Sandra Wiid Physiotherapists

03/06/2023

🫁Respiratory syncytial virus (RSV)🫁

Our little Nina has been admitted with RSV pneumonia, and she’s quite ill. She had all the classic signs.

Read more on RSV here:

You might think parents are overprotective when they don’t want people kissing their babies. This is why.

RSV is currently filling paediatric wards around South Africa at the moment. The cooler weather brings the usual sneezes, but it can also increase your baby’s risk of RSV.

RSV is one of the most common causes of bronchiolitis in children.

🫁What is bronchiolitis?🫁

Bronchiolitis is a lower respiratory tract infection caused by a virus. Many viruses can cause bronchiolitis, but RSV is the most well-known one. It occurs predominantly in children below 2 years of age, particularly infants.

RSV is highly contagious, and nearly all children have been infected at least once by the time they reach their second birthday. It causes cold-like symptoms that can lead to breathing difficulties and hospital admission.

RSV causes up to 90% of bronchiolitis hospitalisations and up to 50% of hospital admissions in winter with pneumonia.

🫁What time of year does RSV occur?🫁

RSV is usually seasonal, peaking in autumn and winter. In South Africa, the peak in RSV season varies slightly by province, with the onset of the epidemic usually in KwaZulu-Natal from December to January, in Gauteng from February to March, followed by the Western Cape in March. RSV peaks from February to June, before the influenza season, from May to September.

🫁How is RSV transmitted?🫁

RSV is transmitted from person to person through physical contact, coughing, and sneezing. It can live for hours on surfaces.

Therefore I cannot reiterate this message any louder:

‼️DO NOT KISS SOMEONE ELSE’S BABY!‼️

Your one kiss or touch can be life-threatening.

Other contributing factors that increase the risk are exposure to to***co smoke, having school-age siblings, attending daycare, and living in crowded conditions.

🫁Who is more at risk for RSV?🫁

Due to their underdeveloped lungs, premature babies and children with chronic lung or congenital heart disease are at the highest risk of severe illness and hospitalisation and may require intensive care.

While adults and healthy children can generally cope with the mild cold-like symptoms, at-risk infants are highly likely to be admitted to the hospital. Preterm infants are 2-5 times more likely than full-term infants to be admitted to the hospital for RSV-related symptoms in their first six months of life.

However, even healthy children can be severely affected by RSV and need hospital admission. They may even die from it.

🫁What are the symptoms of RSV?🫁

RSV usually begins with a mild fever, runny nose, sore throat, mild cough, blocked nose, and ear infection.

It appears to be a common cold because, technically, it is!

Most older children and adults will have these symptoms, and the condition subsides. It is essential to understand not every child contracting RSV will end up in hospital; mostly, they just present with a common cold, but if it complicates, then they will most likely need admission.

🫁What are the danger signs?🫁

If the symptoms progress and worsen, you may see wheezing, difficulty breathing, and trouble eating, drinking, or sleeping. Infants, being unable to breathe, won’t feed well, resulting in dehydration, which is one of the reasons for admission.

As the illness progresses, the lung tissue becomes inflamed and sloughs off, and blocks airways. This leads to wheezing and difficulty breathing. In some very severe cases, the child would need to be put on a ventilator in ICU to help them overcome this respiratory distress.

If you notice your baby's chest pulling in with every breath they take, you should seek medical attention right away. Short, shallow, or rapid breathing and lethargy are red flags for parents during RSV season.

🫁How is RSV treated?🫁

Treatment at home for RSV (or the common cold, as you won’t know how to tell the difference) include using nasal saline drops, a humidifier to keep the air moist, ensuring the baby drinks enough, and using age-appropriate pain and fever medication.

As this is a viral infection, antibiotics would not be indicated.

Most children will recover in 1-2 weeks but can spread the virus for 1-3 weeks, even after recovery.

In-hospital treatment can see children receive intravenous fluids, humidified oxygen, or mechanical ventilation.

🫁How can RSV be prevented?🫁

✅Regular washing of hands with soap and water.
✅Teaching kids proper coughing and sneezing etiquette.
✅Keep your child below 2 years away from others with cold symptoms during the RSV season.
✅Wash toys and surfaces that have come in contact with children with cold symptoms.
✅Discourage other people from kissing your baby.
✅Don’t expose your baby to second or third-hand smoke.
✅Try to breastfeed as long as possible.

🫁Is there a vaccine against RSV?🫁

There is no vaccine to prevent RSV, but there is a medication called Palivizumab (Synagis) that may prevent severe LRTIs in children.

