The Four Letter Word of PT: W-sitting

 

The Four Letter Word of PT: W-sitting

It’s a concern and referral that PT’s, especially in Early Intervention, often get from other disciplines. Child W-sits. Reading that referral we know that this can mean the kid has everything from major gross motor issues to none at all. So what does W-sitting mean for child development? 

What is W-sitting? 

W-sitting is when a child sits on their bottom with their knees bent and feet positioned outside of their hips. If you are standing above them their legs and bodies make the shape of a “W”. 

Should we “always” be concerned with a child W-sitting? 

The short answer is “no”. Typically w-sitting is not a concern if a child only sits in the position briefly or when they are moving in and out of a w-sit during transitions. This is especially true in younger children who are beginning to transition between a variety of position. An important thing to look at is is can the child sit effectively in other positions such as long, ring or side sitting without difficulty or needing to stabilize themselves atypically. 

The “problem” W-sitter and why they are sitting this way:

There are lots of different reasons why kids who are habitual w-sitters use this position. They can include:

  • Weakness in the hips and/or trunk. In this position they do not have to worry as much about utilizing those muscles to keep them from falling over. 
  • Low muscle tone. It does not take as much muscle recruitment to maintain w-sitting vs other positions. 
  • Tightness in the trunk, hips and lower extremities

So what can habitual w-sitting lead to?

  • Increased strain on hips and joints especially for a child who is predisposed to hip dysplasia.
  • Decreased use of core muscles. 
  • Limited cross body movements and trunk rotation over time can lead to lack of development of hand dominance since it is easier to use either hand for tasks in this position. 
  • Can increase tightness in hips, knees and ankles which can later impact balance, coordination and gross motor skills. 
  • It is difficult for children to rotate their trunk in this position. This can later lead to difficulty with writing and table top activities in school. 
  • It is difficult to weight shift side to side which is needed for gross motor skills like running and jumping. 

So what should I do if I have a habitual w-sitter? 

The first step is to try to correct the position.  For a younger child you may need to physically reposition them. For an older child you can give them a verbal cue. I have had families use “criss cross apple sauce”, “feet in front” or “ Can you see your feet?”. 

Have the child:

  • Sit cross legged
  • Long sit
  • Side sit
  • Short kneel(feet tucked under them)
  • Squatting
  • Sit on a step stool

If the child is able to sit in another position without difficulty and  can play or perform tasks that you are presenting them with you likely just have a child who prefers to w-sit. If the child has difficulty sitting, poor posture, needs to stabilize with one arm on the floor or cannot perform tasks/play in other positions a referral to PT is definitely warranted to determine if there is cause for the w-sitting that may also be impacting other gross motor skills. 

Julie Gowan, pediatric Physical Therapist in the Chicago suburbs…

I graduated from Northeastern University in Boston in 1997 and have been a pediatric PT ever since. I did Early Intervention in MA until we moved to Illinois in 2003. I worked in a clinic for a few years doing EI and school age kids before transitioning back to all EI. I love working with the birth to three population and the connections I make with the families.    I am also a wife and mom to two boys(Freshman and 7th grade). We love music and sports(we bleed MSU Spartan green in our house).

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