Another W We Don't Need

Many of the children I treat are W sitters.  Instead of kneeling, sitting on their heels, or crossing  their legs in front of them, they sit in a W, with their legs bent at the knees on either side and their behinds flat on the floor. Children sit this way when they don't have sufficient balance or trunk strength to sit unsupported, so they manufacture the postural stability they need from the wide base of their folded legs.

W sitting is problematic for both orthopedic and neurological reasons.  It's fine to sit like this once in a while, and many toddlers do assume this posture from time to time, but it's not a good default position.  Our bodies were NOT designed to sit like that, and prolonged W sitting is destructive to the bones, muscles, and ligaments that comprise the knees and hips.  Habitual W sitters frequently grow up to be adults who have chronic knee pain.  They may even need knee and hip replacements, their joints have been so compromised by misuse. Anyone who has lived with hip or knee pain even briefly knows how utterly debilitating it is.

Relying on the W position interferes with the child's neurological maturation and development of his balance and coordination.  Sitting this way for long periods every day does not allow the child to rotate his trunk as he is playing.  Rotation of the spine and trunk allows us to reach across the body with the dominant hand to pick up and use objects on either side of us.  W sitting fixes the trunk so that the child must use each half of his body separately instead of coordinating the two sides together.  Since he can't really move much in this position,  he tends to reach with and use the handy hand on the same side, instead of turning, shifting his weight, and crossing over the midline of his body with his dominant hand.   This does not provide the child with the movement experiences he needs to integrate the two hemispheres of the brain, which must communicate together for higher level activities.  This interferes with the child's balance, equilibrium responses, and gross motor coordination.

Children who don't cross the midline due to W sitting often don't establish a strong hand dominance.  Their fine motor control and eye hand coordination suffers as a result, and so does their ability to write and to use their hands to play with toys and games, make crafts, open packages, and manipulate fasteners.

Since they can't rotate their spines, W sitters are also limited in how far they can turn their heads, and so they don't use their eyes the way they should.  Their visual skills, like depth perception and binocular vision, suffer as a result.

These delays affect their schoolwork, since they have not developed the physical underpinnings required to successfully coordinate their hands and eyes for reading and writing, nor the balance and strength they need to sit for long periods.  Because they have not practiced weight shifting and rotating their trunks, which is critical for maintaining balance, navigating the busy hallways, gym classes, and playgrounds at school can be a huge, anxiety provoking challenge.

A child who is observed to be a habitual W sitter at school should be provided with a chair during play and circle time instead of sitting on the floor, or should be given a place against a wall where his back is supported.   Since W sitting in school age children is often an indication of delays in the child's neurological development, a referral to an occupational therapist may be in order.

Home activities that are good for W sitters include toys and games that require crawling or playing on all fours,  like floor puzzles, racing cars, tiddly winks, and marbles.   If your child is small enough, carry him as often as you can on your hip or on your back and give him minimal support.  This will encourage him to grip you with his arms and legs, which will strengthen him. A therapy ball to sit on at home while doing table top activities like homework or while using the computer or watching television is very strengthening to the small muscles of the spine, which are important for posture.  Activities that promote balance and/or upper body strength, like wheelbarrow walking, are helpful.

Teach the child to sit on his heels, or to sit on the floor with both legs next to him on the same side.  These two positions allows him to turn and rotate his trunk.  Train him to tuck his heels under him when he hears a grown-up say "Fix your feet!".

I also recommend to the parents of W sitters that their children not wear shoes indoors, since it's much easier to sit on heels with bare feet.