other developmental milestones like verbal milestone( ability to speak in the local language for communication considered appropriate for the age) and fine motor like pincer grip, hand eye Co - ordination and toilet training are normal and appropriate for his age then the cause of his delayed walking is unlikely to be due to delayed developmental milestones. Other factors including local foot factors like proper plantar arch and presence of non painful weight bearing are important for proper walking in children. After treatment for club foot if the plantar arch is not good for weight bearing that could lead to delay in walking. Also children with Vitamin C deficiency could also have difficulty in walking due to painful muscle. I would suggest you thorough reassessment from the Surgeon who had attended to Club foot to rule out local foot cause as delay in walking. Also he would require thorough Neurological assessment from Pediatric Neurologist. In the meantime I would suggest you the following that will definitely help. 1. Vitamin C and D supplements in diet 2. Massage of foot and leg using olive oil. In my clinical practice majority of these walking problem are likely top be due to thev above possibility I have suggested. Things can be taken care . It requires a good assessment and regular follow up. Do not hesitate to write back to me if you need any further assistance, will be glad to assist you. Take care Wishing your son a happy and healthy life. Take care Best Regards Dr Deepak Kishore MBBS, MS, MCH Consultant Pediatric Surgeon
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Follow-up: What should for slow walking development in a child? 25 minutes later
Thank you for your quick response. I have started giving him Vitamin C and D. His neurologist wants to check his Vitamin D at the end of XXXXXXX He currently goes to physical and occupational therapy. He is about to begin developmental and speech therapies. His physical therapist are puzzled as to what could be holding him back. He wears braces on his feet. He isn't even able to stand on his own. His balance is definitely off. My main concerns are why he was unable to sit up on his own until after a year old and that was with therapy; the way he crawled; and now not walking. The occupational therapist have told me that he has tremors in his hands also. He has had an MRI and is scheduled to have another one in May. He has had genetic test, SMA test, and Muscular Dystrophy test that have all come back clear. Could he possibly have some sort of inner ear problem that is affecting his balance? Do any of his symptoms sound like mild cerebral palsy or any other type of neuromuscular disorder? His pediatrician believes it is some type of neuromuscular disorder. Another couple of things I think are odd is that his teeth on top came in with brown stains on them and he already has cavities. I brushed his gums before he ever had teeth. His top teeth are deteoriating quickly. And, I'm concerned about his size also. My three year old son is in the 75th percentile and my baby is in the 3rd. He eats all the time and doesn't gain weight. Right now he is diagnosed as being "developmentally delayed." Again, he has had a lot of therapy and I work with him a lot. I feel that if he were just delayed, he would be catching up more by now. Is it possible to be developmentally delayed without there being a cause for the delay? Sorry for all the questions.... I have been concerned since he was 5 months and I don't feel that any of the doctors we have seen so far have really helped much. I truly appreciate your response and any advice you may have. Thank You!
Answered by Dr. Deepak Kishore Kaltari 1 hour later
Brief Answer: Cerebral palsy could be considered possibility Detailed Answer: Greetings Dear Madam, Many of the developmental delay could be due to idiopathic cause(There is no definite cause). Possibility of Cerebral Palsy can also be considered. I hope he has also been thoroughly evaluated for Toxoplasmosis and ruled out by appropriate investigation. In our setting we have dedicated Child developmental Clinic(CDC), which regularly assess the developmental milestone and help in Physiotherapy and Rehabilitation. As he seems to have failure to thrive i would also suggest you the following which are the commonest cause for failure to thrive and stunted growth(as his growth is in 3rd percentile only)( Management is Multi-speciality and multi-modality) 1. Rule out Urinary Tract infection: Sub-clinical urinary infection may present with developmental delay, stunted growth and Renal Osteodystrophy and affection of dentition. Urine examination and Ultrasound abdomen will suffice 2. Presence of Occult Spinal Dyraphism: Thorough neurological examination especially of the back to rule out any spine defect with herniation of nerves( Meningocele and Meningo-Myelocele) 3. Toxoplasmosis: 4. Reassessment for possibility of Gastro-oesophageal reflux(GERD): Acid reflux in mouth may cause early dental carries. GERD should especially be considered in a diagnosis of child presenting with rapid carries of tooth. I would suggest you to discuss these probabilities with your Pediatrician and i am sure things an be definitely be taken care of. I do understand the difficulties and frustration you would have gone through. Do get a reassessment , things can be taken cre off. Do write directly to me if you need any suggestion anytime. Assuring you the best always Take Care Best Regards Dr Deepak K K
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