When Should I Worry About My Baby W-Sitting?
Is W-Sitting Okay?
W-Sitting Defined - Common Myths, When to Worry vs When to Watch, and How to Support Your W-Sitting Child
If you’re a parent, you’ve likely heard of w-sitting in children….the good, the bad, and likely… the *kind of* untrue 👀
And while a child w-sitting can be an indicator a child may need some support, there are also many times that a child sitting in the w-sit position is a completely ‘normal’ developmental position - so how do you know when to worry?
Let’s unpack some of the most common w-sitting myths I hear as a pediatric physical therapist (and mom of 3 myself), explore when w-sitting is problematic (and when it’s not!!), and talk through some alternatives & ways to support your child if they are relying on w-sitting more than we’d like to see.
What Is W-Sitting?
W-Sitting refers to the leg position a child makes while seated on the floor involving the legs being in a ‘w’ position if you’re looking at them from a top down angle, with their bottoms resting on the floor, like the image here.
While w-sitting, toes can be inward facing (not usually a concern), pointed straight back (also not usually a major concern), or outward facing (more concerning) - we’ll discuss the importance of this foot position on determining whether your child may need support more in depth below.
W-sitting can be and often is simply one of many play positions a child will move through while engaging and exploring their environment, especially for children that are crawling and in general, for children under the age of 5. However, if it is the primary or only way a child can successfully play using their hands while on the floor, it warrants a closer look.
But why?…..
Is W-Sitting Really That Bad?
Again, W-sitting is such a complicated topic! So often we hear it's an absolute, always “NO!” that immediately needs to be redirected- but the reality is, that's not always true! If you’re wondering why/when reliance on w-sitting can be bad for a child’s development, you’re going to want to keep reading!
While w-sitting is not always an indicator of underlying concerns, if a child (or adult!) is excessively using the w-sit without the ability to play successfully on the floor in other positions, it can cause unnatural stress on the musculoskeletal system and can be indicative of underlying concerns that may benefit from support, including (but not limited to); low muscle tone (hypotonia), core, trunk &/or hip weakness, ligament laxity, hypermobility, limitations in range of motion, and more.
When those concerns are present, an individual may begin to rely excessively on the w-sitting position as a compensatory mechanism to successfully be able to use their hands to engage with toys or their environment. This is because w-sitting is a very stable sitting position. When legs are wide into the w-position, especially when feet are turned outwards as demonstrated by Britney Spears, it creates a very wide base of support, which not only provides stability through the central part of the body, but also reduces the amount of work the core & trunk muscles need to do to hold the body upright against gravity.
With excessive w-sitting (more than ~60-70% of the time when seated on the floor), there is also excessive strain on the developing musculoskeletal system (especially the hips, knees and ankles), with some studies suggesting a potential link between w-sitting and hip dysplasia. More on hip dysplasia can be found here. W-sitting also creates a reduction in active strengthening and range of motion that occurs when a child engages in play while moving through a variety of positions like side sitting, long sitting, ring sitting, kneeling, etc. And In severe cases, excessive w-sitting can even result in malalignment of the legs during development and ongoing back, hip & leg pain that can persist into adulthood.
Tips for supporting your child when excessive w-sitting is present are outlined below.
But you may be thinking…If the concern around w-sitting is when it’s the primary or only position a child can successfully play in, what about seeing w-sitting other times?
Again, W-sitting can be and often is absolutely normal when used in conjunction with other play positions and when children are younger (especially children who are crawling!!). For example, this video demonstrates a child crawling & briefly sitting back into the w-leg position as she approaches the item she wants. She briefly plays in that w-sit (with feet inward) and then begins to crawl again - that is absolutely okay! Another example can be seen here, where the child can be observed moving through a variety of positions while playing to adjust to the toy position - that is absolutely okay as well and shows us that strength, mobility & overall movement patterns are doing just what they should be as they develop & meet their motor milestones!
The presence of intermittent w-sitting amongst other play positions in crawling children (and really children under ~5 years of age) also relates to foot alignment while in w-sitting and the changes in the alignment of legs as a child grows. This is also why we want to see less and less w-sitting as a child gets older. So let’s talk about it!
