Safe Positioning in Slings

Consumer Reports blog this week announces the heartrenching death of 6 day old Derrik Fowler in an Infantino Slingrider. He died of positional asphyxia- when a baby asphyxiates due to the airway being compressed by the weight of his own head.

This happens when babies are poorly positioned in all types of products: car seats, baby chairs & yes, baby carriers. When babies chins are touching their chests, their airway is compressed. They lack the muscular control to lift their heads to prevent asphyxiation, placing them in an extremely dangerous situation- one Derrik's parents must be devastated about.

I cannot imagine their feelings when they learn that his death was completely preventable. In 2006 & 2007, informal tests were done on the respiration rates & oxygen saturation rates of babies in Infantino Slingriders. They were performed by a former RN & babywearing educator. She sent her findings, along with supporting information, to Infantino & to the American Consumer Product Standards council. Further detail can be found at www.thebabywearer.com

While the Infantino sling is obviously a disaster waiting to strike again, poor positioning in any carrier places infants at risk. It is essential that babies faces are never covered by the fabric of a carrier & that their heads are angled back, keeping their chins well away from their chests. The photos on the Infantino product site are a good indicator of the unsafe positioning that must be avoided.

While some brands of carrier are designed in a way that does not allow the possibility of safe positioning, many excellent brands that do allow for it are used in a position that I no longer consider safe or biologically correct- the cradle hold.

There are a number of reasons I will no longer teach this position. In most photos of babies placed in the cradle position, the baby's chin is down at its chest. It is very difficult for most parents to safely position the baby while it is in the cradle hold.

Second, the cradle position does not place the baby in the position it expects to be in- vertically, between its mothers breasts. Dr Nils Bergman, a physician & researcher who has extensively studied the immensely beneficial practice of keeping babies in their habitat- vertically, between the mothers breasts, says: "The baby is in the right place and therefore has the right behaviour."

As a Lactation Educator (LE) & a Babywearing Educator, I often help parents resolve difficult breastfeeding problems by simply recommending Kangaroo care- ie, time spent skin to skin, vertically, between the mothers breasts.

When babies begin a nursing session in the vertical position (moving themselves over to actually nurse), they are best able to effectively coordinate their suck/swallow/breathe reflexes (for more information on these concepts, see the work of Dr Suzanne Coulson , Kittie Frantz, Dr Michel Odent as well as Dr Bergman)

If babies orient vertically, I believe placing them at an angle, or horizontally, can disorient them. In my experience, this can lead to, or exacerbate, breastfeeding difficulties.

The cradle position continues to be taught by manufacturers & educators, but I recommend you avoid using this positioning. It makes it difficult to position the baby safely & appears to contribute to breastfeeding problems.

Instead, newborn babies should be positioned tummy to chest, with their legs in a frog position, knees higher than bum. The carrier should support them well enough that they are not slumping down in it, potentially compromising their airway.

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. Please always be certain that your baby is safely carried.

How do I know which type of wrap to choose?

There are so many types of wrap to choose from! It can be overwhelming- this post will simplify your choice. Understanding the basic characteristics of the most commonly used wraps will help you decide which is best for you.

Stretchy Wraps

Cotton knit jersey wraps (Moby) are a popular choice for a first wrap. The cotton is easily washable & the wraps are straightforward to learn to use. They have both widthwise & lengthwise stretch. Although the suggested use period is from newborn to 35lbs, we recommend them only as a newborn carrier (birth to 12-15lbs). The fabric is simply too stretchy to support a baby's developing body. It is also for this reason that they should never be used for excercising with your baby . They are a great choice for skin to skin care and can be wrapped to look like mom is wearing a t-shirt. These wraps are for front & hip carries. They are one size fits all.

Cotton knit/spandex blend wraps (Sleepy Wrap) is another type of stretchy wrap loved by parents of new babies. The directions are superior, allowing the wrap to be tightened around the baby so the baby is better supported. You may continue to carry your baby with this wrap as long as you are both comfortable, but we recommend them as a newborn carrier, for babies under approximately 15lbs. They are best for front & hip carries and are one size fits all.

Fleece wraps (Calin Bleu) are a great choice for families practicing EC. They include an excellent instruction book. They behave somewhat like other stretchy wraps, but are also for use with heavier babies (up to 20-25lbs) because they have only a bit of lengthwise stretch. They are one-size fits all & can be used in front, hip & back (for experienced wrappers, with caution, as they are somewhat narrow).

Hybrid

Hybrid Stretch wraps (Gypsymama/Wrapsody) are in a category all by themselves! These wraps have virtually no lengthwise stretch, which makes them function like a hybrid between a stretchy & a woven. An instructional dvd is included. These are a great choice if you like the softness of a stretchy wrap but want to purchase a carrier that will be functional for years as opposed to months. They are one size fits all & are for front, hip & back carries.

