Are Baby Walker Warnings Coming Too Late?: Recommendations and Rationale for Anticipatory Guidance at Earlier Well-Child Visits

Baby walkers, traditionally marketed to parents as products that can help babies learn how to walk, are devices composed of a suspended seat surrounded by a rigid frame that is connected to wheels. This design positions infants to sit in a balanced standing position with their toes touching the floor, thereby allowing them to move independently without parental support. For many parents, baby walkers are viewed as an ideal way to encourage their children to begin walking, while keeping them entertained, quiet, and safe.1,2 Research has suggested that, despite their name, baby walkers can potentially hinder a child’s ability to walk. Studies have reported lower locomotive development test scores for babies who used baby walkers than those who did not.1,3,4 In addition, baby walkers may detrimentally affect the development of normal gait patterns and posture in early childhood and may even lead to idiopathic toe walking gait pattern development.5,6 In addition to gait concerns, baby walkers are associated with a high risk of injury. Alarmingly, statistics reveal that approximately 12% to 50% of children who use baby walkers become injured.7 Between 2004 and 2008, there were approximately 3000 children aged 15 months and younger who required treatment in US emergency rooms due to injuries from baby walker usage.8 However, this report did not include cases treated in urgent care centers or pediatric clinics/offices, and therefore, incidence may be higher. Baby walker injuries may be caused by falling down stairs, burns from electrical outlets, or drowning from walking into a pool or accessing the toilet.1 Since babies can independently move in baby walkers, they may be able to reach items on higher surfaces and are therefore at higher risks for reaching hazards, such as pulling hot liquids from counters.8 While the American Academy of Pediatrics (AAP) clearly states that baby walkers do not promote independent walking and stress that baby walkers can delay normal development and motor control, this warning does not appear until the published 8- to 12-month anticipatory guidance period.1,9 With baby walker usage remaining high in the United States, the question arises as to whether this guidance is coming too late. This study examines the age, gait patterns, and risks for injury of babies using baby walkers in video clips posted publicly on YouTube in order to evaluate whether additional anticipatory guidance is needed at earlier well-child visits.