Ask An Expert: Container Baby Syndrome 101 With Dr. Darcy Fass, PT, DPT

When it comes to baby equipment, the options are endless. From infant loungers, bouncers, and walkers to swings and sit-up devices, there are many “container” products that are marketed as tools for development. However, the reality is that none of these “baby containers'' are actually necessary. While they’re admittedly useful in the sense that they allow you to put your baby in a safe, confined space so you can take a quick shower or do the dishes, they can actually do more harm than good to your baby’s development. The American Physical Therapy Association uses the term “container baby syndrome” to describe issues seen in infants who spend too much time in devices that inhibit movement. Babies who spend extended time in these containers are more at risk for developing container baby syndrome. Now, that’s not to say you have to throw out your beloved swing or bouncer this very second. Life is busy, and sometimes we need a few moments to ourselves without our babies crying to be picked up. A bouncer or a swing can help keep an infant calm for those few minutes while you drink your coffee, and both are perfectly fine to use for short durations of time. To help us learn more about container baby syndrome and how to prevent it, we talked to Darcy Fass, PT, DPT, and owner of Tips and Pediatricks. As an expert in pediatric physical therapy, she answered all our questions so we could share them here with you.

Q: What is the maximum amount of time my baby can spend in a "container" each day?

DF: My professional recommendation for the amount of time spent in a container is less than 1 hour per day—cumulatively. Now, ideally, that should really be broken up into shorter increments, so think 10-15 minutes in a container at a time, several times throughout the day. A good rule of thumb is to give your little one at least twice as much floor time (free movement & exploration of their environment) as you do container time. Now, I totally get and understand that some days, there might be a need for longer durations of container time (busy schedule, chores to get done, need some "you-time", etc.) and that is OK! I'm just here to provide recommendations based on my clinical experience and expertise, but sometimes a mom's gotta do what a mom's gotta do! At the end of the day, if your little ones are safe, give yourself some grace! 

Q: What counts as a baby container?

DF: A baby container is really anything that restricts your little one's free range of movement, but there are differences between the extent to which they actually limit their mobility. Some examples of "containers" include, but are not limited to, bouncer seats, swings, Dock-a-Tots, walkers, jumpers, Sit-Me-Ups, Bumbos, other floor sitters, and exersaucers.  Some other examples that you may have to allow your little one to be in for extended periods of time are strollers, car seats, and high chairs. If you are expecting your little one to have to be positioned in these for extended periods of time, plan some movement or floor-time breaks. For example, on a road trip that is hours long, plan to stop at a rest stop to get your little one out of their seat and moving, even if just for a few minutes. 

Q: What are the signs and symptoms of container baby syndrome? 

DF: Ultimately, prolonged container use with improper alignment will result in container baby syndrome. Some signs and symptoms of this really depend on the type of container and how babies are positioned in it, but some will include muscular tightness on certain sides of their body or in certain body parts, observed flat head, preference for extension (jumping repeatedly or toe walking), or disinterest in exploring or moving about their free environment when given the opportunity, because they simply don't know how. Prolonged container use may increase your little one's risk for developing positional or postural preferences, which includes torticollis (neck tightness) and plagiocephaly (flatness on the head). Using a container restricts your little one's free movement, which can keep them in a position that they are not properly aligned in without their abilities to move out of it. To continue, not all containers are bad if used properly and sparingly. It is extremely important to be sure that your baby is cognitively and physically ready for the container that you are placing them in for them to remain safe and to not cause any harm or detriment to their little bodies. For example, if your little one is not quite holding their head up or sitting independently with good trunk control for 5-10 minutes at a time on the floor, then they should probably not be placed in a jumper or walker for extended periods of time, as they do not have the appropriate postural control to maintain safe and healthy alignment of their spine. Also, their little hips may not be ready to accept the weight that these containers require of them when you place them in upright and vertical positions prior to 7-8 months of age. This puts them at a higher risk for hip dysplasia due to shallow hip sockets. Or, if your little one is contained in a jumper or walker for long durations or improperly positioned, this could result in a preference for being on their toes, which could translate to toe walking.  

Q: What if my baby is only happy in a container or when I'm wearing him? Can baby wearing also cause CBS?

DF: At the end of the day, you pick your battles. You give yourself grace. Tomorrow is a new day and you let that mom-guilt of "you're not doing enough or you're doing too much" just disappear. A good rule of thumb is: containers are okay, but try to give your little one at least twice as much floor time as container time. In the strict definition of the word, a baby carrier for wearing is actually a container. However, there are many benefits to baby wearing that can definitely outweigh the risk of Container Baby Syndrome in this case. Sure, baby carriers do restrict their free movement, but they also provide many great things in return! They can help support upright positioning, particularly in babies with reflux who only like to be held vertically, they offer bonding and social interaction opportunities for mom/caregivers, they can help with nursing on the go or improving a parent's ability to multitask (we all know you need this). And, they can help regulate their nervous system for calming/soothing in times of stress or discomfort. So, when you look at it this way, baby wearing is not typically a problem, as long as you appropriately position them for their age and to support their postural alignment. 

Q: How can I get my baby to like floor time more?

DF: There can be tons of reasons why your little one might not enjoy being on the floor. You can start with small bouts of purposeful play, where you spend some time getting on their level on the floor to play while encouraging some motor skills along the way. Sometimes, there may be modifications to how you can achieve certain positions, like tummy time, that can be helpful with improving their tolerance to doing it on the floor. For example, tummy time on your chest, in your arms, or over your lap can help to improve your little one's tolerance to the positions and, in turn, increase their tolerance to floor time. If you need ideas for purposeful play, I have TONS on my instagram page, @Tips_and_Pediatricks and you can also visit my website tipsandpediatricks.com if you feel like you and your little may benefit from a one-on-one consult with me in order to enhance their developmental skills. Also, I have an Amazon storefront that you can find by visiting my profile on Instagram that has idea lists for different toys and products, which are categorized by age group, that can help enhance floor time. However, I promise you, you are your baby's favorite toy.

Q: How much time does my baby have to spend in a container to start showing signs of CBS?

DF: It really depends on their age, developmental stage, alignment when positioned, and in what specific container they are spending time in. It could be ANY length of time, really. The huge takeaway is that it can be as soon as 1 hour spent each day or it can take longer, but the real issue is if your little one is not aligned or positioned properly, or if they are not developmentally appropriate or ready to be contained in that particular product for that long. That's what will cause CBS more than the length of time spent in the container.

Q: If we go cold turkey on baby containers, can we reverse the effects of CBS? 

DF: Yes and no. It depends on how significant the effects were and your little one's age. For example, if your little one is only 1 month old and you start noticing they are getting a flat spot on their head from spending hours a day in a bouncer with their head turned to one side, they have more of a chance to recover and reverse the effects if this is noticed early and the positioning is changed quickly. On the other hand, a 12 month old who spends hours at a time in a jumper may end up with hip dysplasia or extensor tone preference that can lead to other developmental issues down the line. It's always best to get your pediatrician involved and seek physical therapy consult in your area for assistance with reversing these signs. Go with your gut!

Q: How is CBS treated?

DF: This really depends on how significant the effects are, which body parts or motor skills are affected, and which container is the culprit. If you have concerns, a pediatric physical therapist should be your go-to person. Some states require physician referral and others do not! So, just bring it up to your pediatrician and see what you have to do. Pediatric physical therapists can work on a lot of the consequences that come from prolonged positioning in containers, such as torticollis, plagiocephaly, hip dysplasia, toe walking, and developmental delay.