W-sitting: problem or solution?

When a child w-sits he spreads his hips with his bottom on the floor, his knees bent, and his feet behind him, making a "W" shape with his legs.

When a child w-sits he spreads his hips with his bottom on the floor, his knees bent, and his feet behind him, making a “W” shape with his legs.

I’m going to come right out and say it.

I’m a pediatric physical therapist, and I think W-sitting is OK.

Like most physical therapists, I learned in school that W-sitting is bad.  Very bad.  The worst.  When I talk to other physical therapists, even those who don’t treat children, they remember the same thing.  In a recent conversation, one colleague recalled the time she came home from PT school in a panic because her then-5-year-old sister was a W-sitter.  It is a single, pervasive, clear message taught to physical therapy students everywhere.  W-sitting must always be corrected.  But why?

The reasons given usually fall into 3 categories:

  1. W-sitting will cause orthopedic issues such as twisted bones and hip dislocation.
  2. W-sitting will cause muscle tightness, especially in the hips.
  3. W-sitting will aggravate neurological issues such as low muscle tone.

For the first several years of my practice as a PT, I taught families about the dangers of W-sitting, reciting the 3 reasons over and over again.  For the first couple of years I taught pediatric PT, I passed these beliefs onto my students.

Then I became a mother.  And my son was a W-sitter.

And for the first year or so of his life, as he played, I chirped “Fix your feet!” and moved him, over and over again, into other sitting positions.  At first, it wasn’t a big deal. But then he started to get frustrated with me.  And I started to get frustrated with him.  And I noticed that, when I moved him to a new position (or forced him to do so himself), he often wasn’t able to play as well or effectively as he was before my “intervention.”  He was a happy, bright, social kid.  He was developing normally, hitting all his milestones on time, and had no orthopedic or muscular problems that I could identify.  So I stopped worrying about it.  I stopped correcting him.  I started to wonder why I had been correcting W-sitting just for the sake of correcting W-sitting.  And I started to think really carefully about what I was really doing when teaching families to discourage W-sitting.

The truth is, as common as it is for therapists to teach children to “fix your feet,” there is really no evidence to support this practice.  A quick Google search for “W-sitting” reveals hundreds of posts about W-sitting, most written by physical and occupational therapists.  Almost without exception, they caution against W-sitting.  Almost without exception, they give the 3 reasons that W-sitting is bad.  But, in reviewing all 10 posts on the first page of search results on W-sitting, not a single one provides any references for those claims.  Searches for W-sitting on Google Scholar and PubMed come up empty.

“Fix your feet!”  For a practice with such a high level of adoption, there sure is a low level of evidence.

Now, I don’t dispute the fact that children with low muscle tone often choose W-sitting as a preferred position.  It gives them a wide base of support which makes them really stable.  But you know what that means?  They are functional in that position!  They can use their hands better and manipulate toys better because they aren’t using all their energy just trying not to fall down.

I also understand that often, children who W-sit often have orthopedic issues and muscle tightness.  But I don’t think that we can confidently say that W-sitting CAUSES those issues.  Perhaps it’s the other way around – unstable hips and tight hamstrings lead to W-sitting.  Or maybe there’s a third variable that’s causing both problems.  The truth is we don’t know.

And many might argue, “What’s the harm?  It won’t hurt to take them out of W-sitting.  Why wouldn’t we correct it?”  My response would be that correcting it might actually be harmful.  Perhaps not for the child’s physical development.  But what about their interactions with their parents?  Is constantly having a parent telling their child to “fix their feet” promoting good parent-child interactions?  What about parents who worry constantly about their child’s W-sitting?  How much stress and worry are we therapists causing over something we really can’t even prove causes harm? And finally, what about function?  What are we taking away from the child when we correct W-sitting?

So perhaps we therapists should soften a bit on W-sitting.  Not that we should NEVER correct it – sometimes it is clearly problematic for a child.  But we should recognize that W-sitting isn’t an all or nothing proposition.  It can be normal and is not always be dangerous or bad.  It doesn’t always need to be corrected.  Let’s look at children as individuals, address their real impairments, and always keep our eye on enhancing participation rather than reinforcing “normal.”  If low tone and core strength are the issues, let’s address those.  Let’s provide opportunities for a variety of movements and help children explore different sitting positions.

