Negotiating stairs is an important skill for children to master – not only at home, but at school and in the community. Most children begin to crawl up and down stairs shortly after they learn how to four-point crawl. And they learn how to walk up and down stairs shortly after mastering walking.

Children with trisomy 21 however, often benefit from extra practice and support while learning how to go up and down the stairs. Activities and exercises that promote core strength, leg strength and balance are also beneficial. Here are some tips to help your child at each stage of their stair-climbing journey.  

Crawling up the stairs

Once your child learns to four-point crawl, they may be eager to crawl up the stairs. Ensure safety by using proper gates, only allowing access to the stairs under direct supervision and with the help of an adult.

Here are some activities and exercises to help your child crawl up the stairs: 

• Play in a “tall kneel” (on knees, with waist straight)
• Practice crawling over people and pillows  

Crawling down the stairs 

The safest way for your child to crawl down the stairs is backwards on their belly.  Here are some activities and exercises to help your child crawl down the stairs: 

• Sliding down a slide backwards  
• Sliding off the couch or a bed backwards  

Some children are fearful of moving backwards because they cannot see where they are going. If this is the case for your child, try practicing on just 2-3 steps from the bottom.

Walking up the stairs 

Most children learn how to walk up the stairs before they learn how to walk down the stairs. Typically, children learn to put two feet on each step, holding onto the railing with one hand, and holding onto an adult’s hand with their other hand. It is important to practice alternating which foot goes up first to prevent building uneven strength on one side of the body.

Here are some activities and exercises to help your child walk up the stairs with two feet on each step:  

• Kicking a ball  
• Stepping over small hurdles 
• Stepping up onto curbs  
• Stepping up onto step stools  

If your child is having difficulty stepping up the stairs forward, practice holding onto the railing and stepping up sideways.  

Once your child can walk up the stairs with two feet on each step, alternating which foot leads, practice placing only one foot on each step using a foot-over-foot (or reciprocal) pattern.  

Here are some activities and exercises to help your child walk up the stairs with one foot on each step:  

• Place a different sticker (such as a Sesame Street character) on each foot and then say: “Give Elmo a turn, then give Cookie Monster a turn.”  
• Tape cut-out feet of different colors to the stairs, such as a red foot for the left foot and a blue foot for the right foot. Ask your child to step on the red foot, then the blue foot.

Walking down the stairs 

Walking down the stairs is more challenging than walking up the stairs. Your child may master walking up the stairs with a foot-over-foot (reciprocal) pattern long before they learn to walk down the stairs with the same pattern.

Walking down the stairs requires eccentric control of the quadriceps, the muscle found on the front of the thigh. For each step down, your child must perform what is essentially a single leg squat. Many children learn to step down by keeping their stronger leg on the step, supporting their weight on the stronger leg, while lowering themselves down to the next step.  

Here are some activities and exercises to help your child walk down the stairs with two feet on each step:  

• Squatting down to pick up items from the floor  
• Balancing on one foot 
• Stepping down from curbs  
• Stepping down from step stools

If your child is having difficulty stepping down the stairs facing forwards, practice holding onto the railing and stepping down sideways.

Once your child can walk down the stairs with two feet on each step, alternating which foot leads, practice placing only one foot on each step using a foot-over-foot (or reciprocal) pattern. This may be the most difficult stair-related goal for your child to master.  

Here are some activities and exercises to help your child walk down the stairs with one foot on each step:  

• Place a different sticker (such as a Sesame Street character) on each foot and then say: “Give Elmo a turn, then give Cookie Monster a turn.”  
• Tape cut-out feet of different colors to the stairs, such as a red foot for the left foot and a blue foot for the right foot. Ask your child to step on the red foot, then the blue foot. 
• Ask your child to kick their foot out over the edge of the step, and slide their heel down the edge of the step in front of them 
• Provide alternating cues such as “peanut butter” for one foot and “jelly” for the other foot.  

Some children prefer to continue putting two feet on each step. If this is the case for your child, rather than undergo a battle of wills multiple times each day, limit practice of the foot-over-foot pattern while stepping down to 1-2 times per day. You can also try only practicing the foot-over-foot pattern on the bottom 4 steps, then gradually increase the number of steps you practice over time. Do your best to keep the time of day consistent, for example, every morning before school or every night before bath time. Some children benefit from watching a friend, sibling, or parent step down next to them.

More helpful tips 

If your child is visually impaired, they may have difficulty knowing where the edge of each step is. Allow your child to use their heel to feel the edge of the step in front of them, before stepping down. You can also try placing a strip of brightly colored duct tape along the edge of the steps.

If your child is having trouble with stairs on the playground or at school, consider the environment. Your child may benefit from practicing the stairs at school with their school PT at a time when the stairway is not filled with other children talking and moving quickly. Consider asking a teacher or classmate to carry your child’s backpack while they walk up or down the stairs.  

Proper footwear is important for safety on the stairs. Wearing supportive sneakers and orthotics when practicing on stairs inside and outside of the home may make your child more successful.

If your child has mastered going up and down with a foot-over-foot pattern, you can help them advance their skill level by challenging them to carry a backpack or to let go of the railing. You can also try timing your child walking up and/or down and see if they can “beat” their time.

Whether your child is just learning to crawl or is already walking up and down the stairs, there are so many ways to make stair climbing fun and challenging. Always provide supervision and help to keep your child safe. Good luck practicing this important skill!  

Nathalie Musey, DPT, PT, PCS, is a physical therapist with the Specialty Care and Surgery Center in King of Prussia, PA.