With the right support in standing, anything may be possible for your child.


When considering childhood milestones, one of the most exciting milestones for all parents is their child’s first steps, aided or unaided. Regularly as physiotherapists we hear questions like “Will my child ever walk?” This question is never an easy one to answer and sometimes the answer is unclear. However, what we can do to help is to promote as much independence and efficient gait patterning as possible, to progress towards independent walking of some way, shape or form. Sometimes, this means using equipment to help get there. Walkers and gait trainers can help your child move to their maximal potential or learn the patterns necessary to independent upright mobility.


GAIT TRAINERS VERSUS WALKERS - What’s the difference?

A walker is when your child takes full weight on their lower limbs to step, whereas a gait trainer is more supportive and helps your child take partial weight, so that they can learn how to step. Simply put, a gait trainer is a more supportive version of the walker and has adaptive supports to assist your child to stand and learn to step.



Walkers can have attachments for people who need more accessories such as forearm supports if they can’t grip the handles, a hip harness for pelvic stability or a seat for safety. Walkers are often suited for children with reasonable postural control but require assistance for balance, stability and endurance over longer distances.

Crocodile Walker 

Nimbo Walker 

Kaye Walker


Gait trainers:

Gait trainers often come with more support options such as trunk support, pelvic support, seats, and arm prompts so they are more suitable for children who may not be able to support their full body weight and take steps. The supports can be added or removed as required dependent on the child's ability.

 Rifton pacer gait trainer


Mustang gait trainer

Grillo gait trainer


Rifton Pacer Gait Trainer 

Mustang Gait Trainer 

Grillo Gait Trainer 



The evidence for implementation of gait trainers is quite low and majority of recommendations are based on observational and clinical experience. The research suggests that for children with motor impairments using gait trainers, there can be improvements such as increased mobility, increased number of steps, speed and distance, and increased independence.1

Walking itself is important not only for the development of independence and physical strength, but also for psychosocial development. Independent mobility assists in improving:

Hip development and stability

Hip development and stability;

Bone density and skeletal development

Bone density and skeletal development;

Muscle strengthening and stretching

Standing and walking help promote muscle strengthening and stretching to promote muscle length and prevent joint contractures;2

Positioning and pressure relief

Provides alternate forms of positioning and can help promote health by reducing sedentary behaviours and aid in pressure relief;3

Cardiovascular and respiratory functioning

Improves cardiovascular and respiratory function;

Digestion and bowel function

Improves digestion and bowel function through the effects of gravity, reducing constipation and can assist in improving bowel regularity;

Visual attention and awareness

Visual attention and awareness;

Cognitive development

Promotes cognitive development through the ability to explore environments;


Supports socialization and participation by allowing an upright position for eye contact aiding speech development; and

Quality of life, confidence and independence

Promotes improved quality of life, confidence and independence.



Typical child development is not linear and if we look at the World Health Organisation’s windows of achievement for six gross motor milestones4:

  • Standing with assistance can occur between 5-12 months,
  • Standing independently between 7-17 months,
  • Walking with assistance between 6-14 months, and
  • Walking independently between 8-18 months.

The actual timing of when to progress to a walking frame is therefore child dependent and again, a difficult one to answer. Typically speaking if your child is starting to demonstrate appropriate weight bearing in standing and/or initiating steps and is age appropriate for walking then it could be time to start considering. Children with developmental disabilities or severe physical motor impairments benefit from the early provision of a walker or gait trainer if it is felt that they will not develop the ability to independently walk in the foreseeable future. Babies, toddlers or children with development delays not only have a delayed ability to walk but usually have delayed motor skills across all areas of development. Early intervention and gait training with therapist assistance and guidance, can help promote strengthening, weight bearing tolerance, postural control, visual development, and reciprocal (left and right) patterning for stepping. The early provision of a supportive and safe gait trainer allows your child to experience movement and mobility like their peers.

Not all children who use gait trainers will develop the ability to walk unaided, and some may still require assistance to steer the gait trainer or be limited in community use, due to poor endurance and onset of fatigue. However, gait trainers promote play and inclusion with peers at eye level allowing the development of social skills such as turn taking, exploration, problem solving and most importantly, it is fun!

