Warning: The Dangers of W-Sitting
Children move and change positions all the time. The W-positions is one of many sitting positions that children move in and out of during play and daily activities. It is called W-sitting because when you look at the child from above their legs are spread back and out in a W-shape like this: W-sitting is not recommended for anyone. Many typically developing children do move through this position during play, but all parents should be aware that the excessive use of this position during the growing years can lead to future problems.
Why do children W-sit? Every child needs to play and children who are challenged motorically like to play as much as anybody. They don’t want to worry about keeping their balance when they’re concentrating on a toy. Children who are frequent W-sitters often rely on this position for added trunk and hip stability to allow easier toy manipulation and play. Try sitting in various positions. Notice how you got there, got out, and what it took to balance. Many of the movement components you are trying to encourage in a child are used when getting in and out of sitting. No trunk rotation, weight shifting, or righting reactions are necessary to assume or maintain W-sitting. It’s easy to see why this position appeals to so many children because it simplifies the motor demands of sitting, but continued reliance on W-sitting can prevent a child from developing more mature movement patterns necessary for higher-level skills.
Why is this sitting position bad for children? When playing in different sitting positions, children develop 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 needed for a child to develop refined motor skills and hand dominance. When in the W-position, a child is planted in place or “fixed” through the trunk. This allows for play with toys in front, but does not permit trunk rotation and lateral weight shifts (twisting and turning to reach toys on either side). Trunk rotation and weight shifts over one side allow a child to maintain balance while running outside or playing on the playground and are necessary for crossing the midline while writing and doing table top activities.
Who should not W-sit? W-sitting should always be discouraged (and could be very detrimental) for a child with:
- Orthopedic (especially hip) concerns. W-sitting can increase the risk of hip issues so if there is a history of hip dysplasia or other concerns about hip function or structure then this position should be avoided.
- Muscle tightness. W-sitting aggravates tension in the hamstrings, hip adductors, internal rotators and heel cords into a shortened range. If a child is prone to tightness or is a toe walker they need to be avoiding this position.
- Neurological concerns or developmental delays. If a child has increased muscle tone (hypertonia/spasticity) then W-sitting can aggravate these problems and limit the development of better motor patterns.
W-sitting can also discourage a child from developing a hand preference. Because no trunk rotation can take place when W-sitting, a child is less inclined to reach across the body and instead picks up objects on the right with the right hand, and those placed to the left with the left hand.
How to prevent W-sitting problems The most effective (and easiest) way to prevent a problem with W-sitting is to prevent it from becoming a habit it the first place. Anticipate and catch it before the child even learns to W-sit. Children should be placed and taught to assume alternative sitting positions. If a child discovers W-sitting anyway, help him to move to another sitting position. It’s very important to be as consistent as possible. For children who often W-sit during play, you can hold knees and feet together when they are kneeling or creeping on hands and knees. It will be impossible for your child to get into a W-position from there. Your child will either sit to one side, or sit back on their feet. If they sit back on their feet you can then help your child to sit over to one side (try to encourage sitting over both the right and left sides). These patterns demand a certain amount of trunk rotation and lateral weight shift and should fit with most children’s therapy goals but please consult your child’s physiotherapist before applying this strategy to ensure you are a not limiting their motor development. If a child is unable to sit alone in any position other than a W, or has a preference for sitting in that position then it’s important to get an assessment by a physiotherapist to find out why they are using this position and whether it is a current or may become a future problem. Your Therapy Alliance Group physiotherapist can provide strategies and a tailored motor program and also discuss supportive seating or alternative positions such as prone and side-lying to help your child. Call our Toowoomba clinic now to book a physiotherapy assessment for your child. Phone: 1300 66 1945 Therapy Alliance Group provide Speech Pathology (speech therapy), Occupational Therapy, Physiotherapy and more for families from Toowoomba, Highfields, Warwick, Dalby and surrounding areas. We have a special interest in helping children (0-18yrs) and adults with disabilities to achieve their own unique potential and live life to the full.
– by Rachel Tosh
Rachel is a Certified Practicing Speech Pathologist (CPSP) with a wide variety of clinical experience in inpatient and outpatient paediatric care in both Australia and the UK which enables her to translate theory into real life application across diverse clinical contexts. Her latest adventure, Speech Parent is changing the face of paediatric speech pathology internationally by empowering and educating parents of children with communication and feeding difficulties. She describes herself as a recovering work-a-holic (we all know she isn’t actually recovering – seriously who else sends emails at 4:30am!?). Rachel is passionate about: business leadership; literacy and feeding difficulties; educating and empowering others; and optimising therapy outcomes. Although these interests may seem diverse, the recurring theme through them all is a love for facilitating growth and development in others so they can achieve their own unique potential. Things I like: “Lamb roast, reading, helping others and creating systems that work…I may or may not enjoy these together!” Things I don’t like: “People not respecting each other and children missing out because of bad care or broken systems.” Favourite colour: “Can I have the whole rainbow?” How the TAG team describe Rachel: “Passionate”; “Hard working”; “Creative”.
“Be there for others but never leave yourself behind” -Dodinski