Breast and Bottle Feeding Safely in a Sling

Carrying babies is a wonderful way to encourage successful and more long-lasting breastfeeding, as the frequent skin to skin contact and the building of loving relationships help to stimulate oxytocin release.

Oxytocin release (which stimulates let-down) becomes conditioned to the mother’s experience and emotions; the touch, sight, smell or cry of her baby, as well as thoughts of her baby and the natural rhythm and expectation that baby will be hungry soon.

A sling that allows ease of access to the breast encourages responsive feeding, helping the harmonious nurturing relationship to flourish.

Mothers can go about their daily tasks or care for older children while their child’s need for nurture and nourishment can continue uninterrupted. This is normal human behaviour.

If the mother is in distress, unwell, or struggling with postnatal depression or anxiety, her feelings will inhibit oxytocin release and have an impact on breastfeeding. Close physical contact with her child as well as effective emotional support can help a feeding relationship to recover.

A comfortable baby carrier can thus be an excellent solution for a breastfeeding mother and baby who have had a complex start. This can be especially valuable after a difficult labour and birth or a prolonged separation for medical reasons.

The carrier can help create a safe space for the dyad, keeping them close together, allowing them to heal each other, encouraging the hormones of love and bonding to flow. This has a positive impact on breastfeeding.

If breastfeeding comes to an end, the baby carrier can preserve the growing relationship by keeping mother and baby in close contact and help it to continue to blossom.

 

There is always more of a risk to safety when combining breastfeeding with babywearing and it must be done well. Here’s my guide to safe breast and bottle feeding in a sling!

I meet a lot of pregnant ladies in the course of my varied roles, and many new mums, and one of the questions I am most frequently asked is “Will I be able to feed my baby in a sling?”

It’s an important question to deal with, as it crops up so regularly, and for some, is one of the criteria for choosing the right sling for their needs. The simplest answer is that, “Yes, many parents are able to feed their babies in slings, from the breast or from the bottle.”

But this then leads to other vital questions…

1. “Why might you want to be able to feed in a sling?”

2. “How can you keep your baby safe while feeding?”

3. “How can you make feeding in a sling as easy as possible?”

4. “What slings can be helpful for feeding?”


1) Why might you want to feed in a sling?

Most commonly, mums of more than one child find being able to feed the baby on the go very useful. This is especially so if they are feeding responsively, as recommended by the WHO, and have an older child who needs their parent just as much. Quite often, they will have had some experience of breast or bottle feeding already, and may be very familiar with their sling, and will be “old hands” at combining the two skills.

Mums of older children who can feed quickly in a sitting upright position may also find a sling an invaluable and very convenient tool for getting on with daily life.

For mums of small babies, it may be that the sling will be useful to carry their child to a place where they can be taken out to feed in peace and comfort. For others, being able to have baby partly supported with the sling and with one arm may allow a “third hand” to work on achieving latch, and can prove very useful for facilitating feeding. For others and once feeding is established, it can allow some simple multi-tasking rather than being pinned to the sofa.

On the whole, it may help to consider each element as a separate skill to master – how to feed, and how to use the sling, and learn how to combine them safely, however, for some, the sling can actually be an aid to achieving latch. Practice will, of course, be needed, like with every new accomplishment!

2) How can you keep your baby safe while feeding?

All the basic rules of sling safety apply when carrying a baby. The TICKS guidelines and the ABC reminders are below. However, there are different considerations needed with feeding in slings (as baby may not be close enough to kiss, for example). As always, protecting the airway and ensuring breathing is unobstructed is of paramount importance.

Babies, on the whole, are obligate nasal breathers. This means that they find it much easier to breathe through their noses than their mouths, for the first few months of life, and it is essential that noses are kept clear of any obstruction. This is why babies may struggle more than older children with mild respiratory infections affecting the small nasal passages. It is also why they are able to feed for prolonged periods of time without needing to delatch for mouth breathing, and why babies with snuffly noses find it harder to feed.

