Carrying multiples, babywearing twins, babywearing toddler and newborn

Tandem Babywearing, or Carrying Multiples

So you've got more than one baby! Twins, triplets or more? Wondering about tandem babywearing (carrying multiple children at once)?

“Is carrying them in a sling possible?” “Is it safe?” 

“What sling do I need or want?” 

“Where do I start with babywearing twins, or with carrying a toddler and a baby?” 

Carrying multiples, carrying twins, carrying toddler and baby, babywearing
Image shared with permission, Ilhan Omar

There is no doubt that carrying more than one child is one of the things that can baffle and inspire people at the same time, from the practicalities of it to the beauty of two babies in one sling. 

Why carry more than one child?

When people think of carrying multiple children they often think of carrying both babies at once, this is called “tandem carrying” or “tandeming”, however, it is not necessary to tandem carry every time, or even at all! Being able to carry one at a time will free up your arms, meaning you are able to look after both babies at the same time, keeping one soothed while meeting the other’s needs. 

This goes along with all the other many benefits to babywearing that applies to one child and their caregivers. More in depth information about all of these can be found in these articles here and here.

Babywearing can also be an amazing tool to use if you also have older children, to help engage in play with them whilst the younger babies are happily in the sling. There can be some limitations with this as it can be difficult to keep older children in check when tandem carrying, due to some of the movement /speed restrictions! 

How does it work? 

For new parents the idea of learning to use a sling can be daunting and especially for new parents of multiples due to the huge range in choice and the practical logistics of it. The best thing to do is to learn to carry one baby safely and with confidence first, then move on to tandem carrying when needed. 

But how do I learn to use a sling?

There are so many ways to learn now from one-to-one support (if you are local to us in Sheffield, the Sheffield Sling Surgery bookings are here) to self-learning from online videos (do choose channels made by experienced and reputable teachers!)

One of the main benefits of choosing professional support and learning one-to-one is the hands-on and emotional support this service offers. This can range from learning your very first ins and outs of carrying your children, getting a fit check and some tweaks, to expanding your carrying knowledge as you begin to learn your preferences, all with a listening ear and an experienced guiding hand. 

The most important thing is to ensure that you are carrying safely. Feeling safe and confident with professional support can be one of the most helpful inputs for beginning to develop that amazing bond with your child/ren. 

Booking a consultation will help you to gain these skills. Consultants train with various schools of babywearing and they have a wealth of knowledge and experience in carrying children as well as teaching you the practical skills, they may call themselves babywearing or carrying consultants. They have a passion for carrying children and the technical knowledge to know how to carry in a variety of ways, and will support you in however you want to carry. 

Laura; “I carried my first baby everywhere and anywhere so I knew I wanted the same when the twins came along but the idea filled me with all the anxiety! I booked onto a couple of consults and turned up at the drop in sessions at the library to nosey at and try out the styles.

When I first carried both babies I used the stretchy wrap which I was taught to use at a consult. We went through the basics first and got one baby secure then onto adjustments for twins. Each step was explained and I was helped to iron out the niggles to get them and me comfy. The consultation was invaluable! It made getting out and about so easy. Now they’re bigger I’m using all the slings and wraps thanks to more consults and guidance. I love babywearing!”

So what are the options when carrying multiple children? 

There are a vast number of ways to be able to carry multiple children. Some carriers are designed to carry two children at the same time, others can be adapted to suit the needs of your family.

We will first look at the individual carriers that can be used in different ways to carry single or multiple children, then we will look at carriers that have been made specifically to carry twins. We’ll explore using two similar carriers to carry multiple children, and then lastly we will consider the mix and match approach of using different types of slings at the same time!

Individual carriers that can be used to carry one or both children

Stretchy Wrap 

stretchy wrap twins, carrying multiples
Photo credit Rosie Knowles, shared with permission (Ilhan Omar)

A stretchy wrap is a length of fabric, usually made of soft and stretchy machine knitted cotton, that is usually between 4 and 5m long and about half a metre wide. Some have bamboo blended in with the cotton, which adds to the softness and comfort, and some have a small proportion of spandex, which adds to their elasticity and stretch.

When choosing a stretchy wrap it is best to get your hands on a few different brands as they vary in stretchiness and therefore give a different level of support and comfort when two babies are being carried, due to the increased weight. 

The best thing to do when preparing to carry twin is to get to grips with using the sling for one baby, usually the pocket wrap cross carry. Our photo tutorial for putting on a two way stretchy wrap in a pocket wrap cross carry (PWCC) with a single baby can be found here. Once you have mastered this, then you can learn to get both in at the same time (you will need to allow more space for both babies!)

However, when it comes to putting both babies into a stretchy wrap, it can be challenging to learn all of it from a video (many videos are best used as aide memoires once the skill has been learned). Furthermore, some twins may be under the recommended weight limits for the wrap, so it would be beneficial to get in contact with your local babywearing team and book some in person support with them to make sure that everyone is safe. 


This is a beautiful video done by LeKeta Kemp from Tandem Trouble, it shows her demonstrating a pocket wrap cross carry for twins with a sturdy stretchy wrap. 


Babywearing twins
Image credit Rosie Knowles

Pros and cons of using a stretchy wrap for twins 

Pros

  • Once tied, a stretchy is a poppable carrier so can be put on at the start of the day and babies can be taken in and out of the wrap without needing to retie each time.
  • It can be used for one or both babies. 
  • It can feel more affordable than other options.

Cons

  • It can be hard to get the hang of it when you are first starting out, as there is when learning any new skill. However with practice it will soon become manageable. 
  • It can be harder for people with smaller frames and as babies get bigger. 
  • Some people can start to run out of space on their front with two babies!


Close Caboo

The Close Caboo is a hybrid stretchy carrier, the fabric is sewn into a pre-arranged shape (similar to a PWCC), which can be slipped on over arms and head, to offer two ready made hammocks for baby to rest in. 

A Close Caboo can also be used with twins in the same way as a stretchy wrap. It has some of the structure sewn in, so is already partially set up for use. It has two pockets, both adjustable by tightening the fabric through the rings at the side, and then a third layer to tie over the top for security. 

The advantage of the Caboo is that it can be adjusted to size, then popped on. With a few minor adjustments it can be used for either one or both babies, each pocket can be adapted to fit their different sizes. It is also really easy to adjust when the babies are in the Caboo, as the rings can be used to pull the fabric tighter if needed. 

You can find our photo tutorial for getting one baby into a Close Caboo here. With two, each baby sits in separate pockets and they are placed in one by one, with the third layer tied on around both at the end.

Twins in a Close Caboo tandem babywearing carrying multiples
Photo credit Abby Hopewell

 


Pros and cons of using a Close Caboo for twins

Pros 

  • The fabric is a one-way stretch – this can mean less of a slumping risk as babies get bigger and can feel sturdier.
  • It is really easy to adjust when the babies are in.
  • It offers a quick and easy front carry.
  • It is easy to use and learn for one baby as well as two.