Woven

Gauze wraps (Calin Bleu, Gypsymama/Wrapsody) are made of a thin, breathable cotton gauze woven fabric. They have virtually no stretch to them, making them a secure & supportive choice for babies of all ages. Many people use them well into toddlerhood. They can be one size fits all or come in lengths so you can customise the fit.

Traditional woven wraps (Ellaroo) are similar to the gauze wraps in feel & use. They have virtually no stretch to them, making them a secure & supportive choice for babies of all ages. They can be one size fits all or come in lengths so you can customise the fit.

European Style Wovens (Didymos, Storchenwiege, Girasol, Hoppediz, Nati, Ellevill, Neobulle, Bebina, Chimparoo) are made of custom-woven fabrics specifically designed to carry babies. They are a double twill weave, which means that they have no widthwise or lengthwise stretch, but have a diagonal stretch that perfectly supports the baby & the wrappers' body. If you can physically carry the child, you can carry them in a woven! I have personally wrapped a 70lb 7 year old in them on more than one occasion...
Woven wraps are ideal from birth- a woven can be the only carrier you ever need to own. They come in lengths that allow you to customise your wrap to your needs. Many of the fabrics are organic & all are Oko-tex certified to be free from dyes that may harm your child. Instructions can vary from none (Many companies are still creating their English translations) to an excellent book & DVD. Be sure to let the retailer know if you are a new wrapper needing detailed instruction!

Happy Wrapping!

Getting Your Baby Safely On Your Back

Back carrying is often considered an advanced babywearing skill, but it is actually very easy to master. Back carries are nearly always more comfortable for the wearer, since they best distribute the weight. Practice builds confidence!

Before you get started, please remember that you are responsible for your baby's safety. Use caution at all times. Have someone spot you while you are learning, keeping a hand on the baby. While you are putting your baby on your back, bend at the waist, keeping your back straight. Do not stand up until your baby is secure.

These methods are only for demonstrating the process of getting baby on your back & are not complete carries. Follow the directions specific to your carrier to secure it once your baby has been placed on your back.

The method that works best for you will depend on you & your baby's physicality, your baby's age & the carrier you are using. Here are a few methods to get you started!





The Wrist Twist

This method works well with woven wraps & mei tais. It can be done once your baby has good head & neck control.

Have your carrier in place around your waist so it is ready when you are. Hold your baby in front of you, or off to one side, with one hand firmly under their shoulder & one hand firmly over the other shoulder.



Bring your baby up over your head & onto your back, twisting your wrists as you go. Some prefer to do the opposite, crossing the arms while they baby is in front of them & uncrossing them as the baby is moved onto the back.






Slide your baby down your back until he is in a comfortable position in the hollow of your spine. Keep one hand on your baby until they are safely in place.
Spread their legs out into the frog legged position (legs on either side of your back, knees higher than bum)- this makes it difficult for them to roll accidentally. If you are wrapping, pick up the ends of the wrap, holding the top rail.





Pull the carrier quickly away from your back, then up & over the baby. Keep the top rail (or straps) tight the entire time. (The mistake I most commonly see is pictured on the left- by not pulling the carrier away from your back before bringing it up over baby, the fabric gets caught halfway up baby's back. This is clearly unsafe.)






Make sure the carrier is pulled tightly around the baby, keeping them in place.









The Security Blanket

This method works well for people who prefer an added "layer of security" while placing their baby on their back. It is recommended for babies yet to develop head & neck control. It works well with both mei tais & woven wraps.

Centre the wrap/mei tai around your baby's shoulders, supporting their neck with the carrier if need be. Hold them as for the Wrist Twist.



Bring your baby and the carrier up over your head & onto your back, twisting your wrists as you go. Again, some prefer to do the opposite, crossing the arms while the baby is in front of them & uncrossing them as the baby is moved onto the back. Keep hold of the fabric as you do this, keeping it taught around your baby as you bring the straps/rails over your shoulders.





Keep the carrier pulled tightly around your baby, keeping him in place on your back.









From The Ground Up

This method is another variation of the Wrist Twist for a toddler who can stand (some will use it with a sitting baby as well. It works well for mei tais, some soft structured carriers (SSCs) & woven wraps.

Lifting your baby up with one hand over & the other under his shoulders,



Twist him up & around on to your back, using your arm to support him if needed. Reach behind with your other hand to help get him in place.








Position his legs on either side of you (this keeps big kids from rolling too!)









Pull the carrier up to securely hold your baby!










The Hip Scoot

This method works best with SSCs & mei tais. It should be used only with babies with full neck control & is easiest with those who can sit independently.

Place your baby on your hip, with the opposite shoulder strap on & the waist belt secure.





Reach in between the carrier & your back, while bending forward at the waist.
Grab your baby's foot,









Holding it securely as you pull his leg through to the other side. Use your arm to push the baby over.








Centre the baby on your back.










And pull the rest of the carrier up to securely hold your baby!