Therefore, while a baby’s mouth is engaged with the process of sucking and swallowing, his only patent airway is his nose. It is important for the carer to be consciously aware of any potential obstruction, either external (from sling fabric, or breast tissue, or clothing ) or internal (neck bent over too far) and able to rectify it rapidly when required.

how do i keep my baby safe in the sling
from www. babyslingsafety.co.uk
from Babywearing International

Whether feeding upright, or slightly reclined, the safest positions are…

  • those in which the parent is actively engaged and frequently checking on their child, and able to recognise any changes

  • those that ensure a good air supply at all times with no fabric over the head and chin off the chest (check you can fit two fingers underneath if you are unsure)

  • those in which baby’s head is aligned with their spine and only turned slightly to one side if needed

  • those in which baby’s back and occiput (lower part of the back of the head) are appropriately supported

  • those in which baby’s knees are above the bottom and hips are flexed (bent upwards)

  • those that ensure that a baby who has finished feeding or has fallen asleep is returned to the most optimal upright position to keep airway supported and open.

The choice of best position will vary from person to person, depending on the individual circumstances, however, the majority of successful “on-the-go” feeding is done in the upright position.

In my opinion, the greatest risk comes from breastfeeding in positions where baby is held face inwards towards the breast, with sling fabric pulled up over the back of the head, so the face is pressed firmly into breast tissue or the child is curled over into a ball.

Please note this dangerous position is not the same typical gentle reclining in-arms “cradle” positions where the head is well supported in the crook of the elbow and the chin is not on the chest. This is the most common breastfeeding position, with a sling adding a little support, almost like a cushion or a hammock, to take some of the weight off the supporting arm and give you one hand free.

What should a feeding carry look like?

Baby’s head should be completely free of fabric, being supported by the sling up to the nape of the neck, able to latch and delatch as needed. Their lower body should be well supported from knee to knee, either by wrap fabric well and snugly tucked up between your bodies, or a well tied/securely buckled waistband. Both of baby’s arms should be positioned around the feeding breast or bottle, just as if in arms, and the head should not be at an awkward angle.  Feet should be free of fabric and baby should be comfortable and easily able to reach the nipple. If baby is able to achieve a good latch from this position, he/she should be able to feed if ready. Some practice may be needed for both of you!

Feeding in slings is more risky if you have a snuffly baby who is needing to delatch frequently for some mouth breathing, and finds herself unable to do so as her head is not free to pull backwards for a little extra air.

Babies should never be left to sleep in feeding positions as their disproportionally heavy heads can too easily droop or be folded over, with subsequent obstruction of their airways.

**Please remember that loosened slings with longer tails can present a trip hazard if you are feeding on the move.**

 

In general, it can help to think of the sling as a third hand to help support baby in position while you work on achieving a latch. Many people manage to feed happily and safely in slings, once they are armed with good information, and know what to watch out for. It usually works best with older children, too. If you feel unsure about feeding your child in your carrier, do get in touch with a professional who can give you some one-to-one help and advice.

A hip carry may work well (with a wrap/ring sling/cross strap buckle carrier/meh dai).


3) How can you make feeding in a sling as easy as possible?

For breastfeeding, think about ensuring easy access for your baby. Your choice of clothes can make things a lot easier. Loose fronted tops that can be easily moved out of the way, pulled down or lifted up, or those that open and close with zips or poppers, rather than buttons can help. Many mums swear by a combination of a loose shirt that can be lifted up/pulled down with a stretchy camisole or vest underneath that can be lifted up/pulled down. Such layering often provides good cover, if required. Bras that are easy to undo one handed (while your other hand supports baby”s head) are also helpful. Some mums find latching on more successful if they lean forwards slightly to bring the breast up to baby’s mouth, and many need to hold their breast up with one hand for the duration of the feed. Hoods can help with providing some discreet coverage, but remember that temperatures inside slings rise quickly if air cannot circulate freely, and carbon dioxide levels in rebreathed air are raised.

4) What kind of slings are good for breastfeeding in?

It is usually possible to feed a baby in most slings, with a bit of care. I don’t think there is really any such thing as hands-free feeding, as one hand or arm should always be on your baby to provide support, especially before they have excellent head control. But one hand free is better than none! Breast size, shape, flexibiliity and nipple position varies from woman to woman, and from stage to stage in the breastfeeding journey, so each dyad will need practice to work out which height works best for them. Larger breasts may prove more tricky for some.

Please remember that baby’s back and occiput should be well supported with no curling over and his chin should not be resting on his own chest, and once finished feeding, baby will need to be returned to his previous snug, upright and close position, by adjusting the sling appropriately.