Cons

  • The panels are thinner when compared to a stretchy wrap, this means it can be harder to get the position just right to avoid red marks at the knee.
  • It is a little more expensive than a stretchy wrap. 


Woven Wraps 

A woven wrap is a fantastic tool for babywearing, it can be used in so many ways for one or two children of the same or different ages as well as being used alongside a different carrier. Essentially a woven wrap is one long piece of fabric that has been woven specifically to carry children, they vary in length, known as their size (most commonly from 1 to 8), and what length is used comes down to personal preference and what you are going to use the wrap for. You can find more information about woven wraps here

A woven wrap can be used from the very start of your carrying journey with twins, either having both on the front (a front tandem carry) or one on the back and one on the front. If you are planning to do this then a consultation is needed to learn these skills. Back wrapping a small baby is a skill that takes a lot of practice in itself and requires professional support and guidance, and it is best to get to grips with front carries with the woven wrap first. 

Front tandem carries

There are many options with woven wraps for front carrying two babies of a similar size until you run out of room! One of these options is the Jasmine’s Hip Carry which is usually done with sling rings. 

Babywearing multiples, jasmine’s hip carry with rings, babywearing twins
Image courtesy of Steph Oliver Beech, shared with permission, Becca Hutchinson with a Jasmine’s Hip Carry

 

Laketa Kemp Jasmines Hip Carry Tandem babywearing
Photo shared with permission, LaKeta Kemp Jasmine’s Hip Carry

What makes it so special? The Jasmine’s Hip Carry is done using one woven wrap with either one or two rings. Once prepared the wrap can be left threaded through the rings so it is pre-tied and removed for wear at a later time, each side of the carry can also adjusted to suit the size of each baby. This can be tricky to master but lots of practice will help!

This video by LaKeta from Tandem Trouble is a great video to see the logistics of a Jasmine’s Hip Carry with two rings.

Other options are the Amanda’s Tandem Hip Carry,(from Tandem Trouble), which is a ringless carry that knots round the back. There is also a twin version of the popular Front Wrap Cross Carry (from Little but Once), this has no ring and is tied at the front or back depending on what size wrap is used. 

Photo courtesy Dea Revinia, FWCC with twins.

Front and Back Tandem Carries 

A front and back tandem carry can be used for children of the same or of different ages. 

Tandem carry woven wraps babywearing twins
Image credit Rosie Knowles, shared with permission, front and back carry with one wrap

This is because woven wraps are a collection of individual strands meaning they can be carefully tightened section by section to ensure your baby is fully supported from neck to knee pit, with the airway open, respecting the natural gentle curved J and M shaped position. As these back carries tend to be done high up on the parent’s back, caregivers are able to see their baby’s face and feel their breathing on the back of their neck.

When back carrying a newborn, most people will choose a simple rucksack carry, which is just a single layer across the baby, ensuring there is less pressure for tiny bodies. However, getting your baby up on your back can be a challenge and is something that is best learned with the help of a professional. This video from Wrap you in Love will give you an idea of the safe way to do this if you would like to see how it works.

Once you have one child up on your back, you can use the rest of the long wrap, tied in a crossed across the chest ‘Tibetan’ finish, to pop your little one into the cross passes. This can also be done with two different wraps, mostly done when a toddler is on the back in a carry with multiple passes and a short wrap is used as a simple sling pass, passed through the wrap and tied under their bum, as seen below.

Tandem babywearing with woven wraps
Photo credit Will Nham, shared with permission

 Doing a front and back tandem carry can be a lifeline for some parents. Life with small children can often feel very hectic and being able to keep both children close at the same time can be a fantastic parenting tool. 

  Anna Nham; “Solo parenting with a toddler and a baby and the older one refuses to walk home, or tiredness hits and everyone wants a cuddle at the same time. These are the moments I am grateful to be able to tandem carry my kids. There’s 19 months between my two and while I can’t say a tandem is an everyday occurrence, when both of them need some close time or both need to nap at the same time I am always grateful to be able to pop them both up and at least create a moment of peace for me. It was especially important when the baby was smaller and needed more contact. Allowing me to give the older one something familiar and make him feel like he wasn’t pushed out. Now he finds it hilarious  when his brother is put on the front and he is on the back and loves to share that space with him. I definitely can’t get far with 24kg of kid attached to me but I can provide comfort and that’s an invaluable tool to have.” 


Pros and cons for woven wraps

Pros

  • They are very versatile for carrying one or two children. 
  • They can be used for front carrying both children, or for carrying one on the back and one on the front.
  • They can be used with children of different ages.
  • They can be used from birth to the end of your carrying days. 

Cons

  • They can be difficult to learn, but once you have gained the knowledge of how the fabric like to move then it is an invaluable tool .
  • They can be hard to get the right fit every time due to the way they are tightened and deal with a feisty child, but with patience and practice you will get it. 

Carriers designed specifically to carry twins

These carriers have been made with the needs of twin parents in mind and are focused on easy carrying of both children at the same time. They can be expensive, due to the complexity of the engineering (even if they are simple to use!)

TwinGo

This is a fantastic buckle carrier and one of the best known twin carriers around. It gives caregivers the option to carry two children at once, either twins or children that are close in age as it is designed to have one child on the back and one on the front. 

Image credit Becca Hutchinson, TwinGo with toddlers

black babywearing week carrying multiples, tandem babywearing
Image credit Rosie Knowles, TwinGo with babies

It can also be split into two individual carriers meaning that you don’t always have to tandem carry. Here is a demonstration video showing how to use the TwinGo with two children. 

One limitation of the TwinGo is that the panels aren’t adjustable in height or width. This means that it is best used when both children are big enough to fit in the panel knee pit to knee pit (normally around 5-6 months). There are newborn inserts, but inserts can be fiddly when used and cannot be used for a back carry. We recommend trying the TwinGo out before you buy, as the whole bundle can end up being expensive. 


Pros and cons of the TwinGo

Pros

    • It is ideal for carrying two children of the same/similar age with one on the front and back. 
    • It is designed specifically to do this, so it works very well. 
    • The padded straps and waistband add comfort even with heavy children.
    • It can be used as two separate carriers for different caregivers if needed.

Cons

  • It can be fiddly using inserts until babies are big enough.
  • It cannot be used for front tandem carries, only front and back.
  • It can only be used as a front and back tandem carry for babies four months and over, when they have reached the 3 milestones defined by TwinGo. More details about these can be found here.
  • It is expensive.


The Weego

This buckled carrier is designed to carry two babies of the same age on the front only. It has two pouches that are adjustable with poppers on the inside to give the correct panel height (size) which means it can be used from newborn till around 6 months (or 15kg combined weight.) 

