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W-sitting is a position where someone sits on the floor with their knees are bent, positioned out in front of them and their feet are pointing back towards their hips.  If you look at someone sitting in this position from above them, their legs will look like they form a “W”.  This is a relatively common position that babies, toddlers, and many adults use when sitting on the floor, but it is a position that should be avoided.

How babies begin to W-sit?

W-sitting is beneficial in the eyes of babies.  The main reason why a baby may prefer to W-sit rather than use a “ring sitting” or a “tailor sitting/criss cross” sitting position is that it is easier for them.  W-sitting increases the size of a baby’s “base of support”.  In physical therapy, “Base of support” is referred to as: “The area beneath an object or person that includes every point of contact that the object or person makes with the supporting surface.” (from Physio-pedia.com).

People of all ages lose their balance and fall  whenever their center of mass (positioned at the belly button level) goes too far outside of our base of support.  As a result, the larger a person’s base of support, the less likely it is for them to fall over.  Think about sumo wrestlers.  Prior to wrestling, they squat down and place their feet far apart from each other.  This increases their base of support, which makes it more challenging for the other wrestler to knock them down.

Babies gain a similar benefit from W-sitting.  When their legs are positioned to their side, it is much easier for them to keep their sitting balance while playing with toys.  If they are in either a “ring sitting” or a “tailor sitting/criss cross” sitting position, there is a much greater demand placed on their trunk, and it is much more challenging for them to maintain their balance.  This is very common with babies who have “low muscle tone” (babies whose muscles are weaker than “normal” and take longer to strengthen).

Not all babies who W-sit have low muscle tone.  While it makes maintaining their sitting balance easier, there are many babies who have “normal” muscle tone and who meet their motor milestones at the typical age who also W-sit.  These babies may be able to maintain their sitting balance very well if they are placed into a ring sitting or tailor sitting position.

You may be wondering:  If babies W-sit because it makes sitting easier for them, why would babies who are stronger and who do not have delays W-sit?  The answer is:  “habit”.  With these babies, they begin to W-sit because it is the position they end up in when they first learn to rise up to sitting independently.

One of the ways that babies transition to sitting independently is from the hands and knees position.  Sometimes, babies are in the hands and knees position and simply shift their weight back until their rear end is sitting on the floor.  They are now in a W-sitting position.  The babies become used to using this way to get into sitting, and they continue to do it time and time again, becoming a learned movement pattern and thus a movement “habit”.

While this is very rare, another reason why babies may prefer to W-sit is that their femur (large bone making the top part of their leg) may be aligned incorrectly.  Sometimes, the top part of the femur, known at the “neck” is angled forward slightly, causing the head of the femur to sit incorrectly in the hip joint.  As a result, the babies hips are turned in, which is the same position the hip is in when babies are W-sitting.  Again, this is rare, but in order to be comprehensive, I wanted to address it in this article.  This atypical rotation can be ruled out by having an x-ray taking of your baby’s hip joint.

Toddlers who W-sit often started as babies.  Unless addressed by parents, the children will continue to W-sit because it has become a habit and is very comfortable for them.  Adults who W-sit may have started as babies, but that is difficult to say for certain unless they ask their parents.  It is very common in cultures where people sit on their heels during mealtime.  Sitting on your heels is challenging and can become uncomfortable.  As a result, people will start to sit on their heels but over time, their feet will move to the side so that they are now W-sitting.

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Why is W-sitting “bad” for babies?

W-sitting can affect people in multiple ways.  The most apparent ways it can affect someone is due to the position of the hips and knees.  When W-sitting, someone’s hips are turned all the way inward (called “hip internal rotation”).  W-sitting for extended periods of time can cause tightness of the muscles of your inner thigh area and stretch the back part of the hip joint.  There is also a great deal of stress placed on the ligaments of the inner part of the knee.  This is a very abnormal position for the knee.  The weight of your body the places additional stress on the joint and can cause loosening/stretching of the ligament on the inner part of the knee (“medial collateral ligament”).  The functional implications of these effects will be discussed later in this article.

