3 year old - W-sitting, tiptoe walking and lots of limb-flailing/fallin
g over when tired - normal?
I know the tiptoe walking can be a red flag for other things so last summer when she was 2.5 we had the GP refer us to paediatric orthopaeds. They said she's just an idiopathic toe walker and to keep an eye on it and to bring her back 12 months later ( it will be later this summer) to monitor. They said not much can be done at that age as obviously they're too little to keep insisting that they walk on flat feet and they can't be given any exercises to strengthen/stretch.
She is also a W-sitter. It is getting more consistent not less consistent. EVERY time she sits down she wants to sit like that and I am noticing that none of her peers do this.
I watched her ballet class last week and though she is the youngest in the class by about 5-6 months, I couldn't help wondering if there were certain things she was just not managing that others exactly her age might have managed. She absolutely cannot do a hop-skip, for example. She can't manage a knee-bend (plie) at all.
On more fine motor-type stuff, I have begun to notice that her artwork is very wild, still, compared with other little girls at nursery. She can't/won't stay at all within lines when colouring-in. She isn't yet able to draw anything that remotely resembles what it's supposed to (eg a funny-looking person with a head and body and legs... she would just draw a kind of mad scribble instead). I have no idea what is within 'normal' or not!!
When she gets tired, she is constantly falling over (on the spot rather than tripping on stuff, if that makes sense?) and - this is hard to describe - her limbs go sort of like half-cooked spaghetti. It's partly because she is on her tiptoes a lot so she is less stable than if she were on flat feet. But it seems like her legs just sort of give way. Also as if, when she is tired, she just can't stop moving?
I have little to compare her to at close range... I don't know how adept other 3 year olds are at eg catching/throwing a ball. The drawing/colouring thing I have only just noticed any difference as I have seen her little friends colouring in reasonably neatly etc.
She just got a new scooter and is getting the hang of it VERY slowly indeed, she can do the basic scooting action but shows no sign of being able to control it. Other children her age seem to whizz about on the things with ease but I don't know how quickly they got the hang of it. She can do stairs perfectly fine but is wobbly.
She tires fairly easily and isn't a fan of walking
at all too far. I can't tell if she gets tired because she doesn't walk often and therefore just isnt' used to it, or if she dislikes walking because it makes her very tired iyswim.
I'm aware this sounds like a horrible sort of checklist and criticism of all the things she can't do! Which it isn't meant to be. In other news (!) she is happy, incredibly verbal, creative, sparky, bright, funny etc etc. I'm just flagging up all these things that are striking me about her physical development as I don't know if they're something I should be concerned about?
And if so, worth a conversation with the GP?
My brother is dyspraxic so I suppose that's something at the back of my mind...
Sorry, this has become a very long ramble!! Any advice hugely appreciated.
Oh, sorry, she has lliterally just turned 3, if that's useful info!
Have you considered hypermobility? She sounds a lot like my DD. Is she more flexible than usual?
Can't comment on some of it but my ds is 3 in a few weeks and can't draw anything other than scribbles and can only just about scoot. He is pretty good at climbing etc but can't jump and gets more clumsy when tired. Oh and he will walk but would also quite happily go in his buggy.
I had similar concerns about one of mine (though no tiptoeing).
As I put it, she would literally 'fall out of her standing' . GP referred her to a paediatrician and he asked her to walk in a straight line and other simple things like raising arms or legs. There was not a bother on her. I had been concerned about hearing and balance.
Two years later she was found to have severe eyesight issues (she just wears glasses now but it is degenerative). Obviously she had no clue that she couldn't see very well! Neither had I! I would check hearing and eyesight first.
Thanks v much!! LadyNymeria, I thought the paediatric orthopaed might say something about hypermobility when I saw them last summer but she only said that DD was more than usually mobile and not excessively so... should I have pressed for more info?
I think I was just so relieved they weren't saying anything very big was indicated by the tiptoe walking 9as my mother had got me into a panic about that the night before) and should possibly have pushed for more explanation.
Certainly, as I recall, there was mention of her being fairly mobile but not to a very abnormal degree.
