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Out of the Container, and Onto the Floor :

May 22, 2020

Have you ever heard of “container baby syndrome”?

Have you ever heard of “container baby syndrome”? The American Physical Therapy Association uses this term to describe issues seen in infants who spend too much time in devices (or “containers”) that inhibit movement.1 These containers include car seats, strollers, bouncy chairs, and other seating devices used to transport babies to keep them safe and accessible for parents and caregivers. On average, infants spend almost 6 hours per day in these things!2 That’s too much. Excessive time in these devices inhibits movement and places babies at higher risk for a variety of issues, such as plagiocephaly, decreased strength, and delayed motor milestones.1

Many parents and caregivers who have been appropriately instructed on the AAP’s “Back to Sleep” campaign, have extrapolated this information to conclude that “face up” positioning is also the safest and preferred position for infants to maintain throughout the day. It is so easy (and so fun) to engage with babies who are sitting in their bouncy chairs or lying on their backs. These are happy positions with good opportunities for eye contact and easy play. In contrast, babies often make a fuss when they are taken out of their comfy chairs and placed tummy-side down on the floor. It takes work for them to use their arms and lift their head, and sometimes they don’t like it. But, it’s good work, and it’s necessary work for appropriate motor development.

In their systematic review, Hewitt, et al (10.1542/peds.2019-2168) outline the universal nature of tummy time recommendations and explores the literature to date on associated outcomes. While the authors do note a paucity of high quality studies in this area, there is sufficient evidence that tummy time is important to support gross motor development, and is associated with lower BMI in infancy. Although there are no published studies to date looking at the association of tummy time with physical activity in older children, the spectrum of positive infant outcomes attributed to tummy time undoubtedly helps to set them on the path toward the physical literacy and the mastery of movement skills that are crucial for healthy physical activity.  

This is an area where appropriate guidance for parents and caregivers can reap great rewards. Check out this important systematic review for several key points providers can use when educating families about tummy time importance and implementation. Helping parents build a framework for children with the interest and ability to pursue healthy physical activity actually starts in infancy. Get them outside; be a good role model; take them out of their containers; and put them on their tummy. 


  1. Avruskin A. Physical Therapy Guide to Container Baby Syndrome. American Physical Therapy Association. ChoosePT Guide Website. Published 2018. Updated December 10,2018. Accessed May 21, 2020.
  2. Callahan CW, Sisler C. Use of seating devices in infants too young to sit. Arch Pediatr Adolesc Med. 1997;151(3):233-235.
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