Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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On this page

• What Is Container Baby Syndrome?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Container Baby Syndrome?

Container baby syndrome is a collection of movement, behavior, and other problems caused by a baby or infant spending too much time in a container. A container can include any baby equipment, such as:

• Car seats, when used to hold a baby other than for transportation.
• Strollers.
• Molded support seats.
• Bouncy swings or bouncer seats.
• Rockers.
• Nursing cushions.
• Vibrating chairs.
• High chairs, when used other than for feeding.

It is important to note that equipment marketed to promote development in one area can limit development in other areas, especially when used for too long or too early (typically before 7 months). These include:

• Jumpers.
• Exersaucers or standing activity gyms.
• Sit-in baby walkers.

Marketing that promotes products as "important for a child's development" puts pressure on parents to buy the latest equipment for their baby. These devices are convenient and seem to keep babies safe and happy, which encourages parents to use them more. Containers are helpful for outings and when parents need to divide their attention briefly to cook, shower, or help another child. However, confining equipment keeps babies from freely moving their body, arms, legs, neck, and spine. It also prevents babies from exploring their environment.

Research shows the average baby spends five to six hours per day in a container. If you use one of these devices, experts recommend use for no more than 20 minutes at a time.

Signs and Symptoms

Excessive use of containers can cause delayed development of motor skills such as:

• Rolling.
• Crawling.
• Sitting.
• Walking.

Extended container use can eventually lead babies to develop problems such as:

• Flat head syndrome. The skull's shape becomes flattened or asymmetrical.
• Facial asymmetry. The sides of the baby's face may appear unequal due to skull deformity and flatness.
• Torticollis. This condition may develop, in which neck-muscle tightness limits the ability to turn the head to one side or keep the neck and head straight.
• Decreased movement, strength, and coordination.
• Vision, hearing, social, communication, and thinking problems.
• Increased risk of toe-walking or hip dysplasia.
• Overweight or obesity.
• Injury associated with using sit-in baby walkers. Common accidents include head or neck injuries from tipping over in the device or rolling down stairs, or drowning from rolling into a pool. Babies have also been burned by spilled hot liquid due to their ability to reach higher objects or surfaces when in a walker.

Parents, family, or day care providers may be the first to notice problems with development. If you see these problems, contact a physical therapist immediately.

Background

In the early 1990s, the American Academy of Pediatrics created the Back to Sleep Campaign to prevent Sudden Infant Death Syndrome, or SIDS. Research suggests putting babies to sleep on their stomachs on a soft surface with soft materials around them could increase the risk of SIDS. The phrase "Back to Sleep" was coined to help parents remember to clear the crib of blankets, pillows, and stuffed toys and to place babies flat on their backs to sleep.

Although SIDS has decreased by 40% since the introduction of the guidelines, reports of CBS rose to 1 in 7 children by 2008. Some researchers found a 600% increase in CBS from 1992 to 2008. Also, there was an increase in developmental delays thought to be linked to babies spending more time on their backs or in containers and less time on their tummies. Developmental delay describes when a child's development in key mental and physical areas is slower than children of the same age.

AAP more recently coined the phrase, "Back to Sleep, Tummy to Play," reminding parents that babies need tummy time every day starting from birth. This position plays a vital role in helping the baby develop muscle strength, movement, and coordination.

Parents may mistakenly use containers to keep their sleeping or wakeful babies in the "right" position for safety. Others find keeping the baby in a container is convenient and restful for the baby. Unfortunately, this leads to insufficient tummy time. It also limits the time a baby spends sitting up on its own or with parent support and holding its head up, like when held by a person. "Container babies" may not develop their movement, vision, and thinking skills as well as those who get more "floor time" to move freely. Constant pressure on the same spot on the head also can lead to flat head syndrome, which describes several head-shape deformities linked to gross motor (movement) and cognitive (thinking) problems in school-age children.

A baby used to the full support of a container for most of the day may seem unhappy when removed and put on its tummy. Crying may make parents think their baby is uncomfortable on their tummy and place the baby back in the container. However, working and playing in the tummy position is essential for overall development. Crying is likely because the tummy position requires more "work" than sitting or lying in a container.

Tummy time is vital to:

• Strengthen the muscles of the neck and trunk.
• Promote and maintain a rounded skull shape.
• Foster the development of movements and coordination.

Babies should spend lots of supervised free time on the floor in various positions. They should have time on their back, tummy, side, and sitting to develop their motor skills. A toy to stimulate the child's interest and distract from the challenge of holding up their head and reaching can be helpful. See more tips for tummy time activities.

Physical therapists help parents and babies through an active play-based approach to prevent and correct any deformities and muscle problems. They also can recommend ways to change daily routines to avoid serious problems from CBS.

How Is It Diagnosed?

Talk to your child's pediatrician or physical therapist if you have concerns about your baby's development or notice any of the above signs and symptoms.

Parents and caregivers with concerns can refer their child to early intervention services for a full developmental assessment in the United States and territories without a doctor's referral.

