Starfish Therapies

December 31, 2011

Top 10 Blog Posts of 2011

I love Top 10 lists!  Here is this years list of Top 10 Blog Posts:

10.  Core Muscles:  Building a Solid Foundation

9.  No Kid Left Inside – Benefits of Outdoor Play

8.  Having a Ball With Core Muscle Strength

7.  Gross Motor Development vs. Fine Motor Development

6.  Standing Straight and Tall

5.  A Glossary of Sitting

4.  Let’s Play!

3.  What is Protective Extension?

2.  Why is W-Sitting a Four Letter Word?

And the most read blog post by a landslide:

1.  Torticollis:  What Is It?

Thanks for everyone who reads and I look forward to the next year!

September 28, 2011

W-Sitting Revisited

I have decided to post again regarding one of my more controversial topics: w-sitting. W-sitting is a very natural form of floor sitting just like tailor (crisscross cross applesauce) sitting, ring sitting, side sitting, long sitting, and kneeling. All of these positions can be assumed and transitioned out of. In fact I discussed the beauty of movement variability in the development of movement in my previous post.  I was re-inspired to post about w-sitting because of this article I read on the most recent PawPrint Newsletter.  I am going to paste the article in its entire form since I believe Why reinvent the wheel!  She said it great!

The W’s of W-SittingDeanna Maciole

Deanna Macioce, MS, OTR/L

We have all seen those toddlers who are playing with cars or dolls in the common position of “W-sitting”.  And since we see it so often in young children, we may not see it as worrisome, however for many children if left unaddressed long-term “w-sitting” could lead to some overall developmental issues.  With that said, this month’s focus is not to alarm, but to increase an awareness while providing some useful and tactical information for parents, teachers and therapists of the many children who find the position of “w-sitting” comfortable.

Although this is a common position to find a toddler sitting in, it comes with many implications of why it is not good.   For those children who move in and out of the position for short periods of time, it can be looked upon as just a typical playing position that the child will outgrow.  However, for many of the children we see in the therapy world, it can have a greater effect on a child’s overall development  “W-sitting” inhibits exploration, does not allow for proper strengthening of the trunk, and keeps children confined to play only in midline. Effects of long-term “w-sitting” include hamstring tightness and tibial torsion and even hip dislocation. In addition, because it inhibits trunk rotation it also causes overall decreased balance and trunk control.  The lack of trunk mobility causes children who utilize this position on a regular basis the inability to cross midline and explore as much during play.

One of the most common reasons children hang out in this position is low tone.  Early on when children begin to crawl, you often find them stopping in the “w” position regardless of tone issues because they require a wider base of support at this stage.  However, as they get stronger, you should be able to see them transition into a proper ring sitting position with ease.  For the children who present with lower tone, they still require a wider base of support and will utilize a “w” due to ease, comfort, and stability.  In addition, many of the children who do “w-sit” also present with tighter hamstrings, making it difficult and uncomfortable to sit in long sitting, “crisscross applesauce”, or ring sitting.

Ways to naturally work on correcting this it to utilize a toddler chair for sitting activities as much as possible, encouraging a 90-degree position of the hips and knees. When using larger chairs where the child’s feet do not touch the ground, the use of a stool will help obtain this position.  Many children will be able to correct this position with verbal cuing, so you may often hear a parent, teacher or therapist use the phrase, “fix your legs” to cue the child to choose a different sitting position.

Ultimately, to help children move out of this position, choosing activities that strengthen the trunk and improve overall stability are beneficial.  Those would include things such as the use of an exercise ball, yoga, and balance activities.

Exercise/therapy ball activities are great for trunk strengthening; from performing activities while sitting on the ball that encourage trunk rotation to using the ball for completing sit-ups, these are excellent ways to engage trunk muscles and work on balance.  Activities performed in high kneel, such as drawing on a draw erase board or completing a bean bag target throw activity will also nicely engage that trunk muscles for strengthening.  In addition, using a balance board for activities in sitting, such as completing a puzzle, or standing to play catch or Zoomball will also achieve this.  Kid yoga programs, including Yogarilla from Super Duper are a fun way to introduce children to the overall core strengthening and attention improving art of yoga.

