Some Things You Need to Know About Sitting

Lately I have been asked to assess several kiddos in sitting so I though I'd do a quick summary of some things that might be red flags.

According to the Hawaii Early Learning Profile (or HELP) there are several levels of sitting that occur.

• Sitting momentarily while leaning on hands (also known as prop sitting) at 6 months

• Sitting independently indefinitely, may uses hands at 5-8 months

• Sits without hand support for 10 minutes at 8-9 months

That's a pretty large range for developing from prop sitting when placed to independent sitting for play. So let me tell you about some of the issues that have resulted in parents calling for evaluation.

The first is lack of balance in sitting. Some children have a tendency to throw themselves backwards and are at risk of hitting their head. Some children don't have the protective responses to put a hand down as they fall to one side. These are core stability issues that a PT can easily show parents how to work on using unstable surfaces such as a ball, a couch cushion or even your lap. I don't recommend using a Bumbo seat in this circumstance as it does not allow your child to sit with their hips in the correct position and does not allow them to practice balancing. There are several other "props" I use to keep children safe when they are learning to sit.

Some of the parents I have consulted with recently have been concerned about the rounded posture they notice when their child sits. Of course initially during prop sitting the child's spine will be rounded to allow hands to get to the ground. As your child begins to sit more confidently they should achieve a very straight back posture. This also requires good core stability as noted above. But it also requires good hip range of motion and pelvic mobility. Try sitting on the ground and see if your hips have difficulty bending. You will see that you compensate by rounding your back. The rounded back leads to other consequences. It tends to through the head forward which makes looking up and scanning the environment more difficult. It can also lead to a more open mouth at rest which leads to more drooling and poor swallowing. This is why solid foods are not recommended until your child is sitting. Children who don't achieve good static sitting posture may have difficulty sitting and paying attention in circle time and then later fatigue quickly when sitting in a desk at school. Good core control and posture also lead to better fine motor skills.

Lastly, I get asked about W sitters. I can't move my legs into this position but it means the knees are together with the feet cocked out to the sides and the buttocks on the floor. This position puts a lot of stress on the hips, knees and feet over time. It is an easy compensation for kids moving from crawling to sitting. To a PT it means AGAIN that your child may not have a strong core. W sitting locks the pelvis and spine in rounded position and gives the child a wide base to sit on. It prevents the child from making rotational movements (also called transitional movements) that help them go from sitting to crawling. Transitional movements help us scan our environment and use our oblique abdominal muscles. Long term W sitting can result in orthopedic changes in the legs like "knocked knees" and flat or outwardly pointed feet.

Sitting is an exciting milestone and one that is so fun to watch happen. It's the beginning of your child learning to play and change from that newborn to a more interactive little person. If you feel your child is having trouble with sitting feel free to reach out for a consult. I can give you some creative ideas on how to help your child sit statically and then begin to move dynamically in and out of sitting.