Feeding in Stretchy Wraps

There are many different ways to feed in a stretchy wrap. Some methods are safer than others. On the whole, stretchy wraps are mostly used with small babies in the classic upright “hug hold” also known as the “pocket wrap cross carry”. It is these young babies from birth to four months who have the greatest risk of airway obstruction, so it is worth visiting your local babywearing consultant to get some advice and support if you can. I can’t stress enough how important it is to ensure your baby’s back and head is well supported, but still able to move freely to create an effective latch (and delatch), and that baby’s face is visible, not covered with fabric and their nose is clear. Once the feed is over, baby MUST be returned to the previous snug, close, upright seated squat position. There should NEVER be any fabric behind the back of baby’s head.

The video shows how to use a stretchy as a breastfeeding aid. You can see how baby is in the classic tummy to mummy position as the fabric is removed.

I usually advise parents to see their stretchy wrap as a breastfeeding aid. It can add a layer of extra support and spread some of the weight to the non cradling shoulder, and allow a short period of moving around while their child is feeding. It is not hands-free.


Feeding in ring slings

Ring Slings and upright feeding

From a good seated squat position, the pouch can be gently and slowly loosened by lifting the uppermost ring up carefully, so that baby is lowered slightly down your body. Ensure that the loosening is equal across the width of the sling so that baby’s upright seated squat position is maintained. Bring your child to the breast up so he is able to latch on without twisting his neck.

  • Bottle feeders may not need to lower their baby as much, but some loosening will help to ensure baby does not have to twist his head to the side too much for teat access.

 

.

Ring Slings and slightly reclined feeding

From the snug seated squat position, loosen the fabric slowly and carefully to lower baby just a little.  Lean forwards slightly and support baby’s upper body with one hand. Gently recline your baby into the waiting crook of your arm as you bring his far leg around to your front so both legs are together. Ensure the pouch of fabric is well tucked up between your baby’s side and your tummy so he is resting as if in a hammock, slightly turned towards you, bent knees above bottom, feet outside the carrier, with his head and neck resting on your arm. Adjust his location in this position so his mouth is able to reach your nipple – it should look and feel just as if you were holding him in your arms to feed. Keep the top rail of fabric under baby’s neck, do not pull it over his head.

  • Bottle feeding is similar, but baby’s head will be facing the ceiling.


Feeding in Woven Wraps

Woven wraps and upright feeding

Carries such as the Front Wrap Cross Carry and its variants can be easily adjusted for feeding. The knot at the back (or side) can be loosened just a little, with the resulting small amount of slack worked equally and evenly back along the fabric so baby is sitting in a lower pouch with mouth above nipple, but still snug and supported, and in the spread squat position. The whole carry can be moved slightly across to one side or the other, and the baby can then be brought to to the breast. It is easy to switch sides.

Hip carries (especially those with slip knots) are easy to feed from one side.

Bottle feeding is similar, but baby may not need to be lowered quite as much, and may need a little more space at the top edge for the bottle to be accessible without baby’s head having to turn too far.

feeding with a bottle in a woven wrap

Woven Wraps and slightly reclined feeding

This works best with carries that do not have cross passes under baby’s legs, so baby can be gently tilted to one side to rest on your feeding arm. The FWCC can be partially untied so the long tails are hanging down over the shoulders and baby is sitting just in the horizontal pass. He can then be carefully gathered to one side with his far leg brought round to the front, his body turned to face the parent, bent knees above bottom, feet out and head and neck resting on your arm. Adjust his location in this position so his mouth is able to reach your nipple – it should look and feel just as if you were holding him in your arms to feed. Keep the top rail of fabric under baby’s neck, do not pull it over his head. The long tails are usually best left loose as retying them will mean you are not in control of baby’s head during the process.

  • Bottle feeding is similar, but baby’s head will be facing the ceiling.



Feeding in soft structured carriers

Soft structured carriers (mei tais, half buckles, full buckles) and upright feeding

This can work well for bigger babies who have some head control. Baby should be in the carrier at the height she would normally be carried, with back and legs comfy in the seated squat position. To feed, slightly loosen the waistband gently and lower it a couple of inches and retighten, then loosen the side buckles or ties one by one to lower baby to the required position. One side may need to be loosened more than the other as baby feeds from that side. The breast can then be brought to the mouth. It is usually easy to switch sides with the straps being adjusted each time to allow baby to move. Baby’s back and occiput should be well supported with no curling over and his chin should not be resting on his own chest.

