"W-sitting" issues? Drs, PTs...Beth?

[Judegirl]

A friend sent me an article that argues that "W-sitting" (when a kneeling child looks like a frog instead of sitting on his/her heels) should be discouraged because it can lead to various muscular-skeletal problems.

I'm skeptical; it seems to me that if a child is naturally inclined to sit a certain way, this is not likely to be bad for her body.

I'm hoping someone here knows more about this than I do and can shed light on this... Rory sits like this all the time.

Thanks,
Jude

[psophia17]

DS sits like this about half of the time, too - I've never given it a second thought.

[amyff]

Hmmmm... I alway ask my daughter to "criss cross" if she is W-sitting. At preschool (per our pediatric PT's instructions), we always discouraged W-sitting and encouraged "criss cross applesauce" explaining that it safer or healthier for our legs. Kiddos never seemed to mind the request.

[thomma]

I'm not sure why but dd and ds' PT (they had Early Intervention from 3 months old to 3 years old)told us that they shouldn't sit that way. It wasn't an issue for ds but it's something we have to watch/work on with dd.

Kim
t&e 5/03

[lilycat88]

Our ped told a friend of mine (we take our DC to the same ped) not to let her son sit like that. He is also inclined to sit like that most of the time. His lower legs have quite a bit of bow to them. Our DDs early intervention PT also cautioned us against it. Since DD has never sat like that to our knowlege, and she's been out of PT for about a year, the "why" has totally escaped me.

[almostamom]

We just went through some evals about two weeks ago. Both the OT and PT recommended not allowing DS to W sit (funny thing is, he doesn't). Anyway, the PT explained that it can cause problems with the hips, but I don't remember what exactly (since DS doesn't do it, I didn't commit the "why" to memory).

~Linda~
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[shilo]

well, i can tell you what i remember from grad school, but my clinical specialty is on the other end of the age spectrum (geriatrics), so i am sure the peds therapists on the the boards can elaborate/correct :). sorry if it's long-winded - (and of course standard disclaimer - none of this is meant as a formal/professional assessment of anyone's child, please ask your own medical professional's advice if you have specific concerns for their development, yada yada yada)

why do some kids naturally W sit? basically because it is a more stable position. it gives them a nice wide base of support and kind of 'locks' in their pelvis/trunk so that they have less they have to control. kids often adopt this sitting posture so that it frees them up to use their arms/hands easier because they're not wasting energy/effort on controling their trunk and pelvis. if you were to try it yourself (be careful if you do choose to, it does require a fair amount of flexibility in certain muscles) you'd see that you are more stable reaching for things right in front of you, but less able to twist, turn and shift your weight from side to side than in other 'traditional' sitting positions.

why do we (professionals) not recommend/discourage W sitting? basically, it is not recommended/discouraged for both orthopedic and motor development reasons even in 'normally developing' children.

the orthopedic reasons would go along the lines of placing the hips in a position of extreme rotation inward. this can be hard on the developing bones and on the developing muscles. for kids who might have a history of hip dysplasia, or dislocation this is obviously a bad thing. for kids who spend _a lot_ of time in this position, it can adversely affect the way the muscles around the hip joint develop or the way the bones of the joint itself develop, which could at best lead to abnormal movement/pain and at worst make someone more likely to dislocate in the future - this is obviously a bad thing. for kids who have mild to severe tendancies to develop contractures (overly tight muscles), usually because of a neuromuscular or developmental problems, but not always, this is obviously a bad thing. so from an orthopedic standpoint, you might say "my kid is perfectly on target for all of their development, what harm is a little W sitting going to do?" and the answer is _probably_ not much, but it depends on how you define 'a little'. if it is a pattern they are using everyday, you can see how over time, it could lead to less than desirable development of the muscles/bones of the hip (and just to throw a wrench into the deal, the spine and knees and ankles too, since it's all connected :) - my husband was a big W sitter according to my MIL and although he 'developed' just fine from a motor standpoint, he does have really short hamstrings and knee problems which may have been influenced by this early daily W sitting IMHO - although i'd never tell my MIL that).

the motor development reasons are a little more complicated. when kids are first learning how to move and control their bodies, one of the most important skills they master is what we call rotation - in a nutshell, this is the ability to reach across - ie using the right hand to reach over to something out and to the left of your body. it's a skill that requires a lot of control of the whole core of your body, (controlling a twist/turn and weight shift all at once, while using the arm to reach across the middle of your body. this is important not only for better motor control of the core/trunk, but also for developing hand dominance (right handedness/left handedness). because of the wide base of support, and locking out the pelvis and trunk in W sitting, kids who spend _a lot_ of time W sitting may have a delay in developing those rotation skills. so it's not to say that even 'normally developing' kids don't sometimes use W sitting for more stability when they are engrossed trying to learn some new fine motor skill/spending all of their energy on whatever is fascinating them in their hands. but if it is something your child is using all of the time, you might want to consider encouraging other sitting postures that allow more twisting/turning/shifting to help them master that rotation which is so important.

