Should I be concerned about my child’s “W sitting”?

Boy sitting in W sit position

This is a frequent question pediatric therapists hear from parents of young children. W sitting is described as a child sitting with their buttock between their two feet, knees bent, and out to either side. If you looked at this child from above their legs make the letter W.

There are many schools of thought as to why a child sits in this position. It’s normal for a young child between the ages of 3–5 to move in and out of this position while playing. Children are born with more femoral anteversion or the thigh bones are turned in, as they grow the anteversion becomes less. This explains why a child can easily move in and out of this position but an adult would experience much more discomfort.

Many children choose this position for brief intervals of time because it’s comfortable and gives them a wider base of support to help maintain balance. However, there is however cause for concern if this is the child’s only preferred method of sitting, sits in this position for extended periods of time, or if there are other warning signs that accompany W sitting.

Some children lack the core and hip strength required to maintain an upright position while engaged in play. Core and hip weakness in children may present itself in different ways. Key things to watch for include

  • the inability to keep up with other children the same age,
  • toe walking,
  • a limp while walking or running,
  • a strong preference for only one side of the body,
  • walking “pigeon toed” and
  • complaints of pain or fatigue.

Sitting in the W position also limits a child’s ability to fully rotate the upper body resulting in delayed hand preference, decreased table top skills, and decreased ability to integrate both sides of the body into purposeful movement. This may affect a child’s school performance, handwriting and body coordination.

It’s also important to remember that young, growing bodies are affected by habitual patterns. If your child spends an extended period of time in this position, it will affect your child’s growth pattern, possibly leading to orthopedic complications down the road. Muscles may become shortened and tight affecting balance, coordination, and gross motor skill development. All of these above warning signs warrant a trip to the pediatrician and further investigation from a pediatric physical and/or occupational therapist as appropriate.

Not all children who W sit will encounter these health issues but it does increase the risk. Many of these conditions are treatable and preventable. Our advice to parents is to limit the amount of time spent W sitting. Children are wonderful at adapting an environment to engage in more meaningful activities of play. Give children different options for seated play, for example: side sitting with both legs out to one side, long sitting with feet out in front, crisscross or tailor sitting, and sitting on a small bench. These positions allow a child to develop strong core muscles, weight shift from one side to the other, use both sides of the body, develop rotation and hand dominance. Children may be resistant to the change of position at first but over time it will become easier, and more importantly positively affect their future growth and development.

– Christina Paniccia, pediatric physical therapist and supervisor at the Neighborhood Club Grosse Pointe

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