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The 101 on W Sitting

Jul 22nd, 2020 | by Cait Parr, PT, DPT
Cait Parr, PT, DPT

Cait Parr, PT, DPT

July 22nd, 2020

What is W-Sitting?

W-Sitting is when a child sits with their knees folded over in front of them, placing their feet and ankles on either side of their hips. It’s known as W-sitting because it creates a W shape. It’s pretty common for littles to play in the W sitting position. It typically only becomes an issue if your child W sits often or if it is their preferred position to sit. 

 

Why do children W sit? 

  • Bone alignment/positioning in utero (how your child is built can predispose them to W sit) 
  • Core/trunk weakness 
  • Excessive hip flexibility and/or joint hypermobility 
  • Low muscle tone (check out these exercises for hypotonia
  • It’s easier! A wider base is easier, requires less muscle work, and is less fatiguing

Why don’t physical therapists like W sitting? 

  • W sitting forces the knees to rotate inward. Increased stress on the knees can lead to knee pain over time. 
  • It may contribute to in-toeing. If your little is already hypermobile, this is more likely. Feet turning in while they W sit day after day for several years can lead to turned-in toes in other activities, like standing, cruising, and walking. 
  • It causes muscle tightness – in the hips, hamstrings, ankles, and feet. 
  • If your little one is W sitting, they often can’t transition, so their development of motor skills can be affected.  

 

What can you do about W sitting? 

  • Stretch! You won’t be successful getting rid of W sitting if your child is tight. A good stretch needs to last at least 30 seconds. Singing songs or watching short videos can help pass the time!  
  • To stretch hips, try the butterfly stretch! W sitting is internal hip rotation, so we need to stretch those hips in the opposite direction. Sit on the ground with your child in front of you, with the bottoms of their feet touching. Use your legs around your child’s legs in the same position to keep them close and calm. With your hands, apply gentle pressure to both your child’s knees toward the ground.  
  • For a hamstring stretch, consider a tug of war method. Start with you and your child sitting on the ground with straight legs, facing one another. Place the bottoms of your feet against the bottoms of your kid’s feet and reach for their hands, then gently pull them towards you, keeping legs straight. Check where they feel a stretch to ensure you’re stretching hamstrings instead of low back. They should feel the stretch along the back of their legs, not in their lower back.  
  • Don’t forget to stretch those ankles! For a calf stretch, you can have your child sit or lie on their back. Holding your child’s foot in your hand, apply light pressure at the base of the toes and flex the foot up towards their head. Hold for 30 seconds once you feel resistance. There are two muscles in the calf, so keep their knee straight for a gastrocnemius muscle stretch, and you can bend their knee to stretch their soleus muscle. 
  • To address and prevent in-toeing of the foot, we need to stretch the feet in the opposite direction. Start by holding your child’s heel with one hand. With the other hand hold the front of foot at the base of their toes, and gently pull toes in outward direction, toward the pinkie toe side.  
  • Strengthen the core! A weak core causes poor posture. W sitting requires very little core work, so posture will become an issue if their W sitting habit continues.  

 

What are some core exercises to help decrease W sitting? 

  • Crab position. To make it fun, place kiddo’s feet on sliders or paper plates and have your child straighten one leg at a time to destroy a block tower, knock over a bowling pin, or kick a ball.  
  • Ankle art! With your kiddo lying on their back and propped up on their elbows, place a balloon or ball between their ankles. With their knees and hips bent, have them draw a rainbow with their feet moving in an arch. For older kids, have them write out the ABCs or their name with their feet! 
  • Dead bug. Have your child lying on their back, arms and legs in the air. Try it with their knees bent at 90-degree angles or keeping legs straight. Balance a toy or bean bag on their feet or shins to encourage them to hold the position (“don’t let Teddy fall into the lava!”). 
  • Hands and knees play strengthens the core, with the added benefit of an arm workout! Kids will love playing with shaving cream or play dough, coloring or drawing, or even putting together a puzzle.  
  • Knee walking. Have your child knee walk back and forth between two tables several times to build a block tower or bring pieces of a toy. For example, you can place building blocks on one table and have the construction zone on the other table, or the piggy bank on one table and all the coins on the other, walking one object over at a time. This targets core stability and glut strengthening. An alternative activity is knee walking while pushing a weighted laundry basket to further engage tummy muscles! 

 

What are some alternatives to try instead of W sitting? 

  • Side sit, tripod sit/ring sit, or tailor sit, otherwise known as “crisscross applesauce” 
  • Squatting – playing in a deep squat is a good balance challenge. 
  • Get off the floor – a cool kiddie chair gets their hips off the floor and out of a W sit. 
  • If your child is prone to W sitting while playing on floor, a kids’ activity table encourages them to play up higher! These tables often come with extra storage, which is great for Legos, trains, barbies, etc. You can try having them play in tall kneel or half kneel. Bonus points for keeping that tummy off the table!  
  • Hands and knees or lying on tummy are two great floor play positions. 
  • Put them in high tops while they play! A rigid high-top shoe may not decrease W sitting, but it will keep feet in better alignment to decrease in-toeing.  

 

Break the habit! 

Breaking habits is hard, especially when it comes to W sitting. One thing that can help is to get everyone in your household on W sit patrol. Choose a family phrase or tagline for helping the W sitter fix their body. For example, you can tell your family, “If we see Suzy in a W sit, we can say ‘______’ and then help her choose a better position for her body.” Some options to consider: 

  • “feet in front please!” or “feet forward please!” These help when repositioning your child into a ring sit, long sit, or tailor sit, otherwise known as “crisscross applesauce”. 
  • “feet are friends, they stay together!” This one is great for repositioning your child into a side sit, also known as a mermaid sit. 
  • “Sit on your bottom please” works for any alternative sitting position your child may choose.  

Providing these consistent verbal cues as you reposition your child’s legs will help train them to eventually respond to the verbal cue by repositioning their legs themselves. In addition, framing your verbal cue in a positive way, such as “feet in front!”, rather than a negative way, such as saying “no W sitting” or “stop sitting like that!”, is less frustrating and more effective for long-term change.  

 

About the Author

Cait Parr is a pediatric physical therapist at NAPA Center. Her favorite animal is snails, because they remind her to slow down and enjoy the beautiful details about life. She loves desserts almost as much as she loves long walks with her husband on the beach at sunset.

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