When strapped into an infant car seat, baby swing, or even in a wrap or baby carrier, infants and young children’s heads tend to wobble and bobble. Why? They lack the neck muscles to support their giant heads. That’s what you’re here for — taking care of the precious brains while they develop the muscles to do so on their own. Before you stock up on car seat head supports, pillows, wraps, or infant car seat inserts, however, know this: manufacturers are well aware of your baby’s lack of neck muscles. They’ve taken into account an infant’s still-developing spine and the potential damage of head flops. The car seats are tested with this in mind. If you’re installing them correctly you’re child should be safe. That’s a big if.
Consider a child’s physiology. During the early stages of an infant’s vertebrate development, ligaments and tendons are extra stretchable. This explains why infants don’t really experience sprains, but also the reason that, when a head flops side-to-side, while terrifying to see, is relatively low-risk for the baby. It’s when a baby’s head flops forward that major issues can result, as airways can become restricted. If a baby’s poorly positioned in a baby car seat or slumped over in a forward-facing wrap or carrier, parents should absolutely be concerned.
Back to the good news: Car seats are designed to minimize neck movement (as are many wraps and carriers.) The hard part is ensuring babies are properly secured.
“The way the manufacturer intends car seats to be installed, there shouldn’t be a lot of head flopping forward. If you see a child’s head falling forward in an installed seat, it’s probably installed at the wrong angle,” says Dr. Ben Hoffman, Oregon Health and Sciences University pediatrician and chair of the American Academy of Pediatrics’ Council on Injury, Violence and Poison Prevention. In that case, you need to fix the angle of the car seat to provide more head support.
Car Seat Head Support: A Cheat Sheet
- Don’t be overly concerned about a baby’s head flopping left or right, but be hypervigilant about making sure a baby’s head doesn’t flop forward, restricting airways.
- If baby’s head is flopping forward, the most likely culprit is the angle of the car seat. Make absolutely sure car seats are installed correctly. If they are, they should help secure children’s heads.
- Neck braces and other head apparatus are not tested with peer-reviewed data. Car seats, properly installed, are. So focus on perfect car seat installation over accruing neck-bracing gadgets.
Easier said than done. Even the best car seats on the market often require a herculean effort to install, and even after hours of trying to get it right, an alarming percentage of them aren’t properly installed. According to Hoffman, 80 percent of rear-facing car seats are installed incorrectly, and a whopping 95 percent of families with newborns make critical mistakes with car seats. Parents are strongly urged to get their seats checked by a certified technician. And, no, despite rumors to the contrary, firefighters cannot and should not stand in for technicians. (“Some of the most creative and frankly wrong car seat installations I’ve seen have been by well-meaning, uncertified firefighters,” says Hoffman.)
Bottom line: A properly installed car seat should prevent flop-forward injuries, but not necessarily some side-to-side bobbling. Parents still concerned about the head support offered by their child’s car seat might be tempted to resort to the toddler equivalent of airline pillows — animal-shaped neck braces, baby head wraps, inserts, or other apparatus intended to keep the head stationary — but Hoffman recommends that they don’t.
“I wouldn’t put anything around my baby’s neck, to be honest. There’s not going to be any peer-reviewed data on those things, and that’s the gold standard,” says Hoffman. “I think what happens is those things can make a parent complacent. That’s where things are going to happen, especially if there’s something around a baby’s neck.”
Similarly, keeping a baby’s head from flopping forward is important when carrying a child in a pack or wrap. “Wraps and front packs are a slightly different issue than seats,” explains Hoffman. “Wear a front pack with the baby chest to chest. If the head flops back the parent should be able to cradle the baby’s head. If the baby is under 4 to 6 months in a front pack facing away from the parent, there’s a much greater chance of the head flopping forward.”
In other words, parents walking around with their baby facing out are optimizing for cuteness and stranger interactions, not safety. Better to turn the kid around.
“If anything, when there’s a potential for a child’s head to flop forward — whether it’s a stroller or a jogger or a swing or a bouncy chair or anything like that — make sure somebody’s paying attention,” says Hoffman. “Kids sleeping in anything angled in the first year of life … that should only happen when necessary and when there’s constant parental supervision.”