Becoming a parent or grandparent is one of the most joyous experiences in life. Generous friends and family members shower us with baby gifts. And, we cannot resist the urge to build a perfect nest for our little birds. The result? A baby store in our living rooms.
While our intentions are great, the equipment that we have aimed at keeping our babies safe, happy and stimulated may actually cause them harm. Did you know that the over-utilization of baby equipment can lead to developmental delay, speech, sight, hearing and sensory processing difficulties, and musculoskeletal irregularities (i.e. head flattening and imbalanced muscle strength and coordination)?
“Container Baby Syndrome” (CBS) is a collection of movement, behavior and other problems that develop due to a baby spending too much time in baby equipment that resembles a “container” (e.g. car seat, swing, stroller, rocker, nursing cushion, vibrating chair). A "container" is any piece of baby equipment that keeps the baby locked in one position, which is typically flexed and reclined with container walls reducing the visual field. While in this position, the baby lacks the opportunity to strengthen her neck and the muscles on the back part of her body. Being in this position more frequently than in other positions (e.g. on tummy, sidelying or being held) results in muscle imbalance. The baby may likely have difficulty meeting age-expected milestones starting from lifting her head. She also has less motivation to turn her head because the container walls typically reduce the visual field, which hinders the development of peripheral vision and neck strength. This lack of freedom to explore and learn from her surroundings visually and physically promotes weakness as the baby does not practice weight shifting, rolling, kicking and hand/eye coordination as she would if given freedom on a flat surface.
Often you can tell within a few months of age that a baby needs more time in alternate positions, especially on her tummy or on her side. Namely, when a three month old is placed on her tummy, she should be able to lift and hold her head hold for 5+ seconds. By four months old, she should be able to hold it steadily at 90 degrees. Additionally, any tilting of the head, flattening of the skull and/or asymmetry in eye and ear shape or level should be noted.
Head flattening happens very quickly (often by 3 months old) as the soft infant skull molds to the flat surface behind it. If a baby has a flattening across the back of her head (i.e. brachiocephaly), this is frequently an early indicator that the baby is spending an imbalanced amount of time in a container and on her back. She is not getting enough time to practice movements that will further her physical, visual, vestibular and hence cognitive development. After all, a baby learns by moving independently so we want to support that development. If a baby has flattening on one side of her head (i.e. plagiocephaly), she likely has tightness on one side of her neck that will not resolve without specific exercises. Asymmetrical movement patterns will often develop quickly starting with the ability to roll one way and not the other. It is recommended that she is seen by a pediatric physical therapist as soon as possible. The therapist can provide gentle stretches, developmental strengthening exercises and suggestions for home adaptations that allow the baby to move and learn more freely.
The good news is that CBS is 100% preventable! Take a look at your baby’s home and daycare environments. Then, consider that the only “must have” container for your baby is a car seat. And, before you “un-click and carry,” remember that it is a CAR seat. It is understandable how these well-advertised, frequently-purchased items can be over-utilized. We need a place to put our babies down while we cook dinner, do homework with older kids, send an email, etc. Instead of a container, consider reaching for your sling/baby carrier, a blanket on the floor, or placing her in the shopping cart seat or a playpen. If you feel like she needs to be in a container (due to car travel or the need for an incline for reflux, for example), try to provide the same amount of time out of a container practicing a variety of positions such as being held, tummy-time and side-lying. All these options will provide your baby with a variety of movements and opportunities to learn and explore in a way that a container cannot.
If you are concerned about your baby having CBS, a pediatric physical therapist will have useful tips for helping your baby get back on track. And, remember that seeking help early will lead to the best outcomes.
Dr. Allison Hall, PT, MPT, DPT is a mother of three and has had the opportunity to work with hundreds of children, infants and their families over the past 17 years as a pediatric physical therapist. After seeing the parents’ thirst for information on infant development as well as seeing the adverse effects of the overuse of modern baby gear and technology on child development, she aims to help fellow parents in the journey for information on creating natural environments for which babies can grow and learn via her company “bloom” (www.mykidblooms.com).