Sit on w, correct this posture in children?

It is common to observe children playing sitting on the floor with legs out, positioned in W. This position makes it easy to play and handle toys. In English, it's called W-sitting. But is it good for their development that they feel this way? Apparently, they are comfortable and do not present discomfort, but should we correct the way of sit in W?

Rotational pattern

When the lower extremities are rotated outward or inward, it is called a rotational pattern in trauma. The cause of this situation is multifactorial, since it influences the anatomy of the musculoskeletal system in children, muscle tone and joint laxity. In the first years of life, the femur and tibia show internal rotation and a tendency to femoral anteversion, which favors sitting with the legs. legs in W position, with the legs and feet on both sides of the body. In this condition, the neck of the femur that is forming the hip joint leans forward, causing the lower leg to turn inward. This peculiar form of sit in W It is not caused by a disease but by an arrangement of the hips in children. It is a variant of normality. Another consequence of anteversion of the femur during the first years of life is that the child walks with the feet inward, with the appearance that the tips of the feet collide with each other. In English, this situation is called intoeing. It is very common that parents and teachers tend to correct them, but in doing so we constantly frustrate the child and we observe that the game on the floor is not so rich nor is it so easy for them to manipulate the A few years ago this position was viewed with very bad eyes and thousands of negative consequences for the development of the child were attributed to it. Today this vision is changing.

How to reverse or improve the situation of sitting in W?

Since this situation is due to an anatomical and functional immaturity of the infantile musculoskeletal system, as the child grows, the bones grow and externally rotate with development and turn outward, modifying the position of the child when sitting and toe of the feet is oriented outwards. If there is no deformity or limitation of movement in the lower extremities, this situation will resolve spontaneously with the development and maturity of the child. This condition is progressively corrected until it disappears in girls around 10 and 12 years of age and a little later in boys, around 14 years of age.

Who should evaluate this situation?

The specialist in charge of assessing the relational pattern is the child traumatologist. When the child attends the consultation, different aspects are valued or reviewed:

• Position of the child's feet during ambulation (when walking): they can be inward or outward.
• The amplitude of the rotation of the femur: the internal and external rotation of the hip is evaluated.
• The amplitude of the rotation of the tibia: the axis of the foot is evaluated with respect to that of the rest of the lower limb.
• Foot morphology and if it presents deformities.

The anatomical and functional assessment of the lower extremities allows the specialist to know if the rotational pattern is due to a cause of immaturity or there is an anatomical cause in the hip, tibia, or foot.

Is sitting on w a rotational pattern?

If the specialist assesses that it is a changing pattern of development, he will not advise any specific treatment. In cases where pathological patterns are evaluated during the physical examination, such as hip rotation greater than 90º or asymmetries between the femur and the tibia, action can be taken. If there are very important deformities, years ago they were used external devices to return to normal anatomical position the lower extremities. They are currently known to be ineffective. Neither physical therapy or rehabilitation are of much use. In important situations, only surgical treatment has been shown to be able to resolve angle deformities in the lower extremities.

• This peculiar way of sitting is not caused by a disease but by an arrangement of the hips in children. It is a variant of normality.
• If there is no structural problem, deformity or limitation of movement in the lower extremities, this situation will resolve spontaneously with the development and maturity of the child.
• The anatomical and functional assessment of the lower extremities allows the traumatologist to know if it is due to a cause of immaturity or there is an anatomical cause in the hip, tibia or foot.

Dra. Esther Martínez Pediatric Specialist Collaborating physician of