For those low tone children with tight hamstrings, performing leg stretches or utilizing target toss activities with obtaining bean bags from the floor or low stool with straight legs will help to loosen up the muscles.  In turn, you find children are able to maintain the position of “criss-cross applesauce” with more ease.

Therefore, although “w-sitting” is very common among all children, similar to nail biting, it is one of those habits that if addressed early can really making a difference in overall development, especially for children with lower tone.

January 3, 2011

Top 10 Blog Posts of 2010

Its the end of the year and its time for my Top 10 Blog Posts of 2010.  Based on readership these were the posts that got the most views this past year.  If you want to compare to last year check out Top 10 Blog Posts of 2009!

10.  Repetition and the Beauty of ‘Redo’

9.  Standing Straight and Tall

8.  Climbing:  The Catch-22

7.  Having a Ball With Core Muscle Strength

6.  Why is W-Sitting a Four Letter Word?

5. Buns of Steel

4. Strategies for Tummy Time

3.  Do Video Games Promote of Hinder Child Development?

2.  Glossary of Sitting

1.  Sensory Exploration in Today’s Society

There you have it, the Top 10 for 2010!  If you have any ideas for 2011 please share them, I always look forward to ideas for new posts!  Happy Holiday Season to everyone!

January 4, 2010

Top 10 Blog Posts of 2009

I always loved David Letterman’s Top 10 lists so I decided to create my own for the Top 10 Blog Posts in 2009. This is based on the number of times they were viewed.

10. Early Intervention and Budget Cuts in California

9.  Bike Riding

8.  Having a Ball with Core Muscle Strength

7.  Fun Ideas For Sensory Exploration

6.  Why is W-sitting a Four Letter Word?

5.  How Resilient is Your Child?

4.  Buns of Steel

3.  Why is w-sitting Being Promoted in Advertising?

2.  Do Video Games Promote or Hinder Child Development?

1.  Sensory Exploration in Today’s Society

I’m looking forward to see what posts will be top for 2010!  Wishing everyone a happy, healthy and prosperous New Year!

August 16, 2009

Why is w-sitting being promoted in advertising?


Imagine my surprise as I’m flipping through my August 24, 2009 issue of People magazine and I see an ad for Walmart and Healthtex showing a picture of a child w-sitting.  As I’ve mentioned in ‘Why is W-sitting a Four Letter Word?‘ w-sitting is a posture that when used frequently by children can have adverse effects on their gross motor development as well as their posture and hip development.

Just to warn you I’m about to get on my soap box and many of you may think I am being overly dramatic but I am trying to make a point.

I find it appalling that two well known companies would find it okay to show a photo of a child doing something that is not only not beneficial to their development but possibly detrimental.  This may not be something that is well publicized but I am hoping to make it more well known that this is not a good position for children to be utilizing on a regular basis.  How would you feel if you were to see ads with pictures of children riding bikes without helmets, or riding in cars without car seats.  Like I said, I may be overly dramatic but at one time these were common practices and through intervention by the public, and media cooperation these became the norm rather than the rare.  No one thinks twice about putting a helmet on their child even to ride a tricycle and there are all sorts of laws about weight, height and age that you must comply with before you even think about putting your child in the car without a car seat.  I remember when seatbelts weren’t even mandatory.  So, I’m just putting forth that without consistency from parents and professionals out there people will not realize that w-sitting is a really poor choice for kids positioning and an even poorer choice for the media to be utilizing in an ad campaign for two established companies.

Ok, now that I’ve stepped off my soapbox, does anyone else have thoughts on this?

August 2, 2009

Strategies For Stretching


Stretching is something that I think is important to maintain your child’s range of motion.  One solution is Yoga for Kids which can offer many benefits in addition to flexibility.  However, you don’t need to get this fancy to help your child stay limber as they grow.

Hamstrings can start being stretched when they are little, in fact most infants have their own self stretching mechanism, its called – putting their feet in their mouth!  Not only are they exploring but they are also stretching out their legs after being cramped up in the womb for 9 months.  You can also as they get older encourage them to long sit (see A Glossary of Sitting to figure out what this is) which is a functional way of keeping hamstrings at an optimal length.  Have contests with them to see who can touch their toes while keeping their knees on the ground or who can get their back straightest while reaching for the ceiling and keeping their knees on the ground.  For the inbetween ages you can always stretch them out after their bath when their muscles are nice and warm.  Have them lie on their back and keeping one leg flat on the ground raise their other leg up toward the ceiling (while keeping the knee straight).