Kids are smart.  They usually know what they need.  And the body has a way of finding the most effective and efficient way to move.  For many kids, W-sitting isn’t a problem, it’s their solution.

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24 responses to “W-sitting: problem or solution?”

  1. Shelley Mannell says :

    Thanks for this Kendra. I had 2 children who preferred to W sit when they were young. And in my professional practice, I prefer to look at W-sitting as a red flag that points to the need to delve further into the reasons why a child prefers a wide base of support.

    • kendrapedpt says :

      I could not agree more, Shelley! Often (not always) W-sitting is the result of another underlying impairment. As you said, we need to focus our attention on figuring out WHY the child is W-sitting.

    • Buffy Owens says :

      Jana, thank you for sharing a link to my blog in the comments of this post. I was just notified of the share and was thrilled to see it shared here. I am grateful for your thoughtfulness and for the opportunity to read this post. Thank you. -Buffy

  2. lej1123 says :

    This is my first time checking out your blog, and I found this post through the AbbyPediatricOT blog (http://www.abbypediatricot.blogspot.com/). I’m a soon-to-be OT student who is currently volunteering at a pediatric facility and I have heard several therapists and parents correct or chide a child for W-sitting.

    I never really thought to ask why it was such a bad thing, and it happens infrequently so I haven’t yet been “indoctrinated” with the anti-W mindset! However, I think it is very wise of you to take a step back and consider WHY it might be such a bad thing. Your comment that “…I don’t think we can confidently say that W-sitting CAUSES those issues. Perhaps it’s the other way around – unstable hips and tight hamstrings lead to W-sitting. Or maybe there’s a third variable that’s causing both problems” took me back to my days in statistics and research classes where I was made to consider all the possible reasons for an outcome! And you’re right, the correction of the position may ultimately be doing more collateral damage to relationships and functionality than the position is for any physical structures.

    This post was a great reminder for me that critical, questioning thinking and the desire to be evidence-based is always important.

    • kendrapedpt says :

      I’m so glad the blog made you think. Whether you ultimately agree or disagree that W-sitting needs to be corrected, I think we all need to acknowledge that “fix your feet” has become a dogma that few of us question. Thanks for your comment and the re-blog!

  3. lej1123 says :

    Reblogged this on Gotta Be OT and commented:
    As I continue to volunteer and learn more about pediatric occupational therapy, I am finding out so much about things children do that I had never thought might be harmful. One of these things is “W-sitting.” This happens when a child “spreads his hips with his bottom on the floor, his knees bent, and his feet behind him, making a “W” shape with his legs.” (Kendra Ped PT Blog)

    I did not know what the big deal was about W-sitting before I started volunteering, but in my time at the clinic I’ve heard several therapists correct a child who was seated in this position. I wondered why it was such a big and even if it was such a big deal, and Kendra’s post about W-sitting provides great discussion about making sure that therapeutic recommendations are actually evidence-based, backed up by fact and ultimately beneficial to all parties involved.

  4. Sarah says :

    My daughter has increased femoral anteversion diagnosed by pediatric orthopedist at Mass General Hospital. Here is a link to a handout received regarding femoral anteversion and how w-sitting “should not be discouraged or avoided” in this case. No research is cited but perhaps it is based on some. http://www.massgeneral.org/ortho/services/pediatrics/intoeing.aspx
    Thoughts?

  5. Sharon says :

    I was and still am a w-sitter. I am 41 years old. So far, no problems. I played sports when younger and am still physically active. I was born with displaced hips so I figured that’s why I did it. But now my 3 year old does it and she has no hip problems. She sits in other positions but prefers w-sitting. I never knew this was even a problem until I read an article from pediatric physical therapists. My motherly-intuition tells me she’s fine sitting how she wants but I now have this in the back of my head. Thanks for the post, I’m glad to hear another opinion as I’ve not found any real research to support the negative claims. I’ll keep an eye on her posture and coordination though.

  6. Mansi says :

    I think we have a lot of anecdotal evidence regarding W-sitting. We really need some evidence as to how W-sitting affects children with special needs. Since your child is a neurotypical child, can we really apply your observations to children with special needs? Can we really generalize based on the experience of one mom? Although I agree that W-sitting may not cause orthopedic problems, it may aggravate them. W-sitting is usually seen in children with low tone who are unable to maintain an upright posture while sitting on the floor. The knees are in extreme varus and hips internally rotated. Maybe these children develop hip/knee arthritis down the line. But we don’t know it, because there isn’t enough evidence. So, as a pediatric OT, I prefer to err on the side of caution and correct W-sitting. I am only talking from the POV of special needs kids,.

