“She broke her toe when she got up from W-sitting on the floor while she was reading a book!” That was the opener as a mom and her daughter came in for a scheduled physical therapy session.
What is W-sitting, what’s wrong with W-sitting, and what to do about it?
Let’s start with what is W-sitting? In the world of pediatrics and physical therapy, I get asked about this sitting posture a lot. Many young children will move in and out of sitting in a variety of ways when they play. Children who sit with their feet and legs out to the sides and their hips and bottoms on the floor between are in a “W-sit” position.
Several problems with the position develop over time, so parents who are aware of these problems can be the first people who intervene to prevent injury and deformities that develop over time.
Why is it a problem?
First, W-sitting interferes with children developing the trunk control and rotation necessary for midline crossing (reaching across the body) and separation of the two sides of the body. These skills are the foundation for developing motor skills. Since the position prevents a child from being able to rotate the trunk and reach to the side, it makes reaching across the body (midline) to gets toys on the opposite side difficult, if not impossible. For example, kids will rely on using their right arm to reach to the right side without rotating their body, and neglect using the opposite arm to reach across the body to pick up toys. They can reach for toys in front, but won’t twist and turn to reach to either side. These motions of lateral weight shifts (moving over one side of the body), trunk rotation and weight shifting allow kids to transition to stand, walk/run, play and balance freely and confidently. Crossing the midline is necessary for writing and doing activities with both hands at a desk or table. Kids who don’t have this stability and control of their trunk rely on this W-sit “base of support” to “fix” their bodies on a stable, less flexible base.
Second, it’s not just a concern about motor development, but also development of orthopedic deformity. In the case of my little client, the voracious reader, the force of her pushing into her feet and toes in that position over a prolonged amount of time, actually resulted in a fracture!
While fractures are not common, development of hip, knee, and foot deformities are. Common problems that are made worse with W-sitting include muscle tightness and imbalance, especially muscles of the inner thigh, hamstrings, and calf. If a child has other neurological problems or developmental delays (low tone or high tone), this posture can lead to further shortening (contractures) or imbalance of muscle strength. Common orthopedic deformities include hip dysplasia, knee deformities, and even foot and toe problems.
What to do, what to do?
The best way to prevent W-sitting is to prevent it from becoming a habit, by being very consistent….which is THE hardest part of training ANYTHING with our kids! When we see it happening, catch it before it becomes their preferred posture. Teaching our children other sitting positions works well, even if they’ve “discovered” W-sitting. Helping my child move into another posture like “crisscross applesauce” (legs crossed in front) or cheerfully asking him to “put your legs in front” while I assist him to do it works well. When supported with his back against the sofa, it will feel more stable as he gains more trunk control.
During therapy, I often hold a child’s feet together when kneeling or creeping on hands and knees. When playing at home, helping to keep feet together in these activities allows them to push into the knees and feet and shift their weight from side to side. Sitting on a small stepstool/chair or other raised surface with feet on the floor in front of a table works well also. If a child is unable to sit alone in any position other than a W, talk with a therapist about supportive seating or alternative positions. Still concerned about W-sitting and implications for your child? Contact us at Kid’s Creek Therapy and set up a free consultation to learn more! Call 770-888-5221.
Karolee Stauduhar, PT