Mastering the Stairs

Walking up and down stairs is a significant milestone in a child’s gross motor development. It requires strength, balance, coordination, and confidence.

Developmental Milestones and Stair Climbing

• Creeps (hands and knees position) up and down stairs on hands and knees: 15–18 months
• Walks up and down the stairs with support (holding onto the handrail/wall): ~18-24 months
• Walking up and down stairs without support: ~2 to 3 years old
• Walking up and down stairs without support and alternating feet: 3-4 years old

**Children with motor delays may achieve these milestones later or require therapeutic interventions. **

Key Skills for Stair Navigation

1. Leg Strength
2. Core/Postural Stability: The ability to maintain your body in a position to complete a task or activity
3. Balance
4. Coordination
5. Visual and Spatial Awareness: Helps to judge step height and foot placement

Examples on Activities to work on Stair Negotiation

The following activities focus on walking up and down the stairs

1. Strengthening

• Sit-to-stand:
  • Have child sit on a stool/box/small bench
  • Place a mirror, table, or vertical surface (e.g. wall, glass door, fridge, mirror) in front of them to have them reach forward
  • If needed, allow them to place their hands on the surface for additional external support and as they get stronger move them further away from the surface in front of them, so they are not able to use it as support
  • To make it more challenging: place a pillow underneath their feet while they are performing a sit to stand
  • Play Ideas:
    • Complete a puzzle-perform a sit to stand after each puzzle piece
    • Place magnets or stickers (paper taped on wall) on a vertical surface-perform a sit to stand after each piece
    • Tape a long paper on the wall and have them color/draw-perform a sit to stand to change colors
  • Step-ups and step-downs
    • Start on with small curbs while walking around your community/park
      • Initially provide handheld assistance and as they get stronger have them step up and down without your help
    • Use stable boxes and/or step stools with varied heights and stack them in line created a smaller version of a staircase
      • Place them next to a wall so that your child can place their hand on the wall for additional support of needed
      • As they get stronger, have them walk up and down the stairs without support
    • Play Ideas:
      • Completing a puzzle-carrying each piece walking up the steps and walking back down to get more pieces
      • Completing a token toy/activity (cookie jar toy, fishbowl toy, piggy bank toy)-walking up the steps to place an item into the container and walking down the steps to retrieve another item
      • Making a Mr. Potato head-start with an empty Mr. Potato head and have your child walk down the steps to get an item and then walk up the steps to place it on Mr. Potato head
    • Squats
      • Picking up items from the floor and returning to stand
      • To make it more challenging, have them stand on a pillow
      • Play Ideas:
        • While standing, place a ball between the legs of your child and have them squat down and reach for the ball. Then when they return to standing, have them throw it to you
        • Place Squigz toys on a surface in front of your child to the level in which your child will need to squat to them off-this also will make them maintain a squat position working on their endurance
        • Playing in a deep squat position while on the floor

2. Balance Activities

• Standing on One Leg
  • Encourage your child to stand on one leg. If this is difficult for them, start with having your child hold onto your hand or place their hand on the wall while standing on one leg. As their balance and strength improves, you can see if they are able to stand on one leg on their own.
  • Play Ideas:
    • Use a token toy that your child can push a token down with their foot. For example, I like using the piggy bank toy. I place the coin at the insert opening and then I ask the child to “stomp” on the coin.
    • Kicking bubbles. Blow bubbles or use a bubble machine to have your child pop or kick the bubbles with their foot.
    • Place a sticker on the top or bottom of their foot and ask them to lift their foot to grab the sticker.
  • Obstacle courses
    • You can use many things around your home/community to make an obstacle course. Then place each segment in line for your child to complete. Can use a puzzle, stickers, or other toys to have them walk back and forth through the course
      • Use a rolled towel, broom stick, pool noodle to your child step over them. To make it more challenging, you can elevate whatever item you choose with pillows to have them step over taller obstacles.
      • Use an empty box, pot, or container to have your child step in and out of the object.
      • Use your couch cushions, stacked pillows, or sturdy boxes as steps
      • Use curbs or rolled towel/blanket (that is a bit flattened on the top) as a balance beam and have your child try to take steps placing one foot in front of the other
    • Standing or walking on unstable surfaces
      • This is a balance and strengthening exercise as well!
      • Play Ideas:
        • Standing and squatting on a pillow/couch cushion
        • Walking over pillows or couch cushions
        • Walking up and down ramps/hills at the park and/or in your community. This also help work on the coordination and motor control needed to be stable as they walk up and down the stairs
        • Walking on grass at the park
        • Walking on sand at the beach or park

3. Gait Training with Stairs

• While practicing directly on the stairs here are some things you can also try.
  • For safety, when your child is walking up the stairs, I like to stand and walk behind them as it is more likely that if they lose their balance, they will fall backwards. When your child is walking down the stairs, I like to stand in front of them (as I walk backwards down the stairs) as it is more likely that if they lose their balance, they will fall forwards
  • Have your child start by holding onto the wall or handrail while they practice walking up and down the steps. If they have a difficult time holding onto those supports, you can help guide their hands along the railing or wall. I sometimes will place stickers on the railing or wall to give them a visual cue on where to place their hand.
  • If you are working on your child alternating their feet, I also like using visual cues to help them.
    • Place different stickers on their shoes and use verbal prompts to have them step up or down the stairs. For example, the right shoe has a red sticker, and the left shoe has a blue sticker. You can prompt them to walk up the stairs by saying “let’s go up! Go up with your red shoe. Now go up with your blue shoe.”
    • Place a picture, tape, or stickers on each step in an alternating pattern. You then ask your child to step on the visual cue you have taped onto each step
  • If they place both hands on the wall or railing, you can try having them hold an object in one hand if they have adequate balance and stability to so.
  • As your child is learning how to walk up and down the stairs, you might need to provide them with additional support by holding their hips and helping them shift their body to the right to step up or down with their left foot or to the left to step up or down with their right foot.
  • As your child gets stronger and more comfortable with the stairs, you might still need to provide them with handheld assistance as they walk up and down each step.

REMEMBER:

• Always supervise stair practice
• Gradually reduce support only when your child demonstrates readiness

Early intervention is key to help provide individualized treatment and parent education/support to address any concerns and signs of developmental delays. If you have any questions or concerns regarding your child’s development, you can schedule a consultation call with one of our therapists.