What’s wrong with W-sitting?

By Jean McNamara, PT
ADVANCE for Physical Therapists, 1995

 

The W-positions 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?

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 challenged motorically like to play as much as anybody. They don’t want to worry about keeping their balance when they’re concentrating 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 doing 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:

 

 

	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 neurologic 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.

 

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Welcome to ZAC Browser - Zone for Autistic Children

ZAC is the first web browser developed specifically for children with autism, and autism spectrum disorders such as Asperger syndrome, pervasive developmental disorders (PDD), and PDD-NOS. We have made this browser for the children – for their enjoyment, enrichment, and freedom. Children touch it, use it, play it, interact with it, and experience independence through ZAC.

 

It’s Free! To learn more about it, visit http://www.zacbrowser.com/

 

 

 

 

 

 

 

 

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Autism Cares provides support for families affected by Autism During natural Disasters and other Catastrophic life events.

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 Red Flags in Speech Development

Newborn to 3 months:  

 

• Startles to loud sounds

• Quiets or smiles when spoken to

• Seems to recognize your voice

• Increases or decreases sucking behavior in response to sound

• Makes pleasure sounds (cooing)

• Cries differently for different needs

• Smiles when he sees you

 Red flags: No sounds (cooing)/quiet baby; doesn’t react to you 4 to 6 months

4 to 6 months

• Moves eyes in direction of sound

• Responds to changes in your voice • Notices toys that make sounds

• Pays attention to music

• Babbling sounds (more speech-like); many different sounds including “p, b, m”

• Vocalizes excitement and displeasure

• Makes gurgling sounds when left alone and when playing with

Red flags: Quiet baby—no sounds; no eye contact with you; no attention to voice or music

7 months to 12 months

• Enjoys games and peek-a-boo

• Turns and looks in direction of sounds

• Listens when spoken to

• Recognizes words for common items like “cup”, “shoe”, “juice”

• Begins to respond to requests (“Come here,” “Want more?”) • Babbling has both long and short   groups of sounds such as “tata upup bibibi”

• Uses speech or non-crying sounds to get and keep attention

• Imitates different speech sounds

• Has 1 or 2 words (bye bye, dada, mama) although they may not be clear

• Uses communicative gestures such as pointing and pulling

Red flags: Quiet baby—few vocalizations; no sound play or babbling, pointing or gesturing by 12 months; only vowels in vocalizations; does not respond to voice or sounds.

12 months to 15 months

• Maintains attention to pictures

• Understands simple directions especially with vocal or physical cues

• Uses one or more words with meaning 

Red flags: No communicative gestures such as pointing or pulling; vocalizations with only vowels; no imitative skills; no response to parent’s vocalizations; no response to name.

15 months to 18 months

• Says more words each month; vocabulary of 5-20 words

• Vocabulary composed mainly of nouns

• Much jargon-like speech

•Able to follow simple commands without cues (“Get your bear.”)

Red flags: No single words by 16 months; no imitative skills; limited consonants in speech; no response to directions with cues.

18-21 months

• Points to a few body parts when named

• Follows simple commands and understands simple questions (“Roll the ball,” “Where’s your shoe?”)

• Listens to simple stories, songs, and rhymes

• Points to pictures in a book when named

• Uses many different consonant sounds at beginning of words

• Expressive vocabulary of 25-50 words

Red flags: Limited variety of consonants; vowel distortions; few words, limited imitative skills.

21 months to 24 months

• Uses some 1-2 word questions (“What’s that?” “Daddy?” “Bye bye?”)

• Puts 2 words together (“more cookie”, “no juice”, “Mommy book”)

• Language explosion around 18-24 months; vocabulary of 150-300 words by 24 months

Red flags: Limited spoken vocabulary; limited variety of consonants; distortions of vowels or sounds; little response to name, directions, questions.

24 months to 36 months

• Understands differences in meanings of words (in/out, go/stop, up/down)

• Follows two requests (“Get the book and put it on the table”)

• Has a word for almost everything

• Uses 2-3 words to talk about and ask for things

• Speech is understood by familiar listeners most of the time

• Often asks for or directs attention to objects by naming them

Red flags: No language explosion by 30 months; unintelligible speech; small vocabulary; no simple 2-word combinations by 27 months.

36 months

• Hears you when you call from another room

• Answers simple “who?,” “what?,” “where?,” “why?” questions

• Talks about activities at school or friend’s home

• People outside family usually understand child’s speech

• Uses a lot of sentences that have 4 or more words

Red flags: Unintelligible speech; limited vocabulary; short utterances (only 1-2 words); limited consonants; little response to questions or directions.

Review of Red Flags for Developing Speech and Language:

• Little sound play or babbling as infant

• No babbling, pointing, or gesturing by 12 months

• No single words by 16 months

• No spontaneous 2 word phrases by 27 months

• Missed “language explosion” by 30 months

• Any regression in speech, language, or social skills at any age

• No eye contact or response to sounds

• No response to name by 15 months

• No response to directions or questions by 24 months

• Limited number of consonant sounds or vowel distortions by 24 months; low intelligibility for toddler (24-36 months)

• Poor verbal imitation skills by 12 months

• Small vocabulary for age; not much variety

Risk Factors:

• Family history of speech and language disorder

• Medical history of chronic otitis media with effusion

• Motor disorders/muscle weakness

• Limited or poor parental interactions