i guess if it were my child (which it may be in another few years, given his daddy did it), i would look at how often he was doing it (ie every once in a while versus everyday) and when he did it. if i noticed he was doing it for a day or three while trying to master some new fine motor skill, i would probably think 'ok, whatever works'. but if i thought it was becoming a habit, i would probably start actively encouraging other modes of sitting, but that's just me, YMMV of course :).

other peds professionals/mom's with personal experience, please feel free to correct anything you see fit... :)

hth, lori

Sam 5/19/05 How lucky I am that you chose me.

[Wife_and_mommy]

I have very little knowledge about it but am positive that it is not a good position for kiddos and your explanation was marvelous. Thanks. :)


http://www.gynosaur.com/assets/ribbons/ribbon_gold_12m.gif[/img][/url]

[ribbit1019]

Just really quick since I am on dial-up at my parents house. I sat like that A LOT when I was a child. I remember having issues with my legs/hips at around 5 or 6 and my ped told me not to sit like that anymore or else I would have to wear braces. I stopped but I think there was some damage already done (since I'd been doing it for probably 5 years) I grew up with that pain in my right hip and it has gotten worse with age.

Thank you for that very detailed post Lori!

Christy
My Waterbabies
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[brittone2]

What Lori said :)

I actually was a MAJOR W-sitter and can still sit that way. I also have a lot of knee instability (have dislocated my patella, which is the "kneecap" before) and quite limited external rotation at my hip (the opposite position of the hip from W sitting, which may have been caused IMO by sitting like this very often as a kid). That position can stress the knee ligaments quite a bit. Some experts also think it can lead to "torsion" on the bones (which is sort of like "twisting" the bones).

It is somewhat a chicken and egg thing though...it is theoretically possible that I had limited external rotation to start with as a child and maybe preferred to W sit for that reason, kwim?

As therapists, we definitely discourage this position. It is of much much more importance IMO when we are talking about kids that are already delayed or at risk of problems, but in all likelihood, it probably isn't the greatest position for any child to use.

My DS sits like that from time to time. If he's only using it to transition to another position or isn't like that for long, I don't bug him about it, but I do discourage it for any length of time. I have shown him how to sit with his legs in what we used to call "Indian Style" when we were kids (no longer PC to call it that in the medical community) and he'll do that too.

I remember sitting like that for *hours* on end as a kid. I now wonder if that contributed a lot to my knee instability and my lack of external rotation as an adult :)

Thanks for answering that Lori!!

[Dee150]

This sounds weird but after reading all the posts I am still not able to figure out what "W-sitting" is...! Could someone please explain a little more?! (I mean, if you are kneeling, i.e. knees on the floor, how could that look like a frog?:-)....sorry- this sounds even weirder now!)

TIA!

[buddyleebaby]

W sitting is when they pull their heels around back by their butt, with the side if their knees against the floor.
Does that make more sense?
Their legs form a "w" shape.

My dd starts off in a high kneel and eventually ends up in a w. Most of the time she is up again in a minute anyway, but if she appears to be settling in, I go over and correct her sitting.

Etc and attempt to clarify.

[maestramommy]

I don't know about that, but I do know that in a lot of Asian countries that is the normal way of sitting for everyone. People do all sorts of activities (cooking, eating, playing games) while sitting back on their feet rather than cross-legged like we do here. DH was just saying it's amazing that senior citizens continue to be able to do this without falling over and can get up easily as well.

ETA: whoops, I totally misunderstood the position! I was thinking of squatting back on the feet, not sitting on their bum with the legs out and back. Sorry!

BTW, isn't the W position part of a yoga pose? It's funny that we try to get flexible enough to do that later in life :-)

[mudder17]

Yes, the W position is part of a yoga pose, but we also sit on our heels in the yoga pose. :)


Eileen

http://www.windsorpeak.com/dc/user_files/33732.gif for Leah
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Kaya will be a sister, ~11/14/06!

[shilo]

you can see it in a black and white sketch image if you scroll down about half way down this page...

http://www.massgeneral.org/ortho/Pediatric_InToe.htm

lori

Sam 5/19/05 How lucky I am that you chose me.

