Numerous studies have suggested a relationship between walker use and motor development
(2, 3, 4). Several have documented a high incidence of accidents associated with it (5). There is
no current local legislation that prohibits its use, mainly because there are no local studies on it.
Despite this, the walker is still a very popular device, it has a lot of acceptance, because parents
think that it can contribute to the development of gait, they see how pleased children feel in the
walker and they estimate the autonomy that it gives them. It allows. On the other hand, it is not
very common for parents in our environment to appreciate crawling as an important part of
development, if not as another form of mobilization that they can do without, focusing their
efforts on the child walking instead of crawling.
Materials and methods
Between August and November 2003, a survey was applied to the parents or caregivers of 301
children who attended the external consultation of the pediatric service of the Caja Petrolera de
Salud, based on the Denver II development scale. The patients attended mainly to be seen for
the control of a healthy child or trivial diseases such as colds or diarrhea, children with obvious
neurological alterations were not included. A careful physical examination was performed when
the survey response data was unclear. The patients were classified into two groups, considering
children who suffered a delay in the start of walking equal to or greater than 17 months (greater
than the 97th percentile for starting the regimen according to the Denver II test) and controls at
who walked before this time. Both groups were correlated with exposure to walker use and a
history of crawling. It was questioned about the occurrence of accidents and if these were
related to the use or not of the walker, we consider accidents to be any fall, poisoning, ingestion
of a foreign body, or burns. The source of the recommendation for the use of the device was
The data were analyzed in the Excel computer system and the OR and confidence interval
calculations were made in Epiinfo 6.0.
301 children between 14 and 24 months of age were analyzed, of which 10 were not walking at
the time of the survey. (Figure 1). These children were excluded from the gait-related analysis.
But not from the accident analysis. 65.4% of the patients were female.
We hypothesize that the use of the walker has a negative influence on the development of the
beginning of the march. Various studies address this relationship. Although some only showed a
poor negative effect (2) and no evidence to aid walking. Others (3) point out that children who
did not use a walker sat, crawled and walked at the correct age, as opposed to those who did
use a walker who walked late. Some studies show that infants with experience in the walker sat
later than those who did not use a walker and scored lower than on the Barley scale of mental development and motor development, effects were observed in the time of initiation of the use
of the walker , the authors conclude that the risk of using the walker outweighs its benefit (4).
Our findings suggest that there is evidence that the walker delays the onset of gait. A high
number of accidents was also observed, concluding that the walker has more risks than
benefits. Studies that applied the Denver II test (4) evaluated infants, finding that in the group
90% used a walker and 12.5% had one or more accidents related to the use of the device, such
as poisoning or choking. 10.8% of those who used the walker had poor results and none of the
children who did not use it. Research carried out in Australia (5) found that 95% of baby
accidents were caused by using the walker. Of these, 46% required admission to the hospital.
The knowledge on the part of the parents of the risk of its use has also been the subject of
research. (6) The participation of parents in such accidents is considered, since it is common for
them to know of the risks that their use entails. 88% of the mothers who know about the risks of
using the walker do not use it, 38% of the mothers who know the risks use it because they
consider that they serve as entertainment and believe that it helps in motor development. It is
striking in our study that a good percentage of cases the recommendation to use the device was
given by a medical professional.
There are other dangers that infants run, in addition to the blows and falls they suffer during
their movement, the contribution in other accidents such as poisoning is added (7) 45% of
accidents caused by the walker occur by poisoning when ingesting plants, cigarettes,
medications, cleaning fluids, etc. Our study corroborates this association.
In the present study, a very high frequency of Baby Walker is observed, similar to that reported in other
countries (4). Dramatic cases have been reported such as contracture of the ischio-tibial
muscles that resemble spastic dysplegia due to early use of the walker (8).
We found that crawling is a protective factor against developing delayed start of gait. We are
sure that the ability to crawl has a very important influence on babies’ lives, basically giving
them a new vision of the world. When carried laden, children pay little attention to their
surroundings; however, when they begin to crawl, they become more sensitive to seeing where
objects are and how large they are to each other. They begin to pay attention to what things
look like. Crawlers can differentiate similar shapes that are different in color, size, and location
in space.In addition, babies are more successful in finding a toy that was hidden in a box when
crawling around it than when it is held up (9 ).
Moving around on their own also helps them learn to judge distance and perceive depth. Depth
perception appears to be due less to maturation and age than to infants’ experience of moving
within their environment on their own. When infants begin this type of activity they run the risk of
falling and to avoid injury, caregivers remove them from dangerous places or yell when children are about to get into trouble. Babies are sensitive to these actions and emotions, and they learn
to fear where they might fall. The positive effect of crawling has been documented in various
Not all children crawl, but those who do develop postural adjustments in all four limbs. These
settings are acquired through trial and error. Once the child has acquired the ability to sit, the
arms serve as a protective extension; in this way, he transfers the weight from the buttocks to
the hands, lifts the pelvis off the floor and rotates to the side adopting the symmetrical posture of
support with hands and knees. The first movements a child practices when leaning on all four
limbs are small back and forth body changes. In the interest of reaching for a toy, he is probably
developing the ability to shift his body weight laterally toward the opposite hand and leg. At first,
the position of the hands is unstable, but with practice the child will apply adequate force to
alternate the limbs diagonally. Crawling infants develop support patterns in all four limbs to
“semi-crouch” (bear pose). Children who do not crawl tend to move by sitting crawling, crawling,
or simply standing on their feet and walking (9). Studies that evaluated the influence of early
crawling and the development of motor skills of children who crawled and children who did not
crawl in early infancy found that children who did not crawl showed a lower average and specific
development performance in the evaluation of “ Millar ”for preschoolers. This supports the
importance of the hypothesis about the positive influence of the early crawling experience on
the development of the body’s motor and sensory systems and the development of general
motor skills ”(10).
This neurological development can occur in movement through a basic skill that arises at that
time: the ability of a baby to crawl makes it possible to move without depending on anyone else
Crawling is a form of mobilization in children with disabilities, the quadruped crawling pattern
was the most favorable pattern for restoring upright position in patients with polio (11).
In another study several qualitative aspects of crawling were analyzed in a small group of
carefully selected normal infants aged one to four years in a cross-sectional design. Between
two and three years of age, the greatest changes occurred in all the observed aspects, resulting
in differentiated, adaptive and efficient crawling. These changes are proposed to be based on
so-called adaptive variability, an age-related developmental process that appears to be a
prerequisite for cognitive development (12).
In sum, contrary to what most people believe, we find that the use of the walker delays the start
of walking. We verify that the high incidence of accidents advises against its use. Health
authorities must be guided by academic entities that are aware of the potential risks of using the
walker, to prohibit its sale and use in our environment. There is a protective effect when children
crawl against possible delay in starting to walk. We are convinced of the benefit of crawling in
other areas of child development