Sunday, July 18, 2010

Babywearing: Safe Positioning

Article and first image from Tadpoles & Butterflies
posted with permission

This positioning applies to any carrier – ring sling, pouch, wrap, mei tai & soft structured (buckle) carriers and to babies of all ages. If the carrier does not allow for this positioning, it is not a suitable carrier. Older babies/toddlers should be carried in this same general position on your hip or your back.

We recommend ensuring that your baby is generally positioned in your carrier as follows:

~ Vertically, on your chest, with baby’s bum at or above your navel
~ Knees above bum, in a frog legged or M position
~ Spine rounded
~ Head turned to the side, with baby’s chin well above his chest to avoid closure of the airway
~ The fabric of the carrier needs to be properly tightened to support your baby in this position. Fabric should be spread from one knee to the other and must not block the baby’s mouth or nose in any way.

You may notice that the manufacturer’s instructions provided with your carrier suggest positioning that does not meet these requirements - forward facing or cradle positions specifically. We recommend against wearing your baby in either of those positions.

Research consistently shows that when babies are held vertically, skin to skin, on a parent’s chest, their heart rate, respiratory rate & temperature are regulated.* Additionally, they cry less, breastfeed more effectively, and develop quicker and more optimally.* Dr Nils Bergman, a physician and scientist who has extensively studied the beneficial practice of keeping babies in their natural habitat (vertically, between their mother's breasts), says, "The baby is in the right place and therefore has the right behavior."

The cradle and the forward facing positions continue to be taught by some manufacturers and educators, but we recommend you avoid using these positions because they make it difficult to position the baby safely for oxygen flow (respiration), are ergonomically incorrect (spinal alignment) for the baby, as well as the wearer (back pain) and appear to contribute to breastfeeding problems for some.

Babywearing is a wonderful tool that gives babies the minimum they expect - to be carried by their mother. It is also a learned skill that requires a bit of background knowledge to safely perform. For most of human history, girls learned to effectively wrap and sling their baby from all the mothers (and grandmothers) around them. Today, many new mothers in North America must learn from scratch. But practice makes perfect and babywearing soon becomes a breeze - making life much easier on mom and healthy for baby. Please be certain to learn safe wrap styles to wear your little one.

Additional Babywearing Resources Linked Here


Facebook Babywearing Safety Page



safely worn in an Ergo

safely wrapped in the Moby

safely worn in a ring sling




References


-Skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial. Pediatrics 113(4):858-65.


-Tessier R, M Cristo, S Velez, M Giron, JG Ruiz-Palaez, -Y Charpak and N Charpak. (1998) Kangaroo mother care and the bonding hypothesis. Pediatrics 102:e17.


-Anisfeld E, Casper V, Nozyce M, Cunningham N. (1990) Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment. Child Dev 61:1617-1627.


-Quebec Coroner Jaques Robinson warning as reported in The Globe & Mail, Feb 05 2009


-Bergman, N.J., Linley, L.L, & Fawcus, S.R. (2004). Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200- to 2199-gram newborns. Acta Paediatrica, 93, 779-785.


-Charpak, N., Ruiz-Pelaez, J.G., Figueroa, Z., & Charpak, Y. (1997). Kangaroo mother versus traditional care for newborn infants <2000 grams: A randomized, controlled trial. Pediatrics, 100(4), 682-688.


– Hunziker UA, Garr RG. (1986) Increased carrying reduces infant crying: A random-ized controlled trial. Pediatrics 77:641-648 -Durand, R., Hodges, S., LaRock, S. Lund, L., Schmid, S. Swick, D., Yates, T., & Perez, A. (1997).


-The effect of skin-to-skin breast-feeding in the immediate recovery period on newborn thermoregulation and blood glucose values. Neonatal Intensive Care, 10, 23-29.


-Messmer, P.R., Rodriguez, S., Adams, J., Gentry, J.W., Washburn, K., Zabaleta, I., & Abreu, S. (1997). Effect of Kangaroo care on sleep time for neonates. Pediatric Nursing, 23(4), 408-414.


-Christensson, K., Siles, C., Moreno, L., Belaustequi, A., de la Fuente, P., Lagercrantz, H., Puyol, P., & Winberg, J. (1992).


-Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatrica, 81, 488-493.


-Wahlberg, V., Affonso, D., & Persson, B. (1992). A retrospective comparative study using the kangaroo method as a complement to standard incubator care. European Journal of Public Health, 2(1), 34-37.


-Meyer, K., & Anderson, G.C. (1999). Using kangaroo care in a clinical setting with full-term infants having breastfeeding difficulties. American Journal of Maternal Child Nursing, 24, 190-192.


-Gray, L., Watt, L., & Blass, E.M. (2000). Skin-to-skin contact is analgesic in healthy newborns. Pediatrics, 105, 14.


-Ludington-Hoe, S.M., Lewis, T., Morgan, K., Cong, X., Anderson, L., Reese, S. (2006). Breast-infant temperature synchrony with twins during shared Kangaroo Care. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35, 1-9.


-Insel, T.R. (1997). A neurobiological basis of social attachment. American Journal of Psychiatry, 154, 726-735.


-Carter, S.C. (1998). Neuroendocrine perspectives on social attachment and love. Psychoneuroendocrinology, 23, 779-818.


-Lamb, M.E. (1982). Individual differences in infant sociability: Their origins and implications for cognitive development. In H.W. Reese & L. P. Lipsitt (Eds.), Advances in child development and behavior (Vol. 16, pp. 213-239). New York: Academic.