Your physical therapist will conduct a thorough evaluation, including taking the baby's health history. They will ask detailed questions about how your baby spends each day and their activity level. They also will 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 lift their head or reach with their arms when on their tummy in a way expected for their age.
• Vision or hearing problems. The baby may show a delay in following objects with their eyes and seeing toys from different distances.
• Delayed thinking or communication skills. The baby may have delayed development in problem-solving, understanding their surroundings, and babbling or speech.
• Sensory processing differences. The baby may fuss with rolling or swinging and rocking in a container that limits their natural responses to movement.

Your physical therapist may work with a pediatrician or other health care provider to make a final diagnosis. They also may refer you and your baby for further tests to rule out other problems.

If your pediatrician notices signs of CBS before you do, they may refer your baby to a pediatric physical therapist for evaluation and treatment.

How Can a Physical Therapist Help?

Your baby's physical therapy treatment will first begin with an evaluation that includes assessing:

• The shape of your baby's skull and face and how they hold their head and neck.
• Your baby's muscle development or the flexibility of their muscles.
• How your baby moves their head, body, arms, and legs.
• How well your baby can lift and move their head, arms, and legs when lying on their tummy.
• How well your baby can roll over, crawl, and change positions.
• How well your baby can track objects with their eyes and turn their head to look around the room.
• How your baby moves their body to explore their environment.
  Based on their findings, your physical therapist will tailor a treatment plan for your baby's needs.

It is important to start physical therapy for CBS as soon as possible, preferably before 3 months of age, when treatment can help your baby make the greatest gains. However, a physical therapist also can help babies and children older than 3 months gain strength, flexibility, and well-being. Your physical therapist will help improve your baby's:

Movement skills and strength. Your physical therapist may use toys, games, and songs to encourage your baby to learn new movements and strengthen and stretch their muscles.

Positioning routines. Your physical therapist will teach you how to reposition your baby and ways to help them develop typical movement skills, muscle strength, and skull shape. Routines should consist of more floor time, tummy time, and practice sitting upright without the support of a container. Recent guidelines recommend babies get tummy time three times a day, with constant adult supervision. They also discourage having babies sleep in containers.

Parent education. Your physical therapist will help you learn how to position your baby on the floor or in other positions during playtime. If you bottle feed your newborn or infant, they will help you find ways to position your baby in your arms during bottle feeds rather than in a container. Holding babies during feeding allows them to look around, improving neck and eye movement. It also encourages bonding and comfort. Additional suggestions may include using a playpen or soft floor mat instead of a container to allow your baby to be active and safe during playtime. They may suggest changing the position of toys on the floor or mobiles in the crib to encourage your baby to turn their head in different directions. Physical therapists personalize suggestions for each baby and family based on their routines, activities, and priorities.

Therapeutic equipment. Your physical therapist may work with your child's doctor to recommend different equipment, such as a cranial helmet, to improve head shape.

Can This Injury or Condition Be Prevented?

Container baby syndrome is preventable. Expectant or new parents are strongly encouraged to follow the guidelines listed here. Parents can contact a physical therapist to learn how to prevent CBS from developing. Physical therapists also can help treat CBS symptoms. You can protect your baby from day one by following this advice.

How to Prevent CBS

• Limit the use of containers to 10-15 minutes at a time. For every 10 minutes in a container, put the child on the floor for twice that amount of time.
• Limit your baby's time in transport containers, such as car seats and strollers. Only use them when transporting the baby; remove them from the container when you reach your destination. Use a bassinet-style stroller instead of a click-in car seat stroller.
• Consider using a wearable, soft, inward-facing baby carrier to take your baby on walks rather than a car seat stroller. This allows your baby to look around more freely, strengthen their neck muscles, and experience different movements, all while feeling cozy and close to you.
• If your baby falls asleep in the car seat or swing, move them to their crib or bassinet as soon as possible. Do not let your baby sleep in an inclined container like a swing or bouncy chair. Doing so can increase the risk of SIDS, CBS, and head flattening.
• Increase the time your baby plays on their tummy (with adult supervision). Reach out to a physical therapist if your baby has trouble with tummy time.
• Allow your baby frequent, supervised playtime on the floor on their tummy or back, but outside a container. Let your baby play freely in a playpen or gated-off area with a floor mat for safety.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat babies and children with CBS. You may want to consider:

• A physical therapist who is experienced in treating children who have CBS, developmental delays, torticollis, or flat head syndrome. Some physical therapists have a practice with a pediatric focus.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in pediatric physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can search for physical therapists in your area with these credentials and clinical expertise through Find a PT, a tool built by the American Physical Therapy Association.

General tips when you're looking for a physical therapist (or any other health care provider):

• Get recommendations from family, friends, your pediatrician, or other health care providers.
• Ask about the physical therapists' experience in working with children with CBS before making an appointment.
• Check with your local early intervention program for infants and toddlers ages newborn to 3.
• Be prepared to describe your child’s symptoms in as much detail as possible.

The APTA Academy of Pediatric Physical Therapy contributed to this consumer resource. It is for informational purposes only and is not intended to represent the position of APTA Pediatrics.