Gross Motor Delay in Toddlers: Running, Climbing, and What's Typical

Gross motor milestones from 12 to 36 months

Gross motor development in toddlerhood is rapid 1Ref 1Centers for Disease Control and Prevention (2024).Learn the Signs. Act Early. — Developmental Milestones.CDC milestone benchmarks for gross motor development including walking independently by 15 months, running by 18 months, and kicking a ball and beginning to climb by 24 months2Ref 2American Academy of Pediatrics / HealthyChildren.org (2023).Is Your Baby's Physical Development on Track?.AAP guidance on gross motor development, head-to-toe developmental sequence, and the use of the AAP Motor Delay Tool to identify delays in toddlers. A rough sequence of typical milestones:

• 12 months: walking with support or just beginning independent steps
• 15 months: walking independently, beginning to stoop and recover
• 18 months: walking well, beginning to run (stiffly at first), carrying a toy while walking
• 24 months: running more smoothly, kicking a large ball, beginning to jump with both feet, starting to climb low furniture
• 30–36 months: jumping in place, beginning to climb playground equipment, walking up and down stairs with alternating feet

These are approximate averages based on CDC milestones 1Ref 1Centers for Disease Control and Prevention (2024).Learn the Signs. Act Early. — Developmental Milestones.CDC milestone benchmarks for gross motor development including walking independently by 15 months, running by 18 months, and kicking a ball and beginning to climb by 24 months — a range of a few months on either side is typical for each skill, and individual variation is normal.

What gross motor delay can look like

Gross motor delays can be subtle or obvious 2Ref 2American Academy of Pediatrics / HealthyChildren.org (2023).Is Your Baby's Physical Development on Track?.AAP guidance on gross motor development, head-to-toe developmental sequence, and the use of the AAP Motor Delay Tool to identify delays in toddlers. Some signs that may suggest a child's large muscle development is behind include: not running independently by 24 months; falling very frequently for age (all toddlers fall, but persistent frequent falling past 18 months can be worth noting); walking on tiptoes persistently (not just occasionally, which is common); difficulty climbing or going up stairs; low muscle tone (appearing floppy, tiring easily during physical play); or an asymmetric gait with one side of the body moving differently from the other.

Frequent tripping or toe-walking in a toddler who is otherwise developing well is often benign, but persistent patterns past age 2–3 can be worth evaluating.

Causes of gross motor delay

Gross motor delays can have many different causes 2Ref 2American Academy of Pediatrics / HealthyChildren.org (2023).Is Your Baby's Physical Development on Track?.AAP guidance on gross motor development, head-to-toe developmental sequence, and the use of the AAP Motor Delay Tool to identify delays in toddlers. Low muscle tone (hypotonia) — which is a descriptor of muscle quality, not a diagnosis — can slow motor development and is associated with a wide range of conditions, from benign to neurological. Prematurity is a common factor, with motor skills often evaluated against corrected age rather than birth age for preterm infants.

Other contributing factors can include joint hypermobility (very flexible joints), neurological differences, orthopedic issues, or limited opportunity for active floor and outdoor play. In many cases, gross motor delay is idiopathic — no specific underlying cause is found, and physical therapy helps the child develop needed strength and coordination 3Ref 3Frolek Clark GJ, Schlabach TL (2013).Systematic Review of Interventions Used in Occupational Therapy to Promote Motor Performance for Children Ages Birth–5 Years.Evidence for therapy-based interventions to improve motor performance in young children, including play-based physical and occupational therapy approaches.

What pediatric physical therapy involves

A pediatric physical therapist (PT) evaluates gross motor skills, strength, balance, coordination, and muscle tone through observation and play-based activities 3Ref 3Frolek Clark GJ, Schlabach TL (2013).Systematic Review of Interventions Used in Occupational Therapy to Promote Motor Performance for Children Ages Birth–5 Years.Evidence for therapy-based interventions to improve motor performance in young children, including play-based physical and occupational therapy approaches. For toddlers, sessions look like guided play — bouncing on a ball, climbing ramps, practicing transitions. Evidence from systematic reviews supports physical therapy's effectiveness in improving motor performance in children birth through age 5 3Ref 3Frolek Clark GJ, Schlabach TL (2013).Systematic Review of Interventions Used in Occupational Therapy to Promote Motor Performance for Children Ages Birth–5 Years.Evidence for therapy-based interventions to improve motor performance in young children, including play-based physical and occupational therapy approaches.

For children under 3, physical therapy is often available through the early intervention system at no cost 4Ref 4U.S. Department of Education (2023).IDEA Part C — Early Intervention Program for Infants and Toddlers with Disabilities.Federal basis for free physical therapy for children under 3 through early intervention at no cost to eligible families. For children 3 and older, services may be available through school-based programs or private outpatient pediatric PT practices with a referral. A home exercise program is typically part of any PT plan, since consistent practice between sessions drives much of the progress.

Toe-walking: when to pay attention

Toe-walking (walking on the balls of the feet) is common in young toddlers learning to walk and typically resolves on its own by 24 months 1Ref 1Centers for Disease Control and Prevention (2024).Learn the Signs. Act Early. — Developmental Milestones.CDC milestone benchmarks for gross motor development including walking independently by 15 months, running by 18 months, and kicking a ball and beginning to climb by 24 months2Ref 2American Academy of Pediatrics / HealthyChildren.org (2023).Is Your Baby's Physical Development on Track?.AAP guidance on gross motor development, head-to-toe developmental sequence, and the use of the AAP Motor Delay Tool to identify delays in toddlers. Persistent toe-walking past age 2–3 — especially if the child cannot easily come down to flat feet when asked — can be associated with tight Achilles tendons, sensory processing differences, autism spectrum disorder, or other neurological factors, and warrants evaluation.

A child who occasionally toe-walks but can walk flat-footed when they choose is generally not a concern. A child who exclusively toe-walks and cannot flatten their heels down warrants a prompt evaluation by their pediatrician.