Tag Archives: w-sitting

Hypermobile Toddlers: It’s What Not To Do That Matters Most

 

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Do you pick up your toddler and feel that shoulder or those wrist bones moving a lot under your touch?  Does your child do a “downward dog” and her elbows look like they are bending backward?  Does it seem that his ankles are rolling over toward the floor when he stands up?  That is hypermobility, or excessive joint movement.

Barring direct injury to a joint, ligament laxity and/or low muscle tone are the usual culprits that create hypermobility.  This can be noticed in one joint, a few, or in many joints throughout the body.  While some excessive flexibility is quite normal for kids, other children are very, very flexible.  This isn’t usually painful for the youngest children, and may never create pain for your child at any point in their lifetime.  That doesn’t mean that you should ignore it.  Hypermobility rarely goes away, even though it often decreases a bit with age in some children.  It can be managed effectively with good OT and PT treatment.   And what you avoid doing at this early stage can prevent accidental joint injury and teach good habits that last a lifetime.

  1. Avoid over-stretching joints, and I mean all of them.  This means that you pick a child up with your hands on their ribcage and under their hips, not by their arms or wrists.  Instruct your babysitter and your daycare providers, demonstrating clearly to illustrate the moves you’d prefer them to use. Don’t just tell them over the phone or in a text.  Your child’s perception of pain is not always accurate when joint sensory aren’t stimulated (how many times have they smacked into something hard and not cried at all?) so you will always want to use a lift that produces the least amount of force on the most vulnerable joints.  Yes, ribs can be dislocated too, but not nearly as easily as shoulders, elbows or wrists.  For all but the most vulnerable children, simply changing to this lift instead of pulling on a limb is a safe bet.
  2. Actively discourage sitting, lying or leaning on joints that bend backward.  This includes “W” sitting.   I have lost count of the number of toddlers I see who lean on the BACK  of their hands in sitting or lying on their stomach.  This is too much stretch for those ligaments.  Don’t sit idly by.  Teach them how to position their joints.  If they ask why, explaining that it will cause a “booboo” inside their wrist or arm should be enough.  If they persist, think of another position all together.  Sitting on a little bench instead of the floor, perhaps?
  3. Monitor and respect fatigue.  Once the muscles surrounding a loose joint have fatigued and don’t support it, that joint is more vulnerable to injury.  Ask your child to change her position or her activity before she is completely exhausted.  This doesn’t necessarily mean stopping the fun, just altering it.  But sometimes it does mean a full-on break.  If she balks, sweeten the deal and offer something desirable while you explain that her knees or her wrists need to take a rest.  They are tired.  They may not want to rest either, but it is their rest time.  Toddlers can relate.

Although we as therapists will be big players in your child’s development, parents are and always will be the single greatest force in shaping a child’s behavior and outlook.  It is possible to raise a hypermobile child that is active, happy, and aware of their body in a nonjudgmental way.    It starts with parents understanding these simple concepts and acting on them in daily activities.

Wondering about your child’s speech and feeding development?  Take a look at Can Hypermobility Cause Speech Problems? to learn more about the effects of hypermobility on communication and oral motor skills.

Looking for information on toilet training your child with Ehlers Danlos, generalized ligament laxity, or low muscle tone?  My e-book, The Practical Guide to Toilet Training Your Child With Low Muscle Tone, gives you detailed strategies for success, not philosophy or blanket statements.  I include readiness checklists, discuss issues that derail training such as constipation, and explain the sensory, motor, and social/emotional components of training children that struggle to gain the awareness and stability needed to get the job done.  You will start making progress right away!

My book is available on my website tranquil babies, at Amazon, and at yourtherapysource.com.

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Why is W-Sitting Such a Big Deal?

 

Does your child sit on the floor with their legs rotated out to the sides, feet pointing in front of them?  Is this their preferred pattern of sitting on the floor?  Is it, in fact, the only position your really ever see them use on the floor?  Well then, you have yourself a W-sitter.  And it might not be the death knell to development that you may have been led to believe.  But here is why it can affect your child’s walking and sitting, and here are some easy ways to address this issue.

“W” sitting is not an abnormal sitting pattern.  Let me repeat and refine that: it is not abnormal for young children to sit in that position at times throughout the day.  It is a very stable position that allows them to reach forward for toys placed directly in front of them.  If your child uses a variety of sitting patterns, and you have no indication from anyone that they have issues with strength or stability, relax.

Therapists get concerned when three things happen: your child uses only this position when floor sitting, she isn’t comfortable or stable in any other position so that even if you help her sit another way, she pops out of it and reverts to “W” sitting or falls over, and she also has either low muscle tone or weakness in her hip and trunk muscles.  I am not going to delve into the difference between muscle tone and muscle strength, and kids who “W” sit can absolutely have issues with both.  But if your child has that triple play (preference, instability/discomfort, and tone/strength issues) then you should take action to reduce “W”-sitting.

Here is the reason why:  This position will create an imbalance in hip muscle strength, bias your child’s movement patterns in ways that actually weaken their core musculature, and over-stretch the non-elastic ligaments that support the spine and hip.  “W” sitting is a self-fulfilling prophecy.  The more this pattern is used, the less control your child has for strong, dynamic and balanced trunk and hip control.  Therapy can do a great job of helping your child build the strength and control to use a wider range of sitting and movement patterns.  This is what you can do:

  • Pay attention to how they sit, and offer alternatives.  Sitting on a bench or chair that is well-proportioned for them is a good alternative.  This means that you have to offer a young child a table and a chair that allows them to place their entire foot flat on the floor while sitting, and reach objects on a table with ease.  Big-box stores do not sell sets that fit children under 3 unless your child is at the top of the height curve.  Look around for wooden sets that you can make shorter, take a look at the sites that sell Montessori sets or school supply sets.  Don’t let the price tags frighten you: these things sell fast on ebay or craigslist.  When your child is 4 or 5, go out and buy the bigger set.
  • Try not sitting.  Have them stand at a table, and easel, or use toys that stick to the wall or another vertical surface for play.  A child can lie on their stomach or even try hands-and knees play.  Use high kneeling at a table ( child kneels on knees but hips aren’t touching their bottom, their upper body is straight up). Your PT will thank me.
  • This is an extra credit question:  Why would you ask them to lie on their back and play?  Answer:  They engage their core more fully, and their legs are likely to either be planted flat on the floor or raised up in the air in play.  Kick/catch a balloon or something equally silly.
  •  Children love to be seen as more mature.  Tell them that since they are growing up,these new positions are for big kids and grown-ups, and since babies aren’t strong, that is why they prefer to “W” sit.  That should motivate them to give these a try!