Here at Startwell when we talk about containers, we are referring to any pieces of equipment that “contain” a child and keep them in one/limited space. We strongly believe that children should be given space and freedom to develop their physical skills and anything that minimises this should be reduced.
Infants should be physically active several times every day in a variety of ways, including interactive floor-based activity, e.g. crawling.
For infants not yet mobile, this includes at least 30 minutes of tummy time spread throughout the day while awake (and other movements such as reaching and grasping, pushing and pulling themselves independently, or rolling over); more is better.
Once children are walking they should spend at least 180 minutes (3 hours) per day in a variety of physical activities at any intensity, including active and outdoor play, spread throughout the day; more is better.
Over 3’s should spend at least 180 minutes (3 hours) per day in a variety of physical activities spread throughout the day, including active and outdoor play. More is better; the 180 minutes should include at least 60 minutes of moderate-to-vigorous intensity physical activity.
Higher levels of time spent in physical activity are associated with consistently improved: motor development, cognitive development and fitness. Inactivity and sedentary behaviour should be reduced and activity encouraged. The CMO defines inactive and sedentary behaviours as those which involve being in a sitting, reclining or lying posture during waking hours, undertaking little movement or activity and using little energy above what is used at rest. Examples of sedentary behaviours include sitting in a chair, car seat or buggy etc.
We know that containers limit movement and this impacts on their senses, physical development, development of muscles; this can result in children’s spines not developing into the expected ‘S’ shape from the foetal ‘c’ shape. A study published in “Child: Care, Health and Development 2010” examined the motor development of 43 infants allowed to use play-assist containers/equipment. The study found that infants who had the highest containers/equipment usage scored lower on infant motor development, which was measured by the Alberta Infant Motor Scale, whereas the infants with lower containers/equipment usage scored higher on motor development. The study summarised the findings stating that only low – moderate use of containers/equipment should take place within the home and should be avoided in other settings. It also stated that floor-based activities and tummy time were the best options.
We often talk about “Bucket Babies”, this is a term that has been widely used to describe young children that have spent too much time in a confined space. It has also been referred to as container baby syndrome (CBS).
Dr Lala Manners is an expert in early years and physical movement and is the director of the Active Matters website. She states that “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, according to her book The Early Years Movement Handbook.
We have already said that containers are anything that contains a child in a set position or space for a period of time. Dr Lala Manners goes on to discuss in Nursery World articles on physical movement that “‘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.”
Dr Lala Manners explains that if we use containers for long periods of time this can lead to Container Baby Syndrome and she states this is more than the containerisation that she referred to above. In a nursery World article in 2021 all about Health and Container Syndrome, herself and Early years consultant, author and trainer Penny Tassoni agreed stating “These conditions can cause movement, cognitive and social interaction problems and may even create problems including:
Today, parents are exposed to a wide range of containers from baby bouncers, jumpers, door bouncers, bumbo’s, pushchairs, car seats, playpens, highchairs, baby swings, chairs just to name a few and we appear to be forgetting the importance and the purpose of tummy time, floor-based play and free flow space and standing activities and the benefits that they bring. Containers do just that – they essentially immobilise young children and whilst tiny they encourage lying onto the back of the head.
So, we ask are Containers Bad?
Although the majority of containers are safe when they’re used properly and for their designed purpose, we know that many are not used in the timescales or for the purpose that they were designed:
Baby bouncers are designed for babies from birth up until about 18-20 pounds or once children can independently sit. Bouncers are only designed to be used for this age group and the product designers, manufacturers, NHS and Government recommendations state they should only be used twice a day for a maximum of 15-20 minutes and children should never be allowed to sleep in them. We know that they are often used to feed babies and allow them to fall asleep. The reason baby bouncers can be bad comes down to the angle of the bouncer, which is normally around 30 to 45-degree angle, which can be inadvertently dangerous. Babies especially new-borns who these are designed for haven’t developed any of their resting muscles which means that if their head flops forward, they don’t have the muscle tone to lift the head back up. Baby bouncers have been linked to SIDS (sudden infant death syndrome) because if their head flops forward, there is a higher risk of obstruction of the airway which leads to lack of oxygen. They also don’t allow for core strength to be developed or muscles in the arms and legs that are needed for crawling and other physical movements. They encourage the head to be flat at the back and this can increase risk of flat head syndrome.
Solution: Use floor-based activities and tummy time instead and always use a flat firm mattress for sleeping. If you do use a bouncer, make sure it is age appropriate and only used for a maximum of 15-20 minutes twice a day and never for sleeping. If a baby is placed in a baby bouncer, they should always be supervised. At Startwell we do not recommend using them in settings unless all the advice above is followed.
