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Leigha Cuellar, PT, DPT
Physical Therapist

 

What is W-sitting and when does it become a potential issue?

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W-sitting is a floor-sitting position where the knees come together and the feet are spread out to the side of the child’s hips like the picture shown below.

It typically only becomes an issue if your child w-sits often, or if it is his or her preferred position to sit.

What is wrong with W-sitting?

The W-sitting position provides a wider base of support for the child to be more stable when sitting. This means the child does not have to work as hard to maintain his posture during sitting. Children who W-sit choose to sit in this position oftentimes because they feel more stable without having to use their core muscles which helps them to not get as tired.

Once the child realizes that W-sitting is an easier and less-fatiguing position, they will often prefer this position most of the time. W-sitting for extended periods of time can cause a number of problems for the child as they grow and develop:

  • Poor trunk control
    If the child W-sits most of the time, his or her core strength is not being as challenged, nor is his core getting any stronger.

 

  • Bone malalignment
    W-sitting can cause hip internal rotation of the thigh bone (femoral anteversion) and/or internal rotation of the lower leg (tibial torsion). Sometimes the malalignment can predispose the child to W-sit due to the bone anatomy. Other times, the child chooses to W-sit due to decreased core strength and that the W-sitting can ultimately cause bone abnormalities later on.
     
  • Hip laxity/flexibility
    W-sitting puts both hips into maximal internal rotation. Normal hip internal rotation is approximately 45-degrees, while W-sitting can put the child in 90-degrees or greater of hip internal rotation which really stresses the hip joints. If the child frequently W-sits, it is possible for the child’s internal rotator muscles to get very lax and flexible, and the external rotator muscles to get tight.
     
  • Hip weakness
    With joint and muscle laxity, comes weakness. So since there are muscles that are not at their normal length, it is common to also find that the child’s hip muscles are weak as well.
     
  • Poor sitting balance
    W-sitting does not require the child to sit in various positions where they have to utilize their core to reach and play outside of their base of support. Oftentimes, they have trouble sitting in other sitting positions because they are not used to having to engage their trunk muscles to stabilize themselves, in order to participate in the environment around them.
     
  • Delayed milestones
    Children who W-sit may become delayed in various skills such as sitting in a variety of positions, transitioning into/out of various developmental positions, crawling, etc. These skills require significant core strength in order to complete them, and if the child is typically sitting in a position that stabilizes them without using their trunk muscles, they may have difficulty using their core in other gross motor skills. This can result in a delay in reaching the child’s milestones.
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  • In-toe walking pattern
    W-sitting puts the child’s hips into internal rotation which can cause femoral anteversion and/or tibial torsion. With these two bone deformities, it is common to see that the child may walk with his toes turned in or “pigeon-toed.” Walking in this manner can place the child at an increased risk for falls.

    Since the child is walking in an atypical pattern and abnormally weight bearing through his leg joints, there are parts of the bones and joints that receive weight bearing and stresses that typically do not occur. Ultimately down the road, this can cause the child to experience hip, knee, and foot pain.

What can a parent(s) do?

Parents can discourage W-sitting as much as possible to help promote better sitting positions. Find a cue that works for you child such as “fix your legs/feet” or even “no W-sitting.” If the child responds to verbal cues, great, but if not, the parents can physically assist the child into a different sitting position. For example, try any of these developmentally appropriate sitting positions:

Ring Sitting

Ring Sitting

Side Sitting

Side Sitting

Tailor sitting

Tailor sitting

Bench sitting

Bench sitting

Trying new sitting positions will also allow the child to develop and strengthen their core musculature and sitting balance in new ways. Additionally, the child will have new opportunities to transition into and out of these sitting positions into positions such as “hands and knees”, which he was not exploring previously.

Final thoughts.

W-sitting is not always “bad” and is not always a cause for concern. Many times, children outgrow W-sitting and learn better, more functional positions on their own. Additionally, as most children develop, they become less and less anteverted (or in-toed). However, there are a percentage of children who do not “outgrow” W-sitting and/or anteversion, and it is these children who tend to have difficulty with their progression in their gross motor milestones. Cuing your child to sit in different positions can help him or her in many ways. However, it is still a good idea to be evaluated by a physical therapist so they can provide you with more insight about your child specifically, give you home exercises for your child to do for hip and core strengthening, and screen your child’s gross motor milestones to ensure your child is developing appropriately in other areas.

Recommended References to Learn More: 

References are for informational purposes only and they are not intended to replace physician and/or physical therapy treatment(s).

 

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