Car seats are very important while infants are in the car, that part is clearly true. The challenge begins when it’s time to leave the car altogether. Traveling into the home isn’t a problem, but going to a doctor’s appointment, shopping, to the library, out to eat, the list goes on and on. Sooner or later most parents learn that the car seat is a convenient place for baby to be when Mom needs her hands. 
Sadly a growing newborn spine and skull is very impressionable to outside forces, especially being in the exact same position for long periods of time. The Rise of Flat Head Syndrome 

Medical professionals have begun to notice an alarming rise in the incidence of a skull deformity in infants called “flat head syndrome.” Plagiocephaly, the medical term for this flattening of the skull, can occur as a result of consistent pressure on a particular spot. It is a cosmetic condition, but one that can be permanent if left untreated. The increase in plagiocephaly is frequently blamed on the fact that babies are now placed on their backs to sleep, a position that has been shown to prevent sudden infant death syndrome (SIDS). 

If a baby’s head is always in the same position, the pressure can deform the skull. However, back-sleeping is not the only factor. Extended periods of time spent in a baby seat can also contribute to this condition, as can long periods in strollers, swings, and other devices that put babies in a back-lying position. 

Thomas R. Littlefield, M.S., is affiliated with an Arizona clinic that treats plagiocephaly. In an article in the Journal of Prosthetics and Orthotics, he notes that 28 percent of infants who attend the clinic spend 1.5 to 4 hours daily in car seats or swings, and nearly 15 percent are in them for more than four hours per day. Another 5 percent of infants are allowed to sleep in these devices. Littlefield observes that cranial distortion resulting from overuse of car seats and swings is more severe and complex than in children who develop plagiocephaly from back-lying on a mattress. Consequently, he recommends reducing the time spent in car seats and swings, if possible. (1)

Concern over plagiocephaly also led the American Academy of Pediatrics to suggest in 2003 that infants “should spend minimal time in car seats (when not a passenger in a vehicle) or other seating that maintains supine positioning.” When infants must be in a back-lying position, moving their heads occasionally can help reduce pressure and avoid developing a flat spot. The simplest and most effective prevention, however, is to decrease the cumulative time an infant spends on her back. (1)

Poor Positioning for Infants 

Plagiocephaly is not the only problem associated with heavy use of car seats. According to Dr. Jeanne Ohm, executive coordinator of the International Chiropractic Pediatric Association (, many infants in strollers or car seats constantly tilt their heads to one side or the other. “That’s a good indication that their upper cervical spine is out of alignment,” says Ohm. 

Short periods spent in a car seat are fine, but “keeping them in that position where it’s easiest for their head just to fall to the side—that leads to further spinal stress later on in life.” Ohm prefers to see parents carry infants in their arms and use different types of carriers. “Using a variety of carriers supports correct postural development for the child.” (1)

The Benefits of Babywearing 

Babywearing is defined as the act of wrapping a baby in cloth around the torso of a parent and it has a long list of benefits. Parents mainly comment that they prefer babywearing to the traditional methods of carting around a baby carrier, diaper bag, purse and many other items. Especially in scenarios involving a great deal of walking, wearing baby is an ergonomic way to keep Mom or Dad’s back feeling strong (vs. carrying the heavy seat around on only one hip or arm) and keeps baby’s head upright, reducing asymmetrical strain on her little neck, reducing the chances of developing plagiocephaly. 

In infancy the act of babywearing by a breastfeeding Mom can be the most efficient way to keep baby calm and facilitate discreet feedings. In addition to the ease on Mom’s back from having baby’s weight held snugly to her core, baby is much less likely to fuss and cry with Mom’s soothing heartbeat in her little ears. Mom can then leave the car seat in the car, and hopefully consolidate to only one carry bag (or ask her partner to carry all of baby’s extra items). Wearing baby also eliminates the risk of the car seat falling from a table, chair, cart or being kicked by an unknowing passerby. Car seats tend to be large and bulky, often being placed into pathways, around corners and under desks or next to chairs on the floor. This is risky for baby who cannot call out a warning to defend himself and often winds up scared from the encounter, if not injured. 

As baby grows, a toddler can be worn in the front facing out to the world, or on a parent’s back facing forward with Mom or Dad. Some parents are so coordinated they can wear an infant in front and a toddler in back! Now that is some impressive multitasking! In the case of toddler wearing, it has the added benefit of not allowing baby to run off if he is of an ambulatory stage, preventing dangerous encounters where he can be injured, or kidnapped. In conclusion, although the car seat carrier can be incredibly beneficial for keeping baby safe while traveling in the family car, baby wearing just might be a better option in many scenarios. In the end it is always up to the parent to decide which choice is right for their family, however it is always wonderful to know all of the options. 

I hope you’ve found this article helpful. If you enjoyed it, you may want to check out the first post in this article series: Car Seat Struggles + Benefits of Babywearing Part 1.

​Thank you for reading!

1 – Portions of this article can be credited to Catherine McKenzie of the ICPA, and issue #23 of Pathways to Family Wellness.