My Toddler Bottom Shuffles and Is Not Walking at 20 Months: A Paediatric Physiotherapy Case Study
Quick answer: Bottom shufflers often walk later than crawlers, commonly between 18 and 24 months. It is worth an assessment when a child is not walking by 18 months, because bottom shuffling can go together with low muscle tone and very flexible joints. In this case a 20-month-old had both, and the plan was a short block of home physiotherapy and more supportive shoes.
This case study is based on a real child seen by a physiotherapist in our team. Family details, the location and other identifying details have been changed or removed to protect the family's privacy.
The concern: getting around on their bottom at 20 months
Two doctors involved in the child's care referred a 20-month-old for a home assessment. The toddler had crawled at about 13 months, pulled to stand at about 19 months, and had been cruising along furniture for less than two weeks. Their preferred way of getting around was bottom shuffling, leaning onto one hip.
What the physiotherapist found at the home visit
Motor skills for age: a standard infant motor screen placed the child well below the 5th percentile, which confirmed a gross motor delay.
Muscle tone: mildly low throughout the body, with no worrying neurological signs.
Joints: very flexible ankles and hips. Flexible ankles make it harder to feel steady in standing.
Standing: the child was unsure and stiffened when supported upright, a sign of not yet trusting their balance.
Handling: easily upset when moved by someone new, and quick to settle with a parent between activities.
Put together, the picture was gross motor delay with low muscle tone and ankle flexibility, which made standing feel insecure. Bottom shuffling was the child's sensible workaround, because it is stable and fast.
The physiotherapy plan
A home exercise program to support gross motor development, practised with the parent during the visit.
A block of six home visits, two to three weeks apart, to progress the program toward independent walking.
More supportive shoes with a firm heel to give the ankles stability in standing and stepping.
A letter to the referring doctors with the findings, and an update after the block to report how the child responded.
Seeing the child at home meant the physiotherapist could use the family's own furniture and toys, and the parent practised each activity during the visit.
What parents can learn from this case
Bottom shuffling is a common variation, and it runs in families. On its own it is not a problem.
The combination to watch is late standing plus floppiness or very bendy joints.
Children with low tone often dislike standing because it feels wobbly. Confidence comes from supported practice in short bursts.
Shoes can help. Barefoot is best for most new walkers, but a child with very flexible ankles may do better with a firm heel.
When to seek an assessment
See a paediatric physiotherapist or your GP if your child is not pulling to stand by 12 months, not walking by 18 months, feels floppy when you pick them up, uses one side more than the other, or has lost skills.
How can the NDIS help?
Children younger than 6 with delays in their development can get help through the NDIS early childhood approach, and they do not need a diagnosis first. An early childhood partner can connect families with early supports and help them apply to the NDIS if the delay is significant. Physiotherapy reports like the one in this case are useful evidence. See our NDIS physiotherapy page. Families can also see us privately while they wait.
Frequently asked questions
Do bottom shufflers walk late?
Often, yes. Many bottom shufflers walk between 18 and 24 months. An assessment checks that nothing else is slowing them down.
Is bottom shuffling a sign of a problem?
Usually not. It can be linked with low muscle tone or very flexible joints, which a physiotherapist can check.
When should I worry that my toddler is not walking?
Seek advice if your child is not walking by 18 months, or earlier if they are not pulling to stand by 12 months.
What is low muscle tone in a toddler?
Low muscle tone, or hypotonia, means the muscles are more relaxed at rest. Children can feel floppy and need to work harder to hold positions such as standing.
Home-visit physiotherapy in the Inner West
Sydney Child Physio is a mobile paediatric physiotherapy service. We see toddlers at home and at childcare in Strathfield, Burwood, Homebush and across the Inner West. Call 0491 042 992 or contact us.
Related reading
Delayed walking in toddlers: a case study