Using your carrier

Need some help using your carrier as well as possible or having a bit of trouble with getting it comfy? This page contains links to the types of slings, with guides on how to use them, top tips for comfort and troubleshooting help. You can also find safety tips and information about feeding in slings, as well as carrying in different weathers.


healthy hips busting some myths

Healthy Hips - busting some myths

Healthy Hips - this is a very common worry for parents who want to ensure they have the best information regarding their child's safety. Here, Rosie busts some of the myths and assesses what we really know on the subject.

People often ask me about the importance of a good position for their child’s hips in a carrier, having heard about “hip dysplasia” and “knee to knee”. These are good questions to consider, as there is a lot of hearsay and slightly misinformed information circulating around the internet.

I thought it would be helpful to discuss some common queries and consider what “best practice” might be. I will look at what hip dysplasia actually is and assess if narrow based carriers really are harmful to children. I will suggest some alternatives that are much more respectful of child anatomy and more comfortable for baby and parent.

1) What is hip dysplasia?

There are many terms used for this spectrum of related developmental hip problems in infants and children. These are often present at birth. Most recently the term “Developmental Hip Dysplasia” is being used, as there is evidence to suggest that while many hip disorders, (ranging from full dislocation, to unstable shallow sockets) are present at birth, some children with apparently normal hips go on to develop problems in the first year of life.

healthy hips

Image from Hip Dysplasia website

In simple terms, dysplasia means “growing abnormally”. Compared to adults, an infant’s hip sockets are made up of a greater proportion of softer, more pliable cartilage in relation to bone. This means that it is easier, anatomically, for the ball (the femoral head)  to slip out of of the socket (the acetabulum) and be misaligned (subluxated) or fully dislocated. A normally formed hip joint will not encounter problems, but this softer structure, in combination with an abnormal socket shape, explains why some joints will dislocate.

In a child who has an abnormally developed hip joint, the combination of the shallow angle of the socket and the softer structure means that the ball (femoral head) is not held securely within the socket and can become misaligned and even slip out if the joint is placed under downward strain. If it does not slip back in, it is a dislocated joint and will need intervention.

Image from the Hip Dysplasia website

2) Is my child at risk of hip dysplasia?

The causes for hip dysplasia are poorly understood. There seems to be an increased risk if there is a positive family history of hip dysplasia. Female babies seem to be 4-5 times more at risk than males, and several factors in pregnancy seem to be relevant. For example,

  • a tight uterus
  • reduced uterine fluid that constricts the baby and prevents free fetal movement,
  • breech delivery
  • another condition that affects how babies lie in utero (such as fixed foot deformity)

all seem to be related to the presence of dysplasia. The left hip seems to be more frequently involved than the right. Furthermore, the growing baby is exposed to the mother’s oestrogen hormones. Oestrogen is thought to encourage ligament relaxation near the time of delivery, which may help with giving birth, but potentially may also cause the baby’s hip ligaments to be somewhat lax and increase the risk of an unstable joint.

These are not risks that a parent has any control over, clearly.

However, there are studies that strongly suggest that some cultures who swaddle their infants tightly (such as the Native American societies prior to the 1950’s, and some Japanese societies) have a far greater incidence of developmental hip dysplasia and childhood hip dislocation.

It is interesting to see that once the Najavo Indian culture, (who carried their babies tightly bound on cradle boards with their legs straightened ie  extended and adducted), adopted bulky cloth nappies, the incidence of childhood hip dislocation decreased dramatically, even though they continued to use the cradle boards.

This was due to the nappies encouraging the babies’ legs to be held in a more natural flexed and abducted position (like a spread squat, as if child held on hip with legs around parent). African cultures, who do not swaddle their babies, and carry them constantly astride their backs from birth, have a very low incidence of hip dysplasia. You can read a couple of very helpful scholarly articles here and  here for more information.

In 2015 the Journal of Paediatric Orthopaedics published an article based on data from 40,000 children in Malawi and a systematic review of current evidence. “The majority of mothers in Malawi back-carry their infants during the first 2 to 24 months of life, in a position that is similar to that of the Pavlik harness. We believe this to be the prime reason for the low incidence of DDH in the country. In addition, there is established evidence indicating that swaddling, the opposite position to back-carrying, causes an increase in the incidence of DDH. If a carrying position of infants during their early months of development can reduce the incidence of DDH, then a public health initiative promoting back carrying could have significant world health and financial implications in the future management of DDH and also have potentially huge effects on the timing and severity of development of adult hip arthritis.”

“Hence it appears logical to discourage putting the baby’s legs in the extended position, and encourage keeping the baby’s hips spread apart. This latter position places the head of the femur (the ball) against the acetabulum (the socket), and encourages deepening of the socket.” (Quote from Orthoseek–  a source of authoritative information on paediatric orthopaedics.)

So, a parent can potentially reduce the small risk of hip dysplasia by carefully considering some of the practices they adopt.

3) How is hip dysplasia diagnosed and treated?


Diagnosis:
Most suspected cases of hip dysplasia are picked up at birth or at the six week check, by physical examination, but some cases are missed, sometimes with significant consequences. There is a strong case for routine ultrasound screening for hip dysplasia, as comprehensive ultrasound screening during the immediate newborn period has demonstrated hip laxity in approximately 15% of infants (Rosendahl K, et al. Pediatrics 1994;94:47-52)

Treatment: Mild cases can be managed by “double diapering” to keep hips in the flexed, abducted spread squat position. More severe cases may need splinting with a Pavlik harness and sometimes surgery is required. Many children respond very well to this and lead normal lives. If left untreated, and picked up later in childhood (eg a limp) developmental hip dysplasia can have chronic consequences, such differences in leg length, awkward gaits or decreased agility. Older children may even develop early arthritis of the hip. Sometimes complex surgery is needed.

4) Is there anything I can do to reduce my child’s chance of hip problems?

It isn’t fully clear exactly how large a role the choices parents make (eg swaddling, cloth nappy use, carrying in an appropriate sling) have on the likelihood of hip problems later in life. Some babies may have mild DDH at birth that is not discovered at all, and thus unwittingly benefit from good hip positioning that a wider based carrier gives, encouraging the mild laxity to self-correct. There are many cases of babies who have been found to have DDH and been advised to use a wider based carrier by their orthopaedist, and the shallowness has self corrected. Clearly, wider based carriers are beneficial.