  7. Shayna says :

    I am glad to have found your article. I am a firm believer in letting children move at their own instinctual pace. Therefore, I do not put my children in positions they couldn’t otherwise get themselves into. I did not force tummy time, but let them enjoy in when they were ready to roll over. I did not offer hands to facilitate earlier walking, but waited until they were ready to explore this mode on their own. I feel it has allowed them a confidence in knowing their boundaries. That said, it seems as thought children instinctually know what is best for them. Both my children W sit and, as you said, seem happier and more focused on their play. Thanks again!

  8. Barbara Hill says :

    I think all the anti-W-sitting propaganda is a bunch of nonsense. I live in Northern California where there are a great many people whose ancestors came from Asian countries. W-sitting is rather common among their children, and there is NOTHING wrong with them. They do NOT grow up with a lot of muscular or skeletal problems.

    My hobby is genealogy and several years ago I noticed a family photo taken about a hundred years ago in which several children were W-sitting. Nobody thought a thing about it at the time, and as far as I know none of those children grew up with any noticeable problems. I myself W-sat as a child; I am now 70 years old and have never had any problems with my hips or knees, and hardly any with my lower back – far less than average, I would venture to guess. I was never pigeon-toed, either. I began to ask around my distant relatives, and found that all of those who W-sat as children descend from only ONE of my ancestral lines – as far distant as fifth and sixth cousins – and they all turned out perfectly normal. None of my relatives from other ancestral lines could W-sit. So I believe there is a genetic component involved.

    It is probably true that some children with muscular or skeletal problems W-sit because it helps with their stability, but the W-sitting was not and is not the cause of their problems. Somebody seriously needs to debunk this myth.

  9. Alex says :

    Kendra,

    I’m so glad I found this post! I have always been a w-sitter, and I didnt know that it was something that was “bad” or that it even had a name. I started finding all of these websites talking about how the way I’ve sat (and have NEVER been chided for, I might add) my entire life is horrible and ruining my body, and I started getting concerned. People sometimes ask me if it’s comfortable, and to me, it feels natural and is the most comfortable position. I am and have always been perfectly capable of sitting in other positions; I just prefer to sit this way. I never had any type of muscular or skeletal issues as a child, and I still have not. I am 20 now, so I could certainly develop some down the road, but this may or may not be related to the way I sit.

    Thanks for giving me some peace of mind!

  10. Lisa Woitkoski, PT says :

    Finally, someone says out loud what I have been thinking and saying to the parents of the children on my caseload! I fear, the therapist the child has after me thinks I’m out of my mind because I didn’t get on the “No W-sitting” bandwagon!

    Many pictures of me as a child show me W-sitting. I was an athlete and continue to be active. I still can W-sit at 44 years old! For children that are chronic W-sitters with no other way to sit, I work on other ways and recommend that the family promotes other ways as well as W sitting. To truly stop a chronic W-sitting child is a full time job, nearly impossible and unrealistic to ask parents to spend every second of every day changing the way the child sits.

    I had a very motorically involved child with CMV, visual impairment, hearing impairment and hypertonicity in arms and legs. She sat up for the first time by herself in a W sitting position. This is the only way she could sit independently and the only way she could transition into sitting. I worked every therapy session on other ways to sit and other transitional patterns in hopes that we could develop other patterns. Was it better to tell her parents to put her back down on the floor on her back so she could lay there and do nothing just so she would not W sit? Was it appropriate to ask them to go get her out of the position every second of every day? Was it appropriate to take away the only independent upright position this child had? This was a turning point for me in my practice as a physical therapist and my thoughts on W sitting. I agree completely with the need for children to be in a stable position so that they can play effectively, because the need to play and to learn from play is as important as any motor skill.

  11. Wes Groleau says :

    My psych major roommate was fond of saying that psychological literature was ten percent empirical research, thirty percent things someone made up, and sixty percent quoting the others. When I developed a medical problem and starting doing research, I came to the conclusion that a similar coment could be made about medicine in general.

