Does W-Sitting Actually Harm a Child's Hips?
For most typically developing children, W-sitting is a comfortable habit. It is not a cause of hip damage. There is no strong evidence that it leads to hip dysplasia or long-term bone and joint problems. However, if a child sits this way often and also has stiffness, pain or an unusual way of walking, it can be worth looking into further.
Key points
- W-sitting on its own is not proven to harm healthy hips.
- It is common in toddlers and usually fades as they grow.
- W-sitting that persists, together with other signs, may point to an underlying condition such as femoral anteversion.
- If you are worried, a standing hip assessment can check alignment under real weight-bearing load.
- Constantly correcting a child who is otherwise well is unlikely to help and may cause distress.
What is W-sitting and what does the position look like?
W-sitting is when a child sits on the floor with their bottom between their feet and both knees bent. Seen from above, the legs form a W shape. The hips are turned inward and the knees point forward.
It is extremely common. Many toddlers and young children move in and out of this position throughout the day. The wide base gives them extra stability while they use their hands to play.
Is W-sitting actually bad for a child's hips?
The short answer is that the evidence is weak. There is a lot of worry online. Even so, no high-quality study has shown that W-sitting in a typically developing child causes hip dysplasia, bone deformity or lasting joint damage.
The worry first came from what doctors saw in children who already had neuromuscular conditions. Over time, the advice was applied more widely, but the research has not kept up. A 2021 review in the journal Pediatric Physical Therapy found no strong evidence linking W-sitting to bone and joint problems in otherwise healthy children.
- Child moves freely in and out of the position
- No pain or stiffness
- Walking and running look normal
- No other worries about development
- Only comfortable sitting in the W position
- Hip stiffness or reduced range of movement
- In-toeing walk that gets worse or causes tripping
- Pain in the hips, knees or legs
- Known history of developmental dysplasia of the hip
Why does my child sit in the W position?
Children choose the W position because it gives them a wider, more stable base than cross-legged or side sitting. It lets them keep their body steady while they reach, build or draw. In most cases it is simply comfort and habit, nothing more.
Young children's hips naturally allow more internal rotation. This makes W-sitting easy and comfortable.
The wide base means less trunk control is needed, so the hands are free for play.
Some children have a naturally greater twist in the thigh bone. This makes internal rotation feel easier than external rotation.
In a smaller number of cases, W-sitting that persists can be a sign of low muscle tone or joint hypermobility. It is also sometimes seen more often in children with autism or other developmental conditions, though in those cases the sitting position itself is not the concern.
Should I stop my child from W-sitting?
If your child is developing normally and can sit in other positions too, most children's specialists would say there is no need to keep correcting them. Telling a child again and again to change position can create anxiety, without solving a problem that probably does not exist.
However, you should speak to your child's doctor or a children's physiotherapist if you notice any of the following along with the W-sitting habit:
Falls over or seems very uncomfortable in any other position on the floor.
Complains of pain during or after sitting, walking or running.
Feet point inward when walking, getting worse over time or causing frequent trips.
Most children grow out of it. If it continues well into primary school, a check may be useful.
How can standing imaging help if you are worried about hip alignment?
If a clinician suspects that W-sitting is linked to an underlying alignment problem, imaging can help make things clearer. Standard X-rays and MRI scans are taken lying down. This relaxes the muscles and removes the effect of gravity. So they can miss small alignment differences that only show when the body is carrying its own weight.
An EOS scan takes a low-dose, full-length image while the child stands. It uses about 90% less radiation than a standard X-ray, around ten times less. The image shows the hips, knees and legs in one view. This lets the clinician see how the whole chain lines up under real conditions.
This kind of assessment matters most when a child has symptoms along with the W-sitting habit. It is not meant for a child who simply likes sitting this way. Children's imaging at ScanAlign is carried out at 19 Harley Street, London, by an experienced specialist radiographer.
Before your child starts any treatment, or changes the one they are on, it is worth getting a detailed diagnosis first. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
When is MRI the better choice? EOS shows bones, joints and alignment clearly. For soft tissue, cartilage or nerve-related concerns, MRI is usually the better tool. Your clinician can advise which scan is right for your child.
Not sure whether your child needs a scan? We offer a free video consultation to talk it through, with no obligation, before you plan any trip to London.
Book a free video consultationFrequently asked questions about W-sitting
In a typically developing child, there is no strong evidence that W-sitting damages the hips. It matters more if the child also has pain, stiffness or difficulty moving in other positions.
Current research has not shown that W-sitting causes hip dysplasia. Children who already have hip dysplasia may prefer the W position because of the shape of their hip joint. But the sitting position itself is not considered a cause.
If your child is otherwise well and can sit in other positions, correcting them again and again is unlikely to be needed. Gently encouraging other positions is fine, but constant correction can cause needless stress.
W-sitting is sometimes seen more often in children with autism or other developmental conditions. However, it is also very common in typically developing children, so the sitting position alone does not indicate autism.
Most children naturally move away from W-sitting by around age 6 to 8, as their hips mature and their core gets stronger. If it continues well beyond this age, it may be worth discussing with a clinician.
Femoral anteversion is a natural inward twist of the thigh bone. Children with more anteversion find it easier to turn their hips inward, which makes the W position feel comfortable. It usually corrects as they grow. You can read more about femoral anteversion and how it is assessed.
Cross-legged sitting, side sitting (legs to one side), long sitting (legs straight out in front) and kneeling are all good options. Offering a small chair or stool can also help.
No. At ScanAlign, low dose standing imaging, you can book directly without a referral. We recommend starting with a free video consultation so we can make sure imaging is right for your child's situation.
Yes. EOS uses about 90% less radiation than a standard X-ray, around ten times less. The scan takes only a few seconds and is done standing up, which most children find easy.
The price for patients travelling from abroad is confirmed during the free video consultation, or you can book a children's assessment.
Worried about your child's hip alignment?
A short video call with our specialist radiographer can help you decide whether imaging is the right next step. No referral needed, no obligation.
Book a free video consultationWritten by Abbas Dhami (Specialist Diagnostic Radiographer)
Sources
- Catan H, et al. "W-Sitting in Typically Developing Children: Is There Cause for Concern?" Pediatric Physical Therapy, 2021.
- NHS. "In-toeing and out-toeing." NHS Inform guidance on childhood gait patterns.
- Fabry G, et al. "Torsion of the femur: A follow-up study in normal and abnormal conditions." Journal of Bone and Joint Surgery, 1973.
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.