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Container Baby Syndrome Physiotherapy
A “container baby” is a newborn baby or young infant who is placed in
a container, such as a car seat or stroller, for an excessive amount of
time in a given day.
“Container baby syndrome” is the term/name that's used to
describe a range of conditions caused by a baby or infant spending too
much time in such containers. These conditions can cause issues to
- cognitive and
- social interaction problems
- and may even cause
Once symptoms of container baby syndrome are recognized by the family
or a health care provider, the involvement of a senior physiotherapist
(early intervention) helps ensure successful treatment.
Our senior physiotherapists can design an individualized treatment plan to address the
problems of a container baby, and help
- build strength
- restore movement and
- address skeletal deformities
What is Container Baby Syndrome?
Container baby syndrome (CBS) is a collection of movement, behavior,
and other problems caused by a baby or infant spending too much time in a
container—any commonly-used piece of baby equipment that resembles a
- Car seats
- Bumbo seats
- Bouncy swings
- Bouncer seats
- Nursing cushions
- Vibrating chairs
- Activity gyms / centers
Although these containers and equipment are used to help keep the
baby safe from accidents, allow parents and caregivers to more easily
transport the baby, and give the baby play time, this equipment is also
confining, keeping babies from moving all parts of their bodies.
Spending a lot of time lying on the back in a container, for example,
allows little to no movement of the baby's neck, spine, or body.
Although some parents believe that leaving the baby in the container or
equipment is safer, more convenient, and enjoyable for the baby, this
kind of immobilization can actually cause delayed development of common
skills like rolling, crawling, and walking (causing developmental delay)
Staying in a container for a prolonged time can eventually cause issues, such as:
- Flat head. 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.
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.
- Speech, sight, hearing, and thinking problems.
- Attention deficit hyperactivity disorder (ADHD).
- Increased weight/obesity.
In 1992, new guidelines were promoted to parents to help prevent
Sudden Infant Death Syndrome (SIDS), which was thought to be caused by
infants sleeping on their stomachs with soft materials around them that
could block their breathing and cause the infant to suffocate.
phrase Back to Sleep was coined to help parents remember to clear the
crib of soft blankets, pillows, and stuffed toys, and place the baby on
its back to sleep, all of which was intended to keep the baby’s airway
free of obstacles.
Although SIDS has decreased by 50% since the guidelines were
introduced, reports of Container Baby Syndrome instead rose to 1 in 7 children by 2008; some
researchers say incidents of CBS increased 600% in just the years 1992
Difficulties with skills that develop during the first few years of
life, such as
referred to as developmental delays.
The number of children with mild
developmental delays thought to be associated with spending more time on
their backs and less time on their stomachs (called tummy time), has
increased since the early 1990s when the anti-SIDS campaign began.
Many parents mistakenly extend the Back to Sleep approach throughout
the day, using containers to keep their babies in the “right” position,
whether sleeping or awake. Other parents find that keeping the baby in a
container for much of the day is convenient, and seems restful for the
Because of this positioning, the baby spends less time lying on
its tummy, sitting up on its own, and holding its own head up (as it
does when it’s being held by a person). As a result, movement skills are
not developed by the baby.
The constant pressure on the back of the
head while in a container can also lead to a skull deformity called flat
head syndrome (plagiocephaly or brachycephaly, depending on where the
head is flattened).
A baby who has been fully supported in a container most of the day
may express unhappiness by crying when taken out of a container and put
on its tummy for play. This may make the parents think this crying means
the tummy position is not good for the baby, so they place the baby
back into the container.
However, work and play in the tummy position is integral to
The baby is likely crying because this position requires
more work for the baby. Tummy time
- strengthens muscles of the neck and
- promotes and maintains a rounded skull shape and
- fosters the
development of movements and coordination
Our senior physiotherapists educate parents that an active, early approach to
preventing and correcting the deformities and muscle problems caused by
CBS is necessary to avoid lifelong consequences.
How Is It Diagnosed?
Parents, family members, or daycare providers may be the first to
notice that the baby is not fully turning its head or moving its body
very much. They may also notice that the baby’s head is becoming
flattened on the back or on one side, or stays tilted to one side. If you see these problems, contact us immediately!
Our senior physiotherapist will conduct a thorough evaluation that
includes taking the baby's health history. We also
will ask you detailed questions about how the baby is handled and the
baby's activity level each day, and gently test for signs and symptoms
of common CBS problems, such as:
- Delayed movement and skills. The baby may not be
able to roll, sit up, crawl, or, when on the tummy, lift the head or
reach with the arms in a way expected for the baby’s age.
- Vison or hearing problems. The baby may show a
delay in the development of vision or hearing skills, such as following
moving objects with the eyes and seeing toys from different distances.
- Delayed thinking abilities. The baby may have delayed development in problem-solving, in understanding their surroundings, and with language skills.
We may collaborate with a doctor or other
health care provider to make a final diagnosis. Further tests may be
necessary to confirm the diagnosis, and to rule out other problems.
If your physician notices signs of CBS before you do, the physician
may refer your baby to a pediatric physical therapist for evaluation and
How Can our senior PhysioTherapists Help?
We will first evaluate your baby by examining:
- The shape of the skull and face and how the baby holds the head and neck
- The baby’s muscle development
- How your baby moves the head, body, and limbs
- How well your baby can lift the head and limbs when lying on the tummy
- How well your baby can roll over, crawl, and change body positions
- How well your baby can track objects with the eyes
Based on the findings during the examination, we
will make a treatment plan just for your baby's specific needs.
Physiotherapy should be started early, often prior to the baby
being 3 months old, but a physiotherapist can also help a child who
is older regain strength and well-being. Your physical therapist will
help improve your baby's:
Movement skills and strength.
We may employ appealing toys, games, and songs to encourage your
baby to learn new movements and strengthen underdeveloped muscles.
We will teach you
where to reposition your baby and how to aid in developing more normal
movements, strength, and skull shape. This usually consists of increased
floor time and tummy time, and increased times of sitting upright
without the use of a container. Recent guidelines recommend that the
baby enjoy tummy time 3 times a day, with constant adult supervision,
and not sleep in a carrier or stroller at night.
We will help
you learn to safely place your baby on its tummy after every feeding,
nap, diaper change, and whenever the baby is awake and alert. We will also explain how holding your baby for feedings
rather than feeding it in a carrier or stroller allows the baby to look
around, improving neck and eye movement.
Additional suggestions will
likely include using a playpen to allow baby to be active and safe
without being confined to a container, and changing the position of toys
and mobiles in the crib to encourage turning of the head in different
Based on each child's condition, we may prescribe different modalities, such as
protective head gear, to gently aid treatment.
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