Furthermore, by 6 months of age, the risk of hip dysplasia has largely passed, and by one year children are stronger, better developed, and able to place their hips in a healthy position themselves when required for comfort (ie pull their knees up or ask to get down), so older children are not at risk. It is young babies in the first few months of life that need more caution.

2018 update. There has been a small increase in the late diagnosis of DDH, which is thought to be possibly related to the use of tight swaddling, a technique to settle babies that has seen some resurgence recently. Firm swaddling of the lower body forces babies’ legs into prolonged positions of tight adduction and extension which can be damaging to hips that are already vulnerable. Swaddling should always be done in a hip healthy way (read more here about the late diagnosis of DDH).

It would seem sensible, therefore, at least in the early months of life, to encourage babies and small children to have their hips held in a healthy position, that is less likely to place strain on lax ligaments or possibly shallow hip sockets. A good, wide-based sling or carrier can assist with this healthy hip position. This will also be more comfortable for the child – consider perching on or astride a stool versus sitting on a chair or even in a hammock!

It is worth being aware that there is often variance in the advice orthopaedic surgeons offer, based on their depth of knowledge of babywearing. There is little formal research on the effects of slings per se in children with DDH, and much is extrapolated. The Institute of Hip Dysplasia is a helpful resource.

5) Will my narrow-based high-street carrier harm my baby’s hips?

Much debate has been held on the role that narrow -based carriers  may have on the worsening of pre-existing, undiagnosed hip dysplasia, or promoting its development in normal hips. It is worth bearing in mind that few parents use narrow based carriers for any significant length of time, as they are often not especially comfy, and babies’ legs are free to move in the carrier, rather than being held forcibly in one position. Many narrow based carriers are wider than they used to be, so small babies often end up in a slightly abducted and rotated position anyway.

So the simple answer to the question is “Probably not, in the majority of cases.” This assumes your child’s hips are normal, and they are not one of the postulated 15% of infants whose condition is missed by health care professionals (however well-meaning).  These children will most certainly benefit from a wider based carrier.

So you are unlikely to damage your child’s hips if they are healthy. It will be up to you to assess the risk that mild DDH may not have been identified at the routine screening, and make the choice for yourself.

These narrow based carriers usually have a particular feature of robust head and neck support. The reason for this is because a child who has unsupported legs will usually end up with an arched, over-straightened spine where their head and airway is not adequately protected. Baby’s heavy head is more likely to fall backwards, and therefore rigid neck supports are needed to keep him safe. This is in contrast witih carrying positions which do encourage the natural pelvic tuck and therefore a curved spine and baby’s head becoming self-supporting while he rests against parent (think about how you often only need to support baby’s bottom when they are sleeping on your chest or shoulder).

Parents of children with normal, non-dysplastic joints are unlikely to “cause” hip dysplasia by choosing to use one of these narrow-based slings, but these designs do not, on the whole, promote the flexed, abducted spread-squat position that seems to encourage better hip joint positioning and deeper development of the socket. A sling that supports baby’s thighs from beneath (“knee to knee”) is more likely to keep hips in this optimal position, and reduce strain on still-developing joints. It is interesting to note that the bigger brands who are well known for making narrow based carriers have begun to redesign their products to be more broad at the base and more respectful to baby anatomy.

It will be no surprise then, that most professionally-trained babywearing consultants will advocate the thighs being supported right into the knee pits into an M shape, with knees held higher than the bottom (nearer to an imaginary horizontal line out from the belly button). This puts the femoral head into an ideal central position in the socket, and is the position adopted by the Pavlik Harness as you can see above.

Here is are some drawings that show the most typically seen position in a narrow based carrier, and then the ideal hip position in a sling

1) Classic high-street narrow-based carrier. The legs are hanging downwards, entirely unsupported. The infantile hip-socket is taking the full weight of the legs and there will be a lot of unhelpful strain. It is similar to balancing on a beam at the gym with all the weight being borne on a narrow strap between the legs. Baby’s back may be straightened, meaning their head is able to fall backwards, needing rigid head and neck support.

2) A properly fitting, wide-based carrier. Observe the M-shape that has been created, with the thighs securely supported all the way to the knees, which are held above the bottom. The hip joints are in the optimal position, and there is no weight at all dragging down on the joint. Orthopaedic consultants recommend thighs to be resting at an angle of 100 degrees from the midline.

Below is a summary and a side on view of the M-shape position, showing how there is no downward strain on the socket and the child is supported widely across a large proportion of their base. The baby is clearly seated comfortably with their weight widely distributed, and the gentle curve of their spine protected. This baby’s upper body will be supported against the parent with head resting on parent’s chest, and rigid head supports are not needed (using natural anatomical positions).

6) What slings would you recommend for healthy hip position?

All safe babywearing is to be celebrated and encouraged! Using a narrow-based carrier will not harm the majority of children (see above), so if you have one already, there are a few things you can do to improve your child’s comfort such as using a scarf tucked into the seat, as in this video. This will encourage a change of position from legs hanging straight downwards (extended and adducted) to supported knee to knee (flexed and abducted) in the M shape, as discussed above. It is, however, only a temporary solution – I would advise you to use a wider-based carrier.

To reproduce the hip-healthy M shape, when putting a child into a carrier, tilt their pelvises inwards slightly and push the feet below their bent knees upwards to encourage flexion. All babies are different, and some will naturally spread their legs more widely than others. NEVER force your baby’s legs to move into a position that does not come easily.

If you don’t yet have a sling for your baby, go for a soft one that is well designed to both promote healthy hip M-position and encourage the natural gently curved J-spine shape that young children have (rather than a tight C shape where a heavy head would be drooping down onto the chin curled over). The secondary curves begin to develop later on in life – the cervical curve when they gain head control and can lift against gravity, and the lumbar curve at the crawling/walking stage . Until then, spines should not be artificially kept straight (ie babies should avoid too much time in rigid car seats, stiff inflexible carriers, or lying supine on their backs).

It is worth remembering that well-designed slings that focus on supporting a child’s legs and curved spine can be used in a less than ideal way. It is possible to use a good tool in a less than optimum manner, especially when in a hurry, so it is worth taking your time to position the sling well and to be actively aware of your child’s hip and spine positions when putting the sling on.

