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!
March 2021
Excellent article except for #4. Suggesting parents spend money to combat biology (ie babies wake at night) is a problem for me as a long time IBCLC. Otherwise, thank you for this well thought out article. May I suggest you make the print a bit darker, as it is hard for some of us to read the very light print.
Great feedback! Thank you so much for reading.
We have a newborn and we just started using a snoo. The baby does sleep better but I am worried anytime something mechanical is used for a child. I came home late from work tonight , my wife had the baby in the snoo. Baby was sound asleep and it was shaking really hard left and right and the baby’s head was flailing. I woke my wife up and she turned it down . I am now concerned about head/ neck injuries and the Doc already notice some head shape issues. Child is just now 10 weeks, it’s been about a month using it now. Any feedback appreciated ! Ps first article that did not come across as a product endorsement ! Thank you
Congratulations on your new baby. Thank you for reading and commenting. Always check with your pediatrician if you have a concern.
Can you share some bassinets that are recommended for babies?
A good bassinet has a firm, flat surface with ventilation. Here are two examples at 2 price points. I am not familiar with the sturdiness of either of these but the design and reviews indicate sturdiness and that they will not tip over. When baby begins to roll or is nearing a weight of 20 pounds, it’s time to move baby into a full crib. Hope this helps! Please feel free to ask more questions if you have them!
Amazon.com : Baby Delight Beside Me Doze Deluxe Bedside Bassinet : Baby
Maxi-Cosi Iona Bassinet, Essential Blue | Pottery Barn Kids
Thank you for this article. I am a pediatric PT and was trying to find unbiased thoughts on how the snoo affects an infant’s development. You stated my thoughts and concerns so eloquently! Unfortunately, it took me a while to find this article and only because I was looking for some information from a developmental standpoint. I hope more parents read this but the snoo is a sleep aid and most people will only see how it benefits sleep rather than the infant as a whole. I will be passing this along to the parents I work with!
Thank you for your comments. Please feel free to share the article far and wide!
Another concern is the novelty of the Snoo. It has not been around long enough to be fully debugged. Since it’s something that your baby lives in for hours at a time, prudence suggests allowing 10 years of market use before you consider it safe. I know of 3 infants using the Snoo with no issues, but one can only hope there are no long-term effects.
Thank you for reading and commenting!
As a pediatrician I have a few thoughts.
First these are all assumptions and not evidence based.
Second you cannot compare this to the rock n play. They are different set ups.
Third I have not seen an increase or flat heads with snoo use. This is observational.
One other benefit is less moms are cosleeping because of the snoo.
You also ask any mom and they still get up when their child is crying. It’s an opinion that this will effect bonding.
The sack is similar to a halo sack and the argument the halo sleep sack doesn’t cause flat head or restriction to move is lacking.
Thank you for reading and commenting!
Thank you for chiming in doc, I have a three week old and just got the SNOO. I am afraid to co-sleep and I need to get some sort of sleep because I have 2 kids under two now.
My grandson has to have intervention for developmental delay. He also had a head shape issue and had to wear a helmet for two months. I’m glad this information is being shared. I was open to the idea of the Snoo, because I know parenting has changed since my children were little. I did worry about the restriction of mobility but I honor my children’s parenting choices. However, after seeing the results I will speak up with more conviction about this. As a Waldorf early childhood teacher, we know how important it is for children to move. This just affirms it so thank you!
Thank you for your note. So glad you found our article helpful!!
I’m a SNOO mom. My toddler and I are well bonded, she is sweet and affectionate. No head issues. She had no motor delays. It’s called tummy time and active floor play when they’re not sleeping. She was sleeping through the night by 12 weeks and sleeping independently (away from the SNOO) by 5 months. I loved the SNOO for its safety and I would definitely use it again.
Erica, thank you for bringing up the importance of tummy time and floor play when awake. We very much agree! We frequently say “a blanket on the floor is your baby’s best friend.”
https://carolinakinderdevelopment.com/the-importance-of-babys-head-shape-in-development-why-a-blanket-on-the-floor-is-your-babys-best-friend/
I, too, am a snoo mom. I don’t feel like this critique captures the full range of the type of parents who use the snoo. I respond every time my baby cries and I turned off the function that escalates motion when the baby cries. The peace of mind that comes with the snoo’s safety features make me a better mom who is more emotionally present for my baby. I don’t see how the snoo sleep sack is much different from a Halo swaddle. Could you comment on how you see it differing from other types of easy swaddles like the halo?
Thanks for reading and for the question! The Snoo swaddle differs from a swaddle like the Halo sleep sack in that the Snoo swaddle attaches to the bed, thus securing the baby to the bed and impeding natural movement of the shoulders, legs, pelvic extension/flexion, ribcage rotation, weight shifting, and pelvic-ribcage-head connections. A sleep sack like the Halo sleep sack allows more freedom of movement and is less restrictive, which is beneficial for both head shape and development.
