Pediatric therapists are
often confronted with similar concerns in many of the children they treat.
One area frequently addressed is W-sitting. The following was
written for parents and teachers to help answer common questions about this
issue.
The W-position is one
of many sitting positions that most children move into and out of while
playing, but it's a four-letter word to some parents. Why is it
presumed to be OK for some children and forbidden for others?
W-sitting is among
several positions frequently chosen by children to sit in; other positions
include those pictured here.
When playing in these other
sitting postures, children develop the trunk control and rotation necessary
for midline crossing (reaching across the body) and separation of the two
sides of the body. These skills are needed for a child to develop
refined motor skills and hand dominance.
W-sitting is not
recommended for anyone. Many typically developing children do move
through this position during play, but all parents should be aware that the
excessive use of this position during the growing years can lead to future
orthopedic problems.
Why do children W-sit?
Every child needs to play and children who are challenge motorically like to
play as much as anybody. They don't want to worry about keeping their
balance when they're concentration on a toy. Children who are frequent
W-sitters often rely on this position for added trunk and hip
stability to allow easier toy manipulation and play.
When in the W-position, a
child is planted in place or "fixed through the trunk. This allows for
play with toys in front, but does not permit trunk rotation and lateral
weight shifts (twisting and turning to reach toys on either side).
Trunk rotation and weight shifts over one side allow a child to maintain
balance while running outside or playing on the playground and are necessary
for crossing the midline while writing and ding table top activities.
It's easy to see why this
position appeals to so many children, but continued reliance on W-sitting
can prevent a child from developing more mature movement patterns necessary
for higher-level skills.
Who should not w-sit?
For many children, W-sitting should always be discouraged. This
position is contraindicated (and could be detrimental) for a child if one of
the following exists:
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There are orthopedic
concerns. W-sitting can predispose a child to hip
dislocation, so if there is a history of hip dysplasia, or a concern
has been raised in the past, this position should be avoided. |
|
|
If there is muscle
tightness, W-sitting will aggravate it. This position places the
hamstrings, hip adductors, internal rotators and heel cords in an
extremely shortened range. If a child is prone to tightness or
contractures, encourage anther pattern of sitting. |
|
|
There are neurological
concerns/developmental delays. If a child has increased muscle tone
(hypertonia, spasticity), W-sitting will feed into the abnormal
patterns of movement trying to be avoided (by direction of the
child’s therapist). Using other sitting postures will aid in the
development of more desirable movement patterns. |
W-sitting can also discourage a child
from developing a hand preference. Because no trunk rotation can take place
when W-sitting, a child is less inclined to reach across the body and
instead picks up objects on the right with the right hand, and those placed
to the left with the left hand.
Try sitting in various positions. Notice how
you got there, got out, and what it took to balance. Many of the movement
components you are trying to encourage in a child are used when getting in
and out of sitting. Transfers in and out of the Q-position, however, are
accomplished through straight-plane (directly forward and backward) movement
only. No trunk rotation, weight shifting, or righting reactions are
necessary to assume or maintain W-sitting.
How to prevent W-sitting. The
most effective (and easiest) way to prevent a problem with W-sitting
is to prevent it from becoming a habit it the first place. Anticipate and
catch it before the child even learns to W-sit. Children should be
placed and taught to assume alternative sitting positions. If a child
discovers W-sitting anyway, help him to move to another sitting
position, or say, "Fix your legs." It’s very important to be as consistent
as possible.
When playing with a child on the floor, hold
his knees and feet together when kneeling or creeping on hands and knees. It
will be impossible to get into a W-position from there. The child
will either sit to one side, or sit back on his feet; he can then be helped
to sit over to one side from there (try to encourage sitting over both the
right and left sides). These patterns demand a certain amount of trunk
rotation and lateral weight shift and should fit with a child’s therapy
goals.
If a child is unable to sit alone in any
position other than a W, talk with a therapist about supportive
seating or alternative positions such as prone and sidelying. Tailor sitting
against the couch may be one alternative; a small table and chair is
another.
The therapist(s) working with the child will
have many other ideas. Caregivers should ask if W-sitting in now, or
may in the future, be a problem.
