Children who sit on the floor with their thighs rolled inward and their calves rotated out to the sides are told that they are “W-sitting”. Parents are told to reposition their kids immediately. There are even garments like Hip Helpers that make it nearly impossible to sit in this manner. Some therapists get practically apoplectic when they see kids sitting this way. I get asked about W-sitting no less than 3x/week, so I though I would post some information about w-sitting, and some simple ways to address this without aggravating your child or yourself:
This is not an abnormal sitting pattern. Using it all the time, and being unable to sit with stability and comfort in other positions…that’s the real problem. Typically-developing kids actually sit like this from time to time. When children use this position constantly, they are telling therapists something very important about how they use their bodies. But abnormal? Nah.
Persistent W-sitting isn’t without consequence just because it isn’t painful to your child. As a child sits in this position day after day, some muscles and ligaments are becoming overstretched. This creates points of weakness and instability, on top of any hypermobility that they may already display. Other muscles and ligaments are becoming shorter and tighter. This makes it harder for them to have a wide variety of movements and move smoothly from position to position. Their options for rest and activity just decreased. Oops. And they don’t feel uncomfortable in that position. If you aren’t hyper mobile yourself, you might not believe me. Here is an explanation: Is Your Hypermobile Child Frequently In An Awkward Position? No, She Really DOESN’T Feel Any Pain From Sitting That Way.
Sitting this way locks a child into a too-static, too-stable sitting position. This appeals to the wobbly child, the weak child, and the fearful child, but it makes it harder for them to shift and change position. Especially in early childhood, developing coordination is all about being able to move easily, quickly and with control. There are better choices.
A child who persistently W-sits is likely to get up and walk with an awkward gait pattern. All that over-stretching and over-tightening isn’t going to go away once they are on their feet. You will see the effects as they walk and run. It is the (bad) gift that keeps on giving.
What can you do?
Well, good physical and occupational therapy can make a huge difference, but for today, start by reducing the amount of time they spend on the floor. There are other positions that allow them to play and build motor control:
Encourage them to stand to play. They can stand at a table, they can stand at the couch, they can stand on a balance disc. Standing, even standing while gently leaning on a surface, could be helping them more than W-sitting.
Give them a good chair or bench to sit on. I am a big fan of footstools for toddlers and preschoolers. They are stable and often have non-skid surfaces that help them stay sitting. They key is making sure their feet can be placed flat on the floor with their thighs at or close to level with the floor. This should help them activate their trunk and hip musculature effectively.
Try prone. AKA “tummy time”; it’s not just for babies. This position stretches out tight hip flexors and helps kids build some trunk control. To date, I haven’t met one child over 3 who wouldn’t play a short tablet game with me in this position. And them we turn off the device and play with something else in the same position!
Children with EDS and other connective tissue disorders such as joint hyper mobility disorder often have sensitive skin. Knowing the best ways to care for their skin can prevent a lot of discomfort and even injury. These kids often develop scars more easily, and injured skin is more vulnerable in general to another injury down the road. As an OT and massage therapist, I am always mindful of skin issues, but I don’t see a lot of helpful suggestions for parents online, or even useful comments from physicians. I want to change that today.
Use lotions and sunscreens. They act as barriers to skin irritation, as long as the ingredients are well-tolerated. Thicker creams and ointments stay on longer. Reapplication is key. It is not “one-and-done” for children with connective tissue disorders. Some children need more natural ingredients, but you may find sensitivities to plant-based ingredients too. Natural substances can be irritants as well.After all, some plants secrete substances to deter being eaten or attacked!
Preventing scrapes and bruises is always a good idea, but kids will be kids.Expect that your child will fall and scrape a knee or an elbow. Have a plan and a tool kit. I have found that arnica cream works for bruises and bumps, even though it’s effectiveness hasn’t been scientifically proven to everyone. Bandages should not be wrapped fully around fingers, and a larger bandage that has some stretch will spread the force of the adhesive over a larger area, reducing the pressure. DO NOT stretch their skin while putting on a bandage. And remove bandages carefully. You may even want to use lotion or oil to loosen the adhesive, then wash the area gently to remove any slippery mess.
If your child reacts to an ingredient in a new cream or lotion but you aren’t sure which one, don’t toss the bottle right away. You may find that your child reacts to the next lotion in the same manner, and you need to compare ingredient lists to help identify the problem.
Hydrate, hydrate, hydrate. Skin needs water to be healthy, and even more water to heal. Buy a fun sport bottle, healthy drinks that your child likes, and offer them frequently.
Clothing choice matters. Think about the effect of tight belts, waistbands, even wristbands on skin. Anything that pulls on skin should be thought out carefully. This includes shoe straps and buckles. Scratchy clothing isn’t comfortable, but it can be directly irritating on skin. That irritation plus pulling on the skin (shearing) sets a child up for injury.
Teach gentle bathing and drying habits. Patting, not rubbing the skin, and the use of baby washcloths can create less irritation on skin. Good-bye to loofahs and exfoliation lotions, even if they look like fun. Older girls like to explore and experiment, but these aren’t great choices for them. Children that know how to care for their skin issues will grow up being confident, not fearful. Give your child that gift today!