Children's Health,  Share A Story

Guest Blog: Children’s Postural Awareness for Parents

The last of our guest blogs for National Share A Story Month comes from Roberta Cardoso, a Physiotherapist and author of Physiotherapy Today. Roberta has kindly offered to share her story and some great advice with us regarding children’s posture and the importance of getting it right early to avoid complications later in life.

Children’s Postural Awareness for Parents by Roberta Cardoso

Before we explore posture in children, I wanted to share with you a little about myself. I was born in Brazil but raised in America from the age of 14. Here, I graduated with an A.S. degree in Exercise Physiology. I loved sports so started competing professionally in triathlons and adventure racing. In 2008, I moved to Britain to study Physiotherapy, graduating with honours from Manchester Metropolitan University.

I always wanted to become a physiotherapist since I can remember 😊. In high school I participated in every sport there was competitively, enduring a few injuries on my ankles, and I used to spend a lot of time in the Athletic Trainer’s room (they were rehabilitation trainers but not physios) doing rehab for my injuries. I did learn a lot during that time but also the experience helped me want to become a physiotherapist even more.

I started my training in neuro physiotherapy in 2013 and I see both adult and children in this setting. I am glad that I do because if I only saw just adults or just children, it would take me many years more to understand how early child development (i.e. learning to sit) can affect how people carry their posture in adulthood.

Last year, my mom told me that as a child I had suffered with a left hip click and that I had worn special shoes as a toddler to help. This helped explain some of the injuries I had picked up over the years.

I can see from my personal experience with my son, who has a very mild case of left hip clicking, how this is affecting his posture and how he uses his body on a day-to-day activity. I picked up my son’s hip clicking while still in the maternity ward. I was not offered a paediatric assessment until I demanded it.

Doctors were not concerned with the hip clicking and didn’t offer any x-rays. At the age of 12 months the hip was still clicking so an x-ray was done by my demand. Again nothing showed, but it didn’t mean he didn’t have something biomechanically different from right to left hip. I kept observing his development and his left hip was always less effective. He had his first paediatric physiotherapy session at age 18 months, they didn’t seem worried even though his left foot was rotated inwards when walking.

Today he is nearly 3 years old, and is complaining of knee pain when running. I work with him everyday, but I do feel there is something more going on as a mother and as  physio. But because he has been through physiotherapy sessions,  as a mother,  I have let it go a bit after I was told not to worry by his paediatric physio. However, as a physio, I know even this slight issue can cause other problems. So I tried to find a good balance in my heart and head between being the mother and a physio. I think this has helped me be even more observant but also act on demand with him. His left hip tightness may lead to back pain at some point in his adult life. So we stretch and play every day and now it is a routine. He has more good days than bad days.

Seeing highly disabled children and the gap in their abilities, has made me analyse what is missing in our day to day life today that is different from our day-to-day life in 1980’s which is not long ago. But also in the 60’s which reflects our parents time (if you are nearing 50 today😊). You probably heard of your parents saying you weren’t allowed to sit on the sofa in the evening when both parents were in while watching TV. You sat on the floor. Children were told to sit up straight, and you may also of heard your grand parents saying that in their preschool class there weren’t any tables and chairs.

Most jobs were of a manufacturing nature, involving a daily amount of standing, lifting, carrying, pushing and pulling. Housework activity was primitive until not long ago and very manual. So all those comments made by my own patients on my clinical days meant I was listing and creating this theory that we need to sit less to be healthy individuals again.

Think of the primitive man, woman and children; they climbed trees, squatted for the toilet, they ran, walked, sat and slept on the floor. At any time of their active life, they were using 100% of their joint range of movement. In our sitting culture today we use 25% to 55% of our joint range of movement capacity, and the primitive man, woman and child didn’t even have stairs!

I have had many cases where knee pain is the main concern, then ankles and then hips. Most of the time the knees will take most of the strain because it takes most of the shock absorbing from running and jumping. Ankle pain I see a lot of because of poor shoe support and also because of the knee pain itself. When the knee hurts, the hip or ankle will compensate, often turning knees and feet in or out. One case was related to a child having knee pain for 12 months. The preferred position was W sitting (this is where a child will sit with the knees bent and their feet will be resting by the side of their hips). Many kids adopt this position, simply because they are flexible and they can.

However, after minimising the behaviour of sitting in W shape and exercising the core, the pain improved considerably. This would be a long-term commitment from a parent with a child to maintain the good posture in check. By the age of 2, physical behaviours have been engraved in their ways of moving, and by age of 7 or so, it is more complicated to make changes if both parents and child aren’t committed. This is because we will be dealing with growth spurts and every time there is growth there is change in muscle length which creates an imbalance.

When bad postural behaviour is in place, growth spurts (a natural occurrence) can enhance the problem and carryover even after they stop growing. So it is important to keep up with the program and review especially if the child is sporty or very active.

Exploring Childhood Posture Positions

I have put together some key information below explaining different posture positions children adopt. I have also highlighted in this information what is a ‘good‘ postural position and what is considered ‘poor‘ posture that could result in later issues in young/adult life.

Sitting Posture

Toddlers will inevitably adopt a slumped posture when sitting. It’s when the back rounds and bows back and the shoulders will round and point forward. This slumped sitting may turn into a comfortable posture but will lead to back, shoulder and neck problems in periods of growth and even into adulthood. There is also a higher risk of muscle imbalance leading to hip, knee, and ankle problems.

