W-Sitting and Side-Sitting: Is W-Sitting Actually Bad for Kids or Adults?

What is W-sitting, and what else is it called?

W-sitting is a way of sitting on the floor with the bottom resting between the feet, the knees bent in front, and the lower legs folded out to either side. Seen from above, the legs make the letter W. At the hip, the position combines bending, drawing the thighs together and turning them fully inward.⁠^1,3

It goes by several names. Researchers have searched for it as “W-sitting,” “television sitting” and “W-shape sitting,” and Cleveland Clinic lists “reverse tailor sitting” and “frog sitting” as other names. Reverse tailor sitting is the clearest of them: it is cross-legged (tailor) sitting with the legs turned the other way.⁠^1,6

Children most often W-sit while playing on the floor, because the position gives a wide, steady base and leaves both hands free. It is most noticeable between about three and six years old, the age when it is most comfortable, and preschool teachers are often the first to point it out because older children spend more of the day in chairs.⁠^1,3,14

What does the thigh bone have to do with W-sitting?

The upper end of the thigh bone (femur) is twisted slightly forward relative to the knee, an angle called femoral anteversion. Everyone is born with a lot of it. The twist is greatest in infancy and early childhood and unwinds as a child grows, from a mean of about 35 degrees at birth to about 15 degrees in adults.⁠^3,4,5 A child with more twist can turn the thighs inward easily, which makes W-sitting comfortable; a child with less twist finds cross-legged sitting more natural, and for some the W is painful or impossible.⁠^1,3

When the twist is greater than usual, doctors call it increased femoral anteversion, femoral torsion or internal femoral torsion. Boston Children’s Hospital puts it at up to 10 percent of children, somewhat more often girls, and it tends to run in families. It is the most common cause of in-toeing, and a child with it often sits in a W simply because that is the position that fits.⁠^5,8,9,10

This is why W-sitting tends to fade on its own. As the twist unwinds, the position becomes less comfortable and children stop choosing it; the authors of the 2024 review describe W-sitting as common in children and rare in adulthood for exactly this reason.⁠¹

How common is W-sitting?

Very. In a Turkish study of 1,134 children aged three to six, summarized in the 2024 review, 63% sat in a W and 37% cross-legged. A study of 1,538 children found 17.3% W-sitting, and among 104 children who came to a Los Angeles hospital for hip X-rays, 46% of families reported current or past W-sitting.⁠^1,2 The figures differ with age and with how the question was asked, but every study finds it common enough to count as ordinary.

What does the research show about whether W-sitting is harmful?

For typically developing children, the studies that exist point away from harm. The warnings parents hear are that W-sitting causes hip dysplasia, deforms the legs, weakens the core or delays motor skills. None of these is supported by the research, and a 2021 review of pediatric orthopedic myths names W-sitting among the beliefs passed along “without citation.”⁠^1,15

What did the 2024 systematic review find?

A team at the University of São Paulo searched five databases in January 2023 for anything published on W-sitting. Of 3,641 records, seven studies were relevant. The review found no scientific evidence to advise against W-sitting in children, no association with hip dysplasia, and no difference in trunk muscle activation between sitting positions.⁠¹

The authors were frank about the limits. The included studies were cross-sectional surveys, cohorts and one narrative review, rated level III evidence, and two studies that linked W-sitting to in-toeing and flat feet could show only that the two occur together, not that one causes the other. Their conclusion is that prohibiting W-sitting in children lacks evidence and that better studies are still needed.⁠¹ That is a statement about thin evidence pointing one way, not proof of perfect safety.

What did the hip X-ray study find?

The only study built to test the hip question directly came from Children’s Hospital Los Angeles. Researchers asked the families of 104 children having hip or pelvis X-rays about sitting habits, then measured the X-rays for signs of dysplasia. Hip dysplasia was found in 9% of W-sitters and 10% of non-W-sitters, and it made no difference whether a child still W-sat, preferred it or had stopped.⁠² The 2024 review rated this study at low risk of bias.⁠¹

The International Hip Dysplasia Institute reaches the same conclusion: W-sitting is normal for many children, should be allowed, and does not contribute to hip dysplasia.⁠⁹ The lead researcher put it plainly to her hospital: there is “pretty much no scenario” in which W-sitting is a real concern in a typically developing child.⁠³

Why do some therapists still advise against W-sitting?

