Okay OTs: the W question again

[maestramommy]

Can anyone remind me what is it with sitting in a W position? If a child sits like that often and for long periods, is it an indication of a problem, or it will lead to a problem? Dora's SLP saw her sitting like that once, something she'd never seen before, and she said I don't want to let her sit like that too much. She doesn't, but she does it more than she used to. Arwyn sits like that a lot more. Her feet don't fan out, but because she's always on the go, it's the most obvious position to fall back into from a crawl. My new ped said there's nothing wrong with sitting like that, it just means the kid is flexible enough to do so. I know that in yoga there is a position like that. But I've seen it discussed here before and I never got to bring up the yoga question.

[brittone2]

nak-
I think it is partly chicken and egg...some kids sit that way because anatomically it is more comfortable. Some kids sit that way and end up with issues (it can strain knee ligaments, and there's some concern about torsion occurring as a result of sitting for that way for extended periods of time)

see here for discussion of torsion:
http://www.hopkinsmedicine.org/healt...rticleID=83990

Some kids that have low muscle tone will also sit this way because it is easier/more stable for them. However, it would be beneficial for these kids to use alternative positions.

Most pedi physical therapists discourage it. If used as a transitional psotion to another postion or for very short periods of time, it is probably less of an issue. I was a major W sitter as a kid, and I have a lot of problems with limited range of motion with external rotation at my hip (it is uncomfortable for me to sit "criss cross apple sauce" as it is now called LOL). I also have had problems with my patella subluxing/dislocating. I may have been anatomically predisposed to W sit, or W sitting may have set up some problems for me at my hip/knee.

[maestramommy]

Interesting! What is considered extended length of time? Do you have a range? And thanks Beth!

[brittone2]

nak-
I can't really give you a basis for it (I'm not sure if there are any real studies on at what length of time it becomes problematic) but I would be uncomfortable w/ my own kids using it for more than a few mins at most. WIth any kid at risk of delays or having extra joint laxity, I would say not to use W sitting at all.

edited to clarify

[jjordan]

This may or may not help, but when I was younger (about 6-7?) I was taken to a specialist (probably a ped. orthopedist but I really don't know) because my feet pointed in. The gist of it was that my parents shouldn't worry or do anything special about it, EXCEPT to not let me sit in the W position.

Jill

[nov04]

dd1 is extremely flexible and enjoys sitting in this position. She's so flexible that she's been wrongly labelled hypotonic (low muscle tone).

We've always been told by therapists, etc to discourage this as it leads to joint problems. We encourage cross-legged sitting instead because its safer too, less chance of being tripped over.

[ha98ed14]

nak-
WIth any kid at risk of delays or having extra joint laxity, I would say not to use W sitting at all.

edited to clarify

Ok, help me out: What is the connection between delays (as in developmental delay? Speech delay? motor skill delay?) and low muscle tone?

I have a friend who has 2 boys. The older is a very athletic, very verbal, bright kid. The younger is his complete opposite. More timid, slow to crawl, speak, and seems more physically fragile. Now that he is school age, he has been diagnosed with a couple learning disabilites. When he was well past a year and not walking, they diagnosed him as hypotonic/ low muscle tone. Are the two (low muscle tone and slight developmental delay) related?

Had I not known the older boy, I might have thought that the younger was just typical for his family-- a roll of the genetic dice, but that there was nothing wrong per se. But knowing the older one (and they have the same parents) it makes me wonder if there is a condition/ syndrome that causes all these delays to arrive together?

[brittone2]

Ok, help me out: What is the connection between delays (as in developmental delay? Speech delay? motor skill delay?) and low muscle tone?

I have a friend who has 2 boys. The older is a very athletic, very verbal, bright kid. The younger is his complete opposite. More timid, slow to crawl, speak, and seems more physically fragile. Now that he is school age, he has been diagnosed with a couple learning disabilites. When he was well past a year and not walking, they diagnosed him as hypotonic/ low muscle tone. Are the two (low muscle tone and slight developmental delay) related?

Had I not known the older boy, I might have thought that the younger was just typical for his family-- a roll of the genetic dice, but that there was nothing wrong per se. But knowing the older one (and they have the same parents) it makes me wonder if there is a condition/ syndrome that causes all these delays to arrive together?

Tone is a continuum. So you can be lower tone but not have any delays, or higher tone with no problems. However, at the more extreme ends of the spectrum, it can contribute to motor difficulties. The *very* extreme ends of the spectrum would cause severe issues.

If a child has low tone, they may have more issues with learning to crawl, walk, etc. Many kids are just on the lower end of "normal" and it causes them to be mildly delayed. Other kids have really low tone (common with say Down Syndrome, for example) that contributes to more significant delays. Low tone can also affect oral-motor issues (so for example, sometimes we see kids that drool a lot because they don't have good oral muscle tone). It can affect speech as well.

Tone issues can be part of a syndrome or medical condition (because tone is regulated neurologically), or a child can also just be on the higher/lower end of the normal spectrum, leading to more mild delays. Low tone in and of itself doesn't indicate there are cognitive delays. However, it *can* co-exist with other conditions where there are cognitive delays.

Clear as mud?

[ha98ed14]

Clear as mud?

Yup. But the gist of it, if I understand the mud, is that it can present differently in different kids and have different implications or cause different problems depending on a myriad of other factors, like developmental delay. So basically every kid/ situation is different, which always seems to be true to some degree Thanks for the explanation.

[brittone2]

Yup. But the gist of it, if I understand the mud, is that it can present differently in different kids and have different implications or cause different problems depending on a myriad of other factors, like developmental delay. So basically every kid/ situation is different, which always seems to be true to some degree Thanks for the explanation.

It sounds like you get it, despite my less-than-stellar explanation