It contains virus-fighting antibodies. This is not a vaccine, but it’s an injection given once a month throughout RSV season. This medication is highly costly and is only indicated for children with an extremely high risk of contracting the disease.

High-risk children are infants born prematurely and who are 6 months of age or younger at the beginning of RSV season, as well as babies with lung and/or heart disease.

In South Africa, the injections are usually started in January till around June.

Scientists are working toward developing a vaccine for RSV, but right now, no vaccine for the illness is licensed anywhere in the world.

🫁What are the long-term effects of RSV?🫁

Unfortunately, being infected once with RSV does not protect the child from contracting it again.

Some children with complicated RSV continue to have recurrent respiratory symptoms throughout childhood due to lung tissue breakdown and inflammation. It is estimated that of children admitted to the hospital with RSV, almost a third will still suffer recurrent wheezing episodes 10 years later, which may be mistaken for asthma.

RSV can be severe, and it's important to remember that it's okay to say no to an invitation if you're not feeling well or reschedule if a prospective guest tells you they've got a little cold. Sometimes, minor colds can turn into big problems for little babies.

🫁Could it be COVID?🫁

Unfortunately, some of the symptoms of COVID and RSV overlap. Since a virus also causes COVID, it may also cause bronchiolitis. The only way to tell the difference is to have your baby tested.

27/04/2022

🫁Respiratory syncytial virus (RSV)🫁

You might think parents are overprotective when they don’t want people kissing their babies. This is why.

RSV is currently filling paediatric wards around South Africa at the moment. The cooler weather brings the usual sneezes, but it can also increase your baby’s risk of RSV.

RSV is one of the most common causes of bronchiolitis in children.

🫁What is bronchiolitis?🫁

Bronchiolitis is a lower respiratory tract infection caused by a virus. Many viruses can cause bronchiolitis, but RSV is the most well-known one. It occurs predominantly in children below 2 years of age, particularly infants.

RSV is highly contagious, and nearly all children have been infected at least once by the time they reach their second birthday. It causes cold-like symptoms that can lead to breathing difficulties and hospital admission.

RSV causes up to 90% of bronchiolitis hospitalisations and up to 50% of hospital admissions in winter with pneumonia.

🫁What time of year does RSV occur?🫁

RSV is usually seasonal, peaking in autumn and winter. In South Africa, the peak in RSV season varies slightly by province, with the onset of the epidemic usually in KwaZulu-Natal from December to January, in Gauteng from February to March, followed by the Western Cape in March. RSV peaks from February to June, before the influenza season, from May to September.

🫁How is RSV transmitted?🫁

RSV is transmitted from person to person through physical contact, coughing, and sneezing. It can live for hours on surfaces.

Therefore I cannot reiterate this message any louder:

‼️DO NOT KISS SOMEONE ELSE’S BABY!‼️

Your one kiss or touch can be life-threatening.

Other contributing factors that increase the risk are exposure to to***co smoke, having school-age siblings, attending daycare, and living in crowded conditions.

🫁Who is more at risk for RSV?🫁

Due to their underdeveloped lungs, premature babies and children with chronic lung or congenital heart disease are at the highest risk of severe illness and hospitalisation and may require intensive care.

While adults and healthy children can generally cope with the mild cold-like symptoms, at-risk infants are highly likely to be admitted to the hospital. Preterm infants are 2-5 times more likely than full-term infants to be admitted to the hospital for RSV-related symptoms in their first six months of life.

However, even healthy children can be severely affected by RSV and need hospital admission. They may even die from it.

🫁What are the symptoms of RSV?🫁

RSV usually begins with a mild fever, runny nose, sore throat, mild cough, blocked nose, and ear infection.

It appears to be a common cold because, technically, it is!

Most older children and adults will have these symptoms, and the condition subsides. It is essential to understand not every child contracting RSV will end up in hospital; mostly, they just present with a common cold, but if it complicates, then they will most likely need admission.

🫁What are the danger signs?🫁

If the symptoms progress and worsen, you may see wheezing, difficulty breathing, and trouble eating, drinking, or sleeping. Infants, being unable to breathe, won’t feed well, resulting in dehydration, which is one of the reasons for admission.

As the illness progresses, the lung tissue becomes inflamed and sloughs off, and blocks airways. This leads to wheezing and difficulty breathing. In some very severe cases, the child would need to be put on a ventilator in ICU to help them overcome this respiratory distress.

