What is Container Baby Syndrome? Should I be worried about it?
According to the APTA, container baby syndrome, is a collection of movement, behavior and other problems caused by a baby or infant spending to much time in a “container,” any commonly used piece of baby equipment that resembles a container, including:
- Bouncy or Vibrating Seats
- Baby seats
- Car seats
- Baby saucer
So basically anything your baby is strapped in, with limited movement is a baby container.
What are effects of my baby spending a lot of time in a “container”?
I am a mom, I get it, sometimes you just need to go the bathroom and cook, and you need somewhere safe to keep your baby. There are some great things out there to keep babies safe and they are convenient. However, when these pieces of equipment are used for prolonged periods of time, babies are essentially immobilized and “stuck” in one position. Being in a piece of baby equipment limits baby’s ability to move his or her body. Prolonged time in one position continuously puts pressure on the same spot of a baby’s body. Typically this is on the baby’s head. This can lead to a flat spot developing on the back of baby’s head, called plagiocephaly. Sometimes a baby tends to position their body in one way when in baby containers, keeping their head turned to 1 side. This can lead to baby having difficulty turning their head to 1 side, or sometimes even to keep their neck/head straight, which is called torticollis. If a baby is unable to move their head when in a baby container, they may have difficulty visually tracking objects, or following objects visually, which could affect development of visual skills. When babies are contained in a piece of baby equipment they can not work on important skills, such as, crawling, sitting, rolling, walking ect. Spending daily prolonged periods of time in baby containers, can contribute to delay in motor skill development. This is because the baby is not using and developing strength in their muscles the way they would playing on the floor.
As babies get older they may begin to use baby saucers, walkers and jumpers. While these types of equipment do not put pressure on the head and restrain babies as much , they can have other implications. Often babies are put in these pieces of equipment, before they are able to stand in their natural environment themselves and before they are ready to stand. When positioned in these types of equipment, babies are typically on their toes. This leads to strengthening of a babies calf and thigh muscles. Babies also need to develop muscles of hips and glutes to be able to crawl and come to stand themselves. Also, it is essential for babies to develop core/trunk muscles. Being in these baby containers, their trunk is supported and they are not using those muscles. The “slings” put baby’s hips and legs in an awkward position, that is not part of typical position of standing or walking. When babies are in these pieces of equipment they can not see their legs and feet, making it difficult to develop understanding of coordination. Being on their toes, thrusting back and extending their body is often how they are able to move in this type of equipment This is the opposite of what you want to see when a baby is learning to stand and walk. Baby walkers, also are dangerous. Babies can fall down the stairs in them, and reach items they otherwise wouldn’t have access to at all. The American Academy of Pediatrics has pushed to ban baby walkers due their danger.
Where should my baby spend their time?
To limit the effects of ‘Container Baby Syndrome’ encourage floor time and tummy time play when baby is closely supervised and awake. Use a baby container intended to transport baby safely , such as car seat and strollers, only when actually in transit. Remove your baby from their car seat when you reach your destination, versus carrying baby in car seat and leaving baby in car seat in home.
Let’s be practical, I’m a busy mom and I need to use these baby containers…. A Mom’s Advice
Consider alternatives such as:
- Baby Wearing: Baby wearing is a great alternative to putting baby in a container. One the biggest reasons that parents use baby containers is because it is convenient. Baby wearing is a very convenient way to complete many daily tasks, while keeping baby safe and comfortable.
- Floor Time Play: When supervised and awake floor time play is the best place for baby to play.
- Pack and Play or Play Yard: These give babies some safe boundaries for floor time play.
What I always say to parents, is look at your intent. What is your intent of using baby equipment? If your intent is to put your baby safe somewhere for 5 minutes when you use the bathroom, that’s fine. If you are using a container with the intent to help with your baby’s development, it won’t. A study done in the Journal of Developmental Behavioral Pediatrics, showed that babies who used walkers, crawled and walked later than babies who didn’t. Back in the 1970’s when I grew up, 1 in 300 babies had a flat spot on the back of their head. Now, with the increased use of baby containers, 1 in 6 babies have flat spots on the back of their head.
How to get started with tummy time and preventing flat spot on back of head:
Tummy time should start from when babies are newborn. Start with a few minutes as tolerated, a few times a day. Gradually increase time as tolerated. It’s easier if you make it part of your daily routine. For example, after bath, roll baby onto their belly as you dry them off and put on their lotion. When you are sitting watching tv, have your baby lie on their belly over your legs. Or lay on your back, placing baby on your chest, having your baby lift their head to look at your face. ( Don’t do this if you are tired yourself, as you don’t want to fall asleep with baby in this position). A good time for tummy time for newborns is after nap and diaper change, when they tend to be in a happy good mood. While playing on the floor, place toys around baby , motivating them to lift and turn head to different directions.
In addition to tummy time, and limiting use of baby containers, there are some other ways to help reduce chance of getting a flat spot on back of your baby’s head. Switch the way your positioning your baby when feeding. Babies who mostly breastfeed, typically switch sides that their heads are turned to. When bottle feeding, be sure to switch sides you hold baby on. Switch the way you position your baby legs/head in crib and on changing table. This way they are alternating the way they turn their head when looking at you, while laying on back.
How can Physical Therapy help?
Physical therapy can help your baby’s development. A physical therapist can show you how to position your baby throughout the day to encourage muscle strength and motor development. They can show you carrying techniques, positions for play on the floor, and on your body. They can show you simple things you can do in your daily routine of feeding you baby, changing, dressing, and putting them to sleep, that can help their development. Your therapist will show you how to safely incorporate tummy time into your daily routine. As baby develops, they will show you how to help your baby learn to roll, sit, crawl ect. They can recommend positions to play in, using common household items, or your body for support. They can recommend play activities that will encourage motor and sensory development.
Always place baby on back to sleep on a firm sleep surface that meets current safety standards according to Consumer Product Safety Commission. Follow current sleep recommendations of American Academy of Pediatrics. Tummy time play should always be when baby is supervised and awake.
Lisa Frangione, PT,DPT
Pediatric Physical Therapist
Motion Matters LLC
American Physical Therapy Association. Lack of “Tummy Time” leads to motor delays in infants, PT says. http://www.apta.org/Media/Releases/Consumer/2008/8/6/). Published 8/6/2008
American Physical Therapy Association, Move forward Guide. Physical Therapist’s Guide to Container Baby Syndrome. https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=53d90264-1846-4b86-891f-0facc63db3e8 December 10 2018.
Robinson S, Proctor M. Diagnosis and management of deformational plagiocephaly. Journal of Neurosurgery Pediatrics. 2009;3(4):284–295.
Sims A et al. “Infant Walker-Related /Injuries in the United States” Pediatrics. Sept. 17,2018
Siegel, AC, Burton RV. “Effects of baby walkers on motor and mental development in human infants” Journal of Developmental Behavioral Pediatrics. October 20, 1999 355-361.
Abbot, AL, Bartlett DJ. “Infant motor development and equipment use in the home” Child Care Health Development. May 27, 2001. 295-306.