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Use of ‘containers’ such as buggies, car seats, highchairs and bouncers can seem a practical and safe means of occupying or transporting a baby. However, young children regularly spend up to two to five hours a day in these containers, while in the USA this may total 60 hours per week, according to Dr Lala Manners in her new book The Early Years Movement Handbook.
Spending a lot of time on their backs allows babies very little movement of the neck, spine or torso. While babies and infants up to one year of age will naturally change position every two minutes, placing them in a supine or semi-reclined position ensures their trunk, head and neck are supported for long periods, minimising the incidental opportunities to move that can be so integral to development, and reducing any challenge to postural muscles.
This ‘containerisation’ can result in delays to development. Proprioceptive and vestibular senses can be seriously compromised when opportunities to move freely are curtailed, while sitting in a reclining position for long periods has been found to affect oxygen uptake, with the lungs unable to work at full capacity.
CONTAINER BABY SYNDROME
In extreme cases, containerisation can lead to Container Baby Syndrome (CBS), which can include a range of conditions caused by a baby or infant spending too much time in any containers. These conditions can cause movement, cognitive and social interaction problems and may even create problems including:
- Flat head syndrome – when the back or side of the head is abnormally flat.
- Facial asymmetry – when the sides of the face appear unequal as a result of skull deformity.
- Torticollis – difficulty turning the head to one side or keeping the neck and head straight due to muscle tightness on one side.
- Sight problems, as infants are looking forwards all the time.
- Speech and hearing problems.
- Attention Deficit Hyperactivity Disorder (ADHD).
- Increased weight or obesity.
A GROWING PROBLEM
Dr Manners, who is director of the Active Matters website dedicated to early years physical development, says there is nothing new about containers in principle.
‘Containers, in many different versions, have been around for centuries. Primarily used to ensure safety by preventing falling or attacks from animals or germs, what has changed is the prevalence and the amount of time children are restrained for,’ she says.
Early years consultant, author and trainer Penny Tassoni agrees the problem is getting worse. ‘I have seen double buggies with on-board entertainment systems advertised. They come with speakers in the sides and pockets to hold tablets, just in case a child’s surroundings aren’t involving enough! It’s just one more reason not to speak to your child, and for them to lose out on physical activity opportunities, the emotional reading of faces and dealing with the challenges of exploring the world. Going out and about with children should be a great opportunity for interaction.’
There are also issues surrounding baby jumpers, walkers or seats, none of which fully support the spine, so children’s feet are not placed flat on the floor. This is important as it helps tighten the calf muscles, and compromises later walking as legs are placed in a wide position rather than allowing the hips to align to 90 degrees, the optimum for children’s walking development.
Ms Tassoni says these products are a source of very real concern. ‘Baby walkers make me really cross with the manufacturers, because we know they are a high source of accidents and do not support walking, but their existence makes parents believe they must be OK.
‘If manufacturers build any of these products, then for a parent without access to information on child development, they become normalised. Manufacturers have a responsibility to both children and parents when designing and marketing their products. Any health and development warnings should not be buried away. They should be emblazoned in bold.’
TALKING TO PARENTS
While it is vital that parents receive this information, it is understandable that practitioners may struggle to communicate it to them, argues Dr Manners.
‘Most practitioners feel a vague sense of unease about containerisation,’ she says, ‘but in the absence of clear and unambiguous information, they may not be confident enough to speak up.
‘Training in physical development is patchy and poor, relying too much on delivering programmes and complying with the curriculum rather than determining why children need to move, and then creating opportunities that are appropriate for their settings and children.
‘Without clear rationale, practitioners would find it difficult to communicate the risks of containerisation to parents. Some settings do make valiant efforts to promote movement opportunities, but parents often do not engage unless they have to.’
Ms Tassoni agrees talking to parents can be hard for practitioners. ‘Many practitioners are aware of the impact but they feel in danger of nannying and babying parents,’ she says. ‘They are on the back foot already, having to tell parents about diet, exercise and sharing books, and want to work in partnership with parents, not lectureship.’
According to the American Physical Therapy Association, in order to reduce the harm caused by spending too long in containers, practitioners and parents should:
- hold a baby in their arms or a sling for more short periods of time throughout the day rather than leaving them in a container
- limit the amount of time a baby spends in containers such as car seats and buggies by only using them when the baby is actually being transported somewhere
- allow babies to play freely in a playpen or larger play space such as a blanket on the floor
- increase the time a baby lies on its tummy when awake.
THE PIKLER APPROACH
Dr Manners also recommends the Pikler Approach, which promotes a respectful adult-child relationship and naturally paced motor development and free movement.
She explains, ‘I think every practitioner and parent should have some knowledge of this approach – it is completely brilliant. Even just getting the basics would help; that babies and infants need freedom of movement from day one and do not need help or support to progress from rolling to sitting to crawling to standing and walking. They can do this perfectly well by themselves, in their own time and unique ways.
‘Pikler babies tend to be calm, physically very confident, brilliant climbers, toilet trained easily, and strong. They are graceful, find perfect balance and develop perfect posture, core strength, agility and awareness.’
Change on container use may take time, Dr Manners adds, but it is possible. ‘It is way too late to stop it completely. All we can do is to make a clear and consistent case for limiting the use of containers by pointing out the negatives in a positive way and offering alternatives if and when appropriate,’ she says.
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