13 comments:

  1. Good thing my 5 dc didn't know that they were only allowed to sit in the sling one position or it might lead to breastfeeding problems ;-) They nursed for 4 to 6 years respectively which means that I nursed from 1993 to 2010 straight LOL! I also carried my dc for years in a myriad of positions dependent largely on their temperament. Yes, we need to teach safe babywearing, but being restrictive isn't always productive.

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  2. I have loved wearing my kids, but after they hit about 25 lbs, I refuse to take the strain. I guess I'm a wimp like that. However, while my girls were worn, shopping trips, walks, and everything else were so EASY (as opposed to hiking a stroller everywhere).

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  3. After about 28lbs, a great carrier - no strain on the back - is the Ergo.

    http://www.ergobabycarrier.com/

    Actually, all GOOD wraps (woven cotton, the Moby, etc.) should be wrapped in such a way that there is no strain on the body. Baby (or toddler) becomes an extension of his parent. If there is pain, something is not positioned properly, or the carrier is not a good choice (i.e. no hip/core body support, digging into the shoulders, dangling baby by crotch as the Bjorn and Infantino do, etc.)

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  4. I love the position you are describing, but babies do not always consent to being turned in. As a large breasted woman, there is simply no good way to nurse in that position. I have nursed two babies in a variety of positions in carriers, always being careful to protect airways and I think the cradle position is valuable for nursing, as long as you keep a straight back and don't cover the face. Teaching common sense and good positioning are key. Having a baby on you all day everyday requires flexibility, and variety to keep both of you comfortable and baby wearing long term. I wouldn't want to see moms try one position with a babe who doesn't like it and give up.

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  5. It may be good to note also that while there is a general safe position for babies (especially newborns) most will enjoy being worn/carried in different positions depending on their age, height, weight, development, needs, and what they grow accustomed to.

    We had one child who loved this exact position from almost day one. He happily went everywhere we went - but only wanted to be worn on the FRONT. He wasn't a big fan of being worn on the hip or back.

    For large breasted women, a wrap may also be more beneficial than a carrier because it can be wrapped to fit your body rather than having straps and belts that need to be adjusted and don't always 'fit' right to nurse in (if you choose to do so).

    I have large breasts and found the Moby to be easy to nurse in (lifting my breast up and out for baby in this standard in-facing position). But it was difficult to do so in carriers. Other mothers I know enjoyed nursing while carrying in an Ergo or other similar style carrier. So one thing is to try out several and see what works best for you. :)

    The diversity of wraps (how they can be used) makes them especially good - as long as a mother is willing to learn how to wrap them and practice practice practice.

    By the time my first child was a few weeks old, we had the Moby wrap down (and adjusted the wrap style as she grew).

    ReplyDelete
  6. I'd agree with the article that baby facing outward is not generally comfortable for baby (and not safe for newborns). This is one reason good carriers like the Ergo only have the inward facing option.

    It is unfortunate that the 'pop' media culture loves to portray babies dangling from the bjorns. It isn't useful to teach parents improper use of babywearing devices - or those that aren't any good to begin with.

    But each baby will be different, so you have to try things out and see what yours likes best, keeping the general safe guidelines as a rule - straight/curved spine, airway free, upright (not curled laying down), etc.

    A good Babywearing Safety page:

    http://www.facebook.com/BabywearingSafety?v=wall

    ReplyDelete
  7. One of my sons only liked facing outward (once he was old enough to have head control), while the other one liked facing inward, so I think it is hard to generalize about every baby being in one specific position. That's one thing I like about the Pikkolo - it can be used in 4 different positions.

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  8. I appreciate this article and have included a link to it in my blog:
    http://www.olydoula.com/blog/

    Hugs! Carolyn in Olympia, WA

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  9. I LOVE wearing my son on my back, but I can NOT put him that way by myself. I have a Baby K'Tan carrier, which I love, and the back-wearing position works well, but my son is too heavy to wear on my front anymore. Tummy to tummy used to be my favorite position to carry him in, but he's 25 lbs now and it's a strain on my back. Any tips on how to strap him onto my back by myself? I can also use a hip carry with this carrier, but I haven't tried it yet.

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  10. This is a wonderful post but I think saying forward facing out in general is bad. In crotch danglers, yes it is bad. In other carriers, when positioned properly it is ergonomically the EXACT SAME POSITION as forward facing in (once a baby has sufficient head control). The danger then becomes over stimulation and it is up to the parent to know their child well enough to leave the situation or turn them around before that happens. My daughter went through a phase where she would only consent to facing out so she could see the world.

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  11. Grace, I don't think a K'Tan is a safe back carry option. The stretchy material makes it too easy for baby to wiggle out and possibly fall. By 25lbs, the K'tan is really past its ideal use range. You should look into a mei tai or soft structured carrier if you want to continue wearing on your back. Both are easy to do solo.

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  12. Melissa, I'm Arie, I wrote the paper...there are a few reasons I don't believe that's the same position. In a forward facing position with the legs up, the back of the baby's spine is flattened. It needs to be rounded in order to support the weight of the baby's head & upper body. Additionally, the baby's weight pulling forward on the mother's core causes strain on her abdomen & pelvic floor- there's a lot more at play than a risk of overstimulation.

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  13. I have never been able to breastfeed while wearing ever in any position. :( My boobies are to big. I have worn babies in several carriers and when i found teh SSC and Mai Tei carriers, I was in heaven.

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