  12. amy says :

    In your research did you find any connection between w sitting and laterality and or bilateral integration difficulties?

  13. grahamta says :

    I am going to try this. THANK YOU! Constantly they corrected my child’s sitting in early intervention and in 3-4 services. What did it lead to? Frustration and her complete revolt and not wanting to work on the floor. I let her work at a table instead and still she can sit a short while criss-cross, but I never thought…is W sit all that bad really, Maybe it is what she needs. I am going to try letting her W sit. I have nothing to lose…all the W sit ban has resulted in is her inability to work on the floor! By the way…per her current PT…she is very strong. I don’t believe it is core strength at all.

  14. Laura says :

    I might start to nanny for a girl that W sits, and her parents want me to correct her every time she sits that way by saying “fix your feet” (a demanding style that is not the best to use frequently, in my opinion.) It is hard for me to envision saying that every time this little 15-month old girl sits that way, especially coming from one that still W sits on occasion herself! To me, the main reason why I continued to W sit was because it was uncomfortable for me to sit on my bum that lacked padding. W sitting feels more comfortable because you can lean forward on your legs or put your feet under your bum and not hurt your behind. I don’t know what causes what thing, but I know that I do have a pigeon toe, knee and hip/lower back alignment problems from time to time and notice W sitting doesn’t help; but if I have to sit on a hard floor, I usually resort to W sitting anyway.

  15. zekesmom10 says :

    I W sat my whole first decade and sometimes beyond that. It was just comfortable to me. I didn’t even know it was “bad” until a friend insisted we all correct her child for it.

  16. Liz Ditz says :

    I would love to have a discussion about “retained primitive reflexes” as well. Allegedly these cause learning disabilities.

  17. Penny Williams says :

    Thanks for this perspective on W sitting. My son and husband do it, as well as my nephew. My son has low muscle tone and his hips are very loose. He also has significant inward pronation and his feet turn inward. I have wondered if the W sitting caused some of this because his feet didn’t always turn in. Who knows?

    Penny Williams
    Author of “Boy Without Instructions”
    BoyWithoutInstructions.com

  18. Erica Collier says :

    As a former “W sitter,” I developed weak knees by the age of 9 and, as a preschool teacher, I’ve noticed knee issues arising from “w sitting.” Though this article brings up good points, I still maintain the fact that we need to prevent “W sitting.”

  19. Buffy Owens says :

    Kendra,

    Thank you for such a wonderful and honest post!

    I agree that having a black and white view of W-sitting doesn’t really serve anyone. I know adults, life-time W-sitters, who have no ill effects and are incredibly active (even long distance runners without injury). But there are also those that do suffer imbalances in the knees and lower backs. Is this directly caused by W-sitting or the overall organization of which W-sitting is a part of? Hard to say.

    The truth is, humans are dynamic, each person is an individual and no two bodies are the same. The shape and depth of hip joints vary. The shape of the pelvis, the angles of the trochanter, the length of the neck of the femur, all vary from person to person. Not to mention the motivation of the moment and how each individual approaches learning.

    I so appreciate your focus on learning and I love the bit where you say,

    “…we should recognize that W-sitting isn’t an all or nothing proposition. It can be normal and is not always be dangerous or bad. It doesn’t always need to be corrected. Let’s look at children as individuals, address their real impairments, and always keep our eye on enhancing participation rather than reinforcing “normal.”

    I look forward to reading more of and following your blog!

  20. Carrie Ann says :

    I agree and appreciate the idea that W sitting is not problematic for all children. My husband has W sat his entire life. He has a weak core and bad knees now. However my daughter has a level IV brain bleed, hydrocephalus, and was at risk for CP. W sitting became her preferred seating method no matter how hard we tried to stop and give her other methods. I followed some advice “you know what she’s going to do it anyway.” We still discouraged it, fixed it, or gave her other options but weren’t as strict about it. Now she is almost three and when going in to an orthopedic appt just thinking we were getting a referral for something else, we found out her hips are in fact coming out of the sockets and she will need a major surgery fairly soon. While I agree for most typically developing children W sitting may not be the worst thing they can do, I only wish that I could go back and know more about how W sitting can add to hip issues. While W sitting was not the single cause of my daughter’s hip issues, it only negatively affected and aggregated her symptoms/outcome. I would have continued to fight the unhappy battle a little harder if I had known then what I know now.

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