As physiotherapists, it is often hard to predict how independent a child will be with their walking ability however, with early intervention, the right support and by providing opportunities to practice means there can be significant improvements in walking independence or gait characteristics. In addition, these improvements might improve your child’s overall quality of life in the future. For example, through gait training and practice in a walker your child might be able to learn the skills to perform a supported step standing transfer instead of requiring a hoist transfer.

Walkers and gait trainers have contraindications however, which include children who cannot tolerate upright positions due to cardiorespiratory issues, an inability to weight bear due to severe osteoporosis or joint contractures, or significant lack of head control making it unsafe for them to be upright. Therefore, it is important that you consult with your child’s physiotherapist prior to your child using any form as walker or gait trainer.



Choosing a gait trainer requires extensive input from your physiotherapist and multiple trials to determine the most appropriate gait trainer for your child. A walker in Australia utilising NDIS funding needs to be prescribed by your child’s physiotherapist.


Framing – anterior or posterior?

An anterior or posterior frame is just referring to the way the front of your child’s is facing in relation to the gait trainer. Therefore, anterior for them facing the supports and posterior for them facing away from the supports.


Benefits of an anterior frame:

An anterior gait trainer is often ideal for children who need to heavily rely on the support of the walker. It also promotes the momentum of moving forward through a forward lean. Although it reduces hip and trunk extension, sometimes it is necessary for children to use this momentum to achieve functional ambulation and stepping by removing some of the weight of the trunk.


Benefits of posterior frame:

As the support is behind your child, a posterior walker tends to encourage increased hip extension and improve overall posture, closely mimicking a more natural gait pattern and stride length.5 Evidence suggests that majority of walking aid users and their parents preferred posterior walkers,6 with the benefit of having an open front allowing the ability to walk up to surfaces for play or participate in sporting activities. For children who require less assistance, a posterior walker may be the more suitable option.






Overall, clinical recommendations for an anterior or posterior walker are individualised to each client,6 and thorough analysis of your child’s current range of motion, muscle strength, functional mobility and goals will contribute to what walkers or gait trainers you may trial.

The primary goal of trials is to determine the gait trainer that promotes a functional and safe position for your child to practice walking. In addition, physiotherapists will be looking at which walker places your child in an appropriate position to promote muscle activation and strengthening, participation, independence, is more likely to promote functional improvements in gait, as well as ensuring the position is safe for joint development.



  1. The best place to start is by contacting your physiotherapist and having conversations about your child’s goals and how assistive technology may assist in achieving these.
  2. From here, your physiotherapist can explore options with you and your child and start arranging trials with equipment companies.




  1. Paleg G, Livingstone R. Outcomes of gait trainer use in home and school settings for children with motor impairments: A systematic review. Clinical Rehabilitation. DOI: 10.1177/0269215514565947.
  2. Damcott M, Blochlinger S, Foulds R. Effects of passive versus dynamic loading interventions on bone health in children who are non-ambulatory. Pediatric Physical Therapy. 2013;25:248-55.
  3. Verschuren, O., Peterson, M. D., Balemans, A. C. J., & Hurvitz, E. A. (2015). Exercise and physical activity recommendations for people with cerebral palsyDevelopmental Medicine and Child Neurology, 58(8), 798-808.  
  4. WHO Multicentre Growth Reference Study Group. WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatrica Supplement 2006;450:86-95.
  5. Logan L, Byers-Hinkley K, Ciccone CD. Anterior versus posterior walkers: a gait analysis study. Developmental Medicine and Child Neurology. 1990;32(12):1044-8. doi: 10.1111/j.1469-8749.1990.tb08521.x.
  6. Marilyn Poole, Doug Simkiss, Alice Rose & François-Xavier Li (2018) Anterior or posterior walkers for children with cerebral palsy? A systematic review. Disability and Rehabilitation: Assistive Technology. 2018;13:4, 422-433, DOI: 1080/17483107.2017.1385101.