If you are a new parent, then you have probably heard that tummy time is important for your baby, but it’s so important to process the concept of container baby syndrome. In this blog post, we are covering container syndrome, what this means, and what you can do to support your most precious little one.
What is Container syndrome?
Container Syndrome is a term used to describe the lack of skill in infants who are not allowed ample movement opportunities. Container Baby Syndrome is the result of an infant being placed in a container for an excessive amount of time during the day.
Importantly, this is not to shame use of baby containers…or to say that use of these items is to be omitted at all costs. It’s important for the wellbeing of the caretaker to put the baby down sometimes! Things need done around the home. Parents need a shower, or some time to themselves. Other children need cared for.
The important thing to know here is that we are talking about constant use of baby holders all the time, during the day and night. Moving the baby from one container to another is the issue.
Constant use of positioners, or devices is what leads to the syndrome known as baby container syndrome, not using some of these items sporadically.
This extended time leads to structural, movement, and behavioral challenges as a result.
Baby containers include baby equipment and items such as:
- Restrictive playpen that does not allow for movement
- Car seats
- Bumbo seats
- Bouncy seats and swings
- Nursing cushions
- Vibrating chairs
- positioning pillows
- Floor seats
- Infant swings
The other issue is when the devices are used for nighttime and daytime sleep.
It’s easy to fall into that trap of the newborn sleeping in the rocker chair or bouncy seat because the reclined position puts the upper body into a reclined position, which can help with reflux that a baby might have. The warmth and close sides allow the baby to fall asleep easily. But when the newborn is sleeping in this positioner all night and then wakes for a short period and then goes back to sleep in the same device, is when we see the issues with constant pressure on one side of the head and neck positioning that can lead to issues.
For support and help with newborns not sleeping through the night, be sure to check out our blog post on this topic. Occupational therapy professionals can help with sleep during the newborn stage which impacts so many aspects of functional development and family dynamics.
All of the time spent in these baby containers adds up! When in a positioning device such as the ones listed above, little ones are limited in the motor development that results from stretching, wiggling, turning, reaching, and otherwise moving.
Why Worry About Container Syndrome?
As a new parent, you might be wondering “why can’t I just use the wonderful bouncers, baby rockers, and other entertainment devices for infants and toddlers? After all, I got all of these amazing baby chairs, rockers, and positioners for my baby shower…can’t wait to use them!“
Why should I put my baby on the floor? The biggest reason has to do with the benefits to development. Putting a baby in a container such as a jumper, positioning seat, bouncy seat lead to something called container baby syndrome.
It’s understandable why the baby seat or jumper seems like a better option than the floor for a baby. Parents and caregivers have shown a great deal of support for baby “containers” like bouncy seats, Bumbo seats, and activity centers. In fact, these baby holders have become so popular over the years, that a term has been coined; “container baby syndrome”.
When babies are constantly keep in a space where they cannot freely move, how can they be expected to roll, crawl, or walk, when it is the developmentally appropriate timeframe?
Furthermore, babies need experiences where they can learn from their world in a physical way.
They need to discover “what happens when I move my arm and head like this”?’ Babies may fall over, and have some stumbles along the way, but this is how young children learn about gravity and develop postural stability.
Without those learning opportunities, children will only learn that their seat will catch them from falling, no matter how much they wiggle.
With fewer movement opportunities, a delay may be seen in typical development and reflex integration. More serious issues may occur when we keep babies still, like a flattened head from lying down (positional plagiocephaly) or a tight neck that reduces head movement (torticollis).
There is the visual component too. When babies are in a positioner such as a bouncy seat, they are positioned on their back with little to no neck movement. The neck, back, spine don’t receive the time (even minutes) to stretch, turn, and move. But the eyes are limited as well.
When placed on the back in a reclined position, the eyes are not strengthened to look and gaze based on head and neck movements. The eyes may stay in one place and are not challenged to focus on different depths and peripheral stimuli.
Neck movements are limited to turning from side to side, and they eyes tend to follow the neck. This limited eye movement can later impact other areas of development.
Where did container syndrome come from?
In 1992 the “back to sleep” campaign was introduced to lessen the likelihood of sudden infant death syndrome (SIDS). While the rate of SIDS went down 50%, (yay!) container syndrome rose 600%, to one in seven babies!
This is astounding.
Parents are so nervous about SIDS, they place their babies in various containers most of the day. While this seems a safe, convenient, and supportive option, the use of too many “containers” can lead to container baby syndrome.
Babies who have not had enough tummy time may resist this at first, giving the false impression that the container is the best place for them.
What does container syndrome look like?
- Head Shape Flatness. The back or the side of the head is abnormally flat
- Facial asymmetry. The sides of the baby’s face may appear unequal as a result of skull deformity and flatness
- Torticollis. The baby has difficulty turning the head to one side, or keeping the neck and head straight due to muscle tightness on one side of the neck
- Decreased movement, strength, and coordination -the baby may not be able to roll, sit up, crawl, lift the head or reach with their arms while on their tummy.
- Delayed milestone achievement
- Speech, sight, hearing, and cognitive problems – Visual skills can be affected such as following moving objects with the eyes and seeing toys from different distances. Hearing can be disordered, as baby does not hear from all angles. Delayed cognitive skills may arise because the infant is not able to problem solve, explore their environment, or develop language skills
- Attention deficit hyperactivity disorder (ADHD)
- Increased weight/obesity
How to prevent container syndrome in babies
Container baby syndrome is 100% preventable. If you suspect your baby or a client of yours has symptoms of this syndrome, speak with their pediatrician, get a referral to a physical therapist, and begin working on exercises.