Again, thank you for reading and the question. We hope this information is helpful and that you feel supported and empowered with additional information.
Thank you! I was strongly considering a snoo but mainly for the benefit of my own sleep. I can definetly see how responding and comforting my baby in the night would be jeopardized and the importance of that tradition. Also I have read scientific articles against the use of white noise. Sticking with the halo bassinet 🙂
Thank you for reading and commenting!
Thank you for this thoughtful article. Do you have any recommendations on swaddle sacs and transitional swaddle sacs that can be used as babies transition from swaddling to being able to roll over. Assuming one is NOT using the Snoo. I find the swaddling in a simple muslin blanket always comes undone.
Thank you.
So glad you found the article helpful! The Halo Sleepsack Swaddle is adjustable and good for swaddling and transitioning out of the swaddle. We’ll soon write a blogpost on transitioning out of the swaddle. In the meantime, here’s a summary of our recommendations. Stay away from weighted sleep sacks such as the Merlin as in our experience, with babies that are vulnerable, the Merlin actively impede rolling and encourage outstretched arms at a time when the baby is ready to begin rolling. The general rule of thumb is that at 2-3 months it is time to transition out of the swaddle. As with all things human related, there is a variety of experiences. Some babies don’t miss a beat and their sleep is unchanged. Others sleep more chaotically for a maximum of 3 days until they settle in again. It’s a general rule of thumb that when changing a routine with a baby, it takes a maximum of 3 days for a baby to settle in. Again, all humans are different, the 3 day maximum is a rule of thumb.
Thank you for your quick and thoughtful response. My baby is 10 weeks and we have been using the Snoo but we’re starting to question its benefit. We are transitioning our little guy out of it. I’m trying the Halo Sleep Sac tonight but I’ll try the Halo swaddle with arms out tomorrow if the sleep Sac doesn’t work. I’m so glad I found this article. It confirmed some of my suspicions and feelings about the Snoo. Thank you.
Can you explain how/why the snoo exacerbates head shape issues?
Thanks for reading and asking a question. When an infant is placed in the Snoo the forces are more restrictive of movement than traditional swaddling or unswaddled. Thus an infant who is vulnerable to head shape issues (See this article too) nestles into the place of comfort and stays there, either due to comfort and/or inability/lack of strength and flexibility and visual motivationto turn head in a different position. The sometimes subtle, sometimes obvious whole body movements that young infants often make while asleep such as flexing legs or lifting a shoulder/ribcage/leg with a weight shift towards one side and weight-bearing on the other side are restricted in the Snoo. Thus during sleeping hours normal young infant pelvic extension and flexion and ribcage rotation and pelvic-ribcage-head connections are inhibited. Another factor is that there are less frequent parent interactions which mean longer stretches between the baby being picked up, held in a vertical position, soothed, diapered, fed, and repositioned upon lying back down. Frequent repositioning, especially of head shape, is a hallmark of developmentally supportive infant routines.
Those infants with excellent awake time routines will be better able to be resilient to less than ideal positioning at night. However those infants with vulnerabilities (same link as above), even with good daily routines, are less likely to be able to overcome the restrictive sleep time positioning and the plagiocephaly/brachycephaly can be quickly exacerbated. Hope this helps!
Such an important read. Thanks for sharing on a sensitive topic.
Thank you for reading!! We appreciate the feedback.
I appreciate the sensitive language used. I’m a huge fan of the snoo, and largely because of my experience with PPD and PTSD. My little one has slept great in it and it’s given me the space to sleep/function/keep myself and my kids safe (as well as give my partner sleep support after days of caretaking). I appreciate the verbiage throughout the article, very warm and nonjudgmental. I just wanted to mention directly the mental health support it can provide for those mamas that need it.
Thank you for sharing your experience. We are glad our tone resonated with you. Wishing you and your family good health and well-being as you make your way.
Very interesting thank you for this.
I have to say, I am absolutely freaking with anxiety now that I have used the snoo for four months. This article has made me feel like a terrible mother!! I often thought about the little bonding time. My daughter is quiet as a mouse and was from birth. I am confused and a little upset with this article but I appreciate your research and honest opinions. This has absolutely sent me into a spin I’m not going to lie!!! Parenting is hard!! I was searching topics on four month regressions and it led me here. I surely won’t be the only snoo mother feeling like absolute crap from reading this.
Please, please, please reread Note 2 which is reprinted below. Your baby has a treasure in you. You are obviously a very caring parent who seeks out information and who is receptive to adjusting course when you see the need. That is at the very essence of good parenting. If you can, please let go of the idea that “you should have already known this”. We only wrote this article a couple of months ago, I’m not aware of others like it. You are on the cutting edge by having read it at this point.
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!