Below you can see images of the popper system in the Weego, followed by images of the configuration of the pouches. 

Here you can see the inside of The Weego with all the possible placements for the poppers (A&B). You can also see the zips used to close each individual pouch (C), as well as the zips to secure the final layer of the sling around each baby (D).

An amazing article going into full detail about the Weego can be found here. It was written in 2019 by Joe Rawlinson, a dad of twin girls. It is a detailed and honest review about the Weego and how it helped them as a family with newborn twins.

Weego, tandem babywearing
Image credit Jan Bonar with a Weego

Pros and Cons of the Weego

Pros

      • Each compartment can be sized for each individual child. 
      • Both children can be carried on the front at the same time. 
      • Can be left already prepped so no need to re-do the internal poppers until babies have grown considerably.
      • One baby be left in while the other is removed. This can be very useful for nappy changes/feeds etc.

Cons

      • It can be fiddly to get right. 
      • It can feel bulky when on the front with both babies in it. 
      • It can feel heavy due to the narrow, flatter shoulder straps with no waistband.
      • It is expensive.


Twin miniMonkey
Photo credit Erica Hanson, twin MiniMonkey

The MiniMonkey Twin Carrier 

This carrier is designed to carry two children of the same age, on the front only. It is made up of two pouches for carrying babies in an upright position, mimicking a Jasmine’s Hip Carry in a woven wrap, but with the added support of a waistband. The ability to move the position of the pouches along the waistband can be very helpful to get an optimised and more comfortable position for both the wearer and the children.

The MiniMonkey Twin tends to fit babies best when they are about 4-5 months old, as the pouch height can be more challenging to adjust for smaller, newborn babies. This can be done with support from a consultant. Many people find that the Mesh MiniMonkey is easier to use with smaller babies as the material is thinner and easier to tuck for adjustments. Still others find that using two individual MiniMonkey carriers together on either shoulder across the body can be a more comfortable (and cheaper!) way to carry two babies together.

Here is the instruction video.


Pros and Cons of the MiniMonkey Twin 

Pros

      • It is a carrier that is prepared in advance, making it simple to put on each time.
      • Each pouch can be adjusted for each individual child.
      • The spreadable shoulder straps offer more comfort.  

Cons

    • It can be more challenging to use for newborns.
    • The height of each pouch cannot be adjusted so if babies are too small then they may get ‘lost’ in the pouch. This can be overcome with support, or using the mesh version.
    • It is expensive.

Using Two Matching Carriers 

There are many ways of using two individual carriers to carry multiple children, either the same or different types of carrier. A lot of these combinations are learned through trial and error to find out what suits your family best. 

Two Meh Dais and Half BucklesA Meh Dai (also known as a bei dai, formerly known as mei tai) is the common name given to a type of Asian carrier that originated in China many years ago. It consists of a fabric panel with long straps that are wound around the parent’s body, to be tied or twisted or tucked away securely. Different cultures have their own variants of these cloth carriers. A half buckle is the same style with the panel and woven wrap straps, however instead of being tied at the waist there is a buckle fastening. 

Front Tandem Carries 

There are two main ways of using Meh Dais to tandem front carry. This first is that both are used in a standard front carry but both children are held off centre (this can be seen demonstrated below) by Drew Joseph or by doing two hip carries. These can be tricky to master, but practice helps!

With two half buckles the same methods can be applied, however there are also a few brands (such as Didymos Didyclick and Mamaruga Padma)  that can have two panels attached to the same waist band. The advantage of this is that there is only one waistband being used, reducing bulk, but you still have control of placement of the panels. 

Tandem carrying babywearing twins Tandem babywearing twins DidyClick

Images from Rosie Knowles (of LaKeta Kemp using two DidyClicks)

Front and Back Tandem Carries 

Meh Dais and Half Buckles can also be used to carry two children, one on the front and one on the back. It is possible to tandem carry this way from a few weeks old. However, it can be scary and challenging to get a small baby safely on your back alone, just as with a woven wrap, so it is best to get professional support and guidance with this. 


Pros and Cons of Meh Dais and Half Buckles 

Pros

  • They give the comfort and feel of woven wraps but with the convenience of a pre-made panel and the comfort and security of a waistband.
  • Two carriers can be used for both front tandem carrying or front and back tandem carries. Each carrier can then be used individually as needed or by two caregivers.
  • Meh Dais and Half Buckles can be used for a front and back tandem carry from newborn, with professional support. 

Cons

  • It can feel like a lot of fabric in one place with 4 straps being wrapped around you and two waistbands.
  • There can feel like a lot of knots if using two carriers at once.


Two Ring Slings / Two MiniMonkey MiniSlings

 This is a nice option for when you would like to have two individual carriers that can also be used at the same time. Two ring slings offer a front tandem carry like a Jasmine’s Hip Carry, however with two pairs of rings pressing against you it can dig in a bit. Some caregivers deal with this by placing the rings on the back with a flip in the fabric on the front, this can work well with practice but often involves a learning curve. Using two individual MiniMonkey MiniSlings can be a lot easier, it mimics the double front carrying option of the Twin MiniMonkey and works well for small babies. With heavier and older babies, the waistband of the Twin MiniMonkey can be useful for better weight distribution.


Pros and Cons of two ring slings or two MiniSlings

Twin MiniMonkey MiniSlings Tandem babywearing
Image credit Rosie Knowles, two MiniSlings

Pros 

  • Using two separate carriers means there is always the option of carrying one child at a time (or each if there is another caregiver).
  • Two MiniSlings is a great hot weather option.
  • Ring slings can give more adjustability than two MiniSlings.

Cons

  • Two sets of rings can be hard work to adjust easily and be uncomfortable.
  • The first baby can end up sliding under your armpit when putting the second baby in, but this does get easier with practice.  

 

 

 



Two Buckle Carriers

There is a wide variety of buckle carriers that can be used when doing a front and back tandem carry when one baby fits well into the panel and is almost able to sit unaided. It always helps to explore all the different types of buckle carriers and see what would work for your family, as one type does not suit everyone. You may even choose to use different brands together. 

Front tandem carries

There are a few buckle carries that can be used together for a tandem front carry, either off centre or hip carry. These are the Integra, the Ergo Embrace and the Izmi, as these have unpadded waistbands so there will be less of a large bulk around the caregivers middle. However, this can become very fiddly with all of the buckles and the straps across the shoulders. We would recommend booking an appointment with a consultant to make sure everyone is safe.  

Front and Back tandem carries

snowsuits scarves slings and safety carrying in the cold tandem babywearing
Image credit Ilhan Omar

Most brands of buckle carriers can be used for front and back tandem carrying, however it may be more comfortable to choose two with unpadded waist bands, for (example the Integra or the Izmi) as they will sit flat against the waist without too much bulk. Another option would be to use one unpadded and one padded waistband (for example a Tula or Lenny Lamb). This still keeps bulk to a minimum while increasing the feeling of support. There are so many variations you could use, so it is best to have a good look around and see what types of buckle carriers you think would suit you. Most sling libraries will stock a good range for you to try out. 


