The importance of pram orientation for emotional health

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The importance of pram orientation for emotional health: why you need to turn it about

Kate with pram



When I saw Kate pushing Princess Charlotte along in a vintage pram I wondered if there was more to it than simply following tradition. Professionals working in mental health and brain sciences are increasingly aware of the benefits gained by an infant who can make visual contact with a parent … even while out in a pram or stroller.

 Early neuronal development

Eye contact is a fundamental element of human communication and social learning (1,3). Infants are born with a sensitivity to several emotional expressions and during their first year they learn very quickly that the gaze of another person, particularly a caregiver, provides socially significant information (1). A child’s healthy development of neuronal pathways, and emotional regulation, depend on critical periods in early development. The more engaged the child is with the caregiver, the more neuronal activation that occurs, the more aware and curious the baby becomes of their environment, and the less fearful they are to want to interact and explore it.

Mirror Neurons and Emotional Connections

Ever wonder why you laugh when someone is laughing, why you tear up when you see someone else crying, or even yawn when someone yawns? These responses are triggered by mirror neurons. Mirror neurons help us identify with the emotions of another person and studies suggest that people who have more active mirror neurons tend to be more empathetic .

Babies through to toddlers need to be able to see their parents as they go about in the world. They learn by looking into their parent’s eyes and witnessing their facial and body language. Muscle tension, ,mirror neurons, eye movements and the minute dilation’s of the eye’s pupil inform the infant, without words, a lot about their world and the objects in it. Children also learn through mimic so they will follow a caregiver’s gaze and mimic the response to the object of the caregivers gaze.

It is believed that children with mirror neuron dysfunction, develop difficulties in emotional & social skills as well as language, cognitive and motor skills. They will find it difficult to read non-verbal communication and gestures and they may not have learned to reference facial expressions for information. However, parents and caregivers can  promote and strengthen their children’s mirror neurons by making direct face-to-face emotional connection (also called attunement) with the child during early development.

reversible strollerEffects of stress/distress and fear

Infants and adults respond to frightening or overwhelming circumstances in a similar way. The autonomic nervous system will trigger a sympathetic nervous response and switch into flight, fright or freeze mode. The body releases stress chemicals such as adrenalin and cortisol, heart rate increases, pupils dilate, and the gastrointestinal and immune systems slow or shut down. Depending on the child and the circumstances, the child may appear agitated, hyper-vigilant, quietly watchful or even detached or spaced out.

Prolonged or frequent exposure to stress can lead to changes in the child’s brain development and can also lead to a heightened sensitivity which can affect their cognitive ability to learn and achieve normal milestones. It can also lead to issues in the future such as learning and concentration in school, developing trust, being able to relate to others, and to regulate their behavior and self-sooth when distressed. These children are at risk of attracting labels such as ‘hyperactive’, or diagnoses of ADD or ADHD.

Turning it about

Pram orientation can result in young children being prematurely exposed to high volumes of noise, images, smells and many unfamiliar faces. Prams/pushers/strollers facing out into increasingly busy shopping centers and walkways, deny a child any opportunity for visual cues from their carer about the world confronting them, and could potentially trigger longer term effects of over-stimulus and trauma such as anxiety and panic disorders. However turning the pram around to face the caregiver allows the infant the opportunity to learn to respond to short periods of stress or distress appropriately, to access reassurance from the caregiver when needed. As an added bonus the trust that the baby develops with the face-to-face time generally results in a stronger bond between them and the caregiver.



1. Striano, T., Kopp, F., Grossmann, T & Reid, V. (2006) ‘Eye contact influences neural processing of emotional expressions in 4-month-old infants’, Social Cognitive and Affective Neuroscience. Sep; 1(2): 87–94.

2. Davies, M.S., Dapretto, M., Sigman, M., Sepeta, L., and Bookheimer, S.Y. (2011) ‘Neural bases of gaze and emotion processing in children with autism spectrum disorders’, Brain Behavior. Sep; 1(1): 1–11.

3. Farroni, T., Csibra, G., Simion, F., and Johnson, M.H. (2002). ‘Eye contact detection in humans from birth’, Proceedings of the National Academy of Sciences of the United States of America. Vol. 99 (14).


  1. This highlights the importance of leavnign the mobile phone out of sight of the infant when walking the pram!

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