Examples of suitable slings (this list is not exhaustive and is merely a guide). See your local sling meet/consultant/library for more help and advice or read our sling guide.

Stretchy wraps, Close Carrier hybrid

Woven wraps

Ring slings or Scootababy hip carrier

Wide-based buckled carriers

Meh Dais and Half-Buckles and variants

7) What do I do when my child’s legs are too long for “knee to knee” support?

Small babies, sadly, all too soon grow into big babies, with longer legs, and can start to out-grow their slings in terms of thigh support along to the knees. And then they start to toddle! When a child can stand unaided and walk, he will have the muscle and ligament strength to bear the weight of his own legs well, so full knee-to-knee is less important for toddlers, but for smaller babies, helping to support their legs is important. You may need a wider sling, or you can adjust the one you have already with a helpful scarf – there is a great video here from Slingababy.

8) Where can I find more help and support and reading about using a sling for my child?

There are numerous resources in the UK where you can get babywearing advice and encouragement, such as your local babywearing consultant, sling meet, or sling library. The links below will help (again, not an exhaustive list!)

The Sling Pages

The Carrying Matters Sling Guide

Dr E Kirklionis’ book A Baby Wants to Be Carried is highly recommended, for its overview of the evolutionary theory behind baby carrying and the spread squat positioning.

You can read my book Why Babywearing Matters too

Hip Dysplasia Institute statement on babywearing and Hip Healthy status


slings and exercise

Slings and Exercise

Movement is good for you!

Many people wonder about slings and exercise; can they be done safely together?

Movement and being gently active in the early months after your baby is born is good for your mental health and can help with low mood. Being able to get out of the house and enjoy some fresh air and activity with your child can be great, especially if they are at your height and you can interact and chat and share the experience of the world happening around you together. A sling can be a great way to help this to happen - keeping your child safe while you get on the move. Walking with your baby held close and comfortably, building up your tolerance as your body recovers from birth is all you need. It can be a great way to spend time with other people; the endorphins from activity and fresh air can help with the low mood so many longshaw walkparents can experience postnatally. (Read more about carrying in the postnatal period here).


Take your time!

However, doing too much too soon can be unhelpful in the long run, for your body's recovery from birth. Every mother's body is different, and your level of fitness before and during pregnancy will also play a part. Pushing yourself too far too fast can play havoc with wound healing, with slower cessation of bleeding, with prolonged problems with pelvic floor issues, for example. Take your time. There is no need to spring straight back into your pre-birth activities.

Don't fall into the trap of believing that you need to "get your body back as soon as possible." For a mother, the act of bringing life into the world is transformative: your body will never be the same again, and that is a great thing, one to be proud of!

It is good to be fit and healthy, but there is a time for nurturing the new life you have brought into the world, resting and growing together, and a time for weight loss and organised fitness. Simple walking with your baby in a comfy well-fitting carrier and spending time with friends may be all you need for the first few months, for mood lifting and gentle exercise. Does your local sling library organise babywearing walks, or why not start your own?

Points to Consider

If you decide you would like to join fitness or dance or any other classes that have a sling component as it seems a good option for your needs, here are some useful points to consider.

Is your body ready?

  • This is very important. Pregnancy and birth have an impact on the core postural and abdominal muscles and the pelvic floor; it takes time for these to recover. Floors may be weak, but they can also be over-tight, both cause problems.
  • Overloading still-recovering tissues with certain stretching or weight-bearing activities with the extra weight of a child in a sling (especially if it is poorly fitting or worn low and loose) is not wise, and may end up delaying recovery and causing more long term damage. Wide and deep squats (as opposed to narrow based with vertical shins), side lunges and jumps/bounces, for example, are all inappropriate until pelvic floor function is restored.
  • Good posture (with aligned shoulders, pelvis/hips, knees and ankles) matters; many mothers walk with a sway back shape, out of habit or to balance weight of baby, or stand with one hip jutting out. This strains the floor and the core and needs to be addressed.
  • Walking with a baby in the sling, ensuring good alignment and posture, gradually increasing the speed and duration, is usually enough exercise for most women in the early months.
  • Please do not rush; pelvic floor dysfunction is very, very common (14 million women in the UK are known to have an issue, and many many more never seek help and remain undiagnosed).
  • Leaking is NOT normal or to be expected, if you leak with a baby in a sling, on coughing or laughing, you have pelvic floor dysfunction. If you are unsure if your pelvic floor is recovering normally, please see your GP.

Do you have a good carrier to keep your child safe and keep you comfortable?

  • As with all things: your sling is never a substitute for alert responsiveness and your focus should always be on your child and their needs. A sling should hold them comfortably and safely with airway protection and neck support (ideally by appropriate seated positioning that meets the TICKS guidelines). Movements should never allow a baby to be shaken, and should always be done with their head and neck position in mind.
  • Forward facing out carriers, especially narrow based ones, tend to encourage the baby to lean away from parent, which has an impact on parent's posture, overcompensating for the weight by leaning back. Poor posture can lead to significant health problems.
  • It is worth noting that many manufacturer instructions do not recommend exercising with their product; using your carrier for this purpose may invalidate any warranties. Additionally, it is unfortunate that a number of baby carriers are not as well designed as they should be, and their instruction manuals are less than ideal.

Is your baby developmentally ready for this kind of activity?

  • Parental activity should never lead to any kind of shaking for children, particularly with young babies whose heads are disproportionally heavy and whose neck muscles are still not fully developed (babies tire very easily as their muscles fatigue).
  • Babies should not slump over in the sling during the class and should not fall asleep facing out.
  • A good class should respect your baby's development and not include any kind of vigorous repetitive jumping, spinning or shaking movements; your child's safety is the main priority here.

Does the instructor fill you with confidence?

  • Does the instructor have appropriate recognised sling training to ensure your baby is kept safe in the sling at all times? It is worth checking, as it shows a good level of preparation and thought.
  • Do they know enough about baby anatomy and development and muscle fatigue with certain positions?
  • Will they recognise if your child has moved to a position where their airway could be compromised?
  • Will they be able to help you correct this (especially if you are not an experienced sling user)?

