“W”-Sitting “X”-plained

Many young children find that a “W” sitting position is how they prefer to sit on the floor and play. The “W” describes the shape a child’s legs make when he is sitting with the insides of his legs on the ground and his bottom between his heels. “W” sitting may occur because:
- It frees the hands to manipulate toys and other objects.
- It is a very stable position that makes it easier to balance.
- It is comfortable.
Those things are valuable for any functional position, but I’d like to encourage you to help the children in your life to find a position other than “W” sitting that meets those criteria as closely as possible. 

Your mother may have been stretching things a bit when she said, “Stop or your face will get stuck like that!”, but the truth is that the alignment of young bones and joints is affected by the habitual positions they are placed in. Ideally, a child spends most of her waking hours bearing weight in good alignment and performing activities that move the joint through its functional range of motion.  

"W" sitting may be functional, but has potential for negative long term effects.

In children without other neuromuscular complications, the common result of spending prolonged periods of time in “W” sitting is persistent internal rotation of the hip joint and thigh bone leading to in toeing or a “pigeon toed” position when walking.  

The head of the thigh bone and the socket in the hip joint are formed by the pressure placed on them as a child grows and moves. In order to form the head of the femur and the socket in the pelvis and to have stable ligaments surrounding the joint, the head of the femur must be securely in the socket during weight bearing activities. Children born with hip dysplasia may have a shallow socket or a femoral head that moves outside of the socket with an unstable joint capsule. The “W” sitting child has the head of the femur pressing on the back portion of the joint capsule, stretching out ligaments that are essential for joint stability rather than keeping the ball in the socket where it belongs.  

Consider the child with abnormal muscle tone, such as cerebral palsy with spasticity. The characteristics of the “crouch” posture common with CP is with knees bent, hips flexed, hips internally rotated, and hips adducted causing the knees to come together. Want to guess what position the hips and knees are in when a person is “W” sitting? That’s right – knees flexed with hips flexed, adducted, and internally rotated. “W” sitting exacerbates the abnormal posture the child is already at risk for due to other underlying issues. It is desirable to use positioning as much as possible to achieve desirable alignment and minimize the need for surgical procedures to lengthen muscles or derotate twisted bones.  

There are many alternatives to “W” sitting. Some involve adaptive equipment, and some simply involve a little creativity. The most simple is to encourage other positions for floor play. The most straightforward is to encourage a tailor sitting position with knees out to the sides and ankles crossed in front of the body. This may not be tolerated by all children, and those with trunk instability may have difficulty with their balance. Sitting with both knees to one side may work, but is is recommended that the child alternate sides. The child who side sits may need to prop himself with one hand, or may need a bolster or small bench for support. Kneeling is a good play position as long as the heels stay under the child’s bottom and do not move out to her sides to return to the “W” position. Playing with the legs stretched out in front of the body like a letter “V” may also be an option. A child who has difficulty balancing may sit with his back against a wall, use a corner chair, or use something like a small camping chair or stadium seat cushion for back support.

There are also plenty of alternative positions for play off of the floor. Bolsters and bolster chairs encourage the knees to separate and the hips to externally rotate, which is a desirable position for children with spasticity that tends to pull their knees together and rotate their hips inward. Lying on the tummy stretches the front of the hips and places the head of the femur in the joint instead of pressing on the back of the joint capsule. A stander allows a child to bear weight through the legs and hip joints with the feet slightly apart, placing the head of the femur securely in the socket and lengthening the calves and hamstrings. 

If “U” can “V”-eer away from “W” sitting and achieve “X”-cellent alignment, I say, ‘Y” not?! Please share your thoughts/comments.