  • Bottle feeding is similar, but baby may not need to be lowered quite as much, and may need a little more space at the top edge for the bottle to be accessible without baby’s head having to turn too far.

Once finished feeding, baby will need to be returned to the previous snug, upright and close position, by adjusting the sling appropriately.

breastfeeding in a Mamaruga Zensling

So in summary.. “Can I feed my child in my sling?” The answer is a resounding YES YOU CAN, from newborn to toddler, in lots of positions, from breast and from bottle. The key to doing it well is to ask questions about how to do it safely and empower yourself with knowledge to make a choice about how you wish to feed and then practice. It’s all about the AIRWAY! Do ask your local sling professional for some support…. – and enjoy!

 

Some further reading;

Seven Reasons Why Carrying is Great for Breastfeeding Mothers (Jess Hippey for Oscha Slings)


Carry Me Daddy!

“Dear Daddy


When you hold me I feel happy. You are strong and I am safe in your arms. The more time I spend with you the more I trust you, and the more I can let you look after me when Mummy isn’t here.

I love to hear your breathing and the sound of your voice rolling around in your chest. I can hear your heart beating and it steadies me. I can hear you best when I am close to you. I love it when you look at me with your proud eyes, it makes me feel good. I feel loved.

I love being carried on your chest where we can chat till I am ready to snuggle contentedly to sleep.
I love my rides on your shoulders and on your back. The world is so interesting from up high!

I love the games we play and the way you make me laugh till I have no more breath in my body. I love it when you hold me on your lap to read to me. I love it when you hold my hand.

Carry me Daddy, while you still can!”

In-arms carrying and all other means of close and regular contact (such as noisy physical play) is of enormous value in building bonds between fathers and their children. 1 in 4 children lack strong attachment relationships, and slowly our society is recognising the need to address this. In arms carrying can be hard work, and a good comfortable baby or child carrier can make this much easier. Babywearing dads are becoming more and more visible, which is great news for families and for our society.

There can be a common myth that is only mothers who bond with their children in depth, and that the changes in her brain with parenthood are unique to her. This isn’t the case, fathers’ brains are also deeply affected by their caring role and they form strong, lifelong connections to their children if they are closely involved with their young baby as they grow. Bonding can be encouraged in many ways, not just though feeding the baby (which is another common myth). Babywearing is one tool for developing a deep relationship.

Here are some fathers talking about babywearing, what it means to them and why they do it!

Mohamed

Babywearing! How are you faring? Are they still staring? As a father of twins who liked getting things done, there was only so far my two hands could take me when I had two babies to hold. I was hesitant at the science behind stretchy slings when I was first told you could carry more than 1 baby in them, the picture shows how quickly that evaporated into pure elation and joy. "I've got my hands back!" I remember thinking. That was the start to an awesome journey where there was nowhere I couldn't go with the twins. Beyond the physical strength which babywearing gave, I feel like it helped me show my girls that no matter what, I was able to lift them and raise them above whatever it was they were facing and give them a different view while still supporting myself. Why are you fearing if all you are doing is baby wearing?


Read more


carrying children matters, carrying matters, rosie knowles,

Carrying Matters - all about babywearing safety, a guide to slings, and why connection matters

Welcome to the Carrying Matters website, run by the award-winning Dr Rosie Knowles.

 It is important to support caregivers as they build a happy brain for their children. Soft touch and loving connections play a vital role in this. There are so many benefits of babywearing, which can be explored in this site. Babywearing safety matters; my guide to slings and my commitment to sling education will help parents and those who support them feel confident with sling use at every age.

Quick Link to FAQsLooking for some training? Read more and book here.

Listen to Rosie talking about the 4th Trimester period in a new family’s life.

The positive effects of soft touch, close loving contact, and meaningful connections are enormous, and investment early on in family life is well worth it. Holding and carrying is connection; it matters to children, their carers, and society. The close contact helps to build a happy brain, and creates the relationships that buffer against adversity and promote resilience and long term positive health outcomes. It also helps mothers to survive the “4th Trimester” period and the months and years ahead. Here you can find everything you need to know about how to carry your baby safely and well, why babywearing is so normal and useful, how to choose a baby carrier, and help for all sorts of circumstances.