The advice is old and widespread. The 2024 review found that most physical therapists, occupational therapists and teachers advise against W-sitting despite the lack of evidence, and the Los Angeles team opened its paper by noting that parents are cautioned by therapists, teachers, physicians and websites alike.⁠^1,2 Some major health sites still publish the warning: a February 2026 Cleveland Clinic article quotes a pediatric physical therapist who says W-sitting can cause hip, knee and ankle problems later.⁠⁶ Those claims are not backed by the studies that have tested them.⁠^1,15

Where the belief came from is unclear. The review authors suspect it began with children who have cerebral palsy, in whom W-sitting was associated with muscle problems, and was then extended to all children without evidence.⁠¹ If someone told you to stop your child W-sitting, they were most likely passing on advice they received in good faith.

Is W-sitting bad for adults?

For most adults who can do it comfortably, there is no evidence that it is. The 2024 systematic review found a single study of W-sitting in adults, a measurement of muscle activity in eight people, so the honest answer comes from what is known about the anatomy that makes W-sitting possible and about adults who have it.⁠^1,4 Three groups have good reasons to sit differently: people with kneecap pain, people recovering from a hip replacement, and people whose joints partly dislocate.

Why can some adults still sit in the W position?

Because the thigh-bone twist that makes W-sitting easy does not unwind fully in everyone. Some teenagers and adults can W-sit comfortably, and orthopedic surgeons treat a W-sitting habit in childhood as a possible sign that the twist persisted.⁠^3,16 Most children with an inward-twisted femur walk normally by 8 to 10, but some only reach that in their teens, and a small minority keep a marked twist into adulthood.⁠^9,10

Joint flexibility is the other route. In a study of 482 children and adults with joint hypermobility, cited in the 2024 review, around 55% could W-sit now or had in the past, and lax ligaments can add to the inward rotation available at the hip.⁠¹ An adult who drops easily into a W may simply be built with more twist, more flexibility or both.

In a 2017 study of eight adults, also summarized in the review, trunk muscle activation was no different whether they sat cross-legged, side-sitting, long-sitting or in a W.⁠¹ For an adult, then, the W is not a lazy or weakening posture; it is one of several ways to sit.

What happens to adults whose thigh bones stay twisted?

The longest follow-up comes from Norway. Researchers examined 58 adults, at a mean age of 46, who had been seen as children for an anteversion angle of 30 degrees or more and never had surgery, and compared them with 24 adults without it. The anteversion group reported more hip pain and more limits on sport and physical activity, but the differences were mostly small to moderate, everyday activities were unaffected, and only one person had hip arthritis.⁠⁴ An older study of nine adults with excessive anteversion and 249 high school students found no relationship between anteversion and physical performance.⁠¹⁷

Children’s hospitals tell families that femoral anteversion typically does not lead to arthritis or other future health problems.⁠^10,18 Hip specialists add a caution for the minority with a large twist: an abnormal angle changes the forces on the hip and kneecap joints and can contribute to impingement or arthritis, which is why it is measured before hip-preserving surgery.⁠¹⁶ Neither group of findings is about W-sitting itself. The position is a sign of the anatomy, not a cause of it.⁠^8,9

When should an adult avoid W-sitting?

W-sitting bends the knees fully and turns the hips inward, so the situations to think about are the ones where those joints are sore, healing or unstable.⁠¹

• Kneecap pain. Pain at the front of the knee is often worse when the knees stay bent. In a Dutch survey of 87 people with patellofemoral pain, 72% had pain during prolonged sitting, and most said it began with the knees bent to 90 degrees or more; W-sitting bends them much further.⁠¹¹
• A recent hip replacement. W-sitting combines hip bending, drawing the thigh inward and inward rotation, the movements traditional hip precautions limit after surgery.⁠^1,12
• Joints that partly dislocate. W-sitting is common in hypermobility, and in children it is listed among signs that can point to joint instability; if knees or hips sublux, ask a physical therapist which positions suit you.⁠^1,13
• Hip pain or a known large twist. An abnormal femoral angle changes the forces through the hip and kneecap joints, so pain in the position is a reason to stop and get it checked.⁠¹⁶

Hip precautions deserve a word of their own. After a hip replacement through the back of the hip, patients have traditionally been told to avoid bending the hip far, crossing the leg past the midline and turning it inward, the three movements W-sitting combines. A review of 6,900 patients found dislocation rates of 2.2% with these precautions and 2.0% without.⁠¹² Your own surgeon’s instructions, which depend on the approach and implant, are the ones to follow.

