Positioning for Infants, Children and Youth with Significant Postural Needs

For children with moderate to severe postural needs, it is recommended that a referral to an occupational therapist and, or physiotherapist be made for comprehensive evaluation, recommendations and assistance in arranging suitable and safe equipment.  See Table 9.

Table 9: Positioning for Infants, Children and Youth with Significant Postural Needs


Postural Need


Pelvic Stability

  • Pelvic stability provides the base foundation of support in a sitting position. Pelvis should be positioned at neutral or with slight anterior tilt, with 90 degrees hip flexion

Feet Support

  • Support feet on a stable surface as this will influence pelvis and hip stability

Trunk Control

  • Poor trunk control can lead to poor upper extremity and head control. Lateral supports may assist with providing adequate trunk stability for those children that cannot independently maintain a midline position of the trunk
  • Monitor the effect of lateral supports on a child’s respiration

Head Support

  • Head support, e.g. a chair with a high back or a head rest may be required if adequate head control has not yet been achieved
  • The more upright the seated position the more the head and neck need to work therefore tilt or recline may reduce the amount of effort involved in keeping the head and neck in midline
  • Tilt is preferable as it does not change the position of the pelvis

Tray Access

  • Initially provides extra trunk support and stability, and later provides a place for forearms and elbows as the child begins to attempt to self-feed