Pros and Cons of two buckle carriers

Pros

  • Two carriers offer a lot of adjustability. 
  • Each carrier can be used to carry children separately (sharing the load between caregivers, or if one child is in the buggy/walking!)
  • Some carriers work well in combination. 

Cons 

  • Two carriers can feel very fiddly with lots of buckles and straps.
  • Carriers that have fixed position panels can be hard to move around the waist for two hip carries.

Image courtesy of Steph Oliver Beech; a buckle on the front and a Meh Dai on the back Tandem babywearing
Image courtesy of Steph Oliver Beech; a buckle on the front and a Meh Dai on the back

Mix and match options

Sometimes the best option is just to choose the things that work well for you on their own and see how it goes! The possibilities are endless when it comes to the mix and match approach, from a woven and a buckle together, to a Meh Dai on the back and a ring sling on the front. 

Mix and match is often the easiest option when carrying children of different ages, making the most of the slings you already have. For example, a stretchy wrap or a close caboo is a fantastic option to use alongside another type of carrier when caring for a newborn baby and a toddler. The stretchy/Caboo should be put on first of all, and adjusted to fit the newborn snugly and safely. Baby is then taken out, leaving the stretchy/Caboo in place. This frees you up to then get your toddler safely onto your back in your chosen carrier (eg a woven or a buckle) without worrying about your baby during the process. As the stretchy/Caboo is “poppable” and has already been set up for your baby, once toddler is in place, baby can be quickly and easily popped back in (or out again, as needed, eg for a feed, or if your toddler has fallen asleep and baby needs a change or some play time).

Tandem babywearing, stretchy on the front, Beco toddler on the back
Image credit – Ella Hensman, stretchy on the front, toddler buckle on the back

Carrying multiples, tandem babywearing
Twins on the front in a Weego, toddler on the back in a toddler buckle, Image credit

Pros and Cons of mix and match tandem babywearing 

Pros

  • There are many possibilities and a chance to be creative.
  • This mix and match method can be very useful for using the slings you already have, rather than needing to buy more.

Cons

  • It can feel like an overwhelming amount of choice; this is where sling libraries and consultants can offer guidance and get you off to a flying start.

Many families will opt for a sling and buggy combination with two or three children, but it is in fact possible to carry three children at once, as this hero mother demonstrates!

Summary

 The most important thing to remember if you are considering using slings with your children, is to do what is best for your family. This will vary. It could be carrying children individually, one in a sling and one in a pushchair, or it could be tandem carrying. Every family is different, so what works for you might not be the best option for the next family, and what works for your friend might not be best for you. 

Tandem Babywearing stretchy and woven wrap
Image courtesy of Steph Oliver-Beech, shared with permission by Jess Yarborough, stretchy and woven tandem combination

In conclusion, we recommend becoming familiar with carrying one baby first and then progress to tandem carrying in whichever way you feel most comfortable with. If you are unsure about anything, get support from a trained professional, they will be more than happy to give you all the information they can (we love to do it!) and do their utmost to make sure that you are utilizing all the resources that you can. 


Authors Jess Yarborough and Rosie Knowles


Top FAQS

These are the most common questions about babywearing I am asked, in a single helpful list!

Just click on the links to read the relevant blog posts, some are kindly shared from others

Firstly; some of my most popular articles:

Do the babywearing “rules” really matter?

Babywearing and infant mental health

Babywearing and the mother-baby dyad

Where can I get some training about slings and why they matter?

Secondly, I get this query daily. “Can I use your infographics to support families?” ABSOLUTELY! Everything on this website was created to help families with children to feel close and connected. Please credit me appropriately and link back to my website/social media (facebook, instagram)

Here is the link to the infographics (eg the Fourth Trimester/Build a Happy Brain/Why Carrying Matters/Skin to Skin posters and much more)

Carrying in different circumstances

Can I sleep while my baby sleeps in their carrier?

How do I carry more than one child at a time?

How can I carry safely in hot weather?

How do I keep my baby warm while carrying in the cold?  (ie can I put them in a snowsuit?)

How do I keep myself and baby dry when babywearing in the rain? (Coming soon)

Carrying adopted or foster children

What if my child has a disability? See this link for a stories from families living with a range of specific conditions.

What if babywearing just isn’t working for me?


sling faq pelvic tuck professionals training

Health and Social Care Professionals

It is now widely recognised that the early years of a child's life matters enormously for their long term health and wellbeing. Many health and social care professionals are increasingly aware of the need to support new families right from the beginning, helping them to build bonds and promoting the creation of secure, healthy attachment relationships. Sling and carrier use can play a very significant part in this.

Rosie is a practising GP, and has been working in babywearing fields for many years, creating unaffiliated resources for NHS use, writing an evidence-based book on the topic, and has trained many health and social care professionals. This is includes health visitors, infant feeding teams, midwives, paediatricians, nurses, perinatal mental health workers and many more.

Her courses aim to equip professionals with a thorough grounding in the science of infant and maternal mental health, and how slings and carriers promote health for a lifetime. She is very aware of the special considerations that arise when working with newborns or vulnerable children and families, and the particular challenges that may be encountered in clinical sessions. She can tailor courses for particular needs and focuses.

Find out more about training courses

adoptive and foster families

Slings and Adoptive and Foster Families

We all know how vitally important it is for children to build secure attachments with their primary caregivers, both for a sense of security and belonging now and in the future. It is much harder for this supportive relationship to develop when the primary caregiver has difficulties of their own, and when children need to be taken into care. The adverse experiences being endured by children in these circumstances have been shown to have a long term effect on future mental and physical health

This page collects some of the most useful writing on the topic of sling use among adoptive and foster families.

Leah Campbell's story

Adoptive and foster parents will know that their children need all the love they can give; and a sling can play an useful part in building these bridges amidst the turmoil. The biochemistry of creating a secure attachment is not a conscious process, or one that depends on ancestry; the release of oxytocin and the down-regulation of the stress response that happens with consistent, close and loving contact happens in the background.

Carry the Connection website

There are many other benefits in terms of language acquisition, socialisation, and also helping children to learn which of the adults around them are their primary caregivers.

Sue, a foster parent in the South, is a strong advocate of using slings as part of her care.

“Many of the babies who we care for have been exposed to either drugs, alcohol or domestic violence whilst in the womb. Carrying them has, without doubt, enabled them to develop into calm, sociable, happy, securely attached babies who meet (and often exceed) their developmental milestones.

Babies who have been neglected for the first few months of life can be very wary of people and situations. By carrying them they learn more about the world from a position of safety. They take cues from watching our faces and  learn to trust people and situations more more quickly.

