Birthday Cake first appeared in the Birthdays episode of "Elmo's World". She also made a cameo in the video, Bert & Ernie's Word Play during Cookie Monster's song, "One Little Letter," in which she was turned into a chocolate shake that was then drunk by a snake.

The puppet later appeared in Episode 4184, in which Jessica Alba said the cake looked scrumptious. The cake was performed by Joey Mazzarino in this appearance.