[COElizabeth]

James does probably have some motor control problems, and I am working on getting treatment for them (OT evaluations in progress now, though he had a full developmental evaluation last year with no concerns expressed about gross motor skills), but in the meantime, does anyone have suggestions for discouraging the W sit? He does it all the time, and when I try to encourage another position I usually meet a lot of resistance (including crying). So far everyone has said, "Bad, bad, bad" but with no solution! Believe me, I have tried for the past year to change the habit and have had no luck. :(

Elizabeth, Mom to James, 9-20-02
and Charlotte, 11-04-04

[brittone2]

All you can do IMO is really really encourage the other positions...but as a mom, you can't drive yourself totally insane if he's resistant.

Will he let you physically help him into another position? (I know, at his age, probably not ;) )

Good positions are kneeling, tall kneeling (especially for kids with any kind of delay as this works the hip extensors/butt muscles), what we used to call "Indian style" as kids (I've heard it called "criss cross applesauce"...maybe you can make that seem really appealing and exciting LOL), long sitting (legs straight out in front of them and together (good for tight hamstrings)...pretty much anything else.

Really I can't think of any magic touches other than verbal reminders or physically helping him into another position (which I can imagine would be a huge hassle at his age). I'm not a big sticker/star chart kind of person but sometimes those things can be effective for changing a really engrained habit...just to break the "habit" short term. Maybe give him a sticker on a chart everytime he cooperates with sitting a different way than "w" sitting? He's old enough that he might get the concept of a star chart and X number of stars equals some sort of prize, kwim? Again, I basically am not a fan of that kind of thing but it might be helpful in a case w/ a lot of resistance, especially at his age and especially if he's really stuck in a pattern of using it.

I wish I had more suggestions. I'm sure it is frustrating to not know a way to gently break the habit without upsetting him profusely.

[KrisM]

Wow. That's really interesting. I did not know this should be discouraged. I *still* sit like that all the time. I find it much more comfortable than just on my heels. I will have to watch DS for it and see what he does.

[MamaKath]

Interesting discussion. Not much to add from the childhood end but...

My mom was a big w sitter as a kid. By 60 both her hips had to be replaced. She had major arthritis partly due to the w sitting.

[brittone2]

Do we need to do a star chart and a reward system to get you out of the habit, Kris?? ;)

I can totally relate. I could absolutely still sit comfortably in that position if I allowed myself to.

[spunkybaby]

I had the same question and did a search on google. Here's a color picture that I found helpful:

http://www.sojournservicesinc.org/intoeing.html

Not-so-new mom to a spunky toddler
March 2004

[shilo]

up above, someone posted a link after your post, with a 'color picture' of W sitting. it had some other ideas for encouraging other positions, including getting a 'kid sized' chair or chair and tables.

a friend recently got one of those PBK toddler/kid chair knock-offs that her 3.5 year old has taken an instant liking too. maybe if you took your son out and let him pick out his own special chair and really played it up, he might use that?

lori

[kochh2]

I'm a little late in answering, but IITA agre with the other PT's here, and want to add that in the 5 plus years I've been working as a Pedi PT, W-sitting has become my pet-peeve, and so with Aiden, very early on, if he sat like that, I'd gently correct his legs into one of the "better positions" Beth m entioned, and say at the same time, "fix your legs" and so within about 2 months (he was really young-I remember being sturck by WOW he understands us!!) he would just switch to a more appropriate position. My DH swears he used to get STUCK in the W sit as a kid, even had to be brought to the MD a few times, (Imagine putting a kid inthe car like that??) I can't picture it!!
As Lori Mentioned, it gives the kids a wider base of support, and as they are growing, and developing, they continue to need to strengthen their core muscules/abs/backs... so this takes away that opportunity to do so!! It has an impact ont just on the hips, but all the way down to the toes... so, "fix your legs" is more than just a suggestion around here, it's a rule!!!;)
HTH

[Dee150]

Alicia, Lori, and spunkybaby - Thanks! I didn't even realize that that was the 'official' word. Got it now - one other thing to watch out for!

[KrisM]

Maybe! I haven't done it in the past few days, since I read this.

[nfowife]

Is "w" sitting the same as sitting on your knees? I think of W sitting as more of when the knees are touching the ground and the feet/calves are out to the side, also touching the ground (making a "w"). But sitting on your knees is with your calves/feet directly underneath your thighs, with your feet directly under your bottom. Is that way also bad for hip development? I will have to ask the ortho at DD's next check up in July (her every 3 month checkup to monitor her hip development, she was born with hip dysplasia in her left hip and had to wear a pavlik harness for 2 months as a young infant).

[brittone2]

sitting back with your feet underneath your thighs, directly under your bottom is usually called "short kneeling" by PTs. No problems with that (as long as your legs aren't falling asleep and you are staying that way indefinitely LOL).

W sitting is as you described. The inside part of the knee is touching the floor, with legs/feet angling outward (the inside of the calf and inside part of the foot touching the ground) forming a "W". That position is not very healthy for leg development.