Using carriers when introducing babies to their adoptive parents show the babies that this is someone to be trusted. Only I carry the baby in a sling whilst they stay with me although many other people hold them. However from the first day of introductions the adoptive mother wears the baby in my (the baby’s) sling. I believe this shows the baby that Mummy (or Daddy) is a special person which enables the attachment to switch between us. “

“Children with disrupted attachments are often indiscriminate in who they seek to have their needs met by. Children should always be guided back to their parents by family and friends if they are approached by the child particularly for food and nurture. This process is called funnelling and is extremely important in giving a clear message to the child about who their primary caregivers are. A sling or carrier could be helpful in this process, reducing indiscriminate attachment seeking behaviour and discouraging over-enthusiastic family and friends from picking up and nurturing the child.” Carrying the Connection

This blog post from Slings and More (based in the North East) assesses the science behind how slings can help  adoptive and foster parents to build secure attachments.

“Foster and adoptive families have an immense role in helping to form strong attachment bonds with the children they look after and to help those children who do not have strong attachment bonds to begin to form them.”

This is a personal account of a mother’s experience of using slings as she adopted a little girl.

Her father told her: “You two should have some time alone. She needs to learn your smell and the sound of her mama’s heart.”

Perinatal mental health challenges can be very real for adoptive parents too, and slings can be enormously helpful for all shapes and structures of family unit.


educational resources build a happy brain rainbow brain carrying matters

Educational Resources

This page contains various resources that may be useful for education and supporting others. Leaflets, posters and postcard packs can be purchased. Images and PDFs can be downloaded free of charge by clicking on the photos. Please ensure you credit me (Dr Rosie Knowles) if you use them.

Click on the image to download a PDF, or order a pack of high quality printed leaflets using the button below.

Buy the Carry Safe leaflets here

Click on the image to download a PDF, or order a pack of high quality printed leaflets using the button below.

Buy the Guide to Slings leaflets here

Click on the image to download a PDF, or order a pack of glossy postcards or posters using the button below.

Buy the Seven Reasons poster here

Click on the image to download a PDF, or order a pack of glossy postcards or posters using the button below.

Buy the 4th Trimester products here

Click on the image to download a PDF, or order a pack of glossy postcards or posters using the button below.

Buy the Build a Happy Brain products here

Click on the image below to download a PDF, or order A3 posters using the button below.

Buy the Skin to Skin Matters products here - coming soon!

Click on the image to download a PDF, or order A3 posters using the button below.

Buy the Bonding with your Baby posters here

Click on the image to download a PDF, or order A3 posters using the button below.

Buy the Babywearing and Mental Health (mother/father) posters here

Click on the image to download a PDF, or order A3 posters using the button below.

Buy the Babywearing and Mental Health posters (inclusive) here

Click on the image to download a PDF, or order a pack of posters using the button below.

Buy the Carrying in the Heat posters here

Click on the image to download a PDF, or order a pack of posters using the button below.

Buy the Carrying in the Cold posters here

Read Rosie’s well loved Why Babywearing Matters book here, published by Pinter and Martin.

Buy the book here

Read Rosie’s well loved Why Babywearing Matters book here, translated into Polish by Lenny Lamb.

Buy the Polish book here

Bonding with your big kid

Bonding with your big kid is just as important as bonding with your baby. Older children need love and secure attachment relationships too, as their brains are still growing and their foundations still being laid down.

“I wish I had known about slings when I had my first child!”

“My son suddenly wants to be carried all the time suddenly and he’s so heavy now, I feel like we missed the boat.”

“My big girl is finding it hard with our new baby and seems to be much more clingy than usual. I wish I could carry her somehow..”

Do any of these comments seem familiar to you? I hear this kind of thing almost daily, and while part of me rejoices that now, at least, these parents do know how fantastic slings can be for family life, I appreciate their sadness.

But did you know, big kids like to be carried too? How many of us have hoiked our hefty toddlers onto our hips when their legs get tired of trundling along, or felt little arms wound around our necks when they are tearful? How many of our huge preschoolers still appreciate long hugs and piggyback rides? All children need closeness, long beyond the baby stage, long after they take their first steps, long after they start school… and so do grown ups! Loving contact is vital to our emotional health, from cradle to grave.

bonding with your big kid

A sling is, at its most basic, a tool for enabling close contact, almost like another pair of enfolding arms around your child, while your real arms can be used for other things. A good sling, when used well, provides a feeling of all-around gentle pressure, as if being hugged all over. This can be very valuable for children struggling with sadness, with sensory overload, with tiredness, or fear from loud noises, for example. Being close to a parent’s body is reassuring and sends a valuable message to a child that “You are loved. I will look after when you are unhappy, I will keep you close when you need it. I am always here for you.” There are many other advantages to slings beyond this opportunity for connection; not least that they can be very comfortable and help to distribute the weight of a child around your body evenly, making it much easier and much less tiring than in-arms carrying. They can help to provide nourishment –  breastfeeding or bottle feeding on the go, they can make school runs easier, allow greater freedom in exploration, enable naps, and keep exuberant runners out of danger in crowded areas or near roads etc.

Slings with Big Kids

You can use pretty much any kind of sling with a bigger child, even a stretchy, if it is a high quality hybrid one like the JPMBB or the Ergo wrap. I’ve helped a couple of parents with toddlers find the stretchy love, as there’s nothing quite like the enveloping gentle bounce you get with these. They do tend to work best and most easily in front carries.

Ring slings can be fantastic, if you have the shoulder style that suits you best (pleated vs gathered), and made of a fabric that is supportive enough. People often suggest linen or hemp or silk to add strength to the softness of cotton, which indeed they do, but many 100% cottons are more than sturdy enough for heavy children, who can become easier to carry as they develop more core strength and become more compliant and easier to carry than the “bowling ball stage” – it’s worth trying a few out!

Woven wraps are the most versatile, as they can be tied in different ways, in different positions and with different levels of support. As with ring slings, the fabric used can make a difference to how a wrap feels – fibres with extra support can be helpful but may not be necessary, and as above, understanding tightening techniques and how to get a good position can really help you make the most of your current wrap

You can get toddler size meh dais, half buckles and full buckle carriers, even some up to preschool size. Again, it is worth trying a few out at your local sling library as one size does not fit all, and the body size and shape of the carrying parent plays a part too (some preschooler carriers will just be too big for petite mums, for example). Waistbands may need to be worn lower (around the hips) for front carries, and some creative methods for getting a good seat in a back carry may need to be employed! Please do take advantage of your local sling professionals about whether you need a bigger carrier for your child; it may be that your current carrier just needs a few tweaks in technique to get the most out of it. Many people upgrade to toddler carriers earlier than really necessary, and too big a carrier may be more problematic than one thats just a touch small (see my “beyond the knee to knee” article for more information).

worth

What about the inevitable comments “he’s too big to be carried like that, he should be walking!” or “You’ll just make that child clingy, you know”? Well, I think a sling is as valid a means of transport as a pushchair, and far more comfortable than achingly weary in-arms carrying. Don’t be afraid to carry your toddler – for every comment you get, you may well have planted an idea in someone else’s head. Ensure that your child doesn’t feel hurt by any comments, sometimes talking about any incidents together afterwards can be helpful. Using a sling for your bigger child from time to time will not harm them, nor will it make them babies again, any more than a hug or a hip carry would do.