Hip flexors can be stretched by encouraging tummy time.  When your child starts pushing up on their arms it will not only stretch the front of their hips, but also their low back.  This is a stretch that is good for infants all the way up to adults!


Heel cords/calves are also fairly easy to do.  With your child lying flat on the ground hold their heel in your hand and use your forearm to pull their toes up toward their head.  New babies should be really flexible at the ankle but as they get older this motion can get tight, even little kids!  As your child gets a little older, you can also encourage your child to play in a squatting position, just make sure their feet are pointing straight ahead.  This is really functional for them in terms of development and also practical to maintain range of motion.  This way, they don’t even know that they are stretching.

Seth January 2008 004

As you know, I am not a fan of w-sitting for many reasons (see Why is W-sitting a Four Letter Word? if you wish to know).  One thing it encourages is hip internal rotation.  You can maintain internal rotation with a figure 4 stretch or a butterfly stretch.  Figure 4 stretches can be done with your child lying down and bending one knee up and placing their foot on the straight leg so their legs form a 4.  Gently place pressure on their bent knee and their opposite hip.  Butterfly stretching is sitting with their feet touching in front of them and their knees bent.  Have a contest to see who can touch their knees to the ground first or who can get their feet in closest to their body with their knees touching the ground.

figure 4 butterfly stretch

Now, just as a reminder if you have any questions about any of these stretches please don’t hesitate to contact a physical therapist or your pediatrician.  Keep your eye out in the future for more stretching ideas!



June 15, 2009

Buns of Steel

buns of steel

Your baby’s backside (also referred to as:  buns, tush, behind) houses one of their most important muscle groups – their gluts.   Babies and growing kids need strong gluts for several reasons, and not necessarily the aesthetic reasons we adults strive for!

The first reason is that when your baby is born they have an ‘immature’ bone structure which develops over time as your child grows and gets stronger and begins to move.  The strengthening of the gluts helps to de-rotate (or straighten out) their thigh bone (or femur) into a mature shape.  It also works on the angle of the femur where it meets the pelvis (also known as our hips).  These changes are necessary for kids to develop a mature bone structure that can effectively support them as they go about developing their gross motor skills.

A second reason is that as your baby begins standing and walking, they will want to keep their center of gravity over their base of support.  If their gluts are weak they will shift their weight back as a protective mechanism to keep their balance.  Unconsciously they are afraid that if they lean forward over their feet (as most of us do when we walk) they will not be able to support themselves and hence fall, so they keep their weight shifted back over their heels.  This can also cause your child to walk with a wide base of support (similar to a Frankenstein type walk) so that they will not have to shift their weight too much when they are walking.  It is another protective mechanism that allows them to maintain their balance.  I have found that by really working on strengthening the gluts it allows the child to bring their center of gravity forward to and narrows their base of support giving them a more mature walking pattern and a better ability to adjust to balance disturbances.

A third reason that your child needs strong gluts is that it can reduce in-toeing as they grow.  By keeping the gluts strong it will create an external rotation moment that maintain a neutral hip alignment.  Going back to ‘Why is W-sitting a Four Letter Word?‘ w-sitting also increases the internal rotation at the hips and encourages weak and overstretched gluts.  If you want to assist your child in walking with their toes pointing forward, strengthening their gluts is a great way to do this.

A fourth reason is that the gluts are one of three muscle groups that are critical in the development of normal posture.

I hope all of this was understandable!  I took a continuing education course a while ago and it was stressed in this course the importance of developing ‘buns of steel’ in kids (ok, those weren’t the exact words but its such a great phrase!)  As kids develop through their gross motor milestones they are set up to develop strong muscles.  Sometimes our lifestyles today aren’t as conducive to allowing the muscles to develop to their fullest, whether its w-sitting, or lack of tummy time, or our fear of kids hurting themselves so their exploration is limited.  To help counteract this I will share some ideas for helping your kids make sure they are developing the ‘buns of steel’ they should have, just look for my post next week!

April 27, 2009

A Glossary of Sitting

Based on the questions I got from my last post, I decided to create a  glossary of sitting!