Babies should not be placed in a jumper, bumbo, door bouncer or walker until they have developed neck stability, head control and can sit independently. For most babies this will be around the time of five to six months old. Recommendations state that these pieces of equipment should only be used for up to 20 minutes a day, twice a day. We know that they are generally used for a lot longer, but I am pleased to say that we do not generally see them in settings anymore, but we know they are still used in homes.
Door bouncers can cause accidents such as hitting their head, arms, or other body parts against the door frame. All the above containers can set the child’s hips in an awkward position, cause hip dislocation, hip dysplasia, focusing exercise on the wrong leg muscles, hinder skeletal and muscle development and encourage calf muscles getting tight. This is due to the devices encouraging them to stand on their tip toes, which can lead to tight calf muscles and, in some cases, surgery or casting could be required and it can lead to toe-walking later and hinder correct physical movement so general walking is delayed.
Bumbo’s can delay baby’s ability to sit up on their own and doesn’t allow muscles in the legs to develop fully if used too often. The age/weight of use for these pieces of equipment vary with most stating that equipment should not be used once children are mobile or time within them should be reduced. This is an interesting point for us at Startwell as the age you can use them is recommended around 5-6 months but that is also when they are starting to become mobile!
Solution: Use floor-based activities and tummy time instead as there is no unnatural strain on the hips. If parents are using any of the containers above, make sure they know about the limitations and expectations of use. At Startwell we do not recommend using them in settings unless all the advice above is followed.
Car seats are an important piece of safety equipment and should be used for all children under the age of 12 or once they reach 135cm. Please remember to inform parents that if their child falls asleep in their car seat and they reach their desired journey please take them out and place them on a flat mattress to sleep rather than leaving them in the car seat as whilst they keep us safe, prolonged sitting in that position impacts on physical development such as the curve of the spine and physical movement. Also remind them that if travelling for long distances it is important that they take their children out of the car seat and allow them to stretch and move their bodies. Manufacturers recommend a maximum of 2 hours in a car seat.
Pushchairs are designed predominantly for children that are not proficient in the skill of walking and once they are confident and have mastered this skill it should be reduced and eliminated by the age of 3 unless there are medical needs that requires them to be used for longer. More worryingly in recent years manufacturers have increased the weight limit in pushchairs and most can accommodate children up to the age of 7. This encourages them to be used more instead of less and when children are in pushchairs, they are observant learners instead of interactive learners. They are not having the opportunity to explore the environment and be physical which is hindering muscles and physical skills. We encourage you to promote ‘walk to setting days’ and ‘ditch the buggy days’ as well as informing parents of the information above.
Chairs that are appropriate for each age group are important for encouraging children to sit at mealtimes etc. but in settings we have got used to using them throughout the whole day and for every activity. This is a practice that needs to change. Encouraging children to stand, move freely and explore the environment should be at the heart of our practice. By removing or reducing the use of chairs, we are encouraging the development of core strength, helping to develop strong bones, muscles and hearts. Physical activity and reducing the use of chairs encourages and develops active learning, and we all know that children learn best when movement is involved. We want to give children the opportunity to move their bodies in a range of ways that challenges their skills, strength, balance, co-ordination and develops all their Fundamental Movement Skills.
Children that spend too much time sitting will have weaker muscle control, poor core strength and less established physical skills.
Solution: Use car seats and pushchairs as per the recommendations and for the desired purpose only. Remove chairs from the environment to encourage children to move and use their physical skills.
In conclusion all the containers mentioned, if used for prolonged periods of time and not used appropriately may delay motor development as children don’t learn to move, they can cause deformity of heads, spine and joints, increase behavioural problems, delay cognitive development, cause sensory impairments, decrease strength and coordination and lead to obesity. Research claims containers could cause serious long-term harm as it limits the amount of time spent learning to crawl and move around the floor, it can also affect their ability to walk and develop muscles and core strength. Moderation is key but at Startwell we recommend floor-based play, standing activities and space as the best equipment to encourage physical development and help young children:
We know that children that have more access to container free play are likely to crawl and walk earlier and have stronger physical development and skills.
https://www.activematters.org/
https://www.nhs.uk/start4life/baby/baby-moves/
https://www.nhs.uk/conditions/baby/babys-development/play-and-learning/keep-baby-or-toddler-active/
https://www.sportengland.org/research-and-data/data/active-lives
https://www.nhsfife.org/media/33206/help-you-baby-move-and-play-everyday.pdf
https://www.nurseryworld.co.uk/features/article/health-well-being-container-baby-syndrome