My own experience

My big girl, who was nearly 4 at the time of writing, is much less often carried these days; much to my chagrin.. but she is vocal about it when she does want to be carried, climbing up me and wrapping her legs around my waist. I am happy to oblige as I’m never sure how many more carrying days we have left to enjoy. She has moods, and disappointments that the world doesn’t revolve around her, and sometimes she finds it hard to wind down. Often, at these moments, a sling has been our saviour, holding her close so she can relax, feel safe, and  listen to my reassuring murmurs, while I can still get on with some of the things that just can’t wait, or save my back and arms from her lopsided weight! We use all sorts of carriers –  ring slings for quick up and downs, woven wraps for sleepy cuddles, preschooler buckle carriers for rainy school runs, warm snuggly half buckles for winter walks.

 

Even my (then) six year old found a wrap carry a great reassurance one day when he got separated from us at the Yorkshire Sculpture Park; he was very distressed when found half an hour later and just wanted to be holding onto me. My husband’s shoulders got pretty tired after a few minutes; but I was able to carry F on my back for well over half an hour, due to the support and the weight distribution, enough time for him to feel reassured and connected again. I found it really helpful too – it was a pretty horrible forty minutes and having him in close contact was very valuable for my own feelings and allowed me to breathe and absorb, and move on.

end of babywearing

A local story of re-connecting with a sling

I’ve got to know one family with a preschooler pretty well, they hadn’t used a sling for over a year, but started again, almost from scratch. Here’s what they have to say about their experience of carrying a bigger child.

After starting nursery, H became anxious and disconnected. She chewed her fingernails to a painful point, and became difficult to communicate with, as well as regressing in toileting. Instead of adopting behavioural control techniques, I drew on my experience from other parts of our lives and adopted a regression tactic. A big part of this was returning to carrying her in a sling. We had used our high-street carrier rather than a pram on our dog walks, but had given this up over a year before as she had outgrown it.  We wondered if a ring sling would be a solution for short snuggles for reconnecting. H was too heavy to attempt this from online videos, so we booked a workshop with a local sling consultant, who reassured us that she wasn’t too big, and showed us how to ensure we were all comfortable. The ring sling has been perfect for our needs and has really helped us all. More often than not, it has doubled up as a dramatic scarf for the 80% of the time H wanted to walk!

H is now almost 5. Our new buckled carrier is the perfect tool for winding down for bedtime on a camping trip, resting tired little legs whilst hiking (without the bulk of a framed carrier), and elevating her out of danger in busy, crowded areas. I really believe there is no such thing as “too big to sling!”

Slings with Two Kids

Another situation where carrying a bigger child can really help is with sibling jealousy.  The other day I spoke to a family who hadn’t used their sling with their toddler for some time, and now have a new baby. Big sister has been feeling a bit jealous of the new arrival and has wanted to begin breastfeeding again. They asked for some advice, and I suggested that their daughter would really appreciate the contact that would come from using their ring sling and buckle carrier again… and so it seems to have proved. It’s not so much the desire to be a baby again, but more of a chance for communication – “you still belong to me, don’t you?”

I’m working with another lady whose older child is struggling to accept their brand new baby. She asked me to show her how to breastfeed her baby in a sling, in the hope that this would allow her to be hands free to play with her toddler. She’d never carried her first child but was loving the slings with the little one. Successful breastfeeding in a sling is a challenge that requires care to do well and safely, and in my opinion is never fully hands-free. However, one hand available can make a big difference – you can hold a book to read, help with a jigsaw at the table, stir a mixture, hold a hand, for example. Amongst other things, we looked at a ring sling, which can be used for little babies as well as bigger children who love to sit on the hip and look around, so it is a carrier that can be used for children of multiple sizes. Hopefully, carrying the bigger child from time to time while the baby is sleeping, or in a pram or carried by Dad will be helpful for dealing with big feelings and the need to know that his Mum is still Mum and will always be there to meet his needs, even with the new addition taking up so much of her time.

There are some carriers that can be used with small babies and bigger children; which means the same carrier can be used for both children when needed. The ultra- versatile ring sling and woven wraps are good examples, which mould around the parent-child dyad and can be used from birth to preschool age and beyond.

Some mei tais with adjustable width can work well for families with children born with a small age gap. The buckle-waist equivalent half-buckles can be useful, or those with wide wrap straps that can be tied in such a way that bigger children will be supported knee to knee. Some full buckle carriers can be used from birth and their panels can be adjusted to the size of the child. Some come with inbuilt adaptations for using with babies, and some have separately purchased inserts for small babies to rest on until they grow big.

Do visit your local sling library or get in touch with a sling consultant for some help navigating all these options; there will be something to suit nearly every situation!

safe sling position
about rosie

Slings during Pregnancy

During pregnancy, carrying an older child can be an opportunity to help deepen relationships and prepare for the new arrival, being reassuring that things really are going to be all right after all. Carrying while pregnant has its own challenges too; ensuring the bump isn’t compressed, that weight is well distributed, that any symphysis pubis discomfort is not exacerbated. Do see your local sling consultant or chiropractor or physio for help if you need (bearing in mind that many health care professionals may not be up to date with ergonomic, safe carriers.) There is more reading here about carrying while pregnant.

In summary, older children do not stop needing the love and support of their caregivers for a surprisingly long time. Our society seems to believe that we should encourage separation of children and caregivers as young as possible, to breed “independence”, when actually, neurophysiology suggests that children will learn independence at their own pace, as their cognitive and emotional capacities develop.


child care providers

Sling Training for Child Care Providers

Many parents are now expecting their child care providers to have some knowledge of safe sling use, and to use slings with the children in their care. In Sheffield, we provide training for those working in child care settings (as well as a module of the Early Years Parenting PGCE at Sheffield Hallam University). Here Harriet (one of the course teachers) explains why sling use in a child care setting matters.

Contact us to book a course here

Attachment in the Child Care Setting

Secure attachments with their primary care giver is vital to children’s social and emotional development. It helps them to grow into happy and healthy sociable beings.

The relationship between a child and their parents, is of course, paramount. But what about those children whose care is provided by more than one person? What if their care provider is absent for periods of time due to work or illness?