W-sitting:   As you may or may not of read in my last post “Why is W-Sitting a Four Letter Word?” I am not a fan of this sitting position.  You will know your child is sitting this way when you see their bottom on the floor and their knees bent with their feet on the outside of their hips.  If anyone has questions as to why I don’t like this position please refer back to the before mentioned post!


Kneeling: This is a position that can often get confused with w-sitting.  In fact I often have parents get concerned when their child sits like this.  The difference between kneeling and w-sitting is that when kneeling, your child will be sitting with their bottom on their feet, not on the floor. Their feet will be underneath them, not on either side of their hips!  The only time I get concerned with this position is if a child has tight hamstrings and this is the only position they will sit in.  You will notice that they tend not to sit in the following positions.


Side Sitting: I actually really like this position.  It is when your childs knees are bent and their feet are both going toward the same side of their body.  I like this position because it maintains flexibility of their hips without putting them at risk.  This position also forces your child to use their trunk muscles.  Just make sure they are switching between having their feet to the left and their feet to the right!


Short Sitting: This one is pretty easy.  Its how your child sits on a chair or a stool or a step, etc.  The best short sitting is when they have their feet touching the floor so that their knees and hips are bent at right angles.  If you really want them to develop their trunk muscles let them practice sitting without a back rest so they can’t relax into a slump!


Tailor Sitting: Popularly known as ‘criss cross applesauce’ and one of the more favored ways of sitting.  Prior to our world becoming PC it was known as ‘Indian Sitting.’  I say this only because I have found very few people who know what Tailor Sitting is when I say it.  Basically your child’s bottom will be sitting on the floor with their feet crossed in front of them.  This is generally the ideal sitting position for circle time and other floor based learning/playing at school.


Ring Sitting: Very similar to tailor sitting except that your child’s legs are not crossed in front of them, but rather form a ring with their feet touching to complete the circle.  This is a more stable position than tailor sitting especially when children are first learning to sit.


Long Sitting: This position is great for keeping your kids hamstrings stretched out.  It is when they are sitting with their legs straight out in front of them.  If your child is not able to sit up tall in this position or they have to constantly lean back on their hands, it may be a sign that their hamstrings are tight.

I hope this brief description of various sitting positions was helpful.  Even though w-sitting is the only one I have said is bad, your child should be moving in and out of any of these sitting positions easily and not staying in one spot for endless periods of time!

April 21, 2009

Why is W-sitting a Four Letter Word?


I’m constantly amazed at how often I see children w-sitting these days.  I often treat children in pre-school or daycare settings and I see many children plop right down into w-sitting and stay there for an extended period of time.  They are playing without a care in the world and they have no idea that I am cringing inside (well okay I’m sure some of it spills over to the outside).  With the children I work with many parents have no idea that this is not a ‘good’ sitting posture.  Many of them sat that way as a child or their older children sit that way.    “What’s wrong with W-sitting?” addresses many of the issues with w-sitting as well as some ways to encourage your child not to do this.  In addition to what is mentioned in the previous article it is also bad for a child’s hip development and stability.  When a child is born their femurs (thigh bones) are internally rotated and they derotate (a topic for another blog) through development and positioning.  W-sitting actually encourages their bones to stay in an internally rotated position.

One of the most frequent lines out of my mouth is  “fix your feet.”  In fact, when I was home last year I watched my nephew casually come into the living room and sit in w-sitting while playing with his toys.  I quickly got onto my favorite soap box and told him it wasn’t a good way to sit.  Its amazing how much kids listen and pick up because I walked into the room later that week to hear him telling my brother (his dad) that Aunt Stacy said not to sit like that (my brother was sitting on his knees).  In fact, just yesterday I got a picture from my dad (his pop-pop) in my email inbox titled ‘Am I sitting correctly?’  The picture was of him sitting ‘criss cross applesauce’ or tailor sitting!  Anyway, I digress.  The key is to be consistent with not only the words that you use, but also with not allowing them to sit like that.  It would be great if you could help with educating your child’s pre-school teacher or day care worker that w-sitting is not a ‘good’ or recommended way of sitting for kids (below are a list of preferred sitting postures).  The more people that are aware of this, the less it will become the sitting posture of choice for our kids!

‘Good’ or Preferred Sitting Postures:

  • Tailor sitting (criss cross applesauce)
  • Ring sitting
  • Side sitting
  • Long sitting
  • Kneeling

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