Move and Play Paediatric Therapy
Does your child w-sit? Do you need to worry about this? Let’s explore this common and sometimes misunderstood childhood sitting position….
If you google ‘w-sitting’, you will find that there are hundreds of articles available for parents with advice about this sitting position. Some articles will stress how bad w-sitting is and will passionately suggest that you should never let your child w-sit. Others will suggest that w-sitting is part of normal development and is nothing to worry about.
So, as a parent, if your child starts to w-sit, what should you do? Do you need to worry if your child is w-sitting? Or not?
What is w-sitting?
W-sitting is a sitting position in which a child (or sometimes an adult!) will sit on their bottom, between their legs, with their legs pointing backwards on either side of the body. In this position, their feet may be turned inwards or turned out and pointing away from the body. If you were to look at the child from above, their legs would be in the shape of a ‘W’.
W-sitting is most commonly seen in toddlers, but some older kids will continue to w-sit up to 8 or 9 years of age.
Why do children w-sit?
There are a number of reasons why children may w-sit – and not all of them are cause for concern.
The most common reason kids w-sit:
- Femoral anteversion – kids sit in the w-position because they can…
All children are born with femoral anteversion – a condition where the femur (thigh) bones are turned inwards at the top of the bone near the hip. Some children are born with increased or excessive femoral anteversion – extra turned in position of the femur bone. It is this excessive femoral anteversion that allows kids to sit easily and comfortably in the w-sit position.
Excessive femoral anteversion is more often than not a normal variation, and will spontaneously improve over time. And it is often nothing to worry about.
Children typically also have more flexible joints than adults (we tend to get stiffer as we get older), so this increased flexibility also makes it easier for children to w-sit without discomfort.
Other reasons kids w-sit:
- Wider base of support – kids sit in the w-position because it is more stable…
When children w-sit with their legs on either side of their body, the floor surface they are in contact with is very wide, which makes w-sitting a more stable sitting position. You can think of their legs like the wings of a keel on a yacht – by having them on each side, they are more stable less likely to topple over. This makes it easier for your child to use their arms and hands to play, and is commonly seen in children who have lower muscle tone and joint hypermobility.
- Tight muscles or lack of motor co-ordination – kids sit in the w-position because they can’t or find it hard to sit in any other position…
For a small number of children, w-sitting might be the ONLY position they can sit in. This might be due to tight muscles or ligaments in their hips joints, which prevents them from sitting in other positions like legs in front or legs crossed, or it might be due to a lack of motor coordination or motor planning which prevents them from being able to coordinate their muscles to sit in other positions. This might occur when a child has a developmental delay or neurological disorder such as cerebral palsy, spina bifida or other childhood disorder.
When is w-sitting a problem?
As you can see above, 2 out of 3 of the reasons why children w-sit is due to a normal variation in their body development – their hip bones are turned inwards, or they have more flexible joints and muscles. Both these ‘conditions’ tend to improve with time – so when should we worry about w-sitting?
- When your child can ONLY sit in the w-sit position, and cannot (or has difficulty) sitting in other positions.
If your child’s only way to sit is in a w-position, then I would highly recommend seeking out an assessment from a paediatric physiotherapist or paediatrician. This is not within the normal range of movement skills for children, and could indicate an underlying developmental, neurological or musculoskeletal concern.
- When you child uses the w-sitting position more often than any other sitting position.
In this case, while the use of w-sitting is not a concern – the underlying reason why your child is choosing to w-sit that is probably worth getting checked out as it might impact other areas of their development. In addition, overuse of w-sitting will decrease your child’s opportunity to practice weight shifting in sitting, transitioning into other positions, and crossing the midline, all of which may impact on their development into the future.
In the past, there has been concern that sitting frequently in the w-position will, over time, cause the bones of children’s legs to turn even further inwards, cause hip dysplasia, or will cause over stretched or overly tight muscles in the hips and legs. However, there is no research to back this up 1,2.
If your child uses a variety of sitting positions (legs in front, legs in a ring, legs crossed, and w-sitting), then there is no need to worry about correcting them when they do sit in a w-position.
How can I encourage my child to sit in a way other than w-sitting?
If your child falls into one of the two categories above (only w-sits or w-sits often), then as well as seeking out an assessment from a paediatric physio, occupational therapist or paediatrician, there are ways that you can encourage them to sit in alternative positions:
- Encourage them to ‘sit with feet in front’ – when you notice your child sitting in the w-position, prompt your child to adjust their seating position
- Sit in a child’s chair at a table when using their hands for play (rather than on the floor) – sitting in a chair with their feet touching the floor and a table in front will provide your child with the stability they are seeking so that they can concentrate on using their hands.
- Seek the help of a paediatric physiotherapist or occupational therapist for an assessment and strategies to help your child to address the underlying reasons why they prefer to w-sit (for example, activities to build their muscle strength, coordination, or flexibility).
References:
- Goldstein, R., Nazareth, A., Ziarati, P., Mueske, N., Rethlefsen, S. and Kay, R. (2019). Hip Dysplasia is Not More Common in W-Sitters. Pediatrics.
- Mooney, J. (2014). Lower Extremity Rotational and Angular Issues in Children. Pediatric Clinics of North America.
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