Baby Walkers: What's Best for the Infant?

Infancy

Claudia Anrig, D.C.
Originally posted March April 2003

babywalkerAll you have to do is walk into a baby store or attend a baby shower and one item is sure to always be found: the baby walker. Approximately 50 percent of infants will use these man-made upright vehicles (1). And when you ask any young parents about their opinion of the baby walker, it is clear that they believe that these walkers are a Godsend. Ideally, parents see their happy upright infant, capable to travel and staying entertained for numerous hours a week in their environment. What could be better?

What do the studies suggest?
Siegel and Burton published an article in the Journal of Developmental Behavior where they conducted a study of 109 infants' between the ages of six to fifteen months (2). The study compared users verses non-users and analyzed their motor and mental development. The data concluded that infants who used walkers, also sat, crawled and walked late, and scored lower on the Bayley scales of mental and motor skills than the non-walker group.

Crouchman studied 66 infants, divided into three groups according to length of time spent using the baby walkers (3). It appeared that there was no difference between all three groups with the onset of sitting or walking. However, infants in the higher-user group revealed a significant delay in the onset of prone locomotion compared to the low or non-user groups. The study suggested that the exposure of some infants to excessive use of the baby walkers might alter their ability to engage a pathway of normal locomotor development.

Garrett, et al studied 190 infants, of which 107 infants used the baby walkers (4). The average usage time period was 26 weeks. The study revealed that achieving crawling, standing alone and walking alone occurred later in the baby walker group. They concluded for every 24 hours of baby walker use, there was an associated delay of 3.3 days of walking alone and 3.7 days of delay in standing alone. Another study of a set of six twins revealed apparent adverse electrophysiological changes of those six infants using the baby walkers, compared to their twins who were non-users (5).

Engelbert et al presented the cases of two patients who used infant walkers during the time that they were walking (6). These two infants were noted to have developed a disharmonic and delayed motor development, contractures of the calf-muscles and motor development mimicking spastic diplegia.

Not all studies support that developmental delay will occur when there is the usage of the baby walkers (3). One study analyzed 15 pairs of twins suggesting that the use of baby walkers did not influence the onset of independent walking (7).

When comparing studies, there appears to be more evidence to suggest that baby walkers interfere with the natural process of locomotor skills and may be a cause of developmental delay. There is a definite need for more studies, which should include larger group sizes and randomized control trials over previous observational or questionnaire based studies.

Injuries and the baby walkers:
Is it worth the risk?
The evidence regarding injuries to infants using baby walkers is mounting and very common. In 1999, in the United States alone, 8800 children under age of 15 months were treated in emergency rooms from baby walker injuries. The most common cause of injuries resulted from falls down stairs subsequently injuring the head (8).

In another study of emergency hospital visits, injuries of infants under the age of one were recorded. The report concluded that 8.9/1000 infants admitted to the emergency room were attributable to baby walkers and 1.7/1000 of these injuries were of a serious nature (9). It should be further noted that 97 percent of baby walker accidents result in neck and head injuries.

Although most injuries may be minor: bruises and swelling on the head, forehead, face and checks. Serious injuries from baby walkers include: skull fracture, concussion, intracranial hemorrhage, full-thickness burns, cervical spine fracture and death. From 1977 through 1998 there were 34 infant deaths attributed to the baby walker.

Can parents safely use baby walkers?
Considering that the majority of baby walker injuries occur in the presence of adult supervision in the same room (1), it would be difficult to think that these injuries can be reduced, considering that mom, dad or the infant's caregiver are already present in the room but are preoccupied. Perhaps ironically, one of the primary purposes of the baby walker in the beginning is to entertain the infant and give the adult time to possibly complete a task or have a moment of rest.

Further, the Committee on Injury and Poison Prevention of the American Academy of Pediatrics forwarded several reasons why the baby walker should not be recommended (8). Walkers do not help an infant to learn how to walk, and can delay normal motor and mental development. The American Academy of Pediatrics states that the evidence of major and minor injury and death from baby walkers warrants a recommendation ban to the manufacture and sale of the product altogether. And finally, the committee suggests, should a parent elect to use a walker, that they choose one that meets the standards of ASTM F977-96 (must be wider than a 36-inch doorway or must have a braking mechanism designed to stop the walker if one or more wheels drop off the riding surface).3.

A Chiropractic Point of View A majority of those in the chiropractic community, who have focused their practice on the care for the young, have always taken a strong stand against the use of baby walkers. First, it is unnatural to be bipedal and weight bearing prior to learning to sit, crawl and stand. The developmental spine needs to go through each milestone in order. To subvert the natural process may have its effects, not only in term of the form of locomotor and mental development of the infant, but may also have long-term spinal implications (i.e. asymmetry, muscular imbalance etc).

The chiropractor should take the time in his and her practice to educate their parents, not only about the risks of injury from the baby walker, but regarding the possible unseen spinal implications and neurological implications.

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References

Smith GA, Bowman MJ, Luria JW, Shields BJ. Babywalker-related injuries continue despite warning labels and public education. Pediatrics 1997;100: e1.
Siegel AC, Burton RV. Effects of baby walkers on motor and mental development in human infants. J Dev Behav Pediatr 1999 Oct;20(5):355-61.
Crouchman M. The effects of babywalkers on early locomotor development. Dev Med Child Neurol 1986 Dec;28(6):757-61.
Garrett M, et al. Locomotor milestones and babywalkers: cross sectional study. BMJ 2002;324:1494 (22 June).
Kauffman IB, Ridenour M. Influence of an infant walker on onset and quality of walking pattern of locomotion: an electromyographic investigation. Percept Mot Skills 1977 Dec;45(3 Pt 2):1323-9.
Engelber RH, et al. Influence of infant-walkers on motor development: mimicking spastic diplegia? Europ J Paediatr Neurol 1999;3(6):273-5.
Ridenour MV. Infant walkers: developmental tool or inherent danger. Percept Mot Skills 1982 Dec;55(3 Pt 2):1201-2.
Committee on Injury and Poison Prevention. American Academy of Pediatrics: Injuries Associated with Infant Walkers. Pediatrics Vol. 108 No. 3 September 2001, pp. 790-92.

 
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