If none of these applies and W-sitting is comfortable, there is no evidence-based reason for an adult to stop. Changing position regularly is sensible advice for any sitting posture, and people with kneecap pain in the Dutch survey typically felt it only after 16 to 20 minutes with the knees bent.⁠¹¹

Does W-sitting cause in-toeing or pigeon toes?

No. In-toeing in a preschooler is most often caused by the same inward thigh-bone twist that makes W-sitting comfortable, so the two appear together. A review for family doctors states that W-sitting is common in children with increased femoral anteversion but that there is no evidence sitting habits cause or worsen leg problems, and Seattle Children’s tells parents that sitting in a W does not affect the hips or legs or worsen in-toeing.⁠^7,8 The Turkish study that linked W-sitting with in-toeing was a single survey and could not show which came first.⁠¹

One research team in Korea has suggested otherwise. Following 63 children with in-toeing for three years, they found the twist decreased but often stayed moderate, and they proposed that floor-sitting cultures in Japan and Korea, where W-sitting is easy to fall into, might slow the natural correction. They called for further studies to test the idea.⁠¹⁹ The International Hip Dysplasia Institute’s position is that stopping W-sitting has no influence on the twist.⁠⁹

What is clear is the outlook. The twist corrects itself in up to 99% of children, most walk normally by 8 to 10, and braces, special shoes, wedges and exercises do not change that course and may make a child feel different.⁠^5,7,9,10 Fewer than 1% of children with femoral torsion have surgery, and only after the bone has reached its adult shape.⁠⁷ Out-toeing, on the other hand, is less often a normal variant and is worth having checked.⁠⁵

Is there any reason to discourage W-sitting?

Not the reasons usually given, but there is a different and more useful way to look at it. A strong preference for W-sitting can be a signal rather than a cause. The W gives a wide base that needs little effort from the trunk to hold, so children whose muscles tire quickly or whose joints are very flexible may choose it because it compensates.⁠^6,14 In that case, stopping the position does not touch the underlying difficulty; it only removes a strategy the child was using. The useful response is an assessment, not a correction.

Low muscle tone is the clearest example. A 2024 overview of tools for identifying young children with developmental central hypotonia notes that these children often W-sit for the wider, steadier base, and that a clinical assessment algorithm includes W-sitting among the posture signs to look for, though the same authors point out that it is also common in typically developing children aged three to six.⁠¹⁴ In autism, Cleveland Clinic’s therapist describes a correlation but no cause and effect: autistic children who W-sit often have lower muscle tone or trunk control, and the position is “not a definitive sign of anything.”⁠⁶

How does joint hypermobility change the way a child sits?

Children with very flexible joints often sit in unusual positions. In a study of 124 hypermobile children aged one to nine, a slumped, concave posture was the most common, followed by W-sitting, sitting with a foot on the head and sitting in the splits.⁠²⁰ A 2026 scoping review of hypermobility spectrum disorders in children lists W-sitting alongside unusual flexibility, clumsiness, frequent falls and late milestones as signs that can point to underlying joint instability.⁠¹³

The W-sitting itself is not what needs treating. What matters is the rest of the cluster: joints that partly dislocate, persistent pain, fatigue or a child falling far more than peers.⁠¹³ Those are reasons to see a doctor or physical therapist, and the page on Ehlers-Danlos syndrome covers the condition in more depth.

Why is W-sitting handled differently in cerebral palsy?

For children with cerebral palsy, the hips are a genuine concern. In one hospital study of 203 children with cerebral palsy, 51.7% had hip subluxation on X-ray, and the risk rose with the severity of motor involvement.⁠²¹ Children whose walking is delayed or impaired tend to keep their femoral anteversion, as studies in cerebral palsy have shown.⁠¹ If your child has cerebral palsy, Down syndrome, significant hypotonia or a known orthopedic condition, follow the sitting and positioning plan of the therapy team that knows them; the research on W-sitting is about typically developing children.

What other floor-sitting positions are there?

Children move between several floor positions in a session of play, and each trades steadiness against freedom to move. Knowing the names mainly helps when a therapist suggests one.

Is side-sitting better than W-sitting?

Side-sitting is often suggested as the alternative to W-sitting, but in the one study that measured it, in adults, trunk muscle activation was the same in side-sitting, cross-legged, long-sitting and the W.⁠¹ Side-sitting is a fine position to offer and to switch sides in; there is no evidence that it builds strength the W does not.

“Side sitting” also has a second meaning in infant development. Developmental assessments use it for a propped position on one side, with the baby’s weight on the elbow, forearm and leg, which appears at about 7 to 9 months as a baby works toward sitting and crawling.⁠²² That milestone is not the same as the Z-shaped floor position older children use.