- Allow baby plenty of supervised free time on a blanket on the floor, or in a large play yard. Encourage tummy time, reaching for toys, exploration. Some caregivers feel unsure about putting their baby on the floor. A blanket, sheet, or other floor covering can be placed and washed after usage
- Limit baby’s exposure to containers. Use only when transporting the baby, or there is truly no other safe option
- Increase supervised tummy time during the day. Your baby may cry and resist at first, as this may be difficult or uncomfortable. Start slowly and persevere. Colleen from the OT Toolbox has a great article on Tummy Time Myths.
- Hold your infant in your arms, or in a sling for short periods during the day. This will encourage movement, increased head control, and socialization
- Rotate baby through various stations and positions during the day. Holding a baby all of the time is not healthy for a growing child either.
- Floor Play for Babies is another great resource from your friends at the OT Toolbox
- Use gates and other borders to secure a safe place for baby to play, away from wandering pets, or siblings who may step on them
- EDUCATE caregivers and other people about the danger of container baby syndrome. Encourage caregivers to provide opportunities for the baby to explore their environment freely. Demonstrate tummy time and other appropriate movement experiences
Activities to Prevent Container Syndrome
Now that it is understood that playing on the floor is important, let’s get into the many different ways you can do it! One of the easiest ways to encourage floortime with your baby is to lay a blanket on the floor, preferably with a carpet underneath for comfort, and place a toy or two near the baby.
Depending on their age and abilities, the baby may be totally independent, rolling and playing happily. If the children are younger, or less comfortable playing by themselves, this is a great opportunity for a caregiver to step in. A fair amount of babies do not like being on their tummy for various reasons, including medical or sensory.
Babies who have gastrointestinal issues may be hesitant to engage in tummy time, as it is uncomfortable. Work through these difficulties while encouraging floor play.
How do I keep them safe down there? Prepare a safe and clean environment for movement. This may involve baby gates, barriers, or a large corral to allow freedom of movement, without risking baby falling down the stairs. Lie on the floor yourself and see what is down there at child level. You may be surprised to notice extension cords, small objects, or other unsafe objects while you are down there.
- 2 months or younger: Talk with your baby, showing them toys, describing them, and giving them to their hand to feel and explore. Sing songs – whatever songs you know! Encourage them to wiggle their arms and kick their legs along with songs, tickles, or kisses.
- 3-4 months: Your baby will be able to hold tummy time for a bit longer by now. If they have trouble staying there, lay down with them! Be a part of the team, showing them how fun being on their tummy can be. Babies around this age can reach and bring toys to their mouths, so give them safe opportunities to do so.
- 5-6 months: Rolling should be part of the baby’s physical development around this time. Encourage this movement by enticing them with something they love. Maybe it’s you, a special toy, the TV remote, or their next bottle. Try singing Five in the Bed. When the song says “Roll over!” show your baby how to roll. During this time of development, your baby may be moving more than ever. They may even be crawling! Encourage even more floor play with these new skills. As long as the area surrounding them is safe, and you are close by, tons of fun (and important development) can be had! Read here about the types of crawling you might start to see at this age.
- 7-8 months: Just like rolling, encourage crawling by giving the baby lots of space on the floor (that may mean moving aside some furniture) and placing toys or books in various places. There are so many fun games to be played! Playing “Peek-a-boo” where the baby pulls a blanket or towel off to show what’s underneath, is a classic game and critical to development. This teaches baby object permanence. Scatter toys near and far to encourage looking, stretching, and moving.
- 9-10 months: Around this age, your baby will really be on the go. Maybe a baby obstacle course is up their alley…crawl over mom’s legs, under the coffee table, around the dog, and up the step into the kitchen! Creative barriers and safety gates will likely come into play around this stage to keep young children safe.
- 11-12 months: Almost one-year-olds may be walking, which means they will likely not tolerate being in a “container” very well anymore. Now that they are cruising on furniture, squatting to pick up toys, and participating more in play, they may likely lead the way! See what your child’s interests are during floor playtime and follow their lead.
Need more tummy time information? The OT Toolbox has several articles on baby play that support the development of balance and coordination through play.
- Blue-Themed Sensory Play for Babies and Toddlers– Work on visual motor skills, coordination, using both sides of the hands, crossing midline, tummy time, crawling, and movement.
- Baby Brain Building with Balls– Encourage eye-hand coordination, visual tracking, visual scanning, bilateral coordination, crossing midline, motor planning, and more.
- Floor Play for Babies and Toddlers– Use these ideas to encourage floor play with little ones.
- Fine Motor Play with Tissue Paper– Under the supervision of an adult, babies and toddlers can engage with many different out of the box play ideas.
- Play Tunnel Activities for Babies– Use floor-centered toys such as tunnels and floor play mats to engage with little ones.
Another great resource to read more on how to promote development through play is DIR Floortime as it covers strategies to support development through interest-based play.
The National Institute for Health also has a great resource on tummy time.
Victoria Wood, OTR/L has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.
A final note on container syndrome
While the “back to sleep” campaign has certainly been successful, it is not without pitfalls. The rule of thumb for parenting is; everything in moderation. Not too much screen time, sweets, or containers. Parents do not need to be laden with guilt over container baby syndrome. Most caregivers are doing the best they can with what knowledge they have. As they learn more, they will do more.
NOTE* The term “they” is used instead of he/she to be inclusive.