What shall we do with the W sitter?

W sitting can be a controversial topic, up there with gun control, immunisations and the Oxford Comma. A quick google search would have you believe that W sitting is a horrid habit that will doom your child to a lifetime of back pain, orthotics, rubbish handwriting, terrible job prospects and probably a drug habit. I can assure you, I have not found a single study linking W sitting to university drop out rates or marriage failures. On the other hand, there are many people out there confident W sitting is a variant of normal, like being left handed, and that attempting to alter this habit is akin to the draconian measures of the 1950s classroom.

What’s the truth? Unfortunately, I don’t have a great deal of scientifically rigorous data to answer that question, but in this post I will give it a go, based on my experience as a paediatric physiotherapist, and a bit of common sense and knowledge of typical development.

What is "W sitting"?

When sitting on the ground, the child’s bottom, legs and feet are all in contact with the ground, making a W shape. This position often emerges during the period when a child starts crawling, as they rock forward onto hands and knees, and then sink backwards into W sit.

Why do kids do it?

Most adults looking at this position would not associate it with comfort, but the W sit position is usually a very comfortable position for younger children. This is due to structural differences around the hip, with children having more internal twist to the thigh bone than adults, leading to greater range of movement rotating inwards. This position is often more comfortable than sitting with the legs in front for children who are naturally quite hypermobile, or who have tightness/spasticity in their hamstrings, hip adductors and internal rotators.

The W sit position is also extremely stable, making it an easy and efficient position to sit in while watching TV or doing fine motor activities. The combination of a wide base of support and extra stability from the structures around the hip joint mean the core stability muscles can basically take a holiday, while still freeing up the hands for lego and the eyes for Paw Patrol.

When is it a problem?

A typically developing child should have

  • a wide repertoire of positions on the floor and in standing,

  • be able to move fluidly between these positions,

  • cross the midline, rotate, and use both hands at an age appropriate level,

  • be able to sit still for periods of time to do quiet activities,

  • be able to crawl/climb/move/reach/twist with efficiency and increasing control.

In my opinion, W sitting is NOT at all a problem if you can tick the following boxes:

□ Your child has normally developing hips, and has normal muscle tone and muscle length/joint mobility

□ W sit is just one of many positions your child uses for play. You are just as likely to see your child sitting cross legged/side sit, standing, or kneeling as using W sit

□ Your child is able to maintain steady postures in other positions – able to play with two hands sitting legs in front/kneeling, rotate and reach comfortably in different positions, and cross the midline.

□ Your child is able to move with age appropriate coordination, strength and fluidity. This means walking, running, jumping, climbing and balancing at a level similar to their peers

In this case, I would class W sitting as just part of a normal functional repertoire of play positions.

W sitting may be an issue if you notice any of the below:

  • Your child does not tend to sit on the floor in any other position, and uses this position almost exclusively for floor play

  • Your child uses other floor play positions but needs to lean/prop/lie down, and struggles to do two handed play or stay still.

  • Your child walks with a limp, significant in-toeing, up on toes, or has frequent falls

  • Your child has difficulty staying still, and is always on the move, crashing into things and constantly seeking sensory input

  • You child is experiencing developmental delays in acquiring gross or fine motor skills

  • You child often looks awkward or uncoordinated when walking and running, and may have difficulty with higher level activities like hopping and ball skills.

When does W sitting require intervention?

Our bodies are smart, and we are natural problem solvers – when we sit or move in a particular way it is usually for a reason. We are custom built to seek efficiency and “the easiest way”. W sitting is no exception.

The problem if a child uses this position exclusively, however, is that they are missing the opportunity to develop the postural control skills necessary for higher level function. W sitting does not allow development of trunk rotation or lateral weight shift. It is very efficient and does not require much effort from the trunk muscles. Children in this position tend not to cross the midline (reach across their body). Nearly all movement occurs in one plane, rather than across all 3 planes. These are all skills required for higher level movement and balance, and these foundational movement patterns are initially laid down during floor play.

W sitting uses a great deal of internal rotation of the hip and holds the hamstrings and calves in a shortened position. The jury is out if this can influence long term hip development, but in children with a history of hip dysplasia, or spasticity of the muscles of the lower limbs, this position does move the hip into a position of risk. Children with spasticity often have difficulty with maintaining range in their hamstrings, calves, adductors and internal rotators, and this pose places all those muscles in a shortened position. This is also the case for toe walkers with short calves.

Children who use W sit for all fine motor play may experiences difficulties doing fine motor tasks in other less stable positions – for example writing at a table, doing up buttons and zippers, or painting at an easel. This position, unlike other sitting and kneeling postures, doesn’t actively recruit many of the stability muscles around the trunk and pelvis, muscle development that is necessary for upright stability.

W sitting can be a sign that your child has difficulty using other positions for play. Among other things, this can be due to

  • Hypermobility (more natural movement and laxity at the joints), which can make holding static postures and knowing where the body is in space more difficult. The W sit position places the hips at end range of motion, locking them in position, and is usually very comfortable for someone with lots of hip range. Although many children are hypermobile without consequence (think gymnasts!), some children with hypermobility experience difficulty with higher level coordination and movement, frequent sporting injuries or aches and pains. These children will often benefit from assessment and intervention.

  • Hypotonia (low resting muscle tone). Low tone occurs when the resting muscle length is a little longer than normal, resulting in a less efficient muscle contraction, and an increase in the stimulation needed for a muscle to activate. Children with lower tone may feel floppy to handle when at rest, feel very heavy when you pick them up, fatigue quickly and have more difficulty with balance, gross motor and fine motor activities. Because W sitting requires little muscle activation to maintain, it is often the position of choice for children with low tone.

  • Habitual use of the position. Some children naturally gravitate to this position as infants and toddlers, and don’t develop the postural control they need in other positions. This leads to them returning to W sitting time and time again for activities that require control or concentration.

I’ve just peered over the top of my lap top, and little Kevin is W sitting. Eek! What should I do?

  • If you child occasionally W sits, don’t worry. There are many good reasons why children sometimes choose this position.

  • If your child is just learning to crawl, this is often a transient position that makes transferring in and out of hands and knees easier.

  • If they W sit all the time, it is worth thinking about “why”. For some children it is habitual, and simply providing a gentle reminder, or structuring play differently (e.g setting up lego at a small table and chair, placing the ipad or card game at the coffee table so they need to kneel) will lead to an increase in repertoire and trunk control

  • For some children it is a symptom of movement and stability being on the trickier side, and they will benefit from some targeted intervention

  • If have any concerns about development, see a GP, paediatrician or paediatric physio for assessment.