What to do with this in practice. Offering a child several positions is reasonable and costs nothing. Banning one comfortable position has no evidence behind it, and the pressure many parents feel to police W-sitting is out of proportion to anything that has been shown.⁠^1,15

RelatedPostural difficultiesHypotonia

When is W-sitting worth raising with a doctor or therapist?

The position itself is not the reason to seek help. These are the things worth paying attention to:

Talk to your pediatrician or a pediatric physical therapist if your child:

• Sits in a W almost all the time and seems unable to sit in other positions, or cannot sit upright on the floor at all.⁠⁶
• Is not walking by 15 months, has suddenly changed the way they walk, or is still walking mostly on their toes at age 3.⁠³
• Can do something on one side of the body but not the other, or has in-toeing on one side only.⁠^3,5
• Has pain in the hips, knees or legs, or in-toeing or bowing that is getting worse rather than better.⁠⁵
• Is noticeably clumsy, falls far more than other children, has joints that partly dislocate, or is late with walking, running or stairs.⁠¹³
• Still has marked in-toeing after about age 8 to 10 that causes tripping or limits activity.⁠^10,18

The framing that matters: you are not asking for help with W-sitting. You are asking for an assessment of strength, coordination and motor development, in which W-sitting was one observation among several. A difficulty crossing the midline, a postural difficulty or delayed motor milestones may be part of the same picture, and toe walking past age 3 is a separate reason to ask.⁠³

For adults, see a doctor or physical therapist if hip or knee pain limits sport or daily life, if a joint gives way or partly dislocates, or if you have had a joint replaced and are unsure which positions are safe.⁠^4,12,13

If none of this applies, no action is needed. Your child can sit however is comfortable.

How can you encourage other sitting positions?

If you would like your child to use a wider range of positions, that is reasonable and harmless. The key is that it is optional, not corrective.

• Offer alternatives rather than prohibitions. Cross-legged, side-sitting, long-sitting, or a small stool or cushion. Cleveland Clinic suggests a short cue such as “feet in front.”⁠⁶
• Change the setup rather than the child. Play at a toddler table or a low bench makes W-sitting less likely without anyone being reminded.⁠⁶
• Do not insist on cross-legged sitting if it hurts. For a child with an inward-twisted thigh bone, criss-cross can be the painful position.⁠⁷
• Keep corrections light. Seattle Children’s warns that devices and constant reminders about in-toeing can make a child feel different and affect self-image, and the same reasoning applies to sitting.⁠⁷
• Build strength through play instead. Crawling, climbing, kneeling and games on hands and knees develop the trunk control that makes other positions comfortable.⁠⁶ Balance and movement play helps too.
• Expect the habit to fade on its own. As the thigh-bone twist unwinds, W-sitting becomes less comfortable, and most children leave it behind without any intervention.⁠^1,10

Frequently Asked Questions

Relatedcrossing the midlinepostural disordervestibular and proprioceptive processingsensory processing disorder