What’s the reasoning behind the concern about head shape issues? Is it that they’ll be lying on their back until 5 or 6 months rather than rolling over to sleep sooner?
Thank you for your comment. Please see our answer to this question in a previous comment — also check out our article, “13 factors that can cause flattening of the head.”
I have the snoo and have used it for about 3 months now. Upon getting it I decided NOT to use the rocking to put and keep my baby asleep. Instead I just use it for the sound machine and knowing he is safe and not rolling. For about two weeks after bringing him home I had the bassinest. He would roll against the mesh side while swaddled. I would see his face pressed against the mesh and for a few week old baby this was upsetting to see. So, in came the snoo. Whenever my baby wakes up instead of the snoo rocking (I have had it on weening mode from day one) I tend to him change him rock him and back in the snoo he goes. Only every so often (after I’ve calmed him and out him back in the snoo) I choose to have the snoo rock him for a few moments longer. I lock the blue (calm) mode but he never gets to a point where he is crying because I always have him before then. This just felt more natural to me to be the one that soothes him.
He’s 13 weeks and I have just freed his arms from the snoo swaddle. So, while he is hooked in place (this was the most important feature to me) his arms are free and he moves his head from side to side.
Snoo doesn’t mention other parents only using the weening feature from day one. I just decided to do that on my own. It’s an option if you want the safety of the snoo and the soothing of you.
Thank you for your thoughtful comment and sharing your experience.
Tammy Hermann you are a wonderful woman, thank you for sharing all of this and for being such a compassionate messenger.
Thank you! I am the moderator. The comments are written by the blogpost author’s, Susan Klemm MS, OTR/L and Stacy Conder, PT.
I have never been a fan of the snoo. I do not have an option though, since I am a Postpartum Doula and Newborn Care Specialist, I typically have to use what the parents provide. I have found ways to make snoo better for my clients and still keep baby safe but I still do not agree with the whole thing. Tbh i feel like the snoo is a crutch for new parents, as stated its a sleep aid. Don’t get me wrong, I love my sleep too, but the entire point of night time bonding is not as it should be and it just creates more work in the long term. You have to ween the baby from so many habits with this device, where as, if you just started with a bassinet you would be 3 steps closer to a sleeping all jiggt baby at 3.5 months!
Thank you for reading and sharing! Doulas can be of wonderful help. Thank you for all you do.
There are some great points in this article, however it is a missed opportunity for a balanced approach to actually help parents, vs making those that have a Snoo feel awful and those that could actually benefit from a Snoo suffer without utilizing a tool that could help. For all we know, the Snoo could be saving countless baby’s lives. There is not one benefit of the Snoo that is pointed out in this article. You would never know that there are families out there, and babies in Snoos that are thriving! I’ve seen it first hand. You can use a Snoo and still bond beautifully with your baby, and if you are prone to PPD, it can increase your bond with your baby since it will help baby and you to sleep. Comparing the Snoo to the Rock ‘n’ Play, which was inherently dangerous and led to many deaths is misleading. Also, calling the Snoo a positioner is false, and confusing for parents who may actually be using a positioner. The AAP and FDA have examples of positioners on their websites and warn about suffocation in the cushions of these devices. Babies die in unsafe sleep environments. Period. And all parents have complete control over their baby’s sleep space. And if a Snoo keeps an exhausted parent off the couch with a swaddled baby in their arms, it will potentially save that baby’s life. There are so many cases where a swaddled baby died, and it wasn’t the fault of the swaddle as the media loves to emphasize. It was because an exhausted parent fell asleep with a swaddled baby on the couch and the baby then fell out of the parents’ arms and suffocated in the pillows or crevices of the couch. Those that have used the Snoo, please don’t feel guilty. Your decision may have saved your baby’s life! It is important though to heed some of the advice in this article. It is spot on. There are clues your baby will show if they are in a Snoo and at risk for plagiocephaly ~ just check your baby frequently. Most babies will change the position of their head from back to side, to other side, etc. while sleeping. Some babies will not move their head at all. For months on end ~ the baby’s head is always face up. There are ways to help prevent plagiocephaly – move your baby’s head while they are sleeping, tummy time as already noted, no extended time in car seats, swings, or bouncers. I agree with the insight into the movement of the baby as they get older. It is restricted in the Snoo. If it concerns a family, they can move their baby to the crib when their baby naturally starts rolling over from back to tummy around 4 months or so. I hope exhausted families during the pandemic will utilize all resources that can help them, and decide, based on facts and solid information whether or not something is right for their needs. It is all too common these days for parents to hear or read blanket statements. My favorite: “You must stop swaddling at 8 weeks”. Completely false, and yet hundreds if not thousands of swaddled babies that are thriving are abruptly unswaddled at exactly 8 weeks. It’s simple: read the articles, research the facts. 🙂
Thank you for reading and commenting.