W-Sitting

Every picture my parents took of me sitting on the floor below the age of 4 years shows me "w-sitting". What is w-sitting? It is when the child sits on the floor with his knees bent and his ankles are right next to his bottom...as if he had been kneeling and then just relaxed the feet out to each side. It is termed w-sitting, because looking at the child from a "bird's eye" view, the legs look like the letter "W". It is not good on the knees, hips, or feet. In fact I have awful knees probably because I was a big time w-sitter! They squeak when I bend over or walk up the stairs. If I go to aerobics class or walk a far distance, my knees ache for the next 3 days to the point that I can't sleep without pain medicine. So, I am not a fan of letting a child remain in a w-sitting posture for long lengths of time. I am now in my 30s but was told back in my 20s to quit jogging and aerobics classes or my need for a knee replacement would be sped up. So, I stick to biking, pilates, and yoga....wow, do I miss the adrenaline rush of a nice jog!



W-sitting is a posture that babies and toddlers use briefly as they move in and out of various postures. Little ones move so quickly, you will often see them transition from crawling, to sitting, to kneeling, to standing, back down to the floor, etc. So, w-sitting is not bad in and of itself. It is only not a good position if the child remains in that posture for long lengths of time, such as while playing with puzzles or watching television for 10 minutes. It puts unnecessary pressure on the knee joints and contributes to pronated feet (caving in at the ankles and collapsing at the arch). It can alter a child's balance and even make their gait look funny, especially while they run. My daughter tended to want to w-sit as a baby and toddler, and I had to redirect her quite often. I took her to a co-worker (at the time) who was a physical therapist and she gave us stretches and used kinesiotape to help with leg alignment.



Why do children w-sit? Most of the children use this posture because it is easy...it is less work for the trunk muscles because it widens their base of support. Some kids just prefer it just because. But many kids prefer it because they have low muscle tone (AKA hypotonia) or muscle weakness. It is common to see children with developmental disabilities such as cerebral palsy and down syndrome w-sit. I think that my daughter and I have mildly low muscle tone so that is why we have both been w-sitters. It is not uncommon for me to walk into a daycare (I do early intervention OT in natural environments) and see typically developing children using this posture. It does make me cringe, and oh how I want to correct the child. But I can't if the child is not my client. I can however educate the daycare staff about how w-sitting is not a posture that benefits children's gross motor development.



The following are some suggestions that I have found beneficial in reducing w-sitting in a baby, toddler, or older kid.

• For a baby, just correct their posture by placing them in kneeling, criss-cross (AKA Indian style for those of us raised in the 1970s & 80s), or a side-sitting posture
• For toddlers and children, encourage them to sit at a kiddy table and chair while performing fine motor activities such as coloring and puzzles. It is almost impossible to w-sit in a chair
• While the child (not baby) is playing on the floor, have a stool, bench, or tray (like a "breakfast in bed" tray) available. Have the child slide his legs under the device. Because these devices have "legs" or sides, then it increases the chances that the child will sit with his legs out straight to the front of him.
• If the child is in the "terrible twos" stage or is the type who likes control, then give him choices. When you see him w-sit, say "Would you like to fix your legs by sitting criss-cross or legs to the front?"
• Make up a silly song as a reminder. I made up a song titled "Legs in Front" to the tune of Frere Jacque. Then, as I only hummed the tune, my daughter was reminded of correcting her legs out of w-sitting
• Place toys to the side of the child so he will need to reach out of his base of support. This typically encourages a child to side in a side-sit posture (both knees are pointed towards one side or criss-cross style.
• Try not to nag the child by constantly saying "fix your legs" or picking them up and placing them in another posture. I find it best to set up the environment for success by using some of the above-mentioned ideas. Don't redirect the child if he will only be in the w-sit position briefly...if you do, he will tune you out everytime you redirect him...not good!
• There are probably many other ways to help with w-sitting but these are some common ones that I use
• If it is severe enough of a problem, then the child probably needs a physical therapy evaluation. The PT may suggest certain stretches, therapy techniques, furniture, or shoes to help the child
• If the child has sensory processing delays in addition to the low muscle tone, then the child may benefit from an occupational therapy evaluation. At http://www.sense-ablebaby.com/ there is loads of information on sensory processing problems seen in babies and some ideas to help.

Teaching Older Babies & Young Toddlers to Follow Simple Directions

I feel so amazed when my 14-month old son listens to my verbal directions. I keep my words short and simple and I tend to use the same phrases over and over. If he looks confused or ignores me, then I demonstrate what I want him to do, or I guide him to the place, or I point to what I want....you get the jest, I'm giving him other cues in addition to my simple words. He likes to crawl up the stairs when he thinks I'm not looking. He's done this since the age of 9 months old. But now that he has a better memory, he knows it is wrong. I am not putting up a baby gate, because he rarely goes to the stairs and he needs to learn to follow directions. Yet, I am aware that some children are more impulsive than my son and a gate is necessary. Recently, he walks over to the stairs and begins to crawl up, then looks at me and tells himself "no". All I do is give him a look of disappointment and correction...you know the look all of us moms give, it is also known as the "evil eye". This look is all it takes for him to come down and walk away. It sounds like I have a fairly compliant child, and overall I do. But I put expectations on him early on and assumed that with repetition and redirection he could learn to "mind". Never assume it is too soon to do such a thing. Just remember to not use fancy words, use short phrases, and use the same words over and over. Most importantly don't yell or over-react because this may create other issues. Also, be consistent. If you told the toddler to not touch the TV yesterday, then the same rule needs to apply to today, or if not, you can guarantee that tomorrow he will touch it again.

