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Is ‘W-sitting’ bad?

*Please read the entire article for important notes at the end.*

Have you ever noticed your child sitting like this?

Perhaps your child’s daycare, or friends on a playdate, have pointed out that this is ‘W-sitting’ and needs to be corrected. This has probably left you with questions – especially if your little one has sat this way for a long time and you had no idea that it was an issue.

‘W-sitting’ as pictured above, is when a child sits on their bottom, with knees bent, feet tucked under, and legs splayed out to each side in a ‘W’ shape. ‘W-sitting’ provides children with a wider base of support and a lower centre of gravity – this increases their stability and makes it easier for them to concentrate on what they are doing, which is why so many little ones automatically position themselves like this.

Because this position is so common, most parents have no idea that the use of this position can have negative implications on children’s growth and development – especially if a child uses this position often and for prolonged periods of time during floor play. It is not a cause for concern if your child moves briefly in and out of W sitting when playing or transitioning from one position to another.

Complications can include:

• It places abnormal stress on a child’s hips and knees
• May impact on the alignment of the lower leg to the thigh and can be associated with leg pain, especially
  knee pain, often at night.
• May impact on a child’s balance and their ability to cross the midline
• Long term may lead to hip and leg muscles becoming tight and shortened; which can result in a child walking
  ‘pigeon toe’
• May delay the development of perfecting the child’s motor skills
• Long term it can lead to dislocation of the hips
• Children who W-sit may also develop postural problems, such as a sway back – the spine curves too far
  inward – and this affects balance and coordination.
  
  

It can be stressful trying to convince your little one to sit in a different position, especially if they are used to sitting in a ‘w’ shape, and find it comfortable/preferred. There are ways that you can help your little one change this habit:

• The most common alternate position is with feet crossed and knees apart. You can come up with a fun term or reminder, to encourage them to change how they are sitting and to cross their legs instead. It is best to try to make it fun without just telling them to stop ‘W-sitting’.
  
• Model the preferred way to sit.
  
• Be consistent, and use a visual to reinforce the preferred way to sit.
  
• Side-sitting is another alternative if sitting with knees out is too difficult. In side-sitting, knees are bent,
  weight is shifted to one hip, and both feet are out to the same side. This takes away stress from the hip joint
  structures, allowing for easy transitions in and out of sitting.
  
• Long sitting with feet forward and back supported is a great way to stretch out those hamstrings and keep
  hip/knee joints in neutral.
  
• Another way to sit and let gravity help stretch the muscles is to sit on the floor with the soles of the feet
  together, knees bent out to the side.
  
• If a child has a hard time sitting and playing, consider letting them kneel with their feet tucked together
  under their bottom. Monitor that the child doesn’t slowly shift back into the W-shape, kneeling is a great
  position to strength their hip and core muscles.
  
• Finally, squatting or sitting on a low chair will also help keep a child from ‘W-sitting’ during play.

• Provide lots of opportunities for activities that stimulate and strengthen muscle tone in the legs, strengthen
  back muscles and help align the hips by Integrating activities through play – Obstacle courses and climbing
  frames require children to use hands and feet, feet and lower body, hands and upper body, balance, and to
  use equipment in multiple ways. These activities help your child build their core strength, practice crossing
  the mid-line and improve balance.
  
• Exercise the hip joints by singing action songs such as ‘Row, Row, Row your Boat’.
  
• Crawling – play games where your child can get down on her hands and knees – tunnels etc.
  
  

If you notice that ‘W-sitting’ is the only position your child can sit on the floor or if you have concerns with the way
your child walks you can see a paediatric therapist, an occupational therapist, or physiotherapist to have your child assessed.

And remember, if your child has always sat like this and you are only now reading the above – do not feel bad or panicked! This is something you can’t possibly be aware of unless you have been told, and many children choose to sit like this. With the right tools and assistance, you can work to change this habit and prevent any future complications.

References and further reading

W sitting – Occupational Therapy Australia

Whyndam City – Preschool Field Officer Service – W Sitting tip sheet

EDITED TO ADD – 20TH JANUARY 2022

Since publishing this article, we have had a GP registrar with a diploma in child health (who had completed a year of paediatric training), reach out with some information and resources to share with us, that some reputable organisations actually believe “w-sitting” is a normal stage in development and mostly, not harmful at all.

From the International Hip Dysplasia Institute:

“Contrary to popular belief, this W-sitting posture is normal for many children, and should be allowed even though children who can sit like this often walk with their feet turned in – called pigeon toed walking. The medical term that allows W-sitting is called Internal Femoral Torsion because the thigh bone has an increased twist in some people.

Treatments for this common variation were debunked more than twenty years ago, but myths still persist about the best way to stop this way of sitting and walking. This way of sitting and walking is often noticed around the age of three years while the child is very flexible. During further growth, the bone twist goes away naturally in 99% of children without intervention. When this goes away, parents and doctors often credit whatever they did to “help” it go away. Studies have shown that W-sitting does not cause any harm to the developing hips, and does not contribute to hip dysplasia.”

And this excerpt which was published in the article “‘W’ Sitting Is Not Bad for Kids, CHLA Study Finds” by Las Angeles Children’s Hospital last year;

“For years, well-meaning teachers, grandparents and even some health care providers have told parents they should stop their child from sitting in a ‘W’ position. This is when children sit with their butts on floor and their legs bent behind them and splayed to the side of the hips, with the knees facing forward.

In reality, sitting this way is not harmful at all, says Rachel Goldstein, MD, MPH, Director of the Hip Preservation Program in the Children’s Orthopaedic Center at Children’s Hospital Los Angeles. “There is a lot of misinformation out there about ‘W’ sitting,” she says. “You Google ‘W sitting’ and what comes up is a bunch of doom and gloom: ‘Do not let them sit like this, it will hurt their hip development, it will hurt their core development.’”

Dr. Goldstein, who is also Associate Professor of Clinical Surgery at the Keck School of Medicine of USC, says there is no documented evidence showing ‘W’ sitting causes problems. To her knowledge, ‘W’ sitting has actually never been formally studied by medical researchers—which prompted Dr. Goldstein and other researchers to study the topic.

“I wanted to see if we could prove with science that there is a lot of misinformation, that ‘W’ sitting is just a natural part of the development of the hip,” she says.”

This blog had been originally published to warn people of “w-sitting”, using Government reference sheets and podiatrists advice along with other reputable sources, but it seems that it is not that black and white! It is a controversial topic that requires further research.

*In the interest of transparency, we have decided to add in these additional resources and notes without removing information from the original blog.*

We will continue to look into this topic and update our followers as more research and information comes to light!