This page is run by Rosie Knowles, the author of the book Why Babywearing Matters (you can get a signed copy here). She is a GP in Sheffield, a carrying advocate and babywearing expert. She is passionate about supporting parents and carers to be close to their children; holding, soft touch and carrying matters in so many ways.

carrying children matters, carrying matters, rosie knowles,

The simple act of connecting with a small person through the medium of loving touch has powerful and long-lasting effects on both child and carer. Babies need to be held close to encourage normal physiological and psychological development, especially in the early months.  Every child needs love and connection to grow normally: the absence of responsive and supportive relationships that involve loving physical touch will hamper a child’s potential. Mothers heal best with their babies close to them.

Children thrive when they are carried, resilience builds and families flourish when the needs of all its members are met. Carrying is connection; carrying matters!

carry me daddy

Keeping babies safe in any kind of baby sling or baby carrier is of paramount importance. The first most vital issue is to ensure that baby’s airway is open and unobstructed, with chin off the chest and the ribcage well supported. Babies’ temperatures should be considered too; they are surprisingly warm, and overheating can cause problems. Read more about sling safety here.


beco gemini

Secure attachment to other people is vital to human health and wellness; we thrive on relationship, on belonging. Such healthy attachments are the bedrock to future positive mental health and enjoyable relationships. However, 40% of children lack secure attachments, and are significantly disadvantaged. Encouraging carers to spend more time in close physical contact with their children is one way to improve children’s resilience and support everyone’s mental health. Soft touch is an essential part of building a happy brain and positive bonds that last a lifetime.

Read more about the importance of building secure attachments here, and how encouraging close physical contact can help build the resilience that children need to thrive despite adversity.


when the time comes to stop carrying

About Rosie

“I am a mum of 2, a family doctor in the UK (a GP), and a passionate advocate of building secure attachment relationships between children and their carers, due to the long lasting effects this has on future health. I believe that carrying children plays a large part in building such bonds, be it in arms or in a sling. With Carrying Matters, I focus on providing accessible information and education about this for parents and the professionals who support them. Sling and carrier use is not a new concept at all; but our Westernised society has lost the communal sharing of knowledge. We are no longer surrounded by a community of people who can help us get to grips with parenthood and share the load, so we need support in newer and more structured ways. This is what I do; empower people to keep their children close in a safe and positive way.”

Her book, “Why Babywearing Matters”, was published by Pinter and Martin in May 2016. It has been translated into several languages over recent years. She has written for a wide range of publications, including Juno Magazine, and has a regular freelance blogging role for Boba (links can be found in the Blog section).

She founded the Sling Pages, an independent website listing all the known sling professional resources in the UK and Eire, and the Building Bonds Project, a CIC supporting families in times of crisis and financial hardship to access good quality and safe carriers.

She is a practising GP in the UK with a particular interest in holistic medicine as well as children and women’s health and medical ethics. She began her career in hospital medicine but switched to general practice because of its flexibility with family life and the opportunities it presents to be more closely involved with communities, from cradle to grave. She has two children of her own, who have both been carried happily, and a husband who works alongside her at their local Sheffield premises. Rosie founded the Sheffield Sling Surgery and Library in 2013 and has supported thousands of parents across the South Yorkshire region, helped by a volunteer team of fantastic, committed parents who have found carrying their own children to be life-changing. They all want to help their fellow parents to discover this for themselves!

Rosie has won several awards for her work in this field; the Babywearing International Vijay Owens Babywearing Advocacy Award for Lifetime Achievement in Promoting Babywearing in 2016 and the 2019 Association for Infant Mental Health AIMH (UK) award in recognition of those who have highlighted and promoted infant mental health in their discipline.


Rosie developed the “Fourth Trimester” sling meet model with her colleague Lindsay Snow, focusing on the needs of parents with bumps to four months. Families often struggle to deal with the biological needs of their new baby within the confined structures and expectations of modern society, which can be damaging to the building of secure attachments.

The needs of baby and caregivers are both important, as is the mental health and happiness of the whole family. Human beings were not designed to live in small isolated units but in supportive social groupings.

Holding babies close (in arms or in a soft sling) can be a very useful tool for families struggling with mental health disorders, pre, peri or postnatally. The close contact and the soft touch has biochemical hormonal effects that can help to reduce anxiety, improve feelings of wellbeing and connection, as well as lifting the mood. Read more about this here.