RelatedPhysical therapy

Sources

1. Nordon DG, Passone CGB, da Silva CAA, Grangeiro PM. W-sitting in childhood: a systematic review. Acta Ortopedica Brasileira. 2024;32(6):e279277. PMID 39802577. Checked October 11, 2026.
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   “W-sitting or ‘television sitting’ is a position in which children perform flexion, adduction, and maximal internal rotation at the hip when sitting on the floor. From above, their legs make the shape of a W. Children aged from three to six years usually prefer it as it offers more comfort for those with increased joint mobility and anteversion of the proximal femur ... In contrast, sitting in a cross-legged position is more natural for those with decreased femoral anteversion or for whom sitting in a W shape would be painful or impossible.” Searched “on the PubMed, Medline, Cochrane Library, Embase, and PEDro databases”; “This study was conducted at Instituto de Ortopedia e Traumatologia do Hospital das Clinicas at Universidade de Sao Paulo.” “Despite the lack of science-based evidence against this sitting position, most physical therapists, occupational therapists, teachers, and several other healthcare and education professionals advise against it.” The search, in January 2023, “found 3641 articles, removed 614 duplicates, and excluded 3021”; seven studies were included. Its table: Altinel 2007, 1,134 children aged three to six, “37% of the children sat in a cross-legged position, and 63% in W-shape. W-sitting was associated with in-toeing”, with the comment “As in any cross-sectional study, it is possible to associate W-sitting with in-toeing but not to infer causality”; Chen 2010, 1,538 children, “29.7% of children showed joint laxity and 17.3% W-sat”; Lee 2017, eight adults, “No significant difference in muscle activation in the evaluated sitting positions: cross-legged, side, long, W-shaped”; Lamari 2022, “482 children and adults with hypermobility”, “Around 55% of patients with joint hypermobility are or were able to W-sit.” “We suspect anecdotes in which the habit of W-sitting was initially associated with muscular abnormalities in cerebral palsy patients formed the basis of a belief in the harmful effects of W-sitting. This belief was then likely extended to the neurotypical population without adequate scientific evidence.” Of the Los Angeles hip study: “It showed a low risk of bias.” “Ligament laxity during infancy may also contribute to an increased range of motion at the hip, raising internal rotation and W-sitting, as in Lamari et al.” “Children with delayed or impaired gait have a persistent femoral anteversion, as in several studies in cerebral palsy patients.” “All children are born with increased femoral anteversion, which slowly decreases during life, until around 10 years of age.” “W-sitting occurs commonly in children and rarely in adulthood due to the physiological development of femoral anteversion, which naturally regresses and makes it mechanically impossible to W-sit regardless of postural correction or physical therapy.” Conclusion: “W-sitting shows no relation with evidence-based developmental dysplasia of the hip. No scientific evidence suggests any other orthopedic deformity. W-sitting results in no evidence-based different trunk muscle activation. More studies must be performed since the current studies show a predominantly low level of evidence and methodological inadequacies to prove harm in W-sitting. Therefore, prohibiting W-sitting in children lacks evidence.” “Level of evidence III, review article.”
2. Rethlefsen SA, Mueske NM, Nazareth A, Abousamra O, Wren TAL, Kay RM, Goldstein RY. Hip dysplasia is not more common in W-sitters. Clinical Pediatrics. 2020;59(12):1074–1079. PMID 32659120. Checked October 11, 2026.
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   “Parents are frequently cautioned by therapists, teachers, physicians, and online resources about potential negative effects of w-sitting in children (including hip dysplasia), despite lack of evidence.” A prospective cohort “of 104 patients (196 hips), aged 9.9 (standard deviation = 5.7) years, who underwent hip/pelvis radiography”: “About 48/104 parents/patients (46%) reported current or past w-sitting ... There was no difference in measures of hip dysplasia (P > .12) or hip dysplasia frequency between w-sitters (9%) and non-w-sitters (10%; P = .81), or among w-sitting persistence groups (P = .26). W-sitting in children is not associated with hip dysplasia.”
3. Children’s Hospital Los Angeles. ‘W’ Sitting Is Not Bad for Kids, Say CHLA Experts. Undated. Checked October 11, 2026.
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   W-sitting “is when children sit with their butts on floor and their legs bent behind them and splayed to the side of the hips, with the knees facing forward.” “Some children have more inward twist in their thigh bones than other children, so they can easily bring their knees in and feet out. In fact, for some children, sitting with their legs crossed in front of them may be uncomfortable.” “Everyone is born with a lot of twist to their thigh bone, but at around age 8 it starts to untwist.” “It’s often noticed by a preschool teacher because once children enter kindergarten they tend to sit in chairs.” “Some teenagers and even adults can ‘W’ sit comfortably, Dr. Goldstein says.” “There is pretty much no scenario in which ‘W’ sitting is really a concern in typically developing children.” Where the myth came from “remains a mystery.” Worth raising with a pediatrician: children who “aren’t walking by 15 months old, have suddenly changed the way they walk, are still primarily walking on their toes by age 3, or are able to do something on one side of the body but not the other side.”