A good analogy might be a canoe class. If I wanted to attend a class and was required to bring my own life jacket, I might not know which was a reliable brand that would be the most likely to keep me safe. I might ask the advice of a local lifejacket expert, but equally I might buy a cheap one off the internet which has poor instructions that didn't really show me how to keep myself safe or recognise when it wasn't on properly. At the canoe class I would expect that my instructor would be able to give me the once over and check my lifejacket was fit for purpose and on correctly, and would indeed keep me safe, right there and then. I would expect that if my lifejacket began to slip or wasn't in fact on properly during the class, the instructor would be able to identify that and take appropriate measures to remedy this, to keep me safe. I would expect that my instructor would be fully qualified in all aspects of the class - after all I am entrusting my safety to them. Their position of authority means I am more likely to assume that they know what they are talking about, and as a newcomer to canoe classes I will take any advice they offer about the equipment used in the class as expert (even if it isn't).

  • Does your instructor have appropriate qualifications to ensure your postnatal body will not be inappropriately overloaded by the extra weight of baby with the movements in the class? If they have recognised post-natal training they will be happy to share this.
  • Do they enquire about your overall fitness and pelvic floor health and adapt the routines for your needs? The "six week check" at the GP is not sufficient "sign off" (very few GP's have the time to discuss exercising at the postnatal check, if there is one at all!)
  • Do they come across as truly well researched and acting in your best interests?
  • Are they taking your and your child's wellbeing as seriously as you do?
  • Are they being responsible?

I feel strongly that there are many risks involved in taking part in organised classes for fitness/dance with slings. I would urge all my readers to think very carefully before getting involved with anything that has any kind of vigorous movements such as jumping, bouncing, spinning, and so on. Babies need our loving focus, care and attention; their safety must remain the first priority at all times. Your body's recovery matters too; take your time!

 

Do speak to your local sling librarian/consultant (Sling Pages has a list) about any classes you are considering before you go - they will be able to advise you on its suitability and help you find a sling that will work well if they feel the class is safe. There are some well-set up and well trained franchises or individual providers who do take their responsibilities towards you and your baby seriously.

slings and exercise
Dance Like A Mother, Manchester

Further Reading

This post on Babywearing Exercise is extremely helpful for further reading  and should be read by anyone investigating such classes. Thanks to Emma at SlingSure & Fife Sling Library for this.

 


troubleshooting

Troubleshooting your buckle carrier

Want to make the most of your buckle carrier and ensure it is as comfy for you and your child as possible? Here are some troubleshooting handy tips to help!

Before you start, check your carrier over for wear and tear, ensure the buckles aren’t broken, loosen any webbing that was left tightened, prepare anything that needs pre-clipping etc.

Work on your waistband

  • Choose where to place your waistband. This will depend in part on the length of your baby’s torso (the top of their head should be at least close enough to kiss, for airway protection. or higher). This may mean you need to wear the waistband quite high when your baby is small, as free airflow is vital. As they grow longer, the waistband can move further down your body!
  • Waistband-less carriers (for example, the Integra) are positioned mainly for baby’s height and may need to be quite high for little babies as their bottoms sit lower than the webbing waist.
  • Some people like to have the padded waistband right around their natural waist. If it is a wide or stiff band, try to have the lower end at least skimming over the top of your pelvic crests, rather than sitting on top, which may make it more comfortable.

IMG_2853

  • Some people find placing the padded waistband around the upper part of the pelvis helpful; this means that the weight does not rest on top of the pelvic crest and the waistband won’t dig in. Too low down may make it hard to walk. Try a few heights out!

IMG_2854

  • As your child grows your waistband is likely to need to move further down your body (which will also help you to see over your child’s head!)
  • Make sure your waistband sits parallel to the floor rather than tipping forwards to be lower at the front. This distributes weight more evenly.

waistband diagram

Practice your position

  • Hold your child in the ergonomic M and J shaped position you are hoping to achieve, in the location on your body you wish them to be. It is worth taking the time to do this; it is much easier to bring the panel up over a well positioned child at the right height, rather than having to do a lot of fiddling or adjusting later. Their chest should be close to you, chin off their chest, with no slumping over. (see more here)Screen Shot 2016-04-22 at 20.11.58
  • It helps to have your child’s bottom a finger-breadth above the padded waistband. This will help to ensure the panel does not get bunched up underneath baby, which will shorten the panel. (Of course, if you are shortening the panel or using a waistbandless pouched-style carrier this does not apply).

space above waistband

troubleshooting

  • Hold your baby in the correct position and location with one arm, resting against you, and then with the other hand, reach underneath the panel and smooth this up your baby’s back.
  • If you are using an insert, make sure your baby is positioned correctly on the seat and that little feet are not being squashed but are resting on either side of the insert.
  • Ensure you have a good pelvic tuck. This maneouvre encourages your child to sit in the carrier seat with their weight resting on their bottom. not in their knee pits. It encourages their spine to curve gently and will allow them to relax into you, making carrying easier.

J shape position

Sort your straps

  • Weight distribution is most effective when baby’s centre of gravity is closer to yours. This can be achieved by making sure your shoulder straps are snug enough to keep your baby’s chest and tummy in contact with your front, without slumping or leaning back. This will stop your shoulders and neck and from feeling pulled forwards (and prevent your lower back from having to compensate for this strain).

loose vs snug

  • Too tight straps can be uncomfortable as well; find the happy medium.
  • Crossed straps that are positioned too close to the neck will be uncomfortable. Pull each strap vertically down your back and taut, before you bring it round your side to clip into the buckle. Move them further out onto your shoulder and make sure the cross is in the middle of your back before you tighten. You can use any curves that you have to help position the webbing straps and keep the cross low. Too tight straps will tend to ride up to the narrowest point.

cross too high

Here is a video showing you how to fix this if you haven’t got it quite right.

 

  • Ruck straps; the key to getting ruck straps to work is the position of the horizontal belt across the back; how high or low it sits, and the shape of the straps themselves.  Too high can lead to cutting into the back of the neck, and makes the straps push up into the back of the armpits. Too low will reduce any armpit digging but can also lead to lift-off of the straps from the shoulders. Everyone has a “sweet spot” with the belt and the straps; generally somewhere in between. Get the belt right first with the help of another person, and then pull the shoulder straps snug, little bit by little bit. Pulling one side fully snug will shift the whole carrier over to the tightened side and distort the carry and be uncomfortable. This is one reason why the lift-over-the-head preclipped method of getting the carrier on can be much easier, you are not limited to a position that you can reach behind to.

ruck straps

Click here for a photo tutorial of this method.

