Raleigh Therapy Services

Tip-Toe Walking Toddlers

Have you noticed that your child is walking on her tiptoes? It’s certainly not an uncommon sight, but it is one you’ll want to watch if it goes on past age 3.

It is natural for toddlers 18 months and older to experiment with toe-walking as they learn to walk and run. However, if they continue to toe-walk on the balls of their feet past age 3 and no underlying diagnoses exist, the behavior will need to be addressed. Called idiopathic toe walking, this condition can cause a child’s calf muscles to shorten making it more challenging to walk flat-footed.


Why do children walk on their toes?

The three most common reasons children tip-toe or walk on their toes include:

Sensory Processing Difficulties

Children with sensory processing difficulties may walk on their toes for two reasons due to hypersensitivity to floor textures and surfaces or desire for increased sensory input and feeling within the joints.

Underlying Medical Conditions

Underlying medical conditions like cerebral palsy or muscular dystrophy may be another reason a child walks on the balls of her feet. These medical conditions cause an abnormal increase in muscle tone, which can lead to toe-walking.

Learned Habit

A child may toe-walk simply because she prefers to walk on her toes.  And, if done continuously, toe-walking or tip-toeing can cause her calf muscles to shorten making it more difficult to walk normally.


How do I help my child stop toe-walking?

If your child’s continuous toe-walking concerns you, please contact your pediatrician to schedule an appointment for further consideration. Your doctor may refer you to a licensed pediatric physical therapist to evaluate your child’s muscles and strength by assessing her leg muscles and ankle movements.

The physical therapist may recommend an at-home exercise program targeting the calf and front leg muscles. The ultimate goal will be for your daughter to walk using a heel-to-toe pattern rather than choosing her tiptoes.

Some common stretching exercises physical therapists may recommend for toe-walkers include:

Calf Stretches

Ask your daughter to lie on her back with her knees straight. One at a time, bring her feet up towards her head while bending her ankle. 

Wall Stretches

Have your daughter put her hands on a wall with her feet pointed toward the same wall. One foot should be behind the other with the front leg bent. Instruct her to lean into the wall keeping her back leg straight. Both of her heels should remain on the floor while she stretches.

Long Sit Stretches

Ask your daughter to sit with both legs straight out in front of her while wrapping a towel around both of her feet. She should hold the towel at both ends and pull the towel back towards her body while keeping her knees flat and back straight.

Heel Drop Stretches

Have your daughter stand on a step. While keeping one foot planted firmly on the step, ask her to place one foot halfway on the step and drop her heel to feel a stretch in her calf muscle.

Please note, while simple to execute, these exercises should be initiated under the guidance of a physical therapist who will demonstrate the correct stretch positioning, the number of repetitions needed and the appropriate amount of time to hold the stretch.

  Filed under: Awareness, Physical Therapy, Raleigh Therapy Services

Speech & Hearing Screenings for Children

May is Better Speech and Hearing Month and now is the perfect time to spotlight the special role speech-language pathologists, more readily referred to as speech therapists, play in children’s lives. It’s easy to think that a speech therapist is someone who works with others to correct mispronounced words and help them speak—however, speech therapists do much, much more than that.

Speech-language pathologists are professional therapists who evaluate and treat speech, language and swallowing disorders. A pediatric speech-language pathologist may work with a child in any of the following areas:

  • Feeding & Swallowing – safely eating, drinking, and swallowing
  • Articulation– producing the correct speech sounds
  • Voice– speaking with vocal quality, pitch, loudness, and resonance
  • Expressive Language – using language to communicate functionally
  • Receptive Language– understanding what is being communicated
  • Pragmatics – using social language in order to convey needs and participate in conversations
  • Fluency (Stuttering)– speaking using a normal flow and rhythm without interruptions
  • Hearing – communicating in the presence of a hearing disorder

Preschool & Daycare Speech and Hearing Screenings

Your first introduction to a speech-language pathologist may actually be at your child’s preschool or daycare. It is a common practice for local speech-language pathologists to offer free speech and language screenings for young students at these early learning centers. With your consent, a speech therapist will conduct a brief screening to review your child’s articulation, language, voice, fluency, and hearing.

The free screening will provide a quick snapshot into your child’s speech and language skills by utilizing a research-based tool to indicate a pass/fail status. A hearing test may also be performed simultaneously. If your child fails his or her screening or hearing test, a more in-depth assessment is typically recommended to determine if a delay or disorder exists.