4. Gronseth A, Horn J, Liyanarachi S, Gunderson RB, Terjesen T. Long-term outcome of idiopathic increased femoral anteversion in 58 untreated individuals at a mean age of 46.2 years. Journal of Pediatric Orthopaedics. 2026;46(1):13–19. PMID 40842023. Checked October 11, 2026.
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   “The degree of AV is greatest in infancy and gradually decreases towards skeletal maturity, from a mean of 35 degrees at birth to ~15 degrees in adults.” “Fifty-eight patients (46 females) with a mean age of 46.2 years were included in the AV group. The mean anteversion angle was of 40.2 degrees in the anteversion group and 20.6 degrees in the controls ... The anteversion group scored significantly worse than the control group in 5 out of 6 HAGOS subscales ... Only 1 patient in the anteversion group had hip osteoarthritis.” “Untreated adults with idiopathic increased femoral AV at a mean age of 46 years experienced more hip pain and limitations in participation in physical activities and sports compared with healthy individuals, but the limitations were mostly small to moderate.” “The degree of hip complaints seemed moderate, as the scores were within the limits of normal variation in 67% to 89% of the individuals”, “whereas everyday activities remain unaffected.”
5. Vlaic J, Kruk A, Wasko MK. Angular and rotational lower limb alignment variations in children: practical guidance for paediatricians. Medicina (Kaunas). 2026;62(8):1499. PMID 42654396. Checked October 11, 2026.
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   Of in-toeing: “Femoral anteversion is the most frequent cause. It may reach up to 40 degrees in newborns and decreases to about 15 degrees in young adulthood. Clinical features include a negative foot progression angle, excessive internal hip rotation (>70 degrees), and frequent association with W-sitting. Most cases resolve spontaneously by age 8. Conservative measures such as orthotics, wedges, or special shoes do not alter the natural history and may have negative psychological effects.” “In most children, these findings reflect physiological developmental patterns that resolve spontaneously, but unilateral, progressive, or symptomatic cases may indicate pathology and require specialist assessment”; imaging “should be reserved for atypical presentations, asymmetry, progression, pain, or suspected systemic or neuromuscular disease.” “Out-toeing is less often physiological and should prompt careful evaluation for underlying disorders, including slipped capital femoral epiphysis.”
6. Cleveland Clinic. W Sitting Position: Is It Harmful? Health Essentials, February 17, 2026. Checked October 11, 2026.
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   “Also known as ‘reverse tailor sitting’ or ‘frog sitting,’ W sitting is a position that’s common for toddlers and young kids when they’re playing on the floor.” The article’s physical therapist advises discouraging it and says “W sitting can cause major hip, knee and ankle joint issues further down the road.” On autism: “while there does seem to be a correlation, there’s no proven cause-and-effect relationship between W sitting and developmental disabilities”; “We do often see W sitting in children with autism ... But that’s usually because they also have lower muscle tone, decreased trunk control or a weak core. That makes W sitting feel easier for them. It’s not a definitive sign of anything.” Hypermobile children “may appreciate the extra support W position sitting offers.” “Side sitting: The child sits with one leg bent in front of them and the other bent behind, forming a ‘Z’ shape.” Suggestions include a verbal cue such as “feet in front,” floor play “on a toddler table,” and “games that involve crawling, climbing, kneeling and playing on hands and knees”; “or your child can’t seem to sit upright on the floor at all, it may be time to talk with a children’s health provider.”
7. Seattle Children’s. Femoral Torsion. Patient and family education leaflet PE245, October 2025. Checked October 11, 2026.
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   “Most children outgrow it by age 10 to 12.” “Having your child sit on their bottom with their knees and feet out to the side of the hips (‘W’ position) will not affect your child’s hips or legs or worsen the intoeing. However, sitting on their bottom with their legs crossed (criss-cross applesauce) can be uncomfortable for some children with femoral torsion. Let others know that your child should not be asked to sit this way if it causes pain.” “The use of devices or reminders may make the child feel different and can have a negative effect on their self-image.” “Less than 1% of children with femoral torsion are treated with surgery. Surgery should not be performed until the femur has reached the adult shape.”
8. Rerucha CM, Dickison C, Baird DC. Lower extremity abnormalities in children. American Family Physician. 2017;96(4):226–233. Checked October 11, 2026.
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   In the history: “Sitting habits: the W sitting position (Figure 8) is common in children with increased femoral anteversion; however, there is no evidence that sitting habits cause or worsen orthopedic lower extremity problems.” Femoral anteversion “Presents between 4 and 7 years of age”, is “More common in girls” and “Hereditary”; “Children sit in a W position for comfort”; management: “Parental reassurance (usually resolves spontaneously by 8 years of age).” “Orthotics are not beneficial.”