Here is a video of this method.

Perfect your posture

  • Many of us suffer from discomfort when carrying; much of this will be down to how we stand and how well we are aligned. Addressing your musculoskeletal health is a vital part of any carrying journey, indeed it is part of your overall wellbeing. Standing with a forward slump or rounded shoulders, or with your head hanging forward, will all distort your centre of gravity. This will mean that adding a weight to your front, however well adjusted your carrier may be, will cause strain. (image from Phi Fitness)

posture

  • All your major axes should be in alignment. Your head should be in line with your shoulders, and shoulders above your pelvis, which in turn is directly above your knees and ankles. It is common for people to have a pelvis that is not in neutral positioning, which significantly affects your spine and your shoulders; all our joints are connected to each other. Many of us walk with a strong forward lean due to tight calf and thigh muscles. Working on loosening these muscles to increase flexibility and adjust how we stand is very important, as is foot health.
  • It is worth looking at yourself side on in a mirror and watching what happens to your posture as your carrier goes on, and what it is like after ten to twenty minutes of carrying. This will help you to gradually work on how you stand as you carry and improve your comfort. (Image from Nutritious Movement/Katy Says blog)

Katy Bowman alignment

 

Take your time

  • Carrying loads requires a gradual build up of strength, just as training for any exercise. Muscles tone and become stronger with use. Increase the amount of time you carry your child bit by bit, massaging and winding down your muscles after any discomfort.

See your sling library for help


Benefits of babywearing positive effects of carrying for baby isara grey carrier escalator

Positive Effects of Carrying for Baby

Carrying your baby is essential to their normal physical, psychological and neurological development. Human bodies are adapted to be a carrying species, it is part of our evolutionary history, however, our bodies are not as fit or as strong as our nomadic ancestors. It can be hard to carry in arms for prolonged periods of time. Nevertheless, babies need to be held, so a good, safe sling can be very useful in to help with increasing carrying frequency.

Remember, it is the relationship of closeness and loving touch that matters, as well as the position adopted in a good sling. The type of sling or the fabric that you use is just personal preference.

The benefits of babywearing- or the positive effects of carrying for baby are many;  here are a few.

The positive effects of babywearing for baby are many; here are a few.

  • It encourages bonding with the parent and helps to meets baby’s strong need for a sense of security and attachment, which will lead to greater confidence and independence later in life, as well as greater resilience and better long-term physical health.

 

  • It helps to regulate temperature, heart and respiratory rates, and emotional and physical growth. This can be especially useful for premature babies (the term “kangaroo care” and “fourth trimester” come from this concept) or children who are unwell.

 

  • It promotes and encourages the establishment of a successful breastfeeding relationship, in part due to the oxytocin release from the soft touch. Mothers who carry their children in soft slings are more likely to breastfeed beyond the early weeks.

 

 

  • Regular close skin contact is believed to help babies regulate their circadian rhythms better and distinguish the difference between night and day sleep.

 

  • Skin to Skin mattersIt reduces crying, both frequency and duration, (Hunziker and Barr 1986) and can improve sleep. It is safe for your baby to sleep in the sling, if the airway is well protected. Less crying means more time to be in “quiet absorption’, promoting learning and positive interactions with the world. The Esposito study discusses some of the mechanisms behind movement and how carrying is calming for babies.

 

  • Babies with colic can be hard to soothe, but the motion gained from being gently rocked in a sling while the parent/carer walks may help to settle them, and also the parent/carer may feel less helpless. There is no evidence to suggest that babywearing actually reduces colic itself.

 

  • Many parents of reflux babies spend a lot of time holding them upright and have tired arms and sore backs! A good sling that supports an upright position can thus reduce regurgitation and the discomfort of reflux. A spread squat position helps relax puborectalis muscle, to aid bowel elimination.

 

  • The motion experienced by a baby being held by the carer allows the vestibular balance apparatus to develop more rapidly and enhances neuromotor development and muscle strength. It improves neck and head control, but is not a true substitute for “tummy-time” (tummy-time head-lifting is against gravity from a prone position). This is more marked with dynamic in-arms carrying (where this is possible). A sling or carrier should never be used as a prolonged restraint (unless danger is present such as crossing the road). 

 

  • Children should always be encouraged to be active as much as possible (WHO 2019) and if they want to get down and it is safe and practical to do so, this is ideal. However, this doesn’t mean that a child who is otherwise very active needs to be automatically removed from the sling after a certain amount of time. Sleeping babies do not need to be disturbed, just gently adjusted to ensure safety.

 

  • It is believed to encourage sociability and language development; being able to hear the parent’s voice close up and watch their interactions with the world and other people from a higher vantage point is beneficial and also aids formation of family relationships. Studies into reduced talking in outward facing buggies highlights the importance of children being able to communicate easily with their carers.

 

  • It allows baby to retreat from an overwhelming world and snuggle into the parent’s body for respite when needed. This is harder to do with world-facing carries, so encouraging parental responsiveness with front-facing out positions is important. (The challenges of facing forwards is covered in more depth here)

 

  • Babies can learn very easily from a place of consistent safety, as their brains are not engaged with mere survival.

 

  • Good, correctly designed slings that encourage the physiological spread-squat "M shape" position (that mimics hip-perching) can help prevent hip problems later in life in those children at risk of hip dysplasia. There is currently no convincing evidence that narrower based carriers cause hip dysplasia in otherwise healthy hips.

 

  • Babies who are carried are less at risk of plagiocephaly (the flattening of the skull bones at the back of the head from prolonged periods lying on the back, more common since the “Back to Sleep” campaign). Slings are recommended as one solution (by the NHS, too!)

 

Further reading

"Why Babywearing Matters", Rosie Knowles, 2016

To have and to hold: Effects of physical contact on infants and their caregivers, Infant Behavior and Development, Volume 61, November 2020

 


If you would like to read in more depth on this subject, my book “Why Babywearing Matters” discusses much of the evidence base for the importance of carrying. It is normal behaviour for the human species to carry their infants close to their bodies; the book considers the anthropological, physiological and psychological reasons for this. Carrying really matters.


blog

Blog

The Carrying Matters blog page.. enjoy reading! If you have any topics you'd like to see covered, get in touch! I enjoy writing and am always keen to hear of new ideas, and to host guest blog posts too!