If you notice your baby's chest pulling in with every breath they take, you should seek medical attention right away. Short, shallow, or rapid breathing and lethargy are red flags for parents during RSV season.

🫁How is RSV treated?🫁

Treatment at home for RSV (or the common cold, as you won’t know how to tell the difference) include using nasal saline drops, a humidifier to keep the air moist, ensuring the baby drinks enough, and using age-appropriate pain and fever medication.

As this is a viral infection, antibiotics would not be indicated.

Most children will recover in 1-2 weeks but can spread the virus for 1-3 weeks, even after recovery.

In-hospital treatment can see children receive intravenous fluids, humidified oxygen, or mechanical ventilation.

🫁How can RSV be prevented?🫁

✅Regular washing of hands with soap and water.
✅Teaching kids proper coughing and sneezing etiquette.
✅Keep your child below 2 years away from other people with cold symptoms during the RSV season.
✅Wash toys and surfaces that have come in contact with children with symptoms of a cold.
✅Discourage other people from kissing your baby.
✅Don’t expose your baby to second or third-hand smoke.
✅Try to breastfeed as long as possible.

🫁Is there a vaccine against RSV?🫁

There is no vaccine to prevent RSV, but there is a medication called Palivizumab (Synagis) that may prevent severe LRTIs in children.

It contains virus-fighting antibodies. This is not a vaccine, but it’s an injection given once a month throughout RSV season. This medication is highly costly and is only indicated for children with an extremely high risk of contracting the disease.

High-risk children are infants born prematurely and who are 6 months of age or younger at the beginning of RSV season, as well as babies with lung and/or heart disease.

In South Africa, the injections are usually started in January till around June.

Scientists are working toward developing a vaccine for RSV, but right now, no vaccine for the illness is licensed anywhere in the world.

🫁What are the long-term effects of RSV?🫁

Unfortunately, being infected once with RSV does not protect the child from contracting it again.

Some children with complicated RSV continue to have recurrent respiratory symptoms throughout childhood due to lung tissue breakdown and inflammation. It is estimated that of children admitted to hospital with RSV, almost a third will still suffer recurrent wheezing episodes 10 years later, which may be mistaken for asthma.

RSV can be severe, and it's important to remember that it's okay to say no to an invitation if you're not feeling well or reschedule if a prospective guest tells you they've got a little cold. Sometimes, minor colds can turn into big problems for little babies.

🫁Could it be COVID?🫁

Unfortunately, some of the symptoms of COVID and RSV overlap. Since a virus also causes COVID, it may also cause bronchiolitis. The only way to tell the difference is to have your baby tested.

30/07/2021

Numbness, tingling or weakness in your hand/s.

It could be caused by carpal tunnel syndrome. This happens when there is pressure on the nerve which runs the length of the arm, and goes through a passage in the wrist called the carpal tunnel.

Inflammation causes swelling in the wrist, which narrows the space in the carpal tunnel. This could be due to an underlying medical condition such as diabetes, thyroid disorders, high blood pressure, fluid retention from pregnancy. Or it could be due to repetitive overextension of the wrist as a result of positioning of the wrists while using the keyboard or mouse or prolonged exposure to vibrations from using power tools.

You may first notice that your fingers “fall asleep” at night. You may wake up with numbness, tingling and pain in the hand that travels up the arm. As the condition gets worse you could start dropping objects.

Treatment options include lifestyle changes, such as taking breaks or doing less of the repetitive activity causing you pain; exercises - obtainable from your physio; wearing a splint to keep your wrist from moving to lessen the pressure on the nerves; medication; and surgery as a last resort if no other treatments have worked.

For many people with tingling, pain, or numbness in their fingers, carpal tunnel syndrome is the first thing that comes to mind. It’s a common condition, but it’s not the only thing that can cause problems in your hands and wrists. An evaluation done by the physio will determine whether there may be another factor causing your symptoms, such as nerve compression in the neck.

Image by Kate Hliznitsova on Unsplash

19/07/2021

Croup is a viral infection that causes swelling in the windpipe (Trachea) in the area of the vocal cords that results in noisy breathing and a barking cough. The typical cough is described as sounding like the bark of a seal. The illness can start with a wet “snotty nose” for a few days and

16/07/2021

I might not even have 99 problems but fretting about a vaccine that should actually be a no brainer is also not one. JUST VACCINATE!