You can find your local sling library or sling meet by searching the Sling Pages resource, get in touch with them!

Using a sling (carrier) helps parents to keep their child as close as their biology needs, while also being able to function as adults in a demanding and inflexible world.


Rosie trains carrying advocates and sling/carrier peer supporters through the Born to Carry initiative, running courses in Sheffield and nearby. She has trained health care professionals, sling librarians, fitness course leaders and interested parents.

She lectures at conferences and gatherings around the UK and Europe about a range of topics, all related to early years parenting and how slings and carriers can make a huge difference to babies, their carers and to society.

peer supporter training professionals
rosie knowles learning education carrying matters lectures

“I’d highly recommend any enthusiast to attend this course. I found it thoroughly enjoyable and look forward to being able to use this new knowledge to help more parents discover the benefits of babywearing, as I have.”

“Rosie is a wonderful teacher, very clear and good at explaining. I felt she was well educated in her field and able to answer any question thrown at her. Also very friendly which made me feel comfortable and relaxed in a learning environment and confident to ask questions.”

Get in touch with her here.



Beginning to Back Carry

When is it safe to begin back carrying with a sling? This is one of the most frequent questions I am asked and I usually answer with more questions, as there is no one single answer!

Children have been carried on their parent’s backs since the dawn of the human race, because it is a simple and convenient way to carry a child around as you get on with daily life. Families in different cultures from our own tend to share parenting skills and knowledge within the community, so there needs to be no formal teaching, it is just what has always been done and everyone learns how to do it from observation and previous experience (siblings often carry new babies). Babies in traditional families are back carried in pieces of cloth from a very young age without any fuss. It is normal behaviour, and allows meals to be prepared and water to be collected while baby sleeps peacefully in a safe place.

cultural appropriation
from The Eyes of Children Around the World
from The Eyes of Children Around the World

This is a very different way of doing things than in our Western culture, where we have lost much of the communal family life we once had, and parenting skills are no longer passed on in the same way. These days, we need to learn about how to care for our newborns from other sources than our local neighbours; we create virtual villages with social media, rely on organised groups of mums and look on the internet for information about feeding and sleeping. Carrying methods are just the same; infants are not routinely carried in slings and thus we need to ask for advice. This is where sling libraries and consultants are so useful; they are parents who have discovered carrying skills for themselves, honed and practised these skills, and wish to share their expertise with other parents so that carrying can be promoted – carrying children matters.

Front carrying is the most common position for young babies; central or slightly off centre, as this mimics natural in-arms carrying that babies enjoy so much. The closeness and sight of your newborn promotes oxytocin release (vital in attachment) and adds a measure of confidence for you, being able to see any changes in breathing patterns and allow quick and easy rearrangements if needed).


Back carrying can be a particularly contentious issue in Western culture; nobody seems sure what the “rules” are and lots of different advice can be given out.

Back carrying can be done from almost any age, with appropriate care and caution for protection of airway and spine, and with the appropriate sling to facilitate this safe positioning (see the position image). Quite often, parents who have learned how to back carry older children will feel more ready to begin this with their new babies at an early stage, if they want. However, you can learn to carry your first baby on your back and there will be support from professionals if you need it – it can make a big difference, having a guiding hand as it can be scary! The more confident you are with handling your baby and your carrier, the easier it will be.

Not every type of sling is suitable for back carrying. For example, while some buckle carriers do carry newborns very safely on the front, they are usually snug and high up on the chest (close enough to kiss) and any changes in airway position can be quickly seen and corrected. It is much harder to monitor your newborn baby in the same buckle carrier on your back (which will usually end up quite low) and to be sure that your baby is properly supported inside the panel without any slumping over or chin sinking onto the chest. (This is due to their immaturity and greater muscle fatiguability even when they have some head control). Most buckle carrier manufacturers will state their minimum age for using on the back and it is wise to respect this.

Je Porte Mon Bebe (hybrid stretchy wrap) back carry
Je Porte Mon Bebe (hybrid stretchy wrap) back carry

Some stretchy wraps can be used for back carries (see here for more) if they are designed to do so and have been appropriately tested. It is a common myth that you should never use a stretchy for a back carry, however they can be very hard to do well. It requires skill and this is best learned from someone who knows how to do it, for safety. Some people will choose to use a different carrier that they find easier or more convenient.

