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Sitting habits in children

Discussion in 'Pediatrics' started by NewsBot, Sep 19, 2007.

  1. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1

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    Hip rotation degrees, intoeing problem, and sitting habits in nursery school children: an analysis of 1,134 cases.
    Altınel L, Köse KC, Aksoy Y, Işık C, Erğan V, Ozdemir A.
    Acta Orthop Traumatol Turc. 2007;41(3):190-194.
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. deco

    deco Active Member

    This is definitely something I have noticed with children who intoe when walking. When speaking to parents about sitting posture the children always tend to W sit which is a big no no.

    I have used gait plates with mixed results in some of the older children who intoe. I would be intersted to hear other peoples experiences with gait plates.

    Declan
     
  4. Craig Payne

    Craig Payne Moderator

    Articles:
    6
    BUT, is sitting in the W position part of the pathomechanical aetiology of this or do they just sit that way as its easier for them to sit that way?
     
  5. Admin2

    Admin2 Administrator Staff Member

  6. Ronald Valmassy, DPM, who taught our courses at CCPM on podopediatrics, and who was the Chairman of the Biomechanics Department at CCPM during my student and biomechanics fellowship years, taught us that the child with an intoeing problem that sat with the feet and legs positioned along the lateral border of their thighs ("W" style or "television sitting"??) did so because it was a more comfortable way to sit due to their restricted external range of motion in their hips. He also encouraged teaching the parents to have the child sit "Indian style" or "cross-legged" which would tend to gradually increase the external range of motion of the hip in the child whereas sitting "W" style would tend to reinforce the internal femoral position. In additon, I tell the parents to encourage roller skating and/or in-line skating in their intoed children which will force them to externally rotate their hips and hopefully also stretch out some of the the soft tissues elements that cross the hip and that may be partially responsible for their intoed position during gait.
     
  7. Stanley

    Stanley Well-Known Member

    Colleagues,

    About 29 years ago, when I was a clinician in the Podopediatric clinic at OCPM (where we had 40 patient visits/day), I put together the pieces of the puzzle of internal femoral position.

    Children at about 6 months of age have a sitting phase that is between scooting and crawling which lasts for about 2 weeks. Some children miss this phase, so they do not learn to sit. Instead they kneel exclusively which eventually results in the W position. (The first article on the sitting positions was by Fitzhugh in the early 1900's). This position results in the internal rotation of the femur.
    More importantly, during the sitting position, certain reflexes are developed using the hips as a focal point for balance. So when the child starts to walk, and they feel like they are going to fall, they stick out their bun and land on it. Children that miss this, will develop balance reflexes around the knee, so when they become unstable they bend their knee and land forwards on their knees or backwards on their heads. This is the clumsiness that we see with these patients.
    In addition to gait plates, and stretching exercises, balance exercises help with the clumsiness. The balance exercise is to have the child sit on the floor, and roll a ball to him, and then have him roll it back. Make sure that the ball is rolled to one side and then the other.
    There is also the situation where the child takes an excessively long time to learn to walk, for some reason they spend a greater percentage of time kneeling rather than sitting. These children will usually self resolve.

    Regards,

    Stanley
     
  8. deco

    deco Active Member

    I have seen children with significant joint laxity problems who do find this the most comfortable way to sit. I have even come across a child recently who sleeps with the legs in a W position. The parents are normally unaware about the difficulties that this creates and the effect it has on gait.

    The chicken or egg situation, I would imagine that the hip joint may be set in an excessively internaly rotated position at birth. The child may find W sitting more comfortable and stable and it is possibly from this position that the internal rotation worsens.

    Declan
     
  9. caf002

    caf002 Active Member

    OK, I am a dummy, but I cannot help thinking that the significance of this research will emerge when the children are aged greater than 6 years. My hypothesis is the "cause and effect" of sitting, internal rotation and in-toeing will deminish as children assume normal activity with age and growth (current lifestyle issues of the young being an important parameter).
     
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