Tips for Helping Babies with Plagiocephaly: Mis-Shapen or Flat Head

One thing I see alot of at work is babies who have a flat head in the back of their head or on one of the sides of their head. If it is severe enough it is called plagiocephaly. Some babies need helmets, others just need exercises and positional ideas given to the parents and caregivers. If the head is just mildly flat in the back, this often improves as the baby spends more time lying on his tummy for playtime and less time sleeping on his back. It may also improve when the baby is encouraged to look each way equally and not just tilt or turn his head to one side.



My son had a flat spot in the back of his head for the first few months of his life. And even though I laid him down on the floor to play on his tummy, he still had a flat head. It eventually worked itself out, but it is not as round as mine. My husband has a mildly flat head in the back so maybe it is hereditary that both of my children have this same head shape as their dad. But I somewhat blame his case of infant reflux. His reflux was so severe that he went from the 75th percentile for weight at one month of age down to the 25th percentile by 3 months of age. He was on 2 reflux medicines by 4 months of age. But prior to this, he had to be left upright beyond the suggested 15-20 minutes after being fed. Sometimes he would vomit up massive amounts of liquid even 1 hour later...later found out he also has a motility problem. He would choke in his sleep even when placed on a mattress that was inclined at bedtime and naptime. So, I put him in this soothing glider that is at the same angle as a bouncy seat but snuggles the baby in it with more curviness for the head. I hate that he had so much pressure on his head, but I could never have fallen asleep wondering if my son was going to aspirate on his spit up, and possibly lose conciousness, turn blue, or worse, die. Unfortunately, I have seen too many bad situations at work when a baby has severe infant reflux. So, the flat head is the price we had to pay.



Some tips on helping with the head shape for a baby with plagiocephaly, flat head, or just mis-shapen:

• Let the baby play on the floor on his tummy multiple times a day for at least 5 minute increments. If he dislikes this position, then get down to talk or play with him as well as leave toys nearby.


• If his head is flatter on one side of the head than the other, then all throughout the day, do things with him that require him to look to each side. Examples include switching the end that his head is on in the crib or diaper changing table, alternate which hip or shoulder he is being carried over, move the bouncie seat or infant swing to different places in the room so he has to look different directions.


• Introduce infant massage to relax the muscles. Often when the child is favoring one side of his body over the other side, then he gets tightness in the neck or shoulder muscles. Infant massage also helps with improving the sensation to the side of the body that is less favored.


• Have your doctor assess the baby's muscle tone. If the baby has low muscle tone (AKA hypotonia), he may need a physical or occupational therapy evaluation. The low muscle tone may impact his gross motor skills such as rolling and crawling, his feeding skills, and his fine motor skills to reach and grasp for toys. Some babies may also have muscle weakness, torticollis (tight sternocleidomastoid muscle- (SCM)), neurological impairments, or otherwise tight muscles. If this is the case, then therapy may help with preventing bad movement patterns and hopefully lessen developmental delays, but seeing a specialist such as a neurologist may be a good thing in order to know the reason why this is happening.


• Do not leave the baby in positional devices that do not properly fit him and do not leave him in there for long. Many babies I work with that have leg tightness or weakness on one side are left in stand-up bouncers, swings, car seats, & bouncie seats WAY too long. They should only be in the briefly unless there is a reason such as a car ride, sleep, etc. I can definately tell you that 30 minutes for a 6 month old baby to stand up in a "Jumparoo" or "Johnny Jump Up" doorway bouncer is WAY too long, especially when he is not even angled in it correctly.
• Offer toys to each side of the baby such as in the high-chair, car seat, on your lap as he is sitting upright, or lying on the floor.
• Encourage the baby to ly on his side on both sides and to roll to each side (at an appropriate age)
• Give the reflux medicines as prescribed to you by the doctor. Remember that just because your baby needs to stay upright doesn't mean he stays in a device, you can hold him upright for the 15-20 minutes post-feeding.
• If improvements are not seen, please discuss this with your pediatrician as your baby may need a helmet to help with the head shape.

Hopefully, once your baby is sleeping less, playing more, and even crawling, the head shape will improve.

Watching Your Baby's Signals for Hunger

It seems like "Tis the season to be pregnant". I have quite a few friends who are pregnant, and some of them haven't been around babies much. One of them was asking me some basic baby care questions, and of course "How do you know your baby is hungry?" was one of those questions. Glad she asked. Because many people, even those who have been around babies don't know the answer. Or they may answer you by saying "Well, the baby will cry!" or "Look at the clock, how long has it been?".

Babies let us know they are hungry way before they cry. They also let us know they are hungry before the clock might reveal they should. Although most young babies eat every 2.5-3 hours, some eat sooner, especially when going through a growth spurt. Also, formula fed babies tend to not get hungry as quick as breastfed babies because of the calories and contents of formula. The following are some signs the baby may be sending you to let you know it is feeding time:

1. Tries to put fingers, thumb, or fist in his mouth so that he can suck
2. Smacking noises and sucking motions with lips & tongue
3. Fussiness and wiggliness, and eventually flailing limbs if gets too hungry
4. Rooting and if breastfed tries to move toward the breast
5. Fisted hands
6. If the cues are not read and he isn't fed, he will progress to short rhythmical crying. If that is ignored, the crying may progress to an intense waling

Babies need to feel that we meet their most basic of needs. This includes reading the babies signals. Although some parents/caregivers miss hunger signals, other people miss the other signals babies can give us such as when they are bored, over-stimulated, sleeping, or ready to play. A common mistake parents/caregivers make is to feed a baby everytime he cries.
For more detailed information about how to interpret the baby's cries visit http://www.sense-ablebaby.com/. It also includes ways to promote sensory processing in babies.