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What You Should Know About Supportive Sitting
Sitting is key part of a childhood development, opening a world of opportunity that enables learning, interaction, and independence.
Parent HubWhilst independent sitting might not be achievable for all, the opportunity to sit should always be promoted as early as possible. Sitting offers the child their first opportunity to be upright and have their arms free and independent to move and interact as they wish. Sitting upright opens a whole new world of opportunity, which promotes the development of physical, cognitive, perceptual, and sensory skills.
However, the ability to sit upright is made tough by gravity acting downwards on the body. This makes it really tiring and very difficult for children with impaired muscle control and strength to sit upright without some form of external support. This is where specially designed seating supports can be really useful!
What Is A Seating System?
A seating system is a piece of equipment that can support an individual sit upright. They come in all sorts of shapes and sizes, but each is designed to provide postural support in a variety of ways, based on the activities it is being used for. The child’s individual postural needs will also play a part in determining what type of seat is needed.
There are a wide variety of supportive seats, and the exact type and shape will depend on the child’s age and needs. In typical development, children start sitting on the floor with a wide base of support, legs out in front, knees bent, feet touching - this is known as circle sitting. They quickly progress to long sitting, another stable posture with legs straight out in front in a V-shape. It is important to support children down on the floor in these positions, as it provides an opportunity to play and interact with siblings and peers as well as an opportunity to learn how to transfer into and out of each position.
When children reach preschool or nursery school age, a more traditional seated position, with feet under knees, is helpful to enable tabletop activities. Supportive seating can either be a range of different parts, such as cushions and back supports which fit on a wheelchair base, or they can be a complete system, which can adjust and grow with the child. Again, the type and complexity of the supportive seat will depend on the child’s ability to transfer in and out, and the amount of support required to stay upright. Here are a few examples:
What Makes A Seating System Support Posture And Play?
Depending on the type of seating system used, there are typically a wide range of adjustments that can be made to support posture and promote activity.
Some of the key features that you would tend to find on a modular seat can be seen labelled below.
Top Tips To Make The Most Of Your Seating System
As a starting point, we always recommend asking your occupational therapist or physiotherapist for as much advice or information as possible.
This will be your best source of information on how to use the chair to its full potential, as each chair will have been set up to suit your child's individual needs.
We've put together some tips and recommendations, but if in doubt, always reach out to your child's clinician.
Transferring In And Out (Lifts & Hoists)
If you are lifting or hoisting in and out of the chair, it is best to have the chair in tilt, so that the bum can get right to the back of the seat.
Transferring In And Out (Standing)
Standing transfers can be helped by tilting the chair slightly forward. The footplates should also be flipped up and out of the way.
Using The Tilt Functionality
Tilt on a chair refers to its ability to orientate or pivot in space. This helps to remove the effects of gravity, which makes it easier to keep the head and trunk from collapsing when sitting upright. Tilt can also be great for relaxation, as it distributes weight across the body more evenly.
Work with your clinician in determining what level of tilt is best for your child. Remember to consider how tilt might affect vision and communication - if your child is tilted too far back, it might impact on some tasks.
Checking Shoulder Positioning
Keep an eye on where the shoulders meet the backrest. They should be at the same level each time.
Checking Lateral Positions
There should be at least two fingers worth of space between the top of the lateral and the armpit. Any less than this might mean that the child has slid down in their chair.
Checking Armrest Positions
When the child is sat upright, the armrest should come roughly level with the forearm when the elbow is bent to 90 degrees. If the forearm is left unsupported, this can encourage the child to lean to one side or slide down the chair to get support from the armrest.
Checking Leg Positioning
Generally, there should be 2 fingers worth of space between the back of the leg and the edge of the cushion. Any more than this might mean that the child has slid forward and their thighs are unsupported.
Checking Pelvic Belt
The pelvic belt needs to be firmly fastened, but it should still allow your hand to slide beneath it with some ease.
Would you like more advice on how to review the fit of your child's seating system? Download our Seating System Assessment Poster at the link below:
5 Common Questions About Supportive Sitting
Got questions about supportive sitting? Here are some of the most common questions we get asked.
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How long during the day should a supportive seat be used?
Depending on the child’s age and their daily routines, a supportive seat may be used for the majority of the day. This is especially true for powerchair users. It is important that frequent breaks are structured into the day where your child can stand, walk, bathe and play, to stretch and strengthen growing muscles and provide normal loads to developing bones.
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How old should a child be before using supportive seating?
Supportive seating should be prescribed as early as 6 months of age. This is to align with typical developmental milestones. Remember that early seating is important, not just for gross and fine motor development, but the hidden skills too like perceptual, cognitive and sensory development too.
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Why are my child’s feet strapped down?
Think about yourself if you were ever sat on a barstool with your feet dangling and unable to reach the floor. This posture quickly becomes very unstable.
Children’s feet are often secured to the footplates on a wheelchair or seating system for many reasons - the top two are for safety or comfort. If the child has uncontrolled movements, securing the feet will prevent them hurting themselves. Securing the feet also improves positioning by helping to prevent the bottom from sliding forward. Finally, it encourages more weight to be taken through the feet.
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How do I know if my child need reassessed for a seat?
Here is a handy guide which will guide you whether your child’s seat needs re-adjusted for growth or they need reassessed for a new seat.
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Does my child need a pressure relieving cushion?
Luckily most children do not have pressure issues because they change their position frequently. All cushions will provide some pressure relief, and the greater the cushion contours to the shape of the bottom, the more pressure relief it will offer. If you have any concerns about your child’s skin, ask your clinician for an assessment.
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Firefly
The Firefly range of portable products are all about participation. These posturally supportive products are clinically sound, practical and fun, ensuring children with additional needs can take part in everyday life. As well as products, Firefly facilitates an online community where advice and experiences are shared between parents, therapists and charities.
