What Parents Need To Know About Baby Gear

'Baby Holding Devices' or “semi-reclined and confined baby gear” are terms I use to refer to infant products that support newborns in a semi-reclined position. I've heard other folks call them "containers" or "baby buckets".

Whatever you call them, it seems that their popularity drives manufacturers to develop a new form of Baby Holding Device every week! For the purposes of this post, I'm referring to infant car seat carriers (when used outside of the car), infant swings, bouncy seats and rocking seats, infant lounge pillows and foam infant wedges.

The Semi-Reclined & Confined Position

Why even have a term for these pieces of baby gear? Because most parents don't realize that despite the fact that they look different, these devices all support your baby in essentially the same position - semi-reclined with hips and knees bent, back rounded and head supported from behind. Also when in this gear, baby is confined with limited range of motion or movement of the head, arms, legs and torso.

So while you may have moved your baby from one device to another throughout the day, in reality he's remained in the same position.

How Baby Gear Can Impact Development

There isn't anything inherently terrible about Baby Holding Devices - they are merely one aspect of the total environment that impacts your baby’s development. How much or how little your baby spends semi-reclined and confined in gear changes the stage you set for your baby’s unfolding development. There are two types of consequences of your baby spending too much time supported in a semi-reclined position:

the physical impacts of maintaining this position
what your baby is NOT doing when they are sitting in a Baby Holding Device

The physical impacts of baby holding devices:

One of the most obvious negative impacts of lots of time spent in infant positioners is flattening of the head. It’s common to blame Back To Sleep recommendations for increased head flattening in infants. But the plethora of baby gear our newborns lounge in during the day is a huge contributing factor to head flattening that we CAN safely change.

Extensive time in semi-reclined position and confined gear can exacerbate little muscle asymmetries many babies are born with. And this worsening of muscle imbalances contributes to Torticollis (head tilt and head turn in one direction) and Plagiocephaly (head flattening). Most babies are born with very subtle muscle imbalances from being all squished in the womb; when you place your newborn in a semi-reclined position, gravity pulls them into that preferred "womb position" and limits baby’s ability to get into other positions. The cure for most minor newborn asymmetries? Lots of opportunities for movement and play to stretch and strengthen out of the womb position.

If you notice significant asymmetries or preferred positions that aren't getting better, if your baby doesn't appear able to turn her head in each direction or if your little one is developing a flat spot, seek the help of a professional. Discuss your concerns with your child's primary care provider. Bring the photos you've taken to show how frequently you're seeing positional preferences.

What your baby is not doing in baby holding devices:

An important newborn milestone is stretching out of the womb position. Most full-term babies are born with hips and knees, shoulders and elbows bent and back rounded in the stereotypical "fetal position". But that position isn't meant to last long. Beginning in the first week of life, movement and play allow your little one to stretch their muscles and explore how their body can move in a variety of positions beyond the fetal position they arrived in.

Popular baby holding devices are designed to be soft and supportive, holding your baby in a comfy, cozy position. But that supportive holding restricts your infant's ability to strengthen and stretch through movement. Research shows that infants with high use of baby holding devices score lower on infant motor development tests than babies who don't spend as much time in equipment. As parents, we're blasted with information about reading and speaking to your baby for language development, playing music for brain development but often the message isn't as widely shared that movement and play unrestricted by baby gear is important for motor development.

newborn womb position — Newborn Milestone:

stretch & strengthen out of womb position - flexed body and limbs and possibly minor muscle asymmetries

Another area of development impacted by extended time in Baby Holding Devices is sensory processing. As a pediatric Occupational Therapist, I'm particularly aware of how important opportunities to actively engage with the environment are for developing sensory processing and integration skills. Too much time lounging in baby gear decreases a newborn’s opportunities to use their pressure & stretch sense (proprioception) to feel their body wiggling on the ground. They spend less time lifting and turning their head which helps them learn through the movement sense (vestibular). Opportunities to touch a variety of textures - soft fabric, scratchy carpet, their own bare skin - are decreased (tactile). The rich sensory experiences of simple movement and play unrestricted by baby gear help lay baby’s individual foundation for lifelong sensory processing skills and contribute to their body awareness, balance, coordination and more.

It should also be noted that some Baby Holding Devices are marketed for sleep, using terms like "napper" or "sleeper" in their names, despite American Academy of Pediatrics recommendations for "back to sleep" on a firm surface as the safest position to reduce SIDS. The AAP specifically states that car seats and other sitting devices are not recommended for routine sleep and recommends babies be moved to a flat sleep surface as soon as is practical. I know…what new parent wants to move a sleeping baby? But if following safe sleep recommendations from organizations like the AAP are a high priority for you, move your baby when possible to a firm flat sleep surface.

How Much Time in Baby Gear Is Too Much?

There is no hard and fast time limit on baby gear. Babies are different - some are more at risk for developmental concerns, Torticollis or Plagiocephaly. Families are different - some have multiples or siblings or travel demands or colicky babies who only seem happy in baby gear.

My recommendation is that families stay aware of baby gear use, minimize use when possible and respond to their unique baby’s needs. If your baby is developing at a slower pace than expected or has Torticollis or Plagiocephaly, for example, I recommend you go to greater lengths to minimize time in semi-reclined and confined gear.

The Rule of 2 and 15

This is what worked for me and for many families I’ve worked with:

Aim for an average of less than 2 hours per day in semi-reclined and confined baby gear.

Try to remove baby from gear after 15 minutes for active awake time.

Even if those times aren’t feasible for you - try to default to placing baby on a flat surface first and use baby gear only when needed. And when baby is in a piece of gear for more than 15 minutes, check their posture and reposition as needed.

Checking Baby’s Posture In Baby Gear

When you do use semi-reclined and confined baby holding devices, you can minimize risks by checking baby’s posture often and repositioning as needed to achieve:

Midline positioning of head, body and hips

Looking straight at your baby's front, imagine a line running from the top of baby's head to the middle of their diaper. You can help baby maintain a straight neck and spine at this midline or middle of her body. Ensure that baby isn’t being pulled into curved or slumped position and reposition as needed to maintain symmetry around that imaginary midline.

Alternating head turning position

Semi-reclined and confined baby gear tends to worsen any head-turning preference baby might have. This can easily lead to neck tightening (Torticollis) and head flattening (Plagiocephaly). In baby gear, you can encourage balanced head turning to the left and right.

Chin away from chest

A sleeping baby or an awake newborn without good head control can find themselves in positioning that constricts the airway, which is obviously dangerous. Check and reposition your baby as needed to keep their chin away from the chest.