Monday, February 16, 2009

W-sitting

Aaahh, What? W-sitting??? Ok, this is one of the big issues from my therapy days. W sitting is referring to the position of a child’s legs when they sit on their bums with their knees bent and their feet out to either side of their hips. I see the light bulbs coming on. I know you have seen this somewhere before. You did it as a kid or know someone who has. Maybe you have seen it in your own kiddo.
So what? Now that we have a name for it, what’s the big deal? Well, as a mom and as a therapist, it is one of the biggest pet peeves I have. Let me give you a brief run down of why and how to stop your little one from W sitting.

While it may be more common in children with special needs, most children, at one time or another will transition through a phase of sitting in this manner. All children should be discouraged from sitting in a W formation. What the child gets from W sitting is a greater sense of stability. To sit this way provides trunk and hip stability. This allows them to have more control over the toy in front of them. One problem is that it limits their ability to transition into different positions during play. So this makes it difficult to move within their space, change positions or reach for a different toy. When the child consistently sits and plays in this position their development of lateral trunk muscles is hindered. Why is that an issue? Well, this will make it more difficult for them to run and play in gross motor activities on the playground or in sports and this will make it more difficult for them to sit at a desk and attend to a classroom task. Not to mention the effect that it will have on the hips and knees from an orthopedic perspective.

Ok, here is some therapy jargon for you. To have distal control, one must have proximal stability. Blah blah blah. What did she just say??? What that means is that to have good control of a pencil or a crayon that is held in the distant or distal part of the body/arm, there has to be good muscle control and a certain amount of strength in the body parts that are proximal or close to the trunk or base of the body. So if you decrease the amount of time your kiddo is sitting in a W shape, in theory they will develop stronger muscles on the sides of their body throughout their hips and shoulders and this will in-turn give them better control over things in their hands. Things like toys, balls, crayons and pencils.

That covers the why, now lets talk about the how. I’m not saying you have to be on top of your kid every minute and send them to time out for sitting the “bad” way. Just keep an eye out and know in the back of your mind that it will help them in the long run if you correct it early. The first few times you can just give them some suggestions of other ways to sit.
Like sitting with legs crossed.
Or they can side sit.
Or there is long sitting. You can manipulate or move their legs into a better position and model or show them how you can sit correctly. “See how Mommy sits.” After several times, usually a few days or so, a simple verbal command will be enough. “Fix your legs please” and voila. No need to loose any sleep over it, sleep is way too hard to come by.

12 comments:

Colleen said...

I will look for this in my kiddos... Thanks for the helpful tips. I had no idea.

amy trax said...

I did this as a child and I can still sit w style. I never realized the ramifications. I find any other style of sitting very uncomfortable. Very interesting!

amy trax said...

I sat w-style as a kid and I can still do it. I vividly remember my teacher telling me to sit indian style and it was so uncomfortable. Thankfully me kids don't sit w-stlye.

Anonymous said...

I am 18 and I sat in the W sit until about 7th grade. I can still do it, though I avoid it. I already have knee and hip problems due to sitting in that position regularly. My hips are rotated so that my knees point inward when my feet point straight out.
Bottom line: it's not worth it! Don't let your kids do it :)

Anonymous said...

I am 56. 'W'sitting was the only way I sat as a kid. I have a new right hip and and new left knee. I hurt my left knee as a kid (medial meniscus tear). I blew the ACL at sometime in my athletic college career. I have been in physical therapy for 2 years + because I have so much pelvic motion pain. The joint replacements have helped and I have a wonderful therapist that looks at the motion of the entire body and sees the limitations of motion around the hips and pelvis. Don't let your kids sit this way...chronically.

Rebecca said...