There are ways to help your child learn to use the correct posture while playing and sitting. When the child is guided early in their lives, i.e. when they are learning to sit and play simultaneously, this process is easily accepted and seamlessly progressed by the child as they grow older. However, if trying to change a toddler’s posture after they have used the incorrect one for a while or even a couple of years, then careful considerations must be taken into account.

To help encourage children to change their posture you should use of regular and same sentences to guide them into a different posture, this is very important for consistency or you can physically support your child to change his or her posture every time they adopt a poor stance, until they can do it for themselves automatically. Either way, I would recommend using verbal cues with any passive changes to their posture.

Remember to use soft caring voices and avoid telling them off as this could make them feel they are doing something wrong. It might be the wrong posture they could be adopting but it doesn’t mean they are doing it on purpose. Think of it as a training program, like sports classes where they are reminded but not felt as if they are wrong. Taking those into consideration, will help you progress their learning as they grow older and experience growth spurs.

You know your child better than anyone to know how to best introduce changes. It needs to be gentle and repetitive, encouraging and consistent by the parent. You can also ask nursery staff or school teacher and assistants to guide them when they spot your child using incorrect posture.

Putting Shoes On

Toddlers may develop poor posture due to prolonged sitting hours in their day to day lives. Sitting can be accounted for meal times, school, playing, and screen time. If we are not watchful, poor postural behaviour can lead to poor functional activity, such as putting the shoes on.

Will they choose the most core challenging way or the easy way? In the correct picture, lifting the leg up for fitting the shoe, will challenge their sitting balance, core stability, flexibility and keeping the hip joint from tightening.



In the incorrect picture, the foot is brought to the side of the hip, as in the W sitting position. This does not challenge the core, in fact, the core is not needed in this position due to the lean forward and hand resting on floor.

This leg movement will shorten the hip joint as it internally rotates the hip. This can lead to core instability, back pain and knee pain problems if consistently used.

If you think how many times a child puts their shoes on per day, take this functional activity as a practice for good habits and challenging the core to maintain healthy posture for life.

Safe Postural Playing

Toddlers will inevitably adopt a W position when sitting. This is when their knees are bent and instead of their heels being under their bum, they are turned out and resting to the sides of their hips.

This W sitting position may cause hip, knee, and ankle problems and pain growing up. There is also a higher risk of muscle imbalance leading to joint problems later in life.

There are ways to help your child learn to use the correct posture while playing and it is important that this is introduced early in their lives.

If trying to change a toddler’s posture after they have used the incorrect one for a couple of years already, then careful considerations must be taken into account and much like the ‘Putting on Shoes’ example, it is important to use repetitive language and help them adopt the correct position until they can do so for themselves.


Thank you so much for sharing this with us Roberta, some fantastic advice, which actually probably answers some questions around my own back pain… I’m tall for a woman 5:10, and my posture is bad, not to mention my poor core strength after two babies. But reading all of this kind of explains why I have lower back pain and stiffness if I over exert myself. Thank you so much, I will definitely be keeping a beady eye on my babies posture, and listen to them if they complain about any pain in there joints.

Roberta can I ask… One of my boys (almost 3 years old) is extremely hypermobile and the W sitting position is something I am really struggling to tackle so your advice is really helpful. Are there any additional things I should be considering or tips you have for supporting children with Hypermobility?

Hypermobility is a condition that we see quite a lot. This can lead to instability even into adult life. Hence, it’s important to be checked early and maintain a very good monitoring program to help the muscles to grow balanced with each growth spurt. At the age of 3, I would suggest to keep him active, teach the way to sit during play, screen and meal times, encourage crawling when playing cars, play in kneeling and do swimming as a sport. However, if he is experiencing pain then we need to have a full assessment to identify the problem and create a tailor-made program for you to work with him. I try to make sure that any physio activity is introduced during their play time, as a way to help them use a different posture during playtime. A posture that will enhance the core muscles rather than inhibit them. This way they won’t feel like they are being told to do physiotherapy.

If parents are struggling with any issues regarding posture, where can they access help and support?

Always refer to your GP first. They will be the first line of experienced professional to identify any underlying condition to your concern. If they feel there is no major concern and refer to physiotherapy, then if you want clear advice during the waiting time I am happy to help and would suggest that you continue the referral to physiotherapy given by your GP. If nothing has been advised, but you are still concerned, even the slightest of thing, feel free to get in touch for a chat and I ‘ll be glad to guide you at the best of my capability.

There are other postural related topics that I would like to cover, such as, sitting at a desk, studying time and prolonged sitting, back-packs, shoes,  what to look for in your child’s posture when they are doing sports and many more. More updates will come on my website blog, Facebook page, Linked, and Twitter. If you sign up, all these free tips will available to read.

Thanks Roberta, we will add the links at the bottom of this page.

One final question from us… Do you offer a private service for anyone potentially interested?

I do offer private sessions at the comfort of your home in Cheshire and the Manchester area. However, during a video call beforehand, I can help the parent observe the child’s posture and help them with simple tips free of cost. If things aren’t improving I’m happy to come in for a session. I find working at the child’s environment is easier for the child and less intimidating allowing me to analyse the child within their own ways, ( i.e. how they sit in the sofa, how they play on the floor, how they get up etc).

Thanks again for sharing this with us Roberta, it’s extremely informative and I will certainly be taking it on board! For anyone who would like to find out more about Roberta and her work then the links mentioned earlier are below.

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