It was quite hard for them to 'test' much tbh as she was in a godawful mood, screamed whenever they tried to flex her feet etc and would barely even show them how she walked. I had to prise her off me like a koala bear and run to the other end of the corridor just for them to get a quick look at her gait as she hurtled after me screeching for me...
Maybe this summer when we go back she will be more amenable/bribable...
Thanks 5minutes, that is reassuring!!
Thanks 20ff that is definitely worth considering. Her eyesight seems pretty sharp actually from what I can tell but obviously I don't know anything about how to test it properly iyswim.
I agree that hypermobility is a possibility. It should be easier to test for at her age than last year (depending on her mood, of course...)
You could look at the Hypermobility Syndromes Association website for more information. It will tell you what to look out for and give you an idea of what you should be discussing with her paediatrician.
Re colouring in: my DD1 is 4 and can't keep within lines, though she's getting neater. I personally wouldn't expect a child of that age to be able to do so. It's about practice, so maybe children who do a lot of colouring can keep within lines from a younger age.
Thanks so much for that link Grouchy, will check that out straight away.
I agree fundamentally re the colouring-in... also there's part of me that thinks maybe DD is just a naturally messy and not that well coordinated person... it sort of 'fits' with the rest of her personality which is very creative and always darting from idea to idea...
Just occurred to me that she is an appallingly messy eater, too, and though she CAN use a fork/spoon correctly, she often prefers not to, especially when tired... I remember my SIL watching her in horror a few months ago and saying she'd never seen anyone eat spaghetti with their hands before...
They've changed things around a bit so it took me a while to find what I was looking for. I think this is the most useful page re children: hypermobility.org/help-advice/physio-and-occupational-therapy/flexible-kids/
Just wanted to say, I was a W sitter, tip toer & had NO coordination at all. Mum took me to OT's & physio but I wouldn't do any of the exercises.
One day I just stopped but I'm a total pest like that.
If you're very worried, I'd email or phone the secretary of the department you have follow-up under for later this year & say you have some concerns & can they bring the appointment forward.
Thanks again Grouchy, that is a huge help and I appreciate it!!
Sup, I fear my DD may be one of those pests too... It's hard at the moment, really, to say whether she's just quite clumsy and uncordinated (plus a tiptoe walker and W sitter so therefore obviously a little bit extra bendy...) or if there's something a little bit more to it. At 3 I gather dyspraxia, for example, can't even be diagnosed as it's all still within a realm of normal until later on...
I think I will see if we can get her followup appointment moved up a bit and this time I will write down my list of concerns before we go in so that I don't forget anything like last time!
Thanks again everyone.
This absolutely sounds like hypermobility. The W-sitting is a classic sign.
The bad colouring/messy eating is likely down to the impaired proprioception that comes with it.
Source: I have EDS.
I have hypermobility in my feet. As a grew the rest of my body tried to compensate, by the time I was finally diagnosed in my 20s I had severe pain in my hips and calves, and issues with my knees. I hated walking as it was really painful but nobody believed me, I was classed as lazy.
Trust your instincts, keep pushing. Some GPs are awful, it took nearly 2 years of me really nagging mine before I was referred to podiatry where I finally got support.
Re the skipping at ballet - my DD started ballet just after she turned 2, but the class catered for children up to about 4.5. Although she could skip, the vast majority of the children couldn't. When she went onto the 'proper class at 4 (so up to 6 yos) there were still several that couldn't manage it. I think it must be quite a difficult skill to master. I can't remember about the plies
apart from them having to make windows for the fairy to fly through
I have since called the hospital but unfortunately can't get the appointment moved up as we are away the only other week they can offer me.
The appointment is in June which I guess is early enough, only 3 months away and in all honesty I'm not sure there is anything actually urgent that could be done when she is so tiny?
We will continue discouraging her from the W sitting but other than that I guess it's just a case of keeping an eye on it all and noting specific concerns.
I was a little surprised when the orthopaedic specialist didn't flag up any particular hypermobility but as I say it was quite hard to 'do' much at the appointment as DD was so resistant!! Also maybe it was still a v young age (2.4 back then) to be able to say very much of anything with certainty.
Thanks to everyone!
