As pediatric occupational and physical therapists who work mainly with infants, we’ve witnessed a time in history where the amount of baby equipment being used by many parents and child care centers has sky-rocketed. This trend is having developmental implications for some infants. Parents of newborns are vulnerable and need to have reliable information from professionals to combat the heavy marketing to which they are subjected.
Of all the pieces of new equipment that have been marketed to parents over the years, we can’t think of any that we would deem as necessary for a baby’s development. That said, equipment can be an aid to a parent and thus has a role in infant care when used with understanding and used minimally. A savvy parent has been educated and is able to make decisions that are best for their baby and family. Note, equipment is defined as bouncy seats; swings; jumpers; Exersaucers; and sleep positioners such as the Snoo. It can also loosely include such items as the Magic Merlin and others that are designed as a transition item for going from swaddling to being out of swaddling (that will be the subject of another post).
Please know we understand that while a parent may desire to meet their infant’s needs in a certain manner, the realities of one’s circumstances may make that impossible. Having multiples, a baby with medical issues and the pandemic are significant factors that make handling the needs of an infant (or infants) more challenging than in years past.
A word about sleep and parenting, as the main purpose of the Snoo is to increase parental sleep. While it is a reasonable expectation that during portions of the first year of life and beyond, sleep for a parent may be far less than desirable, there is a point where it’s a necessity for a parent to sleep. Please take that into account as we discuss the Snoo below. We can equip you with knowledge, but each parent then needs to take the knowledge and tailor it to their situation; Implementing it in a way that works for their family. We have no judgement. We simply want to give parents information based on the year in, year out experience of the occupational and physical therapists in our clinic, who regularly hear from parents the phrase, “I wish I would have known this sooner.” Once equipped with the information, you have our full support and encouragement to do what you deem best for your infant and your situation. You also have our respect for your love for your baby, your determination, resourcefulness and willingness to sacrifice.
The Snoo has a lovely aesthetic. It is beautifully marketed and was developed by a pediatrician. However, based on the babies we see in our clinic every day, the marketing is highly misleading. Hopefully the information presented here will dissuade parents from investing in this expensive piece of equipment that is not in the best interest of some infants.
Before specifics though, let’s discuss the term, “not in the best interest of some infants.” What that means is that as humans we are highly resilient and despite non-optimal caregiving practices there are many infants that will develop normally. The issue is that some infants will not, and it is very difficult, often impossible, to determine which infants will be impacted and which will not. Some issues are related to head shape, slowed development and may be more obvious. Other issues such as temporomandibular dysfunction or impaired bonding are more difficult to pinpoint and won’t be seen for years but can be very serious.
Five reasons to consider before purchasing a Snoo
Reason 1: There is the potential for negative impact on bonding with your baby due to use of the Snoo.
While there are many products that are not developmentally desirable, the Snoo is designed to interrupt caregiving practices believed to support bonding. Bonding is foundational during the first months of life. That is, during those first months of life a baby learns that “when I cry someone comes and tends to me.” (As an aside, an 18-month-old has learned this well and it’s not uncommon for a toddler to use this mechanism to delay bed time; to wake up parents during the night to play; and on and on. That is an entirely different phase of development that has its own recommendations which differ based on culture and parental style.)
What we are talking about here are the first months of life, and while culture and parental style influence bonding traditions, it is fairly straight forward. The baby cries and learns that someone comes and tends to them. Through the generations, tending to a crying baby at night consists of feeding, a diaper change and movement, warmth and vocal assurance by the parent to the baby that all is well. Babies sometimes get sensorily disorganized and need the parent’s hold to reorient themselves and return to a calm sleep state.
These (hopefully) brief check-ins between parent and infant are physical in nature meaning that the baby is moved during the diaper change and feeding, and is picked up and goes from a horizontal position to vertical when up on the parent’s chest with patting or rocking. There is the parent’s warmth, smell and auditory assurance. There is the kinesthetic assurance from being held tightly and patted. These experiences offer crucial bonding and the infant is learning.
The opposite end of the spectrum are babies who are in orphanages and are not often held and do not fully bond with caregivers. They are at high risk for reactive-attachment disorder. That is a serious issue with lifelong implications related to character development and the ability to have healthy relationships.
There is a spectrum of care. On one end, the baby is being fully tended to, and on the other end a baby’s basic needs for feeding and diapering are met but without the ability for individualized, consistent care and far less opportunities for bonding. It is widely understood that being in an orphanage where individualized care is not feasible puts a baby at risk for deleterious effects (some orphanages are able to provide far better care than others due to resources). Where is the line between that dangerous level of care and ideal care? Between a baby having good enough care and care that isn’t good enough? The answer is probably highly individualized for each baby. Some babies are resilient even in poor-care environments. Others are highly vulnerable.