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Guide to Slings

Guide to Slings

A guide to slings: choosing to carry your child is just the start of an adventure you can share together and both derive a great deal of enjoyment from! It can often feel overwhelming, trying to decide what to try first when there are so many options and everyone has their own favourites. Our guide to slings is designed to help you understand the basics of safe sling use and to know more about the major types of sling.

Useful videos can be found here and the photo tutorials here.

Read more about Common Queries here (such as facing out, carrying in the post-natal period, healthy hip positioning)

Read more about Carrying in Special Circumstances here (such as carrying while pregnant, carrying older children, carrying premature babies)

Do get in touch if you need some help.


sleeping while your baby is sleeping in a sling

Sleeping while your baby is sleeping in a sling

Sleeping while your baby is sleeping in a sling - is this safe?

Imagine the scenario, familiar to all of us.... you are a very tired parent, with a new baby who doesn't seem able to settle down in their Moses basket or cot, and will only sleep when held and rocked. Your baby cries when he is laid down again, no matter how deeply he seemed to be asleep on your chest or your partner's shoulder just a moment ago. This is where you might turn to a baby carrier (typically a stretchy wrap, or a ring sling, sometimes a buckle carrier  or a meh dai), which keeps your baby close, in the supported position she loves, able to hear your heartbeat and breathing, everything smells right, it is warm, she is surrounded snugly with gentle pressure all over and not flailing freely in open space. (See here for more information on the "fourth trimester" theory of meeting baby's needs.)

So far so good,  your baby is positioned well in the sling, airway is protected, breathing is unobstructed, spine and head are well aligned with a supported upper back and a gentle curve into a tilted pelvis. You can see that your baby's face is visible and he is close enough to kiss, there is no slumping, your rocking movements (swaying, walking) and precious closeness and feeling safe in your arms has worked its magic, and your baby is at last, peacefully and contentedly asleep.

Baby falling asleep upright in a sling, airway is safe
Baby falling asleep upright in a sling, airway is safe

At this point, I remember it well, the relief is enormous. The temptation is very, very strong, to just sit down in a cosy armchair and close your eyes, or a have a little lie down on the bed well propped up with pillows. Soon sleep starts to overwhelm you. Just a a short nap.. a few minutes won't hurt, surely, a chance to recharge my batteries for the next parenting challenge.. sleep is so restorative!

The trouble is, one of the central tenets of safe babywearing is to be aware of your baby at all times.

  • The TICKS rules and the ABC guidelines are all aimed at protecting your baby's airway and breathing, and the only way you can monitor this is by being alert.
  • It doesn't take long for a baby's breathing to become compromised, and the risk is greatest under four months, when their heads are disproportionately large and heavy and they have not yet developed the cervical stability needed to support themselves.This takes time - the vertebral bodies need to become strong enough to support the head, then the joints, ligaments, muscles, tendons and other soft tissues in the neck need to develop the required strength, and then the back muscles need to be strong enough to pull the heavy head backwards to avoid forwards or sideways slump. This is an active process, and it is easy for a sleeping baby's head to roll forwards onto their chest. This is why head support is so vital, and why a baby's face must be visible at all times.
  • This is the same reason why children should not sleep in car seats if possible. We've all seen children with their heads hanging forwards at awkward angles. Studies have shown that this forward lolling of the head can cause desaturation (reduced levels of oxygen in the blood). In contrast, another study has shown that a baby asleep in the optimal upright position with chin up and the head well supported on parent's chest does not show such desaturations. It is safe for a baby to sleep upright in a well fitting and supportive sling if the appropriate guidelines are followed.
  • It is also is why bag slings and near-horizontal cradle carries can cause such problems. The enclosing fabric behind the head is dangerous; Babies have heavy heads, more prominent occiputs, and do not yet have the strength to pull their heads up or push against the fabric. The chin ends up resting on their the chest, causing a potential airway compromise.
  • It is also why feeding in a sling needs to be undertaken with caution and a good understanding of safety.
  • It is why there are so many guidelines about safe sleeping while responsible for a child (whether or not you are using a sling).

A sleeping parent will not be able to check their baby's position often, and correct any breathing difficulties quickly. Grunting or snoring or other unusual noises should always prompt a check on your baby's position and it will be very hard to be aware of such changes while you are almost, or fully asleep.

Your body position will change as your muscles relax in sleep. Your arms may move if you are just holding your baby, and if baby is in a sling, it may no longer remain tight and supportive, possibly allowing him to slump over or curl up into a ball with his chin on his chest, or roll to one side. We've all seen this with babies in car seats.  You yourself may roll over as you relax and unwittingly place too much pressure on parts of your baby's body, or encourage him to roll with you.

In short, while you are asleep, you are unaware of what you or your baby are doing. This is why there are so many guidelines about providing a safe sleeping environment for babies, keeping them safe when there is nobody awake.

If you have had something alcoholic to drink, are a smoker, are on medications that could make you drowsy, or have a medical condition that could impair your ability to be aware of your child at all times, you may wish to reconsider how you are caring for your baby when you are tired.

There are of course some ways that a short nap could be done safely with your baby asleep in your arms or  in a carrier. For example, if your partner remains in the room with you and alert while you and baby enjoy a rest together, in a slightly-reclined, well supported position that ensures baby is still upright.  You may be in hospital with your premature baby and are encouraged to share skin-to-skin contact inside a simple stretchy wrap or boob tube or under a blanket.  You and your baby will be very closely monitored throughout if you do nod off in the chair (which often recline at special angles to make it easy for a baby to rest on their tummies, chest to chest with heads well supported.)

If you wish to sleep with your baby close to you, with or without a sling, all the principles for safe co-sleeping apply. The links below explain safe bed-sharing very well.

KellyMom summary - http://kellymom.com/parenting/nighttime/cosleeping/

Mother-Baby Behavioural Sleep Laboratory - http://cosleeping.nd.edu/safe-co-sleeping-guidelines/

BASIS Online - https://www.dur.ac.uk/resources/isis.online/pdfs/ISISPDFbed-sharingJuly2013.pdf

UNICEF Caring For Your Baby at Night http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/caringatnight_web.pdf

If you feel at the end of your tether with your unhappy sleepless little baby, this link  "How to calm crying infants and get a little more sleep" is an excellent article from Sarah Ockwell-Smith.