05/07/2021

Recurrent ankle sprains

Ankle sprains are common injuries. The most common type of ankle sprain occurs when the foot rolls in underneath the leg causing tearing or strain to the ankle ligaments and resulting in outer ankle pain, swelling and bruising. Ligaments will normally take 6-12 weeks to fully heal. The length of recovery however can differ due to the severity of injury.

When a ligament tears or is overstretched its previous elasticity and resilience rarely returns.

The biggest reasons for recurrent ankle sprains are inadequate healing or a poor rehabilitation in balance and ankle postural control after an initial sprain. Without this the ankle can give way often, further stretching and straining the injured ligaments, leading to chronic ankle instability and recurrent strains. Returning to sport too early can compromise sufficient ligamentous repair.

It is recommended that all patients undergo conservative treatment to improve stability and improve the muscle reflex and strength of the lower limb stabilising muscles.

Balance and ankle postural control retraining involves performing exercises that test and improve your balance and ankle stability. This helps to promote ligament healing, joint stabilisation and ankle position sense. Stability exercises that are targeted to individual activities help strengthen the ankle for return to sport, reducing the risk of recurring ankle sprains and the development of chronic ankle instability.

01/07/2021

Dry needling for sinusitis?? Really??

In sinusitis there is inflammation of the lining of the sinuses, which results in the accumulation of mucous. Sinusitis commonly occurs after a viral infection, but can also be caused by seasonal allergies or lifestyle factors like smoking.

Most people with sinusitis complain of pain, a stuffy head, pressure around the eyes, blocked ears, fever, headache and a post-nasal drip.

All of the above-mentioned symptoms can be alleviated using dry needling by giving pain relief as well as providing an anti-inflammatory and vasodilatory (increasing blood circulation) effect. Needling also releases the body’s own opioids, which increases your feeling of wellbeing.

What can you expect?

Needles in your face. It sounds worse than it feels. And drainage of the sinuses usually occurs during treatment with immediate relief.

30/06/2021

How exactly does dry needling help for pain?

As mentioned in the previous post, in dry needling, the needle is inserted into the “trigger point” of a muscle. A trigger point is described as a hyperirritable spot in the muscle that feels like a nodule in a tight band of muscle fibres, often referred to as a knot in the muscle.

Trigger points occur in response to unaccustomed loading of the muscle, sustained postures or repetitive low load stress. These sustained contractions of muscle fibres compresses local blood supply restricting the energy needs of the local region. This crisis of energy produces sensitising substances that interact with some nociceptive (pain) receptors, which then produces localised pain within the muscle. When trigger points are present in muscles there is often pain and weakness in the associated structures.

Dry needling works to:

👌🏻 inactivate the trigger points by mechanically disrupting the integrity of the dysfunctional area of muscle and causes an increase in blood supply to the muscle

👌🏻 this increased blood supply releases chemicals which assist in healing the muscle tissue

👌🏻 needling disrupts the cell membranes, releasing a potential-like electrical activity, which is important in muscle repair and regeneration

👌🏻 it causes a local release of potassium due to the damage of the muscle fibres as the needle passes through, which causes a depolarisation block of the nerve fibres

👌🏻 a release of endogenous opioids (your body’s own natural painkillers) is caused through stimulation of nerve fibres which activate multiple analgesic (pain relieving) systems in the brain.

👌🏻 it is the most successful technique for eliciting a local twitch response, which signals that the needle has reached that part of the trigger point that will be most therapeutically effective.

How does dry needling feel?

Although not as painful as an injection, which uses a wide diameter needle with a cutting edge, the dry needle has a fine gliding point and only a pin prick will be felt. This may be followed by a numbing or aching sensation. You should have an immediate effect of pain relief to a greater or lesser extent depending on your reaction to the needles.

It is possible that you may feel drowsy after needling, but this usually subsides relatively quickly.

Post treatment protocols can differ, but it is clear that movement of the needled muscle is critical. Normal movement of the newly released muscle must begin as soon as possible to combat poor movement patterns and adaptive behaviours. Movement and stretching should be done, and heat can be applied for post-treatment soreness.

28/06/2021

Dry needling vs acupuncture

We often get asked whether we use acupuncture in our practice. The answer is no, we use dry needling. So what is the difference?

Both acupuncture and dry needling use thin, stainless steel needles. For both, needles are inserted into the skin and both claim to treat pain. But that’s where the similarities end.

✨ Acupuncture is an alternative treatment designed to relieve pain, discomfort, or issues by opening up a person’s energy flow or chi.