W-Sitting & Foot Alignment
Unpacking the Importance of Foot Positioning as It Relates to a Child’s Anatomy, Development & Age
I mentioned earlier that a child’s foot alignment while w-sitting can give us a lot of information about whether the w-sitting is becoming a concern and/or occurring because of underlying conditions. During w-sitting, toes can either be facing inward, straight back, or outward. But why does that foot position matter?
Ultimately - it actually boils down to our children’s anatomy!
At birth & until ~3 years of age, the thigh bone is more turned inward than it will be in adulthood. In fact, we are born with approximately 30 degrees of internal femoral torsion being naturally present in the thigh bone. This internal torsion is also known as femoral anteversion and can be one of the primary causes of children walking with toes facing inward (called in-toeing), which typically resolves on its own as a child grows. This is because as a child moves through their milestones, the torsion of the femur slowly changes from the 30-40 degrees of anteversion present at birth, to the normal adult amount of ~15 degrees of anteversion by around 10 years of age.
The increased turning in of the thigh bone in younger children makes w-sitting with toes pointed inward or straight back not only a more comfortable position, but also a more natural transitional position they can easily move through to play in other positions that stretch, strengthen & allow the changes to the developing musculoskeletal system to occur.
However, when w-sitting is excessive, especially in the first 3-5 years of life, that gradual change in anteversion can be impacted, as w-sitting holds the hips & leg in a much more turned in position. This can result in persistent in-toeing once walking, decreased strength, impaired mobility, delays in milestone acquisition, poor balance with frequent tripping/falls, atypical hip development, & even pain that can last far beyond childhood.
When a child is also then w-sitting with the toes facing outward, the lower leg is now rotated in the opposite direction of the upper leg- creating a ton of torque on the developing hip, knee & ankle joints and significantly impacting the ability to transition over that foot (try it yourself to see how hard it is to move over a turned out foot!!).
Toes facing outward also creates a very wide, stable base of support that effectively ‘shuts off’ the big important core & trunk rotation muscles. And while a child (especially over 5 years of age) relying on this stable position to use their hands may be successful in the w-sit, not only are those important muscles shut off, their ability to transition out of the position is impacted AND often times, it is a compensatory pattern for underlying weakness, lower muscle tone and/or muscle tightness.
When Should You Worry About W-Sitting?
Ultimately - we want to see flexibility in the way that a child can sit and engage with their environment. We want a child to be able to easily & fluidly adjust their body position to engage with toys in a variety of ways & positions, which puts them in the driver seat of actively strengthening, maintaining important range of motion that allows higher level skills to develop (and to do so without compensation), and overall laying a strong foundation for a lifetime of pain free movement.
Here are a couple of quick things to consider when it comes to W-sitting & determining whether more supports may be warranted:
1. Does your child use it as ONE play position, or with a variety of others?
Again, children need to be able to use a variety of play positions to engage functionally with their environment, especially when seated on the floor. This can look like legs in a ring sit (O shape), side sit (one leg in a w position, the other in front of them), legs out straight, criss-cross apple sauce, and even a W position at times! Especially when a child is first mastering crawling and transitioning through their environment, you may notice them moving in/out of a w-sit as they crawl and then stop to engage with something. That is totally okay, and normal! If you're seeing a variety of play positions, that is huge!
2. Does your child have difficulty playing in any other position?
If your child is relying on w-sitting more than 60-70% of the time & has a challenging time attempting play in positions other than W-sitting, it is worth looking into with a physical therapy evaluation. As mentioned in #1, w-sitting as one of many positions they play in is usually not a concern. But if it's being used excessively or is the only way they can successfully play on the floor, it can be related to some weakness or imbalances in the strength of muscles that are worth looking more into!
3. Are feet facing inward or outward?
Typically, feet facing inward are not of concern, as that is often the position that is used when moving/transitioning between positions like crawling and sitting. If feet are facing outward, it can indicate a position being used more for stability to play, which again, can indicate some possible things that PT might help with!
4. Are they able to fix their legs and continue playing with simple cues like "fix your feet" or "legs straight"?
If you're worried that W-sitting is becoming excessive, and/or is meeting other areas outlined above, try giving verbal and physical cues. Saying "feet forward" or "fix your feet" while gently cueing them to show them what you mean often is enough to help. Just be sure that everyone cueing them is using the same wording to keep it easy for them to understand AND follow through with!
