The Problem with W-sitting in Toddlers

A Paediatric Osteopath Explains W-Sitting

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Walk in to any toddler group or pre-school, look around at the children happily playing, you will probably spot one or two sitting in the W-position. They look as if they intended to kneel, but their bottom collapsed through and is resting on the floor. Every child has the potential to form a W-sitting habit and once you’ve read this article, when you spot it you are going to want to discourage it. Your child won’t be uncomfortable but the body-wide impact can be widespread and longlasting. Let’s have a look at what’s going on.

What does W-sitting look like?

W-Sitting is easy to spot. It is when an infant, toddler or child sits their bottom on the floor in between their legs. When you stand above your child and look down on their head, you will see their legs have formed a ‘W’ shape.  The W-sitting position is one of many sitting positions a toddler may adopt, but its impact on your child’s body can be long-lasting. You probably aren’t even thinking of your child playing racket sports or whether they will be plagued by back pain or have flat-feet, but the W-position can impact all these.

Why do children W-sit?

Sitting in the W-position is easy so your child doesn’t need to concentrate on keeping their body balanced while they play. This position offers them extra trunk stability as their bottom is firmly supported in between their legs. It’s easy to see why your child will prefer to adopt this lazy sitting position, but the impact on developmental motor skills and orthopaedic structures later can be long-lasting.  For some children, W-sitting isn’t just a habit and can be due to an orthopaedic or core stability problem. Taking your child along to see an osteopath or discussing your concerns with your health visitor or GP can be beneficial to see if W-sitting can be attributed to an underlying cause.

A less common reason for W-sitting can be down to a child seeking the extra sensory input gained from W-sitting due to a sensory integration disorder.  Each time you move, a message goes to the brain to allow you to recognise where that joint is positioned in space. For a child with sensory integration disorder, these messages are very quiet so their joint positioning isn’t accurate and as a result they are often labelled as clumsy. If you sit in the W-position you will feel the stretch it creates throughout your hips and thighs. This stretch from sitting in the W position triggers much louder messages to be sent to the brain so their sensory input is greater and the brain can register the joint position. Children with sensory integration disorder often show body awareness traits such as: 

-         Chewing toys, clothes and other objects more than other children

-         Grasping objects too lightly or too tightly

-         Play involves a lot of physical activity such as jumping, pushing and pulling

-         Clumsiness / tripping over their own feet

What’s the problem with W-sitting?

W-sitting is not a developmental sitting position. In other words, it adds no value to your child’s development to adopt this pose. It is however an easy position for your child to adopt as they wedge their bottom in place and concentrate on playing.  When their bottom is resting on the floor between their legs, they are placing their hips in an unnatural position which can compromise the hip joints and affect how the bones of the legs grow.   Now, we are not saying that the odd W-sit here and there is going to cause a problem, but if your child is a habitual W-sitter it is time to sit up and take notice. Habitual patterns WILL impact their structures as they grow.

What impact does W-sitting have?

The issues that can arise from excessive w-sitting are vast and can impact your child well in to adulthood.  Problems we see in older children and adults visiting our clinics include:

Lack of cross-body coordination

In the W-position, your child’s torso is planted in the ground, supported by the thighs, which makes playing with toys immediately in front easy to do. But twisting and turning to reach toys either side isn’t possible in this position and this is where the problem lies. The rotational and lateral weight transference techniques learned from reaching for toys when sitting non-W are a key development factor. These learned weight transference techniques help you keep your balance when running so you can quickly transfer your weight and catch yourself if you trip or fall. Other activities which involve crossing the midline, such as writing and racket sports are based on these foundation patterns of weight transference. As a result, bilateral co-ordination is often delayed, meaning your child may struggle to use both sides of their body together. The development of a child is sequential so everything happens in order. If one stage is delayed then so will the next and so on. Activities such as skipping, writing and throwing all depend on bilateral co-ordination which stems from lateral weight transference which can’t develop when W sitting.

Pigeon-toes and back pain

A habitual W-sitter will reflect this pattern in their joints, muscles and bones, so sitting in the W-position predisposes a child to stand and walk in the W-position. As a result this can lead to some of the muscles in the hips and legs shortening leading to aches and pains in their back and hips as they grow. One study showed that sitting in the W-position as a pre-schooler may lead to children developing flat feet (1).  You may spot W-sitters who are now adults, running with their legs circling like windmills behind them.

Discourage Hand dominance

Many parents mistakenly think that being ambidextrous is a goal. It is much better for your child to develop strength and dexterity in one hand so it flourishes in fine motor skills, while the other hand can work on being a supporting hand. Think about it – it is far better to have two specialized hands that do their jobs well rather than a pair of mediocre hands trying to do it all. W-sitting may discourage a child from developing a hand preference. How? Because no trunk rotation can take place when W-sitting, a child is less inclined to reach across the body and instead picks up toys positioned on the right with the right hand, and those placed to the left with the left hand.

What can you do about it?

If you notice your child sitting in the W-position frequently, there could be a core stability issue which can lead to over-compensation in other parts of the body. It is worth consulting with an osteopath for specific exercises and advice and to rule out an underlying cause. Here are some things you can start doing straightaway to help:

-         Suggest an alternative sitting position, such as sitting with the legs to one side or straight out in front.

-         A code-word you use with your child when they adopt the W-position so they quickly understand.

-         Share your code-word with nursery and pre-school teachers and other caregivers who spend a significant amount of time with your child

-         Are much more likely to comply with your wishes when they have choice.

-         Offer your child a choice: “Would you like to sit with your legs crossed or out in front?”

-         Place toys to the side of your child so they will need to reach out of the base of support that the ‘W’ offers. This typically encourages a child to sit in a side-sit posture.

-         If your child is going to be in the W-position briefly, resist the urge to correct. Save it for longer periods so it is more effective.

If you find that your child has difficulty maintaining any other position than W-sitting, it may be worthwhile to seek the advice of your GP or osteopath for suggestions on how to correct the position and for treatment of any underlying strength deficits or muscle tightening that has resulted.  Ideally, you want to avoid the development of this habit by following our handy hints, but if you need more support, we’re here for you.

How can an osteopath help?

An osteopath will assess your child’s hips, back, knees and feet to ensure the muscles and joints are   functioning well. Based on these findings, an exercise or stretching program may be prescribed to strengthen weak muscles and lengthen short muscles.

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References

(1)    Institute of Medicine, Chung Shan Medical University, Taichung City, 402, Taiwan. European Journal of Pediatrics (Impact Factor: 1.91). 12/2010; 170(7):931-6. DOI:10.1007/s00431-010-1380-7  Source: PubMed

FELICITY BERTIN: Osteopath, Paediatric Specialist, Author, Breastfeeding Advisor, Mother, etc

Author of Yummy Discoveries: Worry-free Weaning and Yummy Discoveries: The Baby-led Weaning Recipe Book, Trainee IBCLC, Affiliate member of the Association of Tongue-tie Practitioners, Founder of The Association of Bodyworkers, Lecturer in Embryology and Developmental Biology and Neuro-musculoskeletal Medicine. And mummy to two wonderful children.....