Some signs of speech and language disorders that speech-language pathologists will watch for in children include:

Feeding & Swallowing Disorders:
  • Difficulty chewing
  • Choking, coughing, or gagging on food and/or liquids
  • Difficulty transitioning to solids or higher textured solids like meat
  • Difficulty transitioning from bottle to cup
Speech Sound Disorders:
  • Incorrect pronunciation of the letters p, b, m, h, and/or w by 1 to 2 years of age
  • Incorrect pronunciation of the letters k, g, f, t, d, and/or n by 2 to 3 years of age
  • Unclear speech to both familiar and unfamiliar listeners at 2 to 3 years of age
Voice Disorders:
  • Speaking with a hoarse or breathy voice
  • Speaking with a nasal voice 
Language Disorders:
  • Not smiling or interacting with others by 3 months of age
  • Lack of babbling at 7 months of age
  • Not using gestures by 12 months of age
  • Inability to understand what others are saying between 7 months and 2 years of age
  • Unable to say more than 50 words by 2 years of age
  • Unable to combine words by 2 1/2 years of age
Fluency (Stuttering) Disorders:
  • Frequently repeating parts of words or whole words at 2 1/2 to 3 years of age
  • Stretching sounds out like “n-n-n-no” for “no” at 2 1/2 to 3 years of age
  • Struggling to get sounds or words out by 2 1/2 to 3 years of age
 Hearing Disorders:
  • Lack of attention to sounds
  • Not responding to name when called
  • Inability to follow simple commands

  Filed under: Awareness, Better Speech and Hearing, Parenting Tips, Raleigh Therapy Services, Speech and Language Development

What is Autism Spectrum Disorder?

National Autism Awareness Month is underway, and it’s time to “Light It Up Blue” to increase understanding and acceptance for individuals with autism spectrum disorder (ASD) and provide support to their families.

A neurological and development disorder caused by genetic and environmental factors, autism is characterized by a variety of issues including social and relational challenges, speech and non-verbal communication deficiencies, and repetitive behaviors. Estimating that 1 in 68 children in the U.S. has autism, the Centers for Disease Control and Prevention affirms that:

There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less.

As with most disorders, early diagnosis and intervention are key to helping improve a child’s prognosis. Though it is becoming more common to diagnose autism spectrum disorders earlier and earlier, the most obvious signs and symptoms of autism emerge between 18 months and three years of age.

Signs of Autism

The symptoms and effects of autism may vary widely from child to child. While some children may have only a few, mild symptoms, other children may be faced with more severe challenges. Either way, autism is a lifelong condition which affects people of every race, gender, and background.

While there are many warning signs to watch for as your child develops, the most common autism red flags include: impaired social skills, communication struggles, and behavioral difficulties.

Autism: Social Difficulties

A child struggling with autism spectrum disorder social and relational difficulties may demonstrate the following:

  • Appears to be distant, in his or her own world
  • Does not frequently respond to his or her name when called
  • Lack of warm, joyful facial expressions such as smiles
  • Difficulty playing with others or making friends
  • Aversion to being cuddled or touched
  • Trouble engaging in pretend play or using toys in abstract ways
Autism: Communication Difficulties

A child struggling with autism spectrum disorder verbal and non-verbal communications difficulties may demonstrate the following:

  • Avoids eye contact
  • Difficulty communicating simple needs and wants
  • Offers no spoken words by 16 months
  • Echolalia or “parroting” questions and words offered to him or her without comprehension of the communication offered
  • Trouble understanding routine directions or simple questions
  • Uses few gestures such as pointing, waving or reaching
  • Does not understand facial expressions
  • Appears sensitive to sounds, smells, and textures
Autism: Behavioral Difficulties

A child struggling with autism spectrum disorder behavioral difficulties may demonstrate the following:

  • Self-stimulatory behaviors such as rocking, hand-flapping, moving fingers in front of his or her eyes, spinning, or head banging
  • Appears to be inflexible with routine
  • Difficulties adapting to changes in routine or environment
  • Arranges objects or toys in certain ways such as color, shape, or size
  • Seems fixated on certain toys or strange objects including light switches, rubber bands or keys

The Modified Checklist for Autism in Toddlers—Revised with Follow-Up (M-CHAT-R/F™)

The American Academy of Pediatrics recommends that all children receive autism screening between 18 and 24 months of age by using The Modified Checklist for Autism in Toddlers-Revised with Follow-Up (M-CHAT-R/F).

The M-CHAT-R/F is a checklist tool that pediatricians use to identify children who may need a more thorough assessment of possible early signs of autism or developmental delays. If the results of initial screening indicate the need for further evaluation, parents will be directed to contact the local Children’s Developmental Services Agency to begin the process of evaluation and therapy as warranted.

Does My Child Have Autism?

If you are concerned that your child may be exhibiting signs of autism, contact your pediatrician to schedule an appointment to voice your concerns.

Your pediatrician will speak with you about observations and conduct an assessment of your child as well to determine next steps.


Autism Speaks | The World of Autism PSA

  Filed under: Advocacy, Autism, Parent Education, Raleigh Therapy Services