9. International Hip Dysplasia Institute. W-Sitting and Hip Development. Undated. Checked October 11, 2026.
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   “Contrary to popular belief, this W-sitting posture is normal for many children, and should be allowed even though children who can sit like this often walk with their feet turned in – called pigeon toed walking. The medical term that allows W-sitting is called Internal Femoral Torsion.” “Treatments for this common variation were debunked more than twenty years ago ... During further growth, the bone twist goes away naturally in 99% of children without intervention.” “Studies have shown that W-sitting does not cause any harm to the developing hips, and does not contribute to hip dysplasia.” “Stopping W-sitting has no influence on femoral torsion whether the hip is in or out of the socket.”
10. Boston Children’s Hospital. Femoral Anteversion. Undated. Checked October 11, 2026.
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    “Femoral anteversion occurs in up to 10 percent of children. The condition is somewhat more common in girls than boys.” “Most children achieve normal or near-normal walking patterns by the time they are 8 to 10 years old. Others achieve normal walking patterns by the time they reach their teen years.” “Braces, special shoes, and exercises don’t usually speed up or help the body’s own mechanism for self-correcting femoral anteversion.” “Femoral anteversion is self-correcting in up to 99 percent of cases ... Femoral anteversion doesn’t typically lead to arthritis or any other future health problems.”
11. Ophey M, Frieling S, Kerkhoffs GMMJ, Tak I. Pain during prolonged sitting in subjects with patellofemoral pain in Dutch physical therapy clinics: an online questionnaire-based analysis. BMJ Open. 2024;14(11):e086958. PMID 39551596. Checked October 11, 2026.
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    “87 participants (61 (70%) females, mean age 22.0 years”; “63 of 87 (72%) participants reported PDPS” (pain during prolonged sitting); most (85%) reported that it began with the knees bent to 90 degrees or more, after a median of 16 to 20 minutes. “Participants with PDPS reported higher levels of disability than those without.”
12. Crompton J, Osagie-Clouard L, Patel A. Do hip precautions after posterior-approach total hip arthroplasty affect dislocation rates? A systematic review of 7 studies with 6,900 patients. Acta Orthopaedica. 2020;91(6):687–692. PMID 32718213. Checked October 11, 2026.
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    “Hip precautions limiting flexion, adduction, and internal rotation have been prescribed traditionally to minimize dislocation rates following THA.” “6,900 patients were included from 7 Level I–IV studies, with 3,517 treated with and 3,383 without precautions. There was no statistically significant difference in the rates of dislocation between groups (2.2% in restricted group vs. 2.0% in unrestricted group).”
13. Pochcial P, Solomon SC, Bruno KA, Fairweather D, Kinane A, Letzkus L, Gurka KK, Stephens I, Knight DRT. Age-related symptom clustering in pediatric hypermobility spectrum disorders: a scoping review. Orphanet Journal of Rare Diseases. 2026;21(1):264. PMID 42218552. Checked October 11, 2026.
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    “Clinicians should be alert for persistent motor issues, including pronounced clumsiness, frequent falls, and delays in achieving crucial milestones like walking, running, or stair navigation. Children may demonstrate unusual flexibility, adopt postures like W-sitting, or kinesiophobia, all of which can signal underlying joint instability.” The most consistent features were “frequent subluxations or dislocations, chronic musculoskeletal pain, disabling fatigue, orthostatic intolerance, and various gastrointestinal complaints.”
14. Hidalgo Robles A, Paleg GS, Livingstone RW. Identifying and evaluating young children with developmental central hypotonia: an overview of systematic reviews and tools. Healthcare (Basel). 2024;12(4):493. PMID 38391868. Checked October 11, 2026.
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    W-sitting, in which “the child sits on the floor with the bottom between the feet, knees in front, and feet out to the side is often used by children with developmental central hypotonia, as the wider base of support provides increases stability. This position is also common when femoral anteversion peaks in typically developing children (3–6 years) and usually decreases or disappears at older ages.” Its inclusion in evaluating children over 2 “may suggest joint hyperlaxity in combination with hypotonia.” A mixed-methods clinical algorithm “describes items to be considered in postural assessment such as W sitting, winging of scapulae, rounded shoulder posture, and protruding abdomen.”
15. Honig EL, Haeberle HS, Kehoe CM, Dodwell ER. Pediatric orthopedic mythbusters: the truth about flexible flatfeet, tibial and femoral torsion, W-sitting, and idiopathic toe-walking. Current Opinion in Pediatrics. 2021;33(1):105–113. PMID 33315688. Checked October 11, 2026.
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    “Concerns regarding these findings and suggested treatments, unfounded in science, may be passed along verbally or published through various media, without citation.” “W-sitting is not associated with developmental dysplasia of the hip, and there is no scientific evidence to support that it leads to contractures, hip dislocations, or functional deficits.” “Flexible flatfeet, in-toeing/out-toeing, W-sitting, and toe-walking typically improve throughout childhood without intervention. Physical therapy, orthotics and bracing have not been proven effective. Treatment is required in rare scenarios and should be directed by the orthopedic surgeon.”