Photography by Trish Agrell-Smith

What do I do with all this fabric? Choosing a wrap length

Once someone has decided to try a woven wrap, the most common question I am asked is "Which length do I need?" Length choice is an important factor, since many brands come only in select lengths. Most brands are priced by length, so it makes sense to not purchase more wrap than you need! Here are some more things to consider when choosing your length.







The wrap length you need is determined by which ties you want to do- not necessarily by your physical size!! I am nearly 5'5" & wear a size 8- average for a woman. Although I can use wraps ranging from 2.7m to 4.6m, depending on which carry I am using, I can tie most carries comfortably in a 3.7m wrap. While there are some specialty ties that eat up quite a bit of fabric, I rarely find they are needed so I rarely teach them. A good rule of thumb is that the longest tie most wrappers use is the FWCC so if you can tie this, even on the tails, you have the right length.

Front carries, which are normally done only with smaller babies, use up more length than back carries, as a general rule.



Tying on the tails: Most woven wraps have tapered tails, which makes it easy to tie a smaller knot with them. You don't need a lot of fabric for your knot. Most woven fabrics are grippy enough to safely hold a knot with only an inch or two of fabric left hanging. This is called tying on the tails!

If you have too much fabric left over at the end of a tie, you can use it up with some knotting variations like the Tibetan tie in the picture to the left, or you can simply wrap the extra fabric around your middle.




As you gain experience with wrapping, your tightening will improve & you will get more length left in the tails once you have finished your tie. This is another reason to err on the side of a shorter wrap.








The Kangaroo Carries, aka the Ruck , the Kangaroo Front Carry & the Kangaroo Hip carry, all use minimal fabric length. They are also the most supportive of baby & wearer due to the ease of perfectly tightening one layered carries.

It is important to know that manufacturers have never claimed that their sizing is perfectly accurate! The advertised length is normally considered a minimum, as opposed to a guarantee. North American wrappers are often surprised to discover (when they measure their wraps themselves) that their wraps are a significantly different size from what they expected. Many factors can affect the actual length- time since the last washing, strength with which the wrap gets pulled, thread count, fibre content, etc.

While many wrappers do like to have a collection to choose from, most have just one wrap that can do everything. For most people, 3.7-4.1m is plenty of length for that purpose. I hope this post helps you in your decision making process, whether you are choosing your first wrap or your 5th!

Cloth Diapering 101

Parents love cloth diapering! Cloth diapers are ecologically friendly, healthy, inexpensive and in many cases, fun! There are lots of options available & most parents have a few questions before getting started. Here are the ones most frequently asked.

How many cloth diapers do I need?

This depends on how frequently you want to do laundry! Count on 8-12 diaper changes per day. 24 diapers would mean washing every 2 days or so, 18 diapers a bit more frequently than that, 30 a bit less often. Most families who cloth diaper full time (or nearly that) use between 24 & 36 diapers.

How should I wash them?

Washing cloth diapers is simple. Each brand will have specific instructions, which we recommend you follow, but there are a few rules that usually apply. They should not be soaked in water while waiting to be laundered; using a dry pail or a hanging bag is recommended . Soiled diapers can be shaken out into the toilet before being put in the laundry bag.
Detergents with optical brighteners, scents, bleaches & other additives can damage cloth diapers so should be avoided. We like Country Save detergent, available inexpensively at London Drugs.
Most importantly, a very small amount of detergent should be used- 1/4 to 1/2 of the amount recommended on the box.

Tell me about the different types of diaper?

Prefold (aka flat) diapers are typically inexpensive & easy to use. Made of natural fibres, they no longer requiring pinning thanks to Snappi diaper fasteners. They are ideal for practicing elimination communication or for potty learning, as the baby feels wet when they pee. They are usually used with a waterproof cover.

Fitted diapers come in a range of natural & man made fibres and vary greatly in price. They are shaped diapers designed to fit your baby's body. They have either snap or velcro closures. Velcro is ideal for speed, snaps have better longevity. They are usually used with a waterproof cover as well.

All In One diapers include the absorbent fabric & the cover together in one piece. This makes a one step process that is easy for outings, fast changes or for caregivers who aren't familiar with cloth diapering.

Pocket diapers have quickly become most people's favourite! They consist of an outer cover/soft inner layer sewn together into a pocket that is then stuffed with an absorbent insert.
The absorbency of the diaper can be adjusted by adding inserts, or using a different type of inserts.
The layer next to baby's skin is usally water resistant, meaning that the liquid is absorbed through to the insert, where it stays, leaving the baby's skin dry even when the diaper is wet!

Do I have to choose just one kind?

Not at all! While some families like to load up on one diapering system & stick with it, others like to create a collection of different types and brands to be used at different times. We recommend trying a few (6 is good) of each kind if you aren't sure what might work best for you.

Stay tuned for Cloth Diapering 201, with more detail about sizing, diapering accesories & more! Send me your questions for inclusion in our FAQ.