My husband and I work full time. Our two children have attended nursery since they were 6 months old. Between them they are at nursery for 80 hours per week. We have seen first-hand the difference that a strong attachment with nursery staff can make.

For those children who are cared for by extended family or private care providers, building bonds with those carers is critically important. A strong attachment with nursery staff can make a big difference to children’s happiness and comfort, and also to parent’s confidence in leaving their babies with a childcare provider.

Here in Sheffield, where the sling revolution is well and truly underway, nurseries are telling us that prospective parents are asking if they practice babywearing. Parents are listing use of slings as one of the criteria they are using to base their decision of childcare provider.

child care providers

How can sling use help in child care settings?

Slings can help carers to hold children close, responding to their needs quickly and soothing children who are upset. Childcare providers tell us how they put distressed babies or tantrumming children into slings and feel them calm down, as they are rocked and swayed in the carrier, often falling asleep.

Slings are particularly helpful for providing familiarity for children who are already carried in slings by their parents. Using slings with these children can help replicate the routine they have at home and provide a familiar source of comfort.

Slings enable babies to be carried at height, seeing the world through the eyes of the person carrying them. It provides a new perspective for them, being able to observe how their carer interacts with the world, how they communicate with other people, how they behave. This observation and learning helps their social and emotional development as well as their language acquisition.

Slings also provide a safe haven for over-stimulated over-tired babies and children. Holding a baby close in a sling provides them with some respite and rest during a busy and active nursery day.

As well as the emotional and social benefits, for childcare providers, using carriers has obvious logistical and practical advantages. Slings can be used on day trips and walks, whilst one baby is in a sling, the same carer can push a double buggy, maintaining the 1:3 staff to child ratio.


There are a number of circumstances in which slings could be useful for childcare providers:

  • Providing security and attachment

  • Settling-in and transitions

  • Replicating familiar routines from home

  • Encouraging bonding with multiple staff 

  • Assisting in sleep and nap routines

  • Soothing and comforting babies/children

  • Going on day trips and walks

  • Quick carries around nursery buildings

  • Being ‘hands-free’ to look after other children


Different types of slings

There are several different types of slings that could be used. Each type of sling presents different pros and cons and some aspects to consider include:

  • The age range it is best suited to
  • How easy it is to learn and master
  • Potential for trip hazards (for example from long straps)
  • Potential for overheating (for example from multiple layers of fabric)
  • How to fold, care for and store


Safety Guidelines

Of course, whichever sling is used, safety guidelines must be followed. The most important aspect is to ensure children are able to breathe easily; once babies are over 3-4 months they can hold their own heads up and protect their own airways. Ensuring they are not too hot is also important.

The best known safety guidelines in the UK are the TICKS guidelines.

Comfort for children and for the staff matter, as well, so choosing a comfortable sling is a good idea, it is worth trying a few first. If you are a childcare provider using, or thinking of using slings, it is a good idea to undertake staff training and introduce a policy and consent forms. This will give you a chance to try some carriers and see what will work best for your needs.

Parental consent and the consent of staff members should be secured before putting a baby/child in a sling.



carrying in special circumstances

Carrying in Special Circumstances

Sometimes there is a need for extra support with using slings; don’t be discouraged if you or your child have extra needs, there are always ways to keep carrying in special circumstances.

If your child can be held and carried in arms, there is likely to be a way to carry them safely in a sling. Twins can be carried in slings, as can a baby and a toddler at the same time (tandem carrying). There are ways to carry safely in pregnancy, to carry after birth, to carry premature babies. We will help you to carry your child if you have a disability, or if your child has special needs or physical health concerns. We are here to help you find a way to keep them close.

This page links to some useful information; personal stories about carrying in special circumstances, professional advice and useful links. Please see our Common Queries page for simpler situations.

If you have a special story, please get in touch to share them with me for the wider community!

Here is an excellent downloadable article on Potential Therapeutic Benefits of Babywearing by Robyn Reynolds-Miller.

You can find more educational resources here for downloading (such as infographics and leaflets and images)

If you need more specialised support or have a query not covered here, please do get in touch with me or find your local sling library at Sling Pages.


carrying a premature baby

Carrying a Premature Baby

This is Kay and Alex's story of carrying a premature baby. She tells us about their lives together and what role slings have played in their rocky journey. It is a truly inspiring story of great courage and endurance and I am honoured to have played a small part.

 

"For as long as I can remember I have wanted to be a mum, but my real journey to parenthood started 5 years ago. I decided that I didn't want to wait for the "right person" to come along and started looking into fertility treatment for single women.  Unfortunately the process wasn't was easy as I expected; after lots of tests and surgery I discovered that I had endometriosis which may affect fertility..

I started out doing IVI with donor sperm but after two attempts with no success it was suggested that IVF might have a better chance of working. I decided to take part in the egg-sharing programme to reduce the cost and hopefully help someone else too. During this time there was a lot of compulsory counselling to ensure I was aware of all potential outcomes. I'm very lucky that I have a fantastic support system of family and friends around me, especially my parents.

The first attempt at IVF was not straightforwards, I got 14 eggs, (7 of which were donated), but only one was fertilised. This was put back and I got a chemical pregnancy but miscarried. I also got a relatively rare condition called Ovarian Hyperstimulation Syndrome (OHSS) which made me really ill and I had to be hospitalised on numerous occasions. Due to the poor fertilisation rate it was thought that I had poor egg quality so had to pay the full cost of IVF treatment (as a single woman I was not entitled to any NHS treatment.)

On the second IVF attempt, medications were reduced to try lessening the risk of OHSS but because doctors were anxious about this, the egg collection was done too early and 5 eggs were lost during retrieval. This attempt was unsuccessful. I again got OHSS but much milder this time. The emotional rollercoaster or IVF is unimaginable and the hormones of treatment don't help! You spend all your time so focused on preparing to become pregnant, trying to stay positive, eat well etc, then once the embryo is implanted you have the longest two weeks praying you are pregnant and counting down to the day you can take a pregnancy test... but as soon as it is test day comes you don't want to do the test because you are until then "Pregnant till Proven Otherwise" ( PUPO). Internet support groups become your sanctuary because others undergoing IVF can understand what you are feeling, while your family and friends sometimes don't understand why you put yourself through so much. IVF became my only focus.

After the second attempt I had an eight month break to save up as I had used all my savings. I decided that the next would be my last attempt and I would do everything I could to try to help it work so I would have no regrets. I changed my diet (cutting out all processed food), saw a nutritionist, had regular massage (including Mayan abdominal massage) and acupuncture. We changed the IVF regime to one that had a higher chance of success but also a higher risk of OHSS. It was a risk I was willing to take. I had partly given up hope of this round working, as I got two fertilised eggs out of 19 when I began getting the OHSS symptoms again on day 2.

I did a home pregnancy test two days before test day..... and it was positive!