16. Su Y, Chen K, Wu J, Zhu J, Chen X. Femoral version and its clinical relevance in adult hip preservation surgery for developmental dysplasia of the hip. EFORT Open Reviews. 2024;9(9):873–882. PMID 39222332. Checked October 11, 2026.
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    The review gives the normal range of femoral version as 5 to 20 degrees. “Abnormal FV has adverse effects on the biomechanics and musculoskeletal health of the whole lower limb. It affects the lever arm of muscles and the forces that the hip and patellofemoral joints suffer, and can lead to disorders such as osteoarthritis and impingement. In adult hip preservation surgery for developmental dysplasia of the hip (DDH), abnormal FV is sometimes accompanied by other morphological abnormities of the hip, a more severe DDH, and can help predict postoperative range of motion (ROM), and postoperative impingement.” Among clinical signs: “For instance, ‘W sitting’ during childhood may suggest persistently increased FV.”
17. Staheli LT, Lippert F, Denotter P. Femoral anteversion and physical performance in adolescent and adult life. Clinical Orthopaedics and Related Research. 1977;(129):213–216. PMID 608277. Checked October 11, 2026.
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    “The relationship between excessive idiopathic femoral anteversion and physical performance in adolescent and adult subjects is explored in 9 adults with excessive anteversion and in 10 age-matched controls subjected to extensive physical performance testing. Two hundred and forty-nine high school students were studied by assessing running speed and measuring hip rotation ... In both studies no relationship could be found between excessive anterversion and physical performance.”
18. Children’s Hospital of Philadelphia. Femoral anteversion. Undated. Checked October 11, 2026.
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    “It is typically detected when the child is 4 years to 6 years old.” “As the child grows, normal walking patterns typically resume by 8 years to 10 years of age. Occasionally braces or special shoes are prescribed by the doctor, but most studies have not found these treatments to help.” “It is important to know that femoral anteversion typically does not lead to arthritis or any other future health problems.”
19. Park Y, Byun H, Kim MJ, Shin H. Change of femoral anteversion angle in children with intoeing gait measured by three-dimensional computed tomography reconstruction: 3-year follow-up study. Annals of Rehabilitation Medicine. 2023;47(3):182–191. PMID 37403314. Checked October 11, 2026.
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    “A total of 126 lower limbs of 63 children (30 males, 33 females) with intoeing gait were included”; “most children retained moderate to severe severity of increased FAA.” “In countries where floor culture is prevalent, such as Japan and Korea, children with increased FAA are more likely to assume the W-sitting position, which can act as a significant impediment to the natural resolution of FAA.” “In Asian countries such as Korea and Japan, floor living may result in children adopting positions such as W-sitting more easily. In these cases, improvement may be delayed compared with Western children.” “Further studies are required to validate these findings.”
20. Lamari MM, Lamari NM, de Medeiros MP, de Araujo Filho GM, Santos AB, Giacomini MG, Marques VRP, Goloni-Bertollo EM, Pavarino EC. Phenotypic presentation of children with joint hypermobility: preclinical signs. Children (Basel). 2025;12(1):109. PMID 39857940. Checked October 11, 2026.
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    Records of “124 children (59.7% girls) between one and nine years old”: “The concave sitting position was the most common, followed by W, F, and S in decreasing order.” The authors propose that muscle weakness “instinctively leads individuals with JH to sit in the W position”, which gives “an increased base of support and trunk stabilization, which provides a sense of comfort.”
21. Kammar S, Varma A, Paul S, Pillai I. Hips in cerebral palsy: a clinico-radiological evaluation of hip subluxation in cerebral palsy. Journal of Clinical Orthopaedics and Trauma. 2023;43:102224. PMID 37538299. Checked October 11, 2026.
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    “Hip subluxation was noted in 105 of the 203 children with CP (51.7%).” “There was an increased prevalence of hip subluxation noted with increasing GMFCS E&R score as well as increasing topographical distribution.” “Hip subluxation is a significant, debilitating and common treatable complication in children with CP.”
22. Gajewska E, Surowinska J, Michalak M, Gajewski J, Chalupka A, Naczk M, Naczk A, Sobieska M. The third month’s development predicts the side and oblique sit and walking. Journal of Clinical Medicine. 2025;14(23):8492. PMID 41375795. Checked October 11, 2026.
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    “The commonly used AIMS also includes a side sit described as ‘propped lying on the side’, where the child weighs on the elbow, forearm, leg, and one side of the trunk which, as Vojta indicated, occurs from 7 to 9 months of age.”

Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. If your child has a known orthopedic or neurological condition, follow the guidance of their care team. Always consult a qualified healthcare provider about your individual situation.