Understanding your child's normal sleep habits and modulating your expectations accordingly can be really helpful.


So, is it safe for you to be sleeping while your baby is sleeping in a sling? My answer is, that's your call to make, depending on your circumstances. On the whole, I think the risks vastly outweigh the benefits.

Is it safe for a parent to sleep with their child loose in their arms? Again, my answer is, that's your call to make, depending on your circumstances. On the whole, I think the risks vastly outweigh the benefits.

I would always recommend reading the safe bed-sharing guidelines above to ensure both you and your baby gets the safest night's sleep possible.


types of sling

Types of Slings

Different slings suit different families at different stages; one type definitely does not fit all. It is like shoes; what fits your friend, or someone on the internet, may not fit you or your baby, choosing a sling is best done by trying things out!

Here is an introduction to each of the major types of sling, which will help you to assess which might suit your baby and your lifestyle best, and how to use it. Remember it can take a little practice for you both to get used to a carrier.

Stretchy Wraps
and their variants

Read More

Woven Wraps

Read More

Ring Slings

& one shoulder carriers

Read More

Meh Dais, Podaegis, Onbuhimos

Read More

Buckled Carriers

Read More

Troubleshooting your Buckle Carrier

Read More

Useful videos can be found here and the photo tutorials here.


Welcome to Slings

Welcome to the wonderful world of slings! You may be new to carrying and a bit overwhelmed about the choices available. You may be just starting out with your carrier and not sure if it’s the best or most comfortable option and wonder what else there may be. Read on for more information about how to make babywearing work for you, your baby and your family.


New to slings?

Not sure where to start when it comes to using a sling? This is a common concern among parents who have become convinced of the benefits of carrying their baby but feel a bit all at sea about the huge variety of slings and the confusing jargon in the sling community.

  • There are many positive effects of using a sling with a very young baby; there is much evidence to suggest that skin to skin contact between mother and newborn (especially premature) babies can confer great advantages on both. The baby gains assistance with their physiological regulation of breathing and heart rate, temperature control is improved, and the contact helps to establish breastfeeding and promote more rapid growth compared to babies who are not held as close for as long. Furthermore, the baby will feel more secure in his developing relationship with his caregiver, due to the time spent in close contact.
  • The caregiver enjoys positive effects too; he/she may find themselves more able to bond with their baby, due to the increased release of oxytocin, and post-natal depression may be reduced. Being able to be “hands-free” can really make a difference to a family’s ability to get around with their new baby, keeping them active and engaging with normal life.
  • There are also many positive effects for society; such as a reduced burden of mental health and greater fitness.

Firstly, make sure you choose a sling that allows you to carry safely.

This is especially important with young babies who are still small and in need of “fourth trimester” nurturing. In summary, a baby’s airway should be supported with the head well aligned with the spine, thereby avoiding curled-up into ball positions that could impair breathing.

The safest place for a baby is upright, facing his parent, just as they are when carried in arms. His head should be resting against his parent’s upper chest, close enough to kiss, and supported snugly all around to avoid any slumping. Babies naturally adopt a squat position with a slightly curved lower back (you can see this in action when you lay your baby down to change his nappy).

Ergonomic slings will respect this and carry a baby in a seated position, with his knees above his bottom. By bringing knees up, babies’ hips are rotated and do not need to be spread very wide to be resting comfortably, as the image shows. Narrow-based carriers (sold by high-street shops and online) are not unsafe, but they are less ideal and may not be as comfortable for a baby to rest in as one that has a wider seat and encourages the knees to be raised.

Such hip-healthy positioning also helps to stabilise a baby’s back and protects the airway, as it reduces the amount of backward head lolling and uncomfortable straightening of a baby’s curved spine.

Click the link to read more about safe positioning in a sling and click here for information about healthy hip positioning.

This baby has just had her stretchy wrap removed; the sling has held her in the natural "in- arms" position

Safe, anatomically correct and comfortable positioning in arms and in a carrier


Secondly, choose a sling that is comfortable

Many parents find their high-street carriers can be less comfortable than they hoped, especially as their baby grows, and may stop using a sling at all.

Good slings have been designed to mimic in-arms comfortable carrying as much as possible, and many people find they are able to enjoy long walks with their children, up to pre-school age, with such an ergonomic carrier.

Broad weight distribution across the parent’s body matters; a child who is able to snuggle in and shift their weight closer to their parent’s centre of gravity will feel a lot lighter than one who is held in a stiff pocket, or held lower down and facing out (thus pulling away from the parent).

This applies in front, hip and back carries equally. Positioning makes a great deal of difference to your child’s and your experience of the sling, and is the most important factor in how comfortable it is.

You can make your high street carrier more comfortable in a variety of ways, for example by ensuring your baby is higher up on your chest, held snugly, and using a scarf to redistribute the weight. Your baby should be held snugly enough not to swing free when you lean forwards.

Features like the type of shoulder strap (wide or narrow, those that cross over on the back versus those that are more like rucksack straps), the shape and sturdiness of the waistband, and the type of fabric used can also make a considerable difference. It is always worth trying before you buy, and there are many sling libraries around the country that can help you do this. The Sling Pages has a full list for you to check your local resources.

"Scarf hack" for narrow based carriers


Thirdly, think about what kind of sling may suit you and your family best


Stretchy Wrap

If you have a newborn or a baby under six months, most people will start with a stretchy wrap. This is usually a long piece of jersey style elastic fabric that is between 4 and 5 metres long, and can be wrapped around your body to create a snug pocket your baby can nestle into. Depending on the quality of the fabric, the stretchy wrap is usually used up to six months. It is often worth investing a little more for higher quality.

One size (usually) fits all, and it can be tied on and left on all day for convenience, popping baby in and out with ease without needing to take the sling off each time, many parents don’t realise this. It is possible to use the stretchy wrap as a breastfeeding aid, with care and attention to baby’s airway.

You can read more about stretchy wraps here, including how to use it well.

Close Caboo Carrier

This is a slightly more structured and less stretchy variant of a stretchy wrap, with a little less flexibility. It is put on, adjusted carefully, and then baby is popped into each of the cross passes on the front. The fabric can be tightened through the rings to achieve a snug fit. The Close Carrier can be used as a breastfeeding aid if required, with care and attention to baby’s airway, and most people will find it supportive up to three to four months.