I didn't know how to react, so burst into tears before laughing maniacally then calling my best friend and my parents. The excitement wore off quickly though when I was admitted to hospital with OHSS at just 4+1 weeks. At a point when I had hoped that the hard part was over, it turned out that this was just the beginning of another difficult journey.

kay USSAt 18 weeks pregnant, I began getting tightenings. As a midwife, I knew that Braxton Hicks could start early, so I just assumed it was this. though I also worried it might be something more. At 19+4 with continued tightenings, I was seen by my consultant for review and thankfully everything looked ok and possibly just a urine infection causing all this. I was reassured two days later when I had my anatomical scan and everything looked good with a healthy active baby.

I continued to have tightenings but tried to ignore them as everything else seemed OK. Then exactly two weeks later after my scan at 21+6, I started with the smallest amount of bleeding. Again I was reassured as baby seemed OK and it had settled, possibly caused by a cervical erosion, and just to observe. I continued spotting on and off but nothing major, until I was at work on a shift on labour ward at 23+1 weeks pregnant.

I had a significant bleed and was terrified. I felt it was too far on in the pregnancy to lose the baby now but it was far too early to be born. I burst into tears. I am so grateful that I was at work surrounded by fantastic colleagues. I was admitted to the antenatal ward for observation overnight and I didn't go home again.

I continued to have tightenings and bleeding to varying degrees over the next three weeks. Getting to 24 weeks was a major milestone and I was given steroids to mature the baby's lungs. At around 25 weeks my waters went though because of the bleeding it wasn't obvious. Baby was breech and because of the situation I kept being told I might be taken for a Caesarean if bleeding increased or I went into labour. I saw paediatricians who told me stark statistics about survival rates and disability. As a midwife I knew these things but as a mum it just didn't sink in. I was tearful and losing hope. At 25+5 I had a major bleed that got me taken to labour ward and starved in case it continued and and I needed theatre. I spent the next two days in high dependency being observed and in denial.

Writing it down now it seems so silly but even given the bleeding, tightenings and water break it still never clicked to anyone that the pain I was in could be labour. At exactly 26 weeks I was found to be 7cm dilated. Two hours later I had a vaginal breech delivery complicated by the head getting stuck.

Alexander Benjamin was born weighing 1lb 12 oz and in a very poor condition.

newborn Alex

The room was full of people but no-one was saying a word. Looking back at his notes now it says it took 18minutes to stabilise him before taking him to intensive care but it didn't feel that long to me. It seems awful to think about it now but at that point once Alex was born all I felt was relief. I was glad the pregnancy was finally over after months of feeling ill and stressed. I had spent the last few weeks trying to detach from the pregnancy as I feared the worst, but in the moment when Alex was taken away and we (myself, my parents and my friend) were left alone the silence said it all.

phototherapyI know it can often take up to an hour to get a baby settled into neonatal unit with all the lines, Xrays etc so we patiently waited. After nearly two hours I went to ask if we could see him.. the midwife came back saying the consultant wanted to come and talk to us first. I know the language of medical professionals and I honestly thought we had lost him. The consultant came round and told us that "Alex is a very sick little boy" and that the first 24hours would be critical. I think the adrenaline stopped me from feeling the full effects of the situation but looking back now at pictures and videos of those first hours has me choked up. Alex was beautiful to me, but so frail. You can count every rib and due to the manipulation of delivery his leg is almost black with bruising. He was covered with monitoring leads and various IV lines plus on a ventilator to keep him alive. He was put under phototherapy immediately.

Only I was allowed to touch him but couldn't hold him yet.
kay first holdMy first hold came on November 17th, aptly, World Prematurity Day. I was nervous about pulling a line or hurting him but also so excited to hold him! He was put skin to skin down my top and his ventilator tubes taped to me to keep him safe. I can still smell him now and it brings me to tears. As a parent you take for granted the milestones you will see; the birth experience you imagined, the crying baby just born and put skin to skin at once. I didn't get these, and my milestones with Alex are different, but even more amazing after the challenges he has faced. We spent 135 days in the neonatal unit and I was there 12 hours a day for 133 of those days. (Two days I was ill from sheer exhaustion and wasn't allowed in.)

skin to skin ventilatedI spent my time holding Alex as much as I could and when he was too poorly to be held I touched him through the incubator and spoke and sang to him. I felt being physically close would help us both bond better, especially after an awful pregnancy and so much separation. I was already aware of the Sheffield Sling Surgery due to friends attending and had contacted Rosie early on in pregnancy as I had planned to carry my baby in a sling. Once Alex was over the first big hurdle of coming off the ventilator at a month old, I got back in touch to find out if slings could help us while still in the NICU. The physiotherapist on the unit was very in favour of using slings and gave me a Vija top to try, but I felt it was more comfy just using my strappy top as we got so tangled with the wires.By the time we moved to HDU it was a slightly more relaxed environment with staff that seemed more in favour of breastfeeding and skin to skin. I decided, after discussion with Rosie, to buy my first sling, a Hana stretchy wrap.

It felt complicated at first getting used to the technique of wrapping and because of all the monitoring it would often take someone else to help me get all the wires sorted, but once Alex was put into the sling he fell straight to sleep. I noticed that often his heart rate and oxygen sats would improve too and it made me even more determined to keep him close.

skin to skin ventilated

Our journey through special care gives me mixed emotions. On the one hand I would never wish this experience on anyone. The constant stress, not just for myself but also family and friends around me. The fear that if I leave, something might happen. Every time the phone rang panic would set in and don't even get me started on the paediatricians coming up to the ward!

However, my life has changed completely in so many good ways. I have realised and experienced how fantastic the care is from my colleagues. I have become closer to my family and friends and I love watching my parents with Alex. I feel I will be an even more sympathetic and understanding midwife and I hope my practice will change to support women who go through similar experiences. Most of all I have realised my dream of becoming a mum and to the most incredible little fighter I have ever met.

fighter Alex

 

I feel I have a strong bond with Alex and many people have commented on how well I can read him. I believe it is because of staying close to him as much as I have and having him in the sling has facilitated this.

Alex has Chronic Lung Disease and came home on oxygen in March. He is doing incredibly well on the lowest level now, but transporting the oxygen has been a bit of a challenge for me. The canister is heavy and the container rucksack has narrow shoulders so has hurt my shoulders; trying to balance that weight against Alex has not been easy. At times I have felt isolated simply because of that. However I have met some wonderful people on my journey through special care and in the sling community (often the two groups mix!) and we wouldn't be where we are now without these challenges.kay alex hana

We are still using our Hana wrap, and I've been trying out a snuggly Sleepy Nico! I've learned how to use woven wraps; we are beginning to back carry; the end of the oxygen is in sight! Time to tuck Alex up into the Sleepy Nico and reconnect after a long day.

back carry o2


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