W-sitting decreases the opportunity babies have to strengthen the oblique muscles of their core. The obliques are one of the key muscles groups required to perform higher level motor skills including crawling, cruising and walking. While W-sitting, babies will move straight front to back but don’t have the opportunity to shift their weight to the side or to learn how to reach for toys while turning their body. Without this opportunity to strengthen their obliques, delays in higher level motor skills may result.

How W-sitting effects babies and toddlers:

The most common functional implication of children who “W-sit” is that they may walk “pigeon toed”.  When the children walk, their toes may point inward, and their knees may look like they are positioned closer to each other than they are supposed to be.  The common term parents use to describe this knee positioning is “knock kneed”.  If a child is walking using this pattern, they most likely have developed tightness of the muscles in the inner part of their thigh, and it should be addressed.

Children who walk with his pattern often are referred to physical therapy with the parents’ primary concern being that the children are “tripping” and falling frequently.  Walking in this pattern changes the dynamics of a child’s walking pattern and makes it more difficult for children to clear their toes from the floor while walking.  As a result, they end up tripping frequently, especially on uneven surfaces and when they begin to run.

What can parents do?

1. Correct the sitting posture:  When I meet a child who is “pigeon toed” with parents’ concerns about tripping and falling, the first thing that I ask parents is if their child prefers to W-sit.  Undoubtedly, the answer has always been  “yes”.  One of the first things that I like to do to help these children’s walking pattern is to correct their sitting posture.  They most likely have tightness in hips which is pulling their legs inward.  The gradual sitting progression that I will work towards is:

Sitting with the child’s legs straight out in front of them (try to have the toes pointed upwards.  If the toes are pointing inward toward each other, the hips are also turned in)

Ring sitting – Sitting with the legs in front of the child with their knees bend and the knees “falling” toward the outside

Tailor Sitting/Criss Cross – This is often too significant of a change and is too much of a stretch for a young child tolerate initially.  In this position, a child’s hips are in the complete opposite position than it is when W-sitting, and it places the tight muscles on a very significant stretch.  It works much better if parents gradually improve the hip position and gradually loosen the tight muscles of the inner thigh.

It is very challenging for a parent to change a child’s sitting habit.  Be sure to use a consistent phrase to cue your child to avoid W-sitting.  The ones that I have heard parents use include, “Sit nicely”, “Criss Cross Apple Sauce”, “Fix your legs”.  You may have to physically help your child correct the sitting position, but as long as you consistently use the same phrases as you are helping them, your child will eventually know to fix the legs just be hearing your cue.

2. Strengthen Glute muscles:  The other important area of focus on is strengthening a child’s glute muscles (muscles of the rear end).  The glute muscles function by turning the hip outward.  These muscles become weakened when the muscles on the inside of the thigh become tight, which contributes to the leg consistently turning inward.  Ways to strengthen a child’s glute muscles include, but are not limited to:

Squatting down to pick toys up from the floor (as long as the knees do not come together when performing the squat)

Walking up stairs (keep the toes pointing toward and not turning in)

Walking up hills

3. It is also important to rule out additional factors that can cause “pigeon toed” walking including the alignment of a child’s ankle (to make sure that they are not “flat footed” or “pronated” and to have an x-ray performed of the hip to make sure that your child’s hips are aligned properly.

The key to addressing W-sitting is 1.  Knowing what to focus on and 2. Being consistent.  Remember that you are trying to break a habit…and that breaking this habit will be uncomfortable initially due to the tightness of the inner thigh muscles.  Take the steps gradually and understand that certain sitting positions may be too uncomfortable for your child initially.  Over time, the tightness will gradually improve, the glute muscles will gradually strengthen, and any functional implications from the W-sitting that you were observing should gradually improve.

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