The fundamental belief of acupuncture is that illness is the result of blocked or interrupted chi. Chi provides your body with healing energy. Acupuncture seeks to remove these blockages and return your energy flow to a state of balance.

✨ Dry needling is designed to stimulate trigger points, or muscles that are irritable. During dry needling, a practitioner inserts fine, short, stainless steel needles that don’t inject fluid into the body. That’s why the term “dry” is used.

Practitioners place the needles in “trigger points” in your muscle or tissue. The points are areas of knotted or hard muscle.

The needle helps release the knot and relieve any muscle pain or spasms. The needles will remain in your skin for a short period of time. The length of time depends on the practitioner.

✨What are the side effects or risks of dry needling?

The most common side effects around the needle site include bruising, bleeding and temporary soreness.

It rarely is a standalone procedure, and is part of a broader approach, incorporating other traditional physiotherapy interventions into treatment.

The needles do not feel the same as an injection, and even some of the most needle-phobic people have tried it and lived to tell the tale....

Pic by Katherine Hanlon on Unsplash

08/06/2021

Why is chest physiotherapy done and what to expect?

Chest physiotherapy is a group of physical techniques that improve lung function and help you breathe better. It expands the lungs and helps loosen and improve drainage of thick lung secretions (phlegm). The techniques we use are:

🗣 chest percussion, which helps to loosen the phlegm. Percussion involves striking the chest wall with cupped hands, this should not be painful, but may be uncomfortable at worst.

🗣 vibration involves placing the hands against the patient’s chest and creating vibrations by quickly contracting and relaxing. Overpressure is applied at the end of the vibration to encourage a reflexive and deep counter-inhalation(deep breath in), which helps with lung expansion and improved ventilation.

🗣 postural drainage, which involves positioning and turning from side to side to help improve lung expansion and drainage of secretions. Gravity will encourage drainage.

🗣 suctioning to remove secretions that can’t be coughed out. This is the worst part of the entire treatment (ask any parent who’s child has been through physio treatment). We usually only suction children under one year of age, (or older children that have excess phlegm) as their ability to remove secretions by coughing is still weak.

What are the risks of chest physiotherapy?

Chest PT is generally safe for most patients when techniques are appropriate for the patient’s condition. The most common effect that we see is vomiting, especially with suctioning, which is why parents are asked to refrain from giving their child anything to eat or drink for about an hour before treatment.

Chest physiotherapy may be used in conjunction with expectorant medications and a nebuliser to help loosen secretions.

We are the physios to Bloem MomDoc’s kids, seen here when they were still babies.

07/06/2021

What is referred pain?

Ever heard this being said, but unsure what exactly it means?

It is when the perception of pain does not necessarily correspond to the source of the pain. Pain may actually arise from a local structure, but it may also be referred to that site from a structure some distance away.

An example of this is when pain is perceived in the neck or arm in patients with angina (a type of chest pain caused by decreased blood flow to the heart).

There are features of pain that suggest it is more likely to be referred:

👉🏻 a dull, aching nature
👉🏻 poorly localised
👉🏻 deep-seated
👉🏻 movement from point to point
👉🏻 less local tenderness than expected
👉🏻 a failure to respond to local treatment

Referred pain is fairly common, and unless this is recognised, treatment will be unsuccessful.

Image from pixabay

04/06/2021

Speaking of shoulder pain...

One of the most common causes of shoulder and arm pain is rotator cuff impingement.

Shoulder impingement occurs when the rotator cuff tendons are impinged (pinched) as they pass through the space formed by the bones and acromioclavicular joint above and the shoulder joint below. The impingement causes mechanical irritation of the rotator cuff tendons, resulting in swelling and damage to the tendons.

Rest and NSAIDs (non-steroidal anti-inflammatory drugs) can help in conjunction with rotator cuff and periscapular treatment and strengthening. A corticosteroid injection into the joint space can be used as a last resort. But the correction of associated abnormalities needs to be addressed, or the pain will be recurring.

Image from pixabay.

03/06/2021

Shoulder pain

There are many different reasons for shoulder pain that can be caused by injuries affecting the joints, muscles, ligaments, tendons and cartilage.

In order to determine the cause of your pain your physiotherapist will conduct a full evaluation of the shoulder, neck and upper back.

Regardless of the cause, treatment of the shoulder complex requires an experienced physiotherapist who can test the movements and structures of the shoulder and come to an accurate diagnosis of the problem. Treatment can then focus on the core problem.

We will be able to assist you with suitable shoulder range of motion exercises and shoulder strengthening and rehabilitation exercises during your recovery.