Let’s look at some common questions around back carrying.

Can I carry my newborn baby on my back?

Yes, newborns can indeed be carried safely and comfortably. They will need frequent feeding and changing, but many will settle happily to sleep in a back carry. The safest way to do this is usually with a soft and floppy woven wrap. This is because woven wraps are a collection of individual strands and can be carefully tightened section by section to ensure your baby is fully supported from neck to kneepit, with the airway open, spine kept in the physiologically appropriate gentle curve and knees just gently apart to preserve healthy hip positioning. Such back carries are usually done high up on the parent’s back, so they are able to see their baby’s face and feel their breathing on the back of their neck. Most people will choose to do the simple rucksack carry, as the ruck pass doesn’t overspread the hips, and the single layer doesn’t drag fabric at an angle against the back. (Some babywearing schools will insist that this is the best carry to use for the first six months; other schools of thought are more flexible, but on the whole, ruck carries do work best for very young babies). Getting baby up onto the back can be a challenge; the Slingababy video below shows one way to do so safely.

Some very mouldable mei tais (usually made of wrap fabric for the mouldability and control) can be used for back carrying young babies too.

Older babies can be carried in wraps lower down, as in the African pictures above, as the fabric moulds around them properly. It is a common myth that all babies are best off in a high wrap back carry, or that they are safer; it is all in the positioning and skill to keep their airways open. Many parents find lower back carries can be more comfortable than higher ones, especially if they have back pain. It is worth trying a few carries out to see which works best for you and your baby. Videos from trusted sources can be useful, however, not every video on YouTube is a good one; some neglect basic safety checks, and not everyone finds videos an useful way to learn things. Your local sling professional should be able to support you!

Babywearing back carry newborn

When can I put my baby on my back in a soft structured carrier? (eg meh dai, full buckle carrier)

There are no real “rules”. “Rules” are often misunderstood/misinterpreted and can cause needless delay. It is worth noting that most structured carrier manufacturers will have guidelines regarding their use for different positions, and it would be wise to read these to ensure you are within warranty. Every parent needs to make their own decisions regarding when it becomes appropriate to back carry, weighing up their need/desire to back carry with considerations for safety and security. All carriers must provide enough support to prevent slumping and airway compromise.

On the whole, most people feel that the best time to begin back carrying in structured panelled carriers (that may not mould in the same way as a wrap or floppy mei tai and are unable to provide neck support to heavy heads, and generally sit quite low down on the body rather than keeping babies high up near the parent’s neck) is when baby’s upper body and torso muscles are strong enough. They need to have enough endurance to be consistently able to support themselves and hold their heads upright for a significant amount of time without tiring. This typically occurs when babies are beginning to sit unaided (or nearly). This commonly happens around six months, on average – it varies from child to child.

Some children may take longer to develop upper body control, but their parents may be struggling to carry them on the front; do go and see your local sling specialist who can help you find some solutions to this problem and keep you carrying. Generally, if the carrier fits your child properly and provides the necessary support, you can back carry in it. (This will apply to children with disabilities for example; it can take longer to gain head control but back carrying may be important. The right carrier that fits well and is used optimally may work just fine; do go and get some help!) Read more about back carrying children with special needs here in a fantastic article about ableism in the babywearing community.

Some parents will feel the need to back carry a little earlier, for example, parents of twins. The TwinGo carrier suggests that their carrier is suitable for babies of 4months plus, with “strong and consistent” head control. Of course, this control comes to some babies sooner than others, and factors such as the size of your baby and the width of the carrier may play a part in decision making, as well as the presence of other adults for support should your baby need some help.

It is possible to monitor your young baby’s safety on your back with useful items such as mirrors, plus you can often add head and neck support using the hoods. Don’t be afraid to ask a professional for help!

carry me daddy

How can I get my baby on my back?

This usually depends on the carrier you are using, and your levels of confidence, and the community you are part of. If you have grown up watching your family carry babies, it will feel like second nature – but if not, this is where getting advice and support can be so very useful.

Back carries with buckles and meh dais are relatively straightforwards and there are many ways to do it. Some manufacturers will have very simple instructions (which may not always be the most easy to follow), and there are videos on YouTube. It is always best to look at videos with a critical eye to see how well it is done, and those made by trained professionals who are used to making videos are usually the most reliable. My back carry with buckle videos may be useful here – at no point is baby or carrier unsecured.