Ring Slings

This is a piece of woven fabric which has one end sewn securely into two strong rings. They are worn cuppring one shoulder with the child sitting in a pouch on the opposite side of the parent’s body, with the loose end of the fabric threaded through the rings in such a way that the tension holds the fabric firmly and the weight is distributed across the shoulder and back.
They have the advantage of being lightweight and (once the knack is gained), quick to put on and take off. They can be very useful for those who need to be able to carry their child on the hip, or need something that offers the child a good viewpoint in all directions.

Ring slings made of woven fabric and with no padded rails are usually the best option, and shoulder style (pleated or gathered) is a very personal choice. They can be used from birth to toddlerhood, and it can be easy to breastfeed in a ring sling, with the appropriate attention paid to airway and positioning.

Hip carriers

Pouches are another kind of hip carrier which can be very simple, but need to be fitted to size; they can be a risk for babies under 3months if used badly.

The Scootababy is a buckled hip carrier with a waistband which can be used from approximately four months and up into toddlerhood.

Carrying aids and hip seats can make hip carrying easier but are not hands-free.

You can read more about ring slings and hip carriers here and your local sling library will be able to help too.

Woven Wraps

Woven wraps are excellent choices if you want great comfort and longevity. They can be used from birth to toddlerhood and beyond. Woven wraps are long parallelogram shaped pieces of fabric, anything from 2 to 7m long.

They are woven in a particular way to provide gentle all-around pressure, supportive but still soft and mouldable. Most woven wraps are made of cotton, some may contain other fibres such as linen or hemp, for extra support, and come in many different colours and designs.

Many women around the world use local woven cloths for many purposes as well as for child-carrying. These cloths and woven wraps feel very different from the fabrics you might find in a haberdashery shop; these are more likely to fray and tear.

Many people begin with a 4.6m wrap (known as a size 6) and learn a carry known as the Front Wrap Cross Carry. They can take a little practice but they allow a great degree of adjustability and weight distribution around the body. There are numerous ways to tie the same wrap, so they can be used on the front, hip or back at the appropriate ages. Your local sling and carrier consultant or sling library will be able to get you started!

Upright breastfeeding is possible, if done safely with the appropriate attention paid to airway protection.

You can read more about woven wraps here.

Meh Dai/Bei Dai (formerly known as Mei Tai) Carriers and variants (half buckles, onbuhimos, etc)

These are Asian inspired carriers made of soft fabric, and are popular with those who appreciate the mouldability and support of woven wraps but need something with more structure, or speed of use.

They consist of a fabric panel that has two straps at the base which are tied or buckled securely around the waist, and two straps from the top of the panel which can be wrapped around the parent and baby to ensure a snug and comfortable fit. Baby sits in the pouch created by the panel, and the long straps allow a great degree of adjustability to all shapes and sizes. They can be worn on the front, hip and back at the appropriate ages, and upright breastfeeding is often possible, if done safely with the relevant attention paid to airway protection.

Your local sling library should have a few of these to try out.

You can read more about meh dais and their variants here.

Full Buckle Carriers

If you’re not sure about tying fabric, a good option is a full buckle carrier, which has a buckle on the waistband, and the shoulder straps buckle into the panel at the sides. Baby is seated facing the parent, inside a supportive pouch that supports them widely across the base from one knee to the other.

Waistband types vary, from the minimal to the heavily padded, and people’s preferences vary enormously. Some shoulder straps cross over on the back when baby is on the front, others are fixed into a rucksack style. The shape of adult and baby together is very individual, as is the health of the adult’s back, so what suits one pairing will not suit another. More padding does not automatically mean “better” or more comfortable, and those with back pain will not always need heavily structured slings. Good posture and general back health are important – read more about this here.

Buckle carriers can be very quick and simple to use. Often, a little practice to get the straps and positioning optimally adjusted is well worth it. Most good full buckles fit well from three months upwards; some can be adapted for younger babies by rolling the panel or by using inserts to keep baby snug, high up and visible. Many carriers will last into early toddlerhood, and some beyond that, depending on design.

Many mums find that breastfeeding in the buckle carrier is possible, if done safely with the relevant attention paid to airway protection. Most can be used on the back once babies have grown.

Some buckle carriers will allow baby to face the world. This can be great, when done safely and responsively. It is recommended only from four months upwards, not for sleeping in to protect the airway, and only for short periods of time. This is due to the reduced opportunity baby has to see and interact with his parent and learn about the world based on his parent’s response to it – this is known as social referencing. There is also reduced hip and leg support from the narrow base which can be an issue in some circumstances, as well as less comfortable for child and parent. Carriers that provide hip healthy positions facing out are generally preferred. (read more about facing out here.)

You can read more about buckle carriers here.


Fifthly, enjoy your sling and let the world see it!

Why not share your enjoyment with the parents you meet so they can discover slings too? We all carry our babies, some in arms, some in high street carriers, some in wraps, some in ring slings, some in meh dais, some in buckles. We all learn from each other; encouragement is always more productive than criticism!

 

Here is a lovely article from Ellie at Peekaboo Slings about the importance of no judgment; “We want to normalise babywearing and promote carrying your children close – put bluntly, we don’t care about the rest”.

Fourthly, be aware of the changing needs of your baby

The weather conditions may change how you carry your baby; being aware of the heat and the sun, or the cold and the rain may affect your choice of sling and your clothing.

As your baby grows, her own needs will change. She may want to sleep less and look around more. She may prefer hip carries, or even back carries, so she can see into the world into which she is being carried. As she gets heavier, the carrier you began with may begin to feel less supportive for you and for her; for many this marks a move towards “toddler-worthy” carriers. This may be different ways of tying your woven wrap, learning how to adjust the straps on your meh dai to ensure knee to knee support, or moving up to a bigger, toddler-sized (or even preschooler!) carrier when you need to. Your “baby” sized carrier will often last a lot longer than you think.

You will not spoil your baby or make him clingy by carrying him as he grows. Big kids need cuddles too – loving contact is vital to our emotional health and security, from cradle to grave. You can read more about carrying older children here, and your local sling library or consultant should be able to help you make the most of your carrier.