I'm wondering if there's empirical evidence to support these recommendations? If so, do you have any references? I'm an OT as well (currently on maternity leave so I don't have access to the research resources at work) and have often given these recommendations to families I've worked with. But now I'm seeing a lot of w-sitting in "typically" developing kids and they seem to grow out of it with no on-going problems. So I'm wondering if w-sitting can actually be part of "normal" development - just a phase. Or, if it is in fact associated with orthopedic issues, and issues with development resulting from decreased trunk rotation, is it that those who are prone to w-siting are also prone to those other issues as the result of some other underlying issue, like joint laxity? Is w-sitting a symptom and not the cause? What are you thoughts?

I'm also wondering if you have suggestions for discouraging w-sitting in babies? W-sitting is my 10-month old's preferred position for play. I'd like to correct her, but also hate to interupt her play.

jewelryandgiftsbyrebecca said...

Great questions Rebecca. If you watch a child in normal play... they crawl and then when they stop to engage in activity, what happens? They sit back and voila; W-sitting. In a normal child that is hitting developmental milestones and does not seem to have any delays it's not a big issue. I still lean on the side of caution and try to discourage it but as you said, how often do you want to interrupt their play? I have a 1 y/o and he knows the phrase "fix your legs" and understands what I'm looking for. When I say that to him he looks at me straightens his legs and then waits for praise. I was able to get this across to him at about that 10 month mark in less than 2 weeks of fairly regular intervention. When I observed this posture, I would say the phrase and manually tilt him back enough to gently pull each leg forward so that he would be in a long sitting position. I also have a 6 y/o and a 4 y/o. I did the same thing with each of them.

Now as far as the chicken or the egg...
I think it is a common stumbling block for all children. Those who are challenged with other deficits as well, will have W-sitting become an issue that will linger more so than it would with a "normal" child. It is going to be more common in those with low tone and difficulties crossing midline to name a few. The real problem with W-sitting is when it becomes the child's only way to sit and play. That child then is not developing the trunk muscles and trunk rotation that they need. If this child is put into another position and the child cannot engage in their activity then UB strengthening and trunk stability have to be addressed ASAP.

The only article I could scrounge up here at home is from the June 7 1999 ADVANCE for PT. I hope I was of some help. E-mail me and let me know what your thoughts are.

julie said...

Very interesting thread. I'm a physical therapist and mom as well and googled this topic because my normally developing 2 yr old spends a little time in W sitting which I have tried to discourage. As to Rebecca, OT's question on the evidence out there, you can find reported relationships between malicious malalignment syndrome, (femoral anteversion/ tibial torsion) and W sitting. Clinically this looks like what the 18 year-old "Anonymous" post on 2/16/09 was describing. Googleing these terms might send you in the right direction for literature.
As you mentioned, I believe it is a normal phase, but for how long? I liked your technique on simply teaching them to "fix your legs" in addition to putting them in an alternative position. I will start doing that.

Tyciol said...

Is it okay to sit like this sometimes though? I think the reasons for encouraging other positions are 100% valid, but perhaps so long as the other positions are practiced and motor skills developed, this form of sitting now and then could help to keep the external hip rotator muscles from tightening?

I ask because, trying to sit like this now, it feels impossible! I can't help but wonder if we maintained this habit that perhaps we'd still be able to do it?

Anonymous said...

I am 32 and W-sit, although I wish I'd never started. My hips are now rotated inward, causing me to walk pigeon-toed. I really didn't know I did until a patient of mine (I'm a nurse) mentioned it. I asked my husband if I walked that way and he said yes. So now I try to walk "normal" and try to rotate my hips out while I walk, which is very tiring, and probably pointless because the damage is done. I'm wondering if there is any way to reverse the problem and train my hips to rotate the right way? Anyone know?

juliansmama said...

My son is 3 years old and always sits W style while playing. He sometimes sits with his legs out in front of him but only when I say "fix your legs". When I try to help him sit Indian style or with both legs to one side he says it is really hard. I plan to talk to his Dr. about this at his appointment but I was hoping you had some suggestions of how I can help him in the mean time. Thanks!

jewelrybyrebecca said...

Juliansmama... Send me your e-mail and I'll give a a little more feedback on the subject.
rebecca.designs@hotmail.com