As a mother I understand the desire to use baby carriers and keep an infant close. As a practitioner I am also aware of how carriers may impact the spines of parents and babies. This blog offers some valuable information relating to the safe use of baby carriers and provides general tips for correct positioning of your baby in a carrier…
Why use a baby carrier? Benefits of carrying your baby.
The practicalities of baby carriers have made them very popular, but with such a vast array of different carriers available on the market including slings, pouches, wraps and backpacks, it becomes tricky to know which one to choose (if any), and when.
Carrying your baby can have a number of worthwhile benefits. Research has found that using tools such as slings saves 16% more of your energy compared to carrying a baby in your arms 1. This makes sense because properly fitting baby carriers are designed to mimic your in-arms carrying position whilst saving you from having to support your baby´s weight in your arms alone. It is also documented that infants who are carried for 3 + hours per day in the first 3 months of life cry 43% less often than infants carried less frequently2. These babies reportedly show less fussiness and their upright position may help to foster improvements in digestion 2.
The calming effect of being snuggly wrapped and held close to your heart and the gentle rocking of your walking also provides a secure and soothing environment for your baby that is akin to the womb. Being in such close proximity allows you to respond to your baby´s cues (and them to yours) much more readily, and can enhance bonding. Your baby will be able to see and hear the wider world around them from a near adult-eye perspective which, as they get older, provides continued and interesting distraction.
I found one of the greatest benefits to “babywearing” (in those first few months) was my increased ability to move around and do things without having to be separate from my baby. I always felt my newborns were so vulnerable and I wanted to keep my little one close by while I attended to the needs of my other children.
Are there postural risks for babies in carriers?
Concerns that have been raised for baby carriers relate mainly to hip posture and the possibility for placing stress on the spine (spondylolisthesis or forward-slipping of the spinal vertebra). However there is currently very little research that shows these potential risks to be the case. If your child does have “clicky” hips or if breech delivery is a factor, I suggest seeking the advice of a health provider who is able to assess your baby’s hips and guide you on any vulnerability.
In her doctoral research on infant carrying, Dr Evelin Kirkilionis argues that babies are actually well adapted to being carried in an upright position with legs in a straddled and squatted posture 3. She argues that this position, with the baby´s legs drawn up more than 90 degrees and spread approximately 90 degrees, promotes healthy maturation of the hip joint and protects against abnormal formation of the hip socket (hip dysplasia). Additionally, movements from the walking parent are transferred to the baby to provide stimulus and adequate blood supply to the hip joint.
“Very often parents who want to carry their child in carrying devices or carrying slings are warned that it may cause spinal damage, especially if they want to start carrying before the child is able to sit unaided. A longitudinal study of 192 children …. showed no relationship between carrying in the upright position and an increase in postural damage. There was no increase in the number of spinal abnormalities in children who spent 2-2.5 hours a day in carrying devices nor among infants who were carried for 4, 5, 6 or more hours daily – some from as early as the first week of life. None of the children later showed postural abnormalities which could be attributed to early carrying”4.
Importantly however Dr Kirkilionis stresses that outward facing positions (where the baby faces away from the parent) are best avoided for young babies, especially under 4 months of age, due to the dangling leg posture that results 3. Because of the construction of carriers the hip capsule can become stretched or even forced when in this position, potentially promoting malformation of the hip joint. The posture of the torso also tends to become strained. “If the baby sits facing away in the carrier, the straps pull from the front over the child’s shoulders and this often causes a very upright posture since the shoulders are pressed back. In the worst case, in combination with a stretched position in the hip joint, a hollow back is forced”. Babies who face outwards may also not be able to shut off from stimuli and become hyper-stimulated 5. I would suggest that babies face forward only once they are able to support the weight of their own head at around 5 months.
Tips for positioning
By holding your baby with his knees flexed flat against your chest and supporting the his bottom you are supporting your baby in the natural position that his body instinctively assumes to ensure that he is comfortable, warm and safe.7
In her speech at the 2010 International Babywearing Conference 6, pediatric nurse and babywearing educator M’Liss Stelzer highlights that in upright baby carriers the optimal position for newborns and infants under 4 months is chest-to-chest where parents can easily monitor their infant’s breathing and infants are able to use their parents breathing cues to establish a normal breathing pattern. Head position can also be kept optimal, usually turned to one side as would naturally be adopted in a holding position. When reclining carriers are used (in what is called a cradle hold), it is important that your baby’s neck be straight, and the C-shaped curve of the spine and curve of the legs be no more than would normally be seen when a baby is held in arms. Legs should be flexed so that the knees are higher than the bottom to keep the hip joint properly in the socket 6. Stelzer states: “In any carrier, a good test of whether it is correctly positioned is to bring one of the user’s arms up around the baby in the carrier as though it weren’t there. If there is significant movement, then the carrier needs to be adjusted so that they mimic an in-arms position as much as possible” 5.
A general protocol
I have found slings to be good for bubbas when they are tiny; once they gain weight the postural strain for the adults wearing them is not ideal. I recommend that you start with a sling for the first few weeks of your newborn’s life, and remember to regularly check your sling for any signs of wear and tear. Once tummy time has been initiated at around 3 weeks, you could then introduce a baby carrier (unless your child has hip issues as discussed previously). Before purchasing your baby carrier please try various brands and select one that has as much mid and low back support as possible.
Our babies were all rather large (and that’s an understatement) and after a few months I restricted the amount of time I would use a carrier. As they became heavier and heavier I would use the sling for shorter periods throughout the day until finally only my husband would use our baby carrier.
So many of our children spend far too many hours on their backs – on the floor, or in bed. There are enormous neurological benefits for babies having regular small intervals of tummy time and also time where they are upright and being safely held in baby carriers. Both are a critical part of your baby’s neuromuscular development.
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1. Wall-Scheffler C, Geiger K, Steudel-Numbers K. Infant carrying: The role of increased locomotory costs in early tool development. Am. J. Phys. Anthropol. 2007; 133: 841–846. doi: 10.1002/ajpa.20603
2. Hunziker UA, Barr RZ. Increased Carrying Reduces Infant Crying: A Randomized Controlled Trial. Pediatrics 1986; 77(5): 641-648
3. Dr. Evelin Kirkilionis. Carrying babies facing away from the parents body – is this truly positive for a baby? Originally Published in Mothering Magazine July/August 2006:136 http://www.babywearingschool.com/drkirkilionis.htm
4. Dr. Evelin Kirkilionis. Unfounded fear of postural damage by carrying. University Freiburg. Reprinted with Permission http://didymos.com/index.php?s=kirk99
5. Victoria Ward Babywearing Consultant. Babywearing: A Guide for Professionals http://www.slingsandbabycarriers.co.uk/Babywearing-Leaflets%282010314%29.htm
6. 2010 International Babywearing Conference, Idaho: Speech by M’Liss Stelzer, Pediatric nurse and babywearing educator, summary by Jan Andrea Heirtzler, Board member of Baby Carrier Industry Alliance. http://www.sleepingbaby.net/infantsafety.pdf