Please contact us for your comprehensive shoulder assessment. We look forward to hearing from you!

Image from pixabay

01/06/2021

Come see us for an evaluation if your child is W-sitting.

🐒W-sitting🐒

I corrected a child’s sitting the other day, and people looked at me with a question mark expression. Kids have been W-sitting for decades, but child development experts have warned that it is actually detrimental to a child’s development.

🐒What is W-sitting?🐒

This is a common position in which some children like to sit on the floor. They sit on their bum, with their knees bent and rotated inwards, so their lower legs and feet are on the floor beside them. If you look at the child from the top, it forms a W shape.

This may look like an uncomfortable position to an adult, but children are much more flexible than adults, so this is actually a very comfortable way to sit,

🐒Why do kids W-sit?🐒

W-sitting is an easy, stable position for a child to sit. It leaves their hands free to play, and they don’t have to work hard to keep their balance.

Children with low muscle tone, decreased balance, and core muscle control, usually prefer to W-sit.

🐒Is it okay if my child only does this occasionally?🐒

W-sitting is developmentally appropriate, and all children will sit this way in their life, especially around the age of 3 years.
Problems, however, arise when children start sitting this way for extended periods. Children form habits very easily, so preventing them from forming the habit is much easier than breaking the habit once it has formed.

🐒Why is W-sitting bad?🐒

Since it is an easy way to sit without using their core muscles, it may have many negative effects.

🪑It may delay the development of their core muscle control and stability. This may cause delayed development of fine motor skills and mature movements necessary for later skills. They usually rotate their trunk less, so they don’t often cross the midline. This will cause delays in their fine motor development to later be able to cut with a scissor, write neatly, and even tie their shoelaces.

🪑Since the hips are rotated excessively, it may tighten some and stretch other muscles around the hips, causing balance and coordination problems when older. If your child prefers walking on their toes or with their feet turned in, this needs to be investigated further since it may be due to the tightened muscles.

🪑When a child sits normally, they constantly have to shift their position and turn their bodies to play. Children sitting in a W-position for too long makes them reliant on a wide base of support, and they need to shift their weight around less. They also rely less on their core muscles for postural control.

🪑W-sitting can also lead to poor posture later in child- and adulthood, leading to back and hip pain.

🪑This way of sitting can prevent the development of a hand preference. They can’t turn their trunk effectively, so they prefer playing on one side or only use one hand on the same side. This may lead to coordination problems in the future.

🪑W-sitting can cause the hips to prefer to remain in rotation, causing an abnormality in the way they walk.

🪑Children diagnosed with hip problems like hip dysplasia should be discouraged from sitting this way, as it may increase the risk of hip dislocation.

🐒Can it be a sign of other problems?🐒

If your child constantly falls, is clumsy, has delayed motor milestones, poor posture, and prefers to W-sit, consider seeing your paediatrician for an assessment. Occupational therapists and Physiotherapists can also assist with an assessment if you are worried.

🐒What is the best way for my child to sit then?🐒

🦵Cross-legged – try to teach them to alternate the leg going on top as well.
🦵Side-sitting – In this position, they are seated with their knees bent and both feet at the same side.
🦵Long-sitting – both legs straight to the front
🦵Sailor-sitting -both knees bent with their feet touching.
🦵Kneeling or squatting

🐒How can you prevent W-sitting?🐒

This takes a lot of work from your side. You need to constantly make them aware they are sitting in this position when you catch them doing it. Have a verbal cue that makes them aware, like: “sit nicely” or “feet forward.”

Show them other ways of sitting, like crossing their legs or sitting with their legs straight. After showing them a few times, the verbal cue will be enough.

Explain to your child why you don’t want them sitting in the W-position. Tell them it builds strong tummy muscles so they can play even better.

Try to keep it positive. Make up a song, tickle them or blow a whistle. Your child will respond much more to positive acts.

🐒What if my child is already W-sitting often?🐒

W-sitting quickly becomes a habit since it’s much easier for your child to sit this way.

You will need to find activities to strengthen your child’s core, and you can achieve this by allowing them to play as much as possible outside. Allow them to climb, kick and hang as much as they want. Balancing on a balance beam or even just playing some Twister can motivate them to use those core muscles and rotate their trunk.

If there is no improvement In your child’s core strength, consult with a physiotherapist to assist.

Use verbal cues as mentioned above, and expect some resistance at the beginning. Praise your child when you catch them sitting in the correct position.