W-sitting 101

By Alison Gebhardt, Paediatric Occupational Therapist, NAPA Centre

W-sitting is when a child sits with their knees bent in front of them, placing their feet and ankles on either side of their hips and their bottom on the floor. This position is known as W-sitting because it creates a W shape. This sitting position becomes an issue if your child W sits often or if it is their preferred position to sit.

Why do toddlers/ children W sit?

• Bone alignment or positioning in utero (how your child is built can predispose them to W sit).
• Excessive hip flexibility and/or joint hypermobility.
• Low muscle tone.
• Core and trunk weakness. Some children with a weak core may choose to sit in this position as they are able to use two hands to play and in other seated positions, they need to prop themselves up with one (or two) hands which makes play increasingly difficult.
• It’s easier! W-sitting creates a wider base of support which means it is easier to sit upright, easier to balance, requires less muscle work, and is less fatiguing.
• Children may start sitting in this position because it is easier for them, and through repetitively sitting in this position (and for long periods), their muscles can get tight and make it uncomfortable to sit in different positions.

Why don’t therapists like W-sitting?

• W-sitting forces the knees to rotate inward. Increased stress on the knees and hips can lead to knee and/or hip pain over time.
• It may contribute to in-toeing. If your child is already hypermobile, this is more likely.
• It causes muscle tightness – in the hips, hamstrings, ankles, and feet.
• If your child is W-sitting, they often can’t easily and fluently transition out of this position, have limited side to side weight shifting, and limited trunk rotation, so their development of motor skills can be affected.
• When in this W-sitting position, children are not required to switch on and use their core muscles.

What can you do about W-sitting?

• Stretch! You won’t be successful getting rid of W-sitting if your child is tight. A good stretch needs to last at least 30 seconds. Singing songs or watching short videos can help pass the time!
• Strengthen the core! A weak core causes poor posture. W-sitting requires very little core work, so posture will become an issue if a child’s W-sitting habit continues.
• Encourage other forms of sitting.

What are stretches that help?

To stretch hips, try the butterfly stretch! W-sitting is internal hip rotation, so we need to stretch those hips in the opposite direction. Sit on the ground with your child in front of you, with the bottoms of their feet touching. Use your legs around your child’s legs in the same position to keep them close and calm. With your hands, apply gentle pressure to both your child’s knees toward the ground.

For a hamstring stretch, consider a tug of war method. Start with you and your child sitting on the ground with straight legs, facing one another. Place the bottoms of your feet against the bottoms of your kid’s feet and reach for their hands, then gently pull them towards you, keeping legs straight. Check where they feel a stretch to ensure you’re stretching hamstrings instead of low back. They should feel the stretch along the back of their legs, not in their lower back.

Don’t forget to stretch those ankles! For a calf stretch, you can have your child sit or lie on their back. Holding your child’s foot in your hand, apply light pressure at the base of the toes and flex the foot towards their head. Hold for 30 seconds once you feel resistance. There are two muscles in the calf, so keep their knee straight for a gastrocnemius muscle stretch, and you can bend their knee to stretch their soleus muscle.

To address and prevent in-toeing of the foot, we need to stretch the feet in the opposite direction. Start by holding your child’s heel with one hand. With the other hand hold the front of foot at the base of their toes, and gently pull toes in outward direction, toward the pinkie toe side.

BREAK THE HABIT!

Breaking habits is hard, especially when it comes to W-sitting. One thing that can help is to get everyone in your household on W sit patrol. Choose a family phrase or tagline for helping the W sitter fix their body. For example, you can tell your family, “If we see Suzy in a W sit, we can say ‘______’ and then help her choose a better position for her body.” Some options to consider:

• “feet in front please!” or “feet forward please!” These help when repositioning your child into a ring sit, long sit, or cross legged sitting.
• “feet are friends, they stay together!” This one is great for repositioning your child into a side sit, also known as a mermaid sit.

Initially, providing these consistent verbal cues as you reposition your child’s legs will help them to eventually respond to the verbal cue only by repositioning their legs themselves. In addition, framing your verbal cue in a positive way, such as “feet in front!”, rather than a negative way, such as saying “no W-sitting” or “stop sitting like that!”, is less frustrating and more effective for long-term change.

What are some core exercises to help

Crab position: To make it fun, place your child’s feet on sliders or paper plates and have them straighten one leg at a time to destroy a block tower, knock over a bowling pin, or kick a ball.

Ankle art: With your child lying on their back and propped up on their elbows, place a balloon or ball between their ankles. With their knees and hips bent, have them draw a rainbow with their feet moving in an arch. For older kids, have them write out the ABCs or their name with their feet!

Dead bug: Have your child lying on their back, arms and legs in the air. Try it with their knees bent at 90-degree angles or keeping legs straight. Balance a toy or bean bag on their feet or shins to encourage them to hold the position (“don’t let Teddy fall into the lava!”). Hands and knees play strengthens the core, with the added benefit of an arm workout! Kids will love playing with shaving cream or play dough, colouring or drawing, or even putting together a puzzle.

Rolling and crawling: You can have your child roll up a slight incline, across a crash mat or rolling wars where they need to roll and push you or a gym ball away to get to the other side. Crawling can be great fun over uneven surfaces like a crash mat, crawling backwards up a ramp, or crawling trains (also on your hands and knees, you hold onto your child’s ankles and become a train carriage and they need to pull you to collect passengers.

Knee walking: Have your child knee walk back and forth between two tables several times to build a block tower or bring pieces of a toy. This targets core stability and glut strengthening. An alternative activity is knee walking while pushing a weighted laundry basket to further engage tummy muscles!

What are some alternatives to try instead of W-sitting?

Encourage other forms of sitting (such as sitting crossed legged, long sitting, side sitting or kneeling – ensuring feet are under the bottom in kneeling rather than out to the side). If a child is having difficulty sitting in a cross-legged position due to tightness the muscles in their inner thighs, you can sit the child on a wedge or have their bottom on a slightly raised surface from their feet.

Squatting – playing in a deep squat is a good balance challenge. If your child is moving from lying on their stomach into W-sitting while playing on floor, a kids’ activity table encourages them to play up higher! You can try having them play in tall kneel or half kneel. Bonus points for keeping that tummy off the table!

Hands and knees or lying on your stomach are two great floor play positions.

NAPA Centre is a specialised paediatric clinic that brings together innovative therapies for children living with disabilities from all over the world under the one roof. Their qualified Physiotherapists, Occupational Therapists and Speech therapists will customise their approach to each child and deliver therapy in either an intensive format or as ongoing weekly sessions. NAPA Centre is located in Sydney and Melbourne, Australia and Los Angeles, Denver, Boston and Austin in the USA. For more information visit napacentre.com.au