Positioning

 Positioning is a word used by therapists to describe the posture or position of the body that best enables a child to achieve every day activities, such as eating, playing and sleeping. Just imagine the number of positions and postures you use in your daily life. Imagine if you had to do everything in your whole day sitting in one position. We all need to change our position during the day, depending on the activity we are doing, and our comfort. Some children with a disability may be unable to change their own position, and so positioning equipment and extra help is often needed.

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Why is positioning important?

If a child is using all their energy to maintain a position, or are using their hands for support to keep their balance, play and movement can be hindered. To get some idea of what this is like, imagine trying to learn to write while lying on your back or swallowing with your head tilted back! Good positioning can:

  • challenge children to learn new skills
  • limit fatigue (tiredness) by providing extra support
  • provide pressure relief and comfort
  • prevent muscles becoming tight over time
  • allow children to mix with others and play
  • improve concentration and learning
  • improve handskills such as handwriting
  • improve breathing posture, and improve digestion, eating and drinking
  • prevent pain and discomfort.

Disclaimer: General information only - you should consult with the relevant professional before using it with a particular child. See disclaimer details.

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Things to consider when choosing positions

Therapists work with children, carers and their families to work out the best way to use different positions and equipment for activities. A number of factors may need to be considered, for example:

  • goals of the activity – some activities require more supportive positioning than others, for example handwriting, as compared with just watching TV
  • time of day – some children may be more tired towards the end of the day, and may need more support
  • location – such as school, childcare
  • the child’s abilities - for example, how well the child can sit on their own
  • muscle tightness and range of movement
  • lifting and handling – some children may need extra help to get into certain positions and it is important that they can do this safely.
  • comfort and pressure -  Physiotherapists often recommend a position change during the day to prevent pressure sores, muscle tightness and discomfort. This is especially important for children who cannot shift themselves around when they become uncomfortable
  • health or medical issues - for example, a child with reflux may not be able to lie flat on their back.

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Positioning equipment

There are lots of different types of positioning equipment. Some common ones include:

Drawing - child standing in a standing frame while doing some drawing. Standing frames - These can be a good way to get some weight bearing for healthy bones, while also stretching many leg muscles.  Children can use standing frames for activities when other children are standing, providing them the chance to be at the same level as their friends.

Drawing - boy sitting in a corner chair playing with a toy. Corner chairs - These are useful for stretching the muscles behind the knee (hamstrings). They allow children to be well supported when they are sitting on the floor.

Drawing - boy lying face down on wedge, feet toward the lower end. Floor wedge - Tummy lying (prone) over a floor wedge is a good way to stretch the muscles at the front of the groin, (hip flexors) and the spine. This position works the muscles that help to maintain head and trunk posture.

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Positioning to prevent deformity

Children with some disabilities develop muscle tightness or deformity as they grow due to:

  • spending longer periods of time in certain positions
  • spasticity or increased muscle tone
  • growth – bones growing more quickly than muscles
  • limited active movement
  • children being unable to move themselves or ‘stretch out’ on their own.

Positioning can help to manage muscle tightness and deformities. A physiotherapist will be able to advise on the best positions to use.

Positioning to help a child to play and move

Positioning and the use of positioning equipment can provide many different opportunities for play and movement. Speak to your child's physiotherapist and occupational therapist for ideas on how best to position your child for play.

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Positioning when sitting in and using a wheelchair

Good wheelchair positioning will improve:

  • the comfort of the child
  • the general health of the child
  • how well the child uses their wheelchair
  • how well the child uses their hands and eyes
  • how well the child communicates
  • how well they use equipment such as a communication device or computer when sitting in their wheelchair
  • the safety and comfort of the child when eating and drinking.

View the factsheet  Positioning Tips for Wheelchair Users (PDF - 125Kb)

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Positioning at school

The physiotherapist and occupational therapist work closely with the child, their teacher and carers. 

Physiotherapists can provide information and support around how best to position a child to access the curriculum at school. Positioning and the amount of physical support needed will be different for every child, and will depend on the demands of the activity. For example, a child may not need much support when sitting and listening to a story, but may need more supportive seating when doing handwriting.

The physiotherapist or occupational therapist may suggest equipment to assist the child to access the curriculum, such as a special chair, or a slope board.

Drawing showing child in good sitting positioning when eating.Positioning for mealtimes

Read information on this topic on the Mealtimes page.

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Transfer and Positioning Care Plans

The physiotherapist can provide a Transfer and Positioning Care Plan (TPCP) for places such as schools and childcare centres, outlining the safest and most practical way to position children.
View the factsheet   Transfer and Positioning Care Plans (PDF - 50Kb) 

Send an on-line message to a Novita physiotherapist OR complete a   Transfer and Positioning Care Plan Referral form (PDF - 49Kb)  if you think a Novita client needs a TPCP.


Disclaimer Detail: The above information on is of a general nature only and does not constitute advice. Novita Children's Services makes no representations, express or implied, as to the accuracy, usefulness, suitability or application of the information to a child's particular circumstances. Use of the information above is at your sole risk, and you should seek professional advice before acting or relying on the information. Novita Children's Services accepts no liability for any damages or loss that may arise from the use of, or any omission from, the information provided. In using this site, you are agreeing to the Terms and Conditions of Use for the site.

Glossary

Muscle tone

The level of tension in the muscle.

Range of movement

The full amount of movement possible in a body joint (such as the knee or elbow).

Slope board

A sloping work surface that can be placed on a desk. Many boards allow adjustment of the angle of the board.

Spasticity

The increased stiffness or ‘muscle tone’ experience by children with cerebral palsy. Muscle spasm can often be felt when such a child’s limbs are moved. The limbs are hard to bend or straighten because of the spasticity of the muscles. The doctor usually finds increased tendon jerks in a child with spasticity.

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