W-Sitting vs. Z-Sitting: What’s the Difference?
One of the most common follow up questions I get related to w-sitting is…“Why is w-sitting not ideal but one leg being in a w (like a z-sit) is okay?”
And honestly, this is SUCH a great question, so let’s talk about it!
Z-sitting, also known as a side sit (shown above), as compared to W-sitting, is actually a POWERHOUSE position for posture, strengthening, range of motion, mobility & transitions & SO much more!
When you start to see your child doing a side/z-sit, not only are they gearing up to learn how to transition from sitting <> the floor, they’re also very likely being close to learning to crawl, which is a HUGE developmental goal. More on the why crawling is the most important milestone can be found here!
AND, because the toes are typically pointed inward toward the body while in a side sit, there is significantly less stress on the knees and hips as compared to a wide w-sit (especially with toes turned outward), as I mentioned above.
So all in all- let the side/z-sit live, it’s great to see and truly a position we should ALL (children & adults alike) be building into our lives!
Autism, Neurodivergence & W-Sitting…is there a connection?
In recent years, there has been many rumors floating around the development space regarding autism & w-sitting, including some going as far as to say w-sitting is always an indicator of Autism (insert the *most* massive eye roll I can muster)…
But is there actually a connection?
We’ve established that when w-sitting is excessive or persistent, it is often a compensation for underlying concerns. These can often include; lower muscle tone than normal (including hypotonia), core weakness, the presence of hypermobility &/or ligament laxity, and even sensory processing difficulties. Interestingly, many of these are also present in higher incidences with Autistic individuals, as well as Neurodivergent individuals in general.
But- the truth is, while there is a higher incidence of the underlying conditions that can also contribute to excessive w-sitting in Autistic &/or Neurodivergent individuals as compared to the general population, the presence of w-sitting alone is not a diagnostic indicator of Autism.
While I won’t be covering this more in depth in this blog, to learn more about hypermobility in general, see here.
What to Do If Your Child W-Sits - The W-Sit Wrap Up
The biggest thing we want to see from our children’s movement is a VARIETY of play positions, like shown in this reel or this post.
As general rules, noticing the following related to w-sitting and your child warrants a mention to your pediatrician &/or consideration of a physical therapy evaluation, especially if you’re seeing the reliance on w-sitting in conjunction with other concerns like low muscle tone, ligament laxity or delayed motor milestones.
Those include:
If a child plays/sits in the w-sit position more than 60-70% of the time
If a child can not easily play in other positions & has to rely on that wide base position to successfully play with their hands
If a child can’t EASILY transition into/out of a variety of play positions, including w-sitting
If a child cannot or will not fix their legs with simple cues like “feet forward” or “legs straight”
If there are other concerns related to muscle tone, strength, hypermobility, etc.
If a child is delayed in meeting other motor milestones
Physical therapy is an immensely helpful tool for not only identifying any underlying areas contributing to reliance on w-sitting that could use support, but also determining the best course of action for addressing those areas & setting your child up for success.
And to address w-sitting that is not falling into the above categories, two of my top helpful strategies for addressing the w-sit include:
Gentle correction strategies, including choosing one verbal cue used like ‘feet forward’ or ‘legs out’.
Encouraging alternative sitting positions like ring sitting, long sitting, side sitting, or even short sitting on a bench if it is challenging for them to sit in other ways.
For lots of my favorite toys to support sitting play, check this round up of my tried & true favorites out.
Ultimately - I hope this gives you some reassurance that truly, not every w-sit is a crisis. However, consider the information above, stay aware & supportive of your child’s motor development & needs, and more than anything, don't ever be afraid to request a PT evaluation if you have any concerns about persistent w-sitting (or anything else for that matter)!
Looking For More Milestone Support?
Download my FREE guide, Let’s Get Crawling! In this guide you will learn WHY crawling is such an important milestone for your little one, the BENEFITS of hands & knees crawling for future development, and activities to ENCOURAGE your little one’s crawling success!
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