When strapped into a car seat or secured in a wrap, infants and young children tend to look like bobbleheads. The combination of weak neck muscles, gravity, and jostling can make children’s craniums particularly jostle-able, fraying parental nerves because it just doesn’t look right or healthy or even safe. As protectors, parents want nothing more to shield an infant’s still-developing spine from the (easily overestimated) potential damage of head flops. Fortunately, doing so is pretty simple provided parents get the right equipment, follow directions, and use caution.
An erratically bobbing head — neck craned at a seemingly unnatural angle — conjures thoughts of pinched nerves, slipped discs, and cracked vertebrae in adults. But, for children, the danger isn’t actually neck strain at all. During an infant’s early stages of vertebrate development, ligaments and tendons are extra stretchable, which explains why infants don’t really experience sprains or the like. So when a head flops side to side, it may be slightly uncomfortable for a baby and terrifying to look at, but the risk of major damage is actually minimal. It’s the forward flop — not backward or side-to-side — that can cause major issues as a result of restricted airways. If a baby’s poorly positioned in a car seat or slumped over in a forward-facing wrap or carrier strapped to a distracted parent, parents should absolutely be concerned.
Here’s the good news: car seats are designed to minimize neck movement and many wraps and carriers do so as well. The hard part, though, 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 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.
How to Make Sure a Baby’s Neck is Supported
- Don’t be overly concerned about a baby’s head flopping left or right, but be hyper-vigilant about making sure a baby’s head doesn’t flop forward, restricting airways.
- Make absolutely sure car seats are installed correctly. If they are, they should help secure children’s heads.
- When possible, don’t let children nap or rest on an incline.
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 majority of them aren’t properly installed. According to Hoffman, 80% of rear-facing car seats are installed incorrectly, and a whopping 95% 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 left-to-right and right-to-left bobbling. Parents still concerned about that can resort to the toddler equivalent of airline pillows — animal-shaped neck braces or other apparati 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.”
“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,” says Hoffman. “If the baby is under 4-6 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. Or, if not, to keep a very close eye on where their little head is at.
It all boils down to good gear and attentive parents: If a baby’s upright or even slightly inclined, that can mean a flopping head and restricted breathing. The best way to keep airways open is to use the right equipment (and to use it correctly) any time a baby might be in an inclined position — especially since babies tend to fall asleep and slump over in pretty much any situation.
“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.”