Does Your Child W-Sit?

W-sitting: Why do kids prefer it, what effects does it have on your child, and when is physical therapy warranted?

“W-sitting” – It has been coined a negative and scary word to some, but is W-sitting actually detrimental and should parents worry when their child is playing in this position? New research suggests that W-sitting, while not the preferred sitting position for children, may not always be an indicator for future issues, however it may be important to identify which variation of W- sitting your child utilizes.

As physical therapists, we are primarily concerned when the legs and feet are turned outward.The reason is because this position is opposite of what “typical” fetal and infant development looks like. Imagine your baby in the womb all cuddled up with his or her legs in a tight crisscross applesauce position – essentially, your baby’s legs and feet are turned inward. And typically, when your baby learns to sit, they will “ring” sit with their legs forming a circle in front of them, again in that inwardly rotated position. This inward rotation helps facilitate transitions into hands and knees and establishes movement patterns required to strengthen the outer butt muscles – critical muscles for standing, balancing, walking, and squatting.

1. Why might your child prefer W-sitting?

There are several reasons your child may prefer W-sitting. First, your child may have very flexible hips. It is not necessarily abnormal for a child to have a lot of mobility and some kiddos are just extremely flexible (just look at the crazy flexible young dancers out there). Second, your child’s femur (thigh bone) may be positioned more forward in the pelvis, which means his or her hip is able to turn inward more and allow them to W-sit comfortably. Some kiddos are just born with different bony alignment, and it’s not always a problem. And lastly, your child’s inner thigh muscles may be super tight and their outer thigh/butt muscles may be weak which makes sitting in crisscross applesauce uncomfortable.

2. What effects does W-sitting have on your child?

The main concern is if your child is repeatedly transitioning from W-sitting into squatting/standing or from squatting/standing to W-sitting and cannot tolerate sitting in other positions, such as crisscross, kneeling, or long-sitting (legs straight in front of them). Then, this can be an indicator that they are not able to recruit appropriate muscles to develop the strength needed for typical gross motor activities. The repeated transitions into and out of W-sitting can prevent strengthening of butt and core/abdominal muscles – thereby, reducing strength and stability for activities like standing on one leg, squatting, or jumping. It is these strength and stability deficits that contribute to in-toeing, hip instability, back pain, and knock-knees, not W-sitting itself.

Given there are underlying reasons for W-sitting, it is important to understand that W-sitting is not the direct cause of other problems you may see. The four misconceptions listed below are not true: 

1. W-sitting will result in hip subluxations or dislocations.
2. W-sitting will cause my child to walk with their toes turned inward.
   
3. W-sitting will cause back pain.
4. W-sitting will cause knock-knees while standing, squatting, or walking. 

3. When is physical therapy warranted?

If you see the following, your child may need PT:

• Unable to sit in other positions when asked (i.e., cannot side-sit to either side, crisscross, kneel)
• Has poor balance and falls often.
• Cannot squat without the knees touching each other.
• Is not developing gross motor skills at the same rate of other kids.
• Not jumping, climbing stairs by switching feet, or making good attempts to run by around 3-years-old.

Do you think your child would benefit from physical therapy services? We would love to provide you with more helpful activities and ideas to encourage other sitting positions. Please do not hesitate to call Infinity Kids today for a free consultation! We hope to meet you and your child soon.

Written By: Clarissa Aguirre