Helmet Therapy
Watch Out in Prams & Car Seats! The "Container Baby" Risk
Prolonged time in prams and car seats can increase the risk of flat head syndrome in babies. Learn how to reduce the risk with simple repositioning strategies.
For today's parents, prams, car seats and bouncy chairs are indispensable helpers. We need these devices to transport our babies safely, get them off to sleep, or keep them occupied while we get on with things.
But on the other side of the coin lies a growing problem caused by the overuse of these devices: Flat Head Syndrome (Brachycephaly/Plagiocephaly). The medical world refers to a baby spending the majority of the day inside these "boxes" as "Container Baby Syndrome". At CranioWell Orthotics and Prosthetics Centres, we have compiled the essentials of using these devices safely and healthily.
What Is the "Container" (Enclosed Space) Trap?
The internal structure of car seats and pram carrycots is typically hard plastic covered with a thin layer of foam. For safety reasons, these seats are designed to keep babies held in place.
When a baby is inside one of these seats:
- They Cannot Move: Turning from side to side or changing position is difficult.
- Constant Pressure: The back of the head is in constant contact with the hard base of the seat.
- Effect of Gravity: Due to the angle of the seat, the head is pressed further backwards by gravity.
The result? If you take your baby out of the car, carry them in the pram, and then continue to leave them in the pram to sleep when you get home so as not to wake them, flattening at the back of the skull becomes inevitable.
Car Seats: Safety or Risk?
Let us make an important distinction: a car seat is UNQUESTIONABLY the safest place for a baby while travelling in a vehicle. It can save a life in an accident.
- Rule: NEVER take your baby out of the car seat while the vehicle is in motion.
- Risk: The risk begins when the vehicle stops. Using the car seat as a "bed" or "indoor chair" is harmful to head shape.
5 Golden Rules for Protecting Head Shape While Travelling
It is possible to reduce the risk without compromising parents' convenience:
1. The "For Travel Only" Rule
Use the car seat only in the car. When you get home, transfer the baby to their bed (a flat surface), even if they are asleep. Leaving them in the pram for hours because "they're sleeping so beautifully, I couldn't bear to move them" accelerates flattening.
2. Choose Babywearing
Popping to the shops or going for a short walk? Use a carrier or sling instead of the pram.
- Babywearing takes the head completely off any surface. Zero pressure!
- It also strengthens neck muscles and increases the bond between parent and baby.
3. Repositioning in the Pram
When the baby is lying in the pram carrycot, regularly change the direction their head is facing. If they are looking right on one walk, hang toys on the other side so they look left on the next.
4. Take Breaks
On long car journeys, take a break every 2 hours. Take the baby out of the seat, hold them in your arms, and relieve the pressure on their head for a while.
5. Carry Tummy-Down, Not Always Back-Down
When carrying your baby indoors, give the back of the head a rest — not always on their back, but sometimes facing outwards or over your shoulder.
Frequently asked questions
Can I put an extra cushion in the car seat?
NO — ABSOLUTELY NOT. Car seat manufacturers and safety experts prohibit the use of any pillows, head supports or blankets other than the original parts of the seat. In an accident, these additions can slip and cause neck injury or prevent the harness from functioning properly. Safety comes before head shape.
My baby spends a lot of time in a vibrating bouncer at home — is that a problem?
Yes, it is. These devices also fall into the "container" category. They restrict the baby's movement. Use them for a "parent break" of 15–20 minutes a day (for a shower or cooking), but do not leave the baby in them for hours. The best play area is the floor (a play mat).
Will the helmet fit in a car seat?
CranioWell helmets are custom-fitted and slim in construction, so they generally do not cause problems in car seats. However, with the helmet on, the head may sit slightly more forward. The harness straps may need to be loosened accordingly and then refastened securely.
Conclusion: Finding the Balance
Prams and car seats are not our enemies — they are friends that make our lives easier. The problem is not the devices themselves, but the amount of time spent in them.
When you take your baby out of their "containers" and place them on a flat surface where they can move freely (Tummy Time) or hold them in your safe arms (babywearing), you support their motor development and preserve that beautiful head shape.
If flattening continues despite being careful about pram use, you can visit CranioWell for a 3D scan to assess the situation.