So how does all of this relate to the Snoo? The Snoo design harnesses the infant to the sleep surface in a manner different than traditional swaddling. When the device senses movement or crying, it begins to jostle. If the movement and crying persist, the device continues to increase the level of jostling and rocking and adds white noise that gets louder and louder. At some point, the infant will stop crying. In our view, some infants stopped crying because they were lulled back sleep while other infants stopped crying because they learned, “I cried and no one came and so I gave up.” In both cases, the baby is back asleep, and it is impossible to know which baby has no ill-consequences and which does. In all cases, the baby remains in the horizontal position, their limbs do not move, they do not feel the warmth, get patted by or hear the voice of their parent. Their diaper isn’t checked and they are not given the opportunity to feed.
Reason 2: The Snoo may increase the risk for head shape issues.
In our clinical experience, those infants prone to having head shape issues will often have them exacerbated by being in the Snoo. Please note that head shape issues are not only a cosmetic issue, as research correlates certain head shape issues with long-term alignment of the jaw, eyes and ears which can have pain and functional implications such as temporomandibular dysfunction.
Reason 3: The Snoo also limits a baby’s ability to move.
Traditional swaddling is helpful and organizing for many infants. This differs from the harness system used with the Snoo. Traditional swaddling is removed around 3 months of age so the baby can safely roll to his or her sides and eventually roll over. The Snoo markets that it impedes rolling and thus is safer from a SIDs perspective. This is in opposition to the American Academy of Pediatrics which recommends placing an infant on her back to sleep AND that when the infant independently repositions her or himself to their sides or tummy, it is safe and desirable to allow this.
As occupational and physical therapists we strongly agree that at around three months of age it is important for an infant to be placed on their back but be free to reposition him or herself independently. When this is impeded, rolling when awake is delayed. This often leads to delayed crawling and exploration of one’s environment. Please note that a baby that sits or walks early but did not crawl for a significant period of time is not an ideal developmental trajectory (also the subject of a future blog post).
Reason 4: It is a very expensive.
Each family needs to consider if those resources would be better spent in other ways such as investing in a night nanny or a consult with infant sleep experts, on savings for higher education later on, or an emergency fund in case of job loss or car repairs, etc.
Reason 5: The marketing promotes strict adherence to their protocol, including bringing or rentng a Snoo when out of town.
This lays the foundation for creating sleep issues later as the infant is not learning how to sleep in various environments.
If a baby falls asleep in a car seat, we recommend moving the baby to a flat surface to sleep immediately upon returning home. This is for the baby’s head shape and development. It is also to support the baby as she or he learns how to sleep with some noise, some movement, and some changes in environment. That will be a baby who grows into a toddler and preschooler that can sleep at grandma’s house, on vacation, and so on.
While schedules and routines are very important for young children it is advised to not be overly rigid. When adhered to with complete rigidity, schedules and routines can lay a foundation for the child to have limited flexibility with schedules changing. When a baby is moved occasionally during sleep, it can help lay the foundation for the child to be adaptable to changes. (Not to say that blame for a poor sleeping preschooler is to be placed on a parent’s shoulders. All small humans are learning so very much and get stuck in some areas. Some are picky eaters; others have trouble sleeping; some get frustrated very easily; some are shy; some don’t like the dark; and on and on).
Note 1: The Snoo is similar to the Fisher-Price Rock ‘n Play in that occupational and physical therapists and pediatricians sounded an alarm bell. Parents raved about the benefits of the Rock ‘n Play while pediatricians and occupational and physical therapists were citing many concerns. This went on for years. On April 12, 2019, Fisher-Price recalled all Rock ‘n Plays, advising that consumers should immediately stop using the product. The Snoo is similar in that many professionals have reservations and concerns and see negative impacts. See also: Dr. Natasha Burgert and Dear Fisher-Price®… — KCKidsDoc and The Fisher-Price Rock ‘n Play Sleeper is NOT for sleeping | The Pediatric Insider (wordpress.com)
Note 2: If you already have the Snoo and after reading this post are feeling defensive or worried about the effects, please know that that is part of parenting. It’s good to learn as much as possible but the information is not always available before decisions are made. Or the information was available and your understanding or ability to utilize it wasn’t there. It’s okay! Parenting entails constant course adjustments. Every parent is doing the best that they can while facing new developmental phases and novel situations and with that often comes course corrections and at times of regret. It’s okay! Just change course when you need to.
We hope this information and the tone it is presented in has been helpful. Having a baby while being heavily marketed to and while receiving loads of information from well-meaning family members and friends makes for a challenge for any parent. Pat yourself on the back as you are seeking out sources of information that are experienced and want the best for you and your baby. Again, know that we have compassion for parents and caregivers of newborns and you have our admiration and encouragement!