OP no, I don't think urgent at all. You can't treat hypermobility, only manage symptoms. In my case this has meant supports to wear in my shoes, to top me turning my ankles. It's more of a 'good to know' type thing really.
Um. What you describe sounds exactly like my 3yo DD who has recently been diagnosed with very (very very) mild cerebral palsy. Everything you mention, DD does.
Not saying that is the case with your DD (there are plenty of other possibilities as mentioned above) but it's definitely worth considering. You really need a referral to a paediatric neurologist or at the very least a good consultant general paediatrician. DD saw a podiatry/biomechanics person age 2.5 who did not see any issues <facepalm>
Did she have any sort of prematurity or trauma at birth at all, as those are the usual sources of CP? (Though some cases of CP derive from a stroke in the womb which can be undetected at the time). How was she wrt to hitting motor milestones as a baby - DD hit hers on time but remained wobbly for longer than others iyswim. Can she flex her foot to 90 degrees to her leg (be careful not to force them if testing this).
If it were to be mild CP, there isn't any urgent treatment as it's more a question of physio and management - I'd say the only things worth doing for now are : 1) supportive footwear - solid boots like Kickers help discourage toe walking, and can also help reduce the spaghetti legs and tripping 2) keep her active as much as her energy levels allow; ballet and swimming both great, also walking and the playground.
If the mention of CP is scary - don't panic. Even if that is what your DD has, at this level it is very very very mild (and in previous generations would probably have been undiagnosed). Most, probably all cases of CP that one reads about will be considerably more severe.
minipie, hello! I remember you from pregnancy boards I think and sleep threads... I think we have entered into 'conversation' before when I had a different username...
That's such a helpful post, thank you... she was born at 39 weeks but only because I had a planned C-section... She hit her motor milestones on time, as you say your DD also did.
Can I ask what it was that made you push for referral to a paediatric neurologist? I mean, really, what it was that concerned you about your DD enough to ask for this (or was it suggested by a GP?) Did you go the private route or NHS? I'm generally keen to avoid private with DD as I feel confident that the NHS is the right place for sensible advice on paediatrics but I don't know if it might make sense to call on our insurance for this one? Just to try to get a bit more time out of a specialist, if you see what I mean?
Actually minipie, I have PMd you, I hope that's OK!
My DD (just 2) is under physio/ podiatrist for similar issues. At the moment the hospital provide her shoes and not much else.
She was born at 33 weeks though so I'm going to look in to mild CP following the interesting info from minipie. She has a fabulous paediatrician who I imagine would have picked that up but you never know.
Dizzee my DD was born at 34 weeks. However she was also not breathing at birth (didn't breathe for 3.5 mins) and the neurologist we saw thought it was more likely that that was the cause of the CP, rather than being a 34 weeker, as she said it's usually the <30 weekers or the very tiny for dates babies who get CP. But nobody can be sure of the cause really. Anyway, no harm in asking your paed if he/she has a good neuro colleague you could see - the neurologist we saw was able to say it was verly likely CP just from watching DD walk (although we did have an MRI to confirm).
My DS was similar at 3. No W sitting, but the falling was awful. He is now 5.5 and has come on so much in the last couple of years. The tip toe walking has almost stopped, he rarely drools now and he falls much less frequently.
I would suggest a good pair of supportive ankle boots e.g. Timberland or Kickers. The tiptoe walking did not worry me much (as he sometimes walked normally) but it used to increase the falling. I think that lack of cutlery use is perfectly normal in a pre school aged child but if you wanted you could try a set of Junior Caring Cutlery, my son has found his useful, although he still prefers his hands.
We saw an OT who suggested exercises to improve core strength which he had no interest in participating in! I think that any activity they enjoy is the best bet. Ballet sounds great, but we have had to stick to puddle splashing, walks in the woods etc.
He is pretty comfortable on his scooter now, but would not have been at 3. There is a big range in motor skills in young children and I now try not to compare him to the kids zooming past us on their bikes/scooters etc and look for the ones that are not so speedy. My son cannot hop, skip or balance on one leg.
We have no diagnosis but I am hoping to have him assessed for dyspraxia when he is old enough.
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