Welcome to The Movement Team blog again! Today’s article is the third of our Paediatric specific topics. We have received wonderful responses to the previous blogs about tummy time and infant milestones, so hopefully this topic can be just as helpful. If you have a topic that you would like us to cover, please let us know through our Facebook page or website!
When discussing children’s posture and movement skills, there are a lot of variables to consider. All the small factors that help make each baby unique also influence the way that each baby learns to move. We build skill on top of skill until we eventually have our very own individual movement preferences and patterns.
As we grow, the complexity of our movement patterns increases and so does the variability. There are many more ways to sit, than there are to roll. There are many more ways to walk than than are to sit! Sometimes as a community we place particular meaning on some ways of moving. Over time we can start to see some movement patterns as good and some as bad. We often then lose site of why these movement patterns might have been considered good or bad in the first place. The category becomes fixed and as soon as someone sees a child doing something in the ‘bad’ category it is considered a problem. This is not necessarily the case.
I would like to single out one such movement pattern that has been living in the ‘bad’ category for a long time! The topic of this blog:...W-Sitting.
W-sitting is similar to kneeling (knees out in front), but in the W-position you have your bottom on the floor and your feet out to either side. Your legs then loosely form a W! This can be very hard for adults to do, but often fairly easy for kids (this has a lot to do with the amount of internal twist in our femurs (thigh bones) as kids).
So if the old wives tales are to be believed, W-sitting might be a sure sign of anything from future arthritic hips to flat feet. The truth though is a little less exact.
What Google says:
Google search ‘w-sitting’ and you find an almost infinite number of links to sites with titles such as ‘what’s wrong with w-sitting?’, ‘the trouble with w-sitting’, ‘never let your kids sit in the ‘W’ position’! Dramatic to say the least.
What Scientific Research says:
Conversely a search of the scientific literature reveals very few studies specifically considering the affects w-sitting. Most of the articles that do talk about w-sitting do so in the context of specific childhood conditions (e.g. Cerebral Palsy) and have not reported significant implications for children without these conditions.
There is however a huge amount of evidence about the normal changes that our bodies go through as we grow. The proportions of our body parts change, the shape of our bones vary, and our strength and skills alter significantly.
So W-Sitting must get its bad rep from somewhere right?
Most adults find w-sitting very hard and potentially quite painful. The amount of twist in our thigh bones reduces as we grow through childhood and western cultures rarely use all of our available hip range of motion so by the time we are adults many of us have lost the ability to comfortably sit in this position.
For children however W-sitting is a normal type of sitting posture. Just like side sitting, long sitting, cross legged sitting, kneeling, squatting and lunging, w-sitting is a good way to play on the ground. Like most things in life, in moderation w-sitting is totally ok.
So… what do I do when I see my child w-sitting?
Initially… not much. Postures do not strictly belong in a good or bad category. W-sitting provides a very useful purpose for kids and spending some time in the position is unlikely to cause any dramas in the short or long term.
Remember that children are problem solvers; even if the problems they are solving might not be the ones we always want. If your child is trying very hard to colour in a particular drawing or to construct a block tower on the floor and w-sitting provides them the stability they need to do that, then they have just found a successful way to solve their problem! Good on them!
If it is so useful, should I encourage my child to w-sit if they are not already?
No... encouraging a child who doesn't w-sit to do so is definitely not a thing worth doing. It is the opposite situation that is more of a concern. If W-sitting is the main (or only) way a child sits, things do become a little concerning. There are two main reasons why w-sitting isn’t that great. I suspect it is for these reasons that it has got such a bad reputation!
1. It’s efficient…maybe too efficient!
Sitting in a w-position provides an extremely wide base of support. Also, because the hip joints are positioned almost as far as they can go in one direction, a lot of the passive joint structures are pulled tight which provides extra stability. This all means that a child can pretty much get away with switching off all their postural muscles (think ‘core strength’) and still stay upright. Much like a pyramid, there is not much risk of them falling over!
2. Maybe it’s not great for your bones…or maybe it’s just not helpful!
While the long term evidence isn’t solid enough to stress this point too much. There are theoretically a number of reasons why w-sitting at the very least is not helpful for our bone development and some articles have loosely linked w-sitting to an in-toeing walking pattern. Remember that comment about our thigh bones ‘untwisting’ as we grow. Well that process is dependent on both movement and muscle pull. Positions like squatting produce a ‘helpful’ twisting force on our bones and also engage activation of a really good range of muscles. If we were to drop into w-sitting all the time instead of squatting or sitting in more active positions, then perhaps we would miss out on some really useful benefits of these other positions.
We also know that in most situations but especially in walking/running activities, internally rotating our lower limbs (think flat feet, knock knees, and poor hip control) is both inefficient and associated with many forms of pain. It is also really really hard to balance on one leg if that leg is rolling in. Learning to control this normal tendency to 'roll in' is a key part of learning to move efficiently!
So in summary we don’t love but also don’t hate w-sitting?
Yes, there are some good reasons why w-sitting isn’t great. Instead of trying to stop a child w-sitting though, I would encourage you to find ways to help your child develop other strengths. If you notice you child always w-sits when playing with a particular toy (or iPad) on the ground… instead of telling them not to w-sit, perhaps try moving the toy to a table; or just ignore their w-sitting and later practice some really useful skills by playing games that involve balancing on one leg, squatting, jumping, or running with accuracy! As they get stronger and grow older, there is a good chance the w-sitting will phase out anyway...
A final and important comment:
Children who are experiencing difficulty with their postural skills, have delayed gross motor ability or have other developmental conditions may well w-sit as a way of compensating for these difficulties. On these occasions, consider how the child is going in all aspects of their development. If you notice a wider pattern of difficulty or delay, then please see a health care professional. In these cases the w-sitting is not the concern, but the larger picture of developmental difficulties may be.
B.Phty (Hons), G.D. Paed. Neuro. Rehab.
Tim has 8 years of Physiotherapy experience and is an expert in Paediatric (Baby’s and Children’s) Physiotherapy. Tim’s the person to see if you have any concerns about your baby or child’s movement skills or development.
Tim is co-owner and director of The Movement Team. Tim also holds an Advanced Physiotherapist position within a Child Development Service in the public health sector.
Tim has worked across the breadth of paediatric health (acute hospital, disability care, developmental, community and private clinics) and has completed numerous national and internationally recognised education courses in topics including developmental orthopaedics, high risk infant management, respiratory functioning and infant movement.
Tim's formal training consists of:
Bachelor Physiotherapy (Hons) - University of Queensland
Graduate Diploma Paediatric Neurological Rehabilitation - University of Western Australia
Tim additionally holds the following positions and memberships:
Chairperson of the Queensland Paediatric Physiotherapy Clinical Network 2013 - present
National Paediatric Group Member - Australian Physiotherapy Association
Potentially useful articles:
Relevant factors influencing flatfoot in preschool-aged children Chen et al 2010
Lower Extremity Abnormalities in Children Sass et al 2003
The clinical information included in this article is of a general nature and might not apply to every family. Please see your local health professional for individualised developmental advice.