Can slow and (un)steady still win the race? A narrative review of developmental gait characteristics and clinical implications in children born preterm

Unlabelled: Independent walking is more than a developmental milestone, as it reflects the integration of neuromuscular maturation, postural control, and sensorimotor coordination. In children born preterm, both the timing and the characteristics of independent walking may differ from those observed in term-born peers. This narrative review synthesizes current evidence on independent walking acquisition and gait features in preterm-born children throughout different stages of life, from toddler to school age, and discusses the clinical implications of quantitative gait assessment, with a focus on innovative wearable technologies, during neurodevelopmental follow-up. Preterm birth is consistently associated with a 1-2-month delay in independent walking onset compared with term-born peers, even after correction for gestational age (GA), with greater delays reported in infants born at lower GA or with very low birth weight (BW). Beyond milestone attainment, both qualitative and quantitative studies describe less mature gait patterns during early walking and the preschool years, including shorter step length, wider base of support, prolonged double-support phase, increased temporal variability, and reduced gait complexity. These characteristics likely reflect compensatory strategies related to immature postural control and sensorimotor organization. Although many spatiotemporal parameters improve with age and walking experience, subtle differences may persist into school age, particularly under more demanding conditions such as dual-task walking. However, currently available studies on preterm gait are quite heterogeneous in terms of GA, BW, and/or individual walking experience of included individuals and gait analysis methods employed. Furthermore, evidence regarding gait characteristics in preschool and school-aged preterm children is still relatively scarce, thus hampering a deeper understanding of preterm-born children's gait development after the toddler stage. Conclusion:  Instrumented gait analysis systems and wearable technologies, including inertial measurement units, enable objective and ecologically valid assessment of gait performance. Quantitative gait parameters have shown associations with standardised gross motor scores and may provide additional information beyond milestone history alone. Incorporating structured quantitative gait assessment into longitudinal follow-up programmes could support more detailed monitoring of motor development and inform individualised rehabilitation planning in children born preterm. What is known: • Children born preterm generally achieve independent walking later than term-born peers and may show immature gait features, particularly during the first years of life. • Most available evidence is heterogeneous and focuses mainly on walking onset or early gait, with limited data extending into preschool and school age. What is new: • This review integrates evidence on gait development from the fi rst independent steps to school age, identifying persistent abnormalities mainly in children born at lower gestational ages, with lower birth weight, or under demanding walking conditions. • It highlights the potential role of quantitative gait analysis and wearable inertial sensors as complementary tools for longitudinal neurodevelopmental follow-up and individualized rehabilitation planning.