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.

Babywearing & Exercising

One of the major reasons parents love to babywear is because it allows them to continue their active lives! Hiking, cross-country skiing, Nordic walking, even a walk around the block, can all easily be done with your baby (s) along for the ride. Any low-impact activity can be done while babywearing- high impact sports, like running, cause too much jarring to be safe or comfortable.

Fitness instructors have caught on & there are now many fitness & dance classes offered to new parents, designed for you to participate while wearing your baby. I think these are wonderful, because they recognise a baby's need to not be separated from his mother, as well as the mother's need to get out & exercise.

It is essential, when doing any physical activity, to be sure that the carrier you are using is appropriately supportive for you & your baby, and that your baby is properly positioned. This applies to all situations- the walk around the block, or the mom & baby exercise class.

FAQ about babywearing while exercising:

How should I position my baby?
The photo on the right shows a well positioned, properly
supported baby:
*baby is facing inwards (a back carry is also fine!)
*rounded spine
*knees higher than bum, in the frog position
*legs out
*baby is high on the wearers' body (close enough to kiss)
*fabric is carefully tightened around baby, spread from one knee to the other
*baby's head is tilted back, face uncovered, to ensure that there is no risk of the airway becoming blocked

Everyone in my class faces their baby out-
why shouldn't I?
I always recommend against wearing your baby forward facing, for many reasons.
Firstly, the above guidelines for positioning cannot be met- they are important because babies rely on the frogged legs & rounded spine to properly support & distribute the weight of their head & upper body. This is especially important when you are moving around.
Secondly, when a baby is facing away from you, their weight is hanging off your body, as opposed to cuddling in to it- this causes strain on your lower back, shoulders & especially your pelvic floor (which can lead to incontinence, particularly after pregnancy/birth).
Lastly, many babies exhibit signs of stress while facing out- flailing their arms & legs, splayed fingers, or balled up fists (relaxed babies have relaxed hands), loud vocalisations, etc.

How can I keep myself comfortable?
When your baby is properly supported in the right carrier, you should feel comfortable while wearing them. Muscle strain is a sign that something is not right. Some tips to keep in mind:
-Maintain your own posture- contract your stomach muscles & keep your core stabilised
-Use only 2 shouldered carriers, with the straps properly centred on the balls of your shoulders, never your neck
-Wear your baby high on your body- in either a high back carry, or close enough to kiss in a front carry
-If you are wearing for a longer period of time, re-tie your carrier every so often to distribute the weight to different muscle groups
-Remember that babywearing is weight bearing exercise- you will be using more energy to do less work than if you were not carrying!

Which carriers do you recommend?
-A woven wrap is most appropriate, providing the most support & flexibility
-A mei tai or SSC (soft structured carrier) can work well also, paying special attention to the baby's spine being rounded & the fabric supporting the baby from one knee to the other.

*I recommend avoiding using stretchy wraps- they do not provide the support that a baby needs to maintain a safe position while you are exercising. I am especially concerned with positional asphyxia- this is caused by the collapse/closure of a baby's airway due to the weight of their head. This can happen when a baby's head is tilted down, with the chin against their chest.

There are 2 exceptions to this rule- the Gypsymama/Wrapsody Stretch & the Calin Bleu Fleece
both of which have widthwise stretch, but very little lengthwise stretch. They allow for proper tightening & will not sag with use. They are not considered true stretch wraps as such- most people refer to them as hybrid wraps.

How long can I wear my baby for?
This questions has 2 answers! If you mean per day, the answer is, as many hours per day as you & your baby feel comfortable. If you mean for how many years, the answer is that many babywearers continue to wear well into childhood. I always bring a wrap or 2 when hiking with my kids, now ages 7, 4.5 & 2.5. The little ones like to take breaks on my back when we go for longer distances. A wrap is also my backup safety plan- if someone injures them self, they can be easily carried out.

How do we handle inclement weather?
We are Canadian- we handle inclement weather for most of the year! Luckily, there are many innovative products designed to keep you & your baby warm & dry while babywearing. We have sourced our favourites for baby & parents , from legwarmers to babywearing jackets. These all make babywearing practical & fun all year round!

I hope this helps you to feel confident in heading out to have fun & keep fit with your baby! We would love to hear your favourite activities to do with your little ones :)


Second photo by Trish Agrell-Smith