Here is a link to my photo tutorial for the “walk like an Egyptian” method.

The key thing is to know your carrier and know your child. Being familiar with the buckle placement or or how to tie knots/tighten webbing is important. If you have a willing child who will comply with back carrying, it will be easier to practice, however, if your child is very unwilling, it may be best to wait for another day. You may be able to distract your child with a small toy as you go, and mirrors are useful so they can still see your face if they are not used to seeing the back of your head and wonder where you have gone!

Your local sling resources will be happy to teach you and this may be a very good way of rapidly improving your technique and confidence.

Back carries with a ring sling can be very useful, especially as the “seat” of the carry is created on the front or side of the parent, and then shifted around to the back. There is a knack to this, and also several ways to make the carry more secure and comfortable.

Back carries with woven wraps can be more tricky, as the fabric needs to be tightened around the child bit by bit, and again, a willing child is a blessing for those learning how to do it. The age at which you start will influence your choice of method; most experts will suggest a bundled “santa toss” with the baby already secured in the pouch for newborns, as this is the most controlled and safe way. Of course this will depend on your previous experience. Older children (3months plus with hips opened enough to sit on the hip), can also be put on the back using the hip scoot. Over the shoulder “superman” tosses are popular, it is wise to ensure you are fully supporting your baby by their shoulders, rather than holding them only by their arms (which can put some pull strain on shoulder joints). It takes practice to do it well – even seasoned babywearers who feel confident can find back carrying with a woven wrap a challenge, and none of us get it right every time – the “wrapping mojo” is real!

I really do recommend seeing a professional to get some help and teaching if you are planning to back wrap a young baby, as there is a lot to get right. For example, the correct tension to support neck and airway for safe breathing, getting it snug all round to avoid baby slumping to one side or slipping down inside, and getting the right amounts of slack out at various points to ensure there isn’t too much tightness around the neck and the knees which can leave red marks. Some people do teach themselves to back carry with videos and manuals and with their peers, but there is no harm and much to be gained from trained support (just the same as getting support with breastfeeding, or learning to drive a car – an instructor will probably help you to be ready for your driving test sooner than a non-professional.) I have some videos here which I feel may be best as reminders.

Back carries can be useful for pregnant mums, once the bump gets a bit too big for front carries, or if pelvic pain strikes, making hip carries hard (these are best limited if possible anyway, to avoid uneven loading of loosening ligaments). It is wise to build up your strength and tolerance for carrying as your body changes; little and often is key.

In summary, back carrying can be great fun. It is challenging to do well, and takes practice, however, once mastered and done safely, it can be very satisfying, and for many, it adds a new lease of life to their carrying journey. I do urge you to seek the services of teachers to help if you are finding it hard, or uncomfortable – we are here to support you and empower you to keep on carrying!

And don’t forget; sometimes front carries are just as lovely!

carrying a premature baby

beyond the knee to knee

Beyond the "Knee to Knee"

How much does it really matter to have a carrier that fits from one kneepit to the other? Read on for a discussion of this topic that moves beyond the knee to knee.

Quite a few people visit  my sling library on the lookout for toddler carriers, as their little ones are “no longer knee to knee” in the sling that they have, and asking me what comes next!
In Sheffield the problem arises particularly in relation to Sleepy Nico baby carriers, which are very well loved here. People are reluctant to move into other carriers that may not feel so comfy,, but don’t wish to hurt their children or be unsafe by using a sling that may be too small, or moving to a “toddler size” that may actually be too big!. There is a lot of conflicting information on the internet about the sizing of carriers which many people find very confusing to navigate….

SO…

1) What is knee to knee?

Knee to knee simply means that the carrier you are using supports your child across the full width of both thighs, from one knee to the other, reaching into the knee pit. This ensures a comfortable seat for your child, more like sitting in a hammock, than perching on a stool. The diagram below shows a carrier that is reaching knee to knee, and the side on view shows how this will create a comfortable seat.healthy hips hip dysplasia slings

Having the knees raised above bottom also increases flexibility at the hip joint and makes it easier to flex and extend. Try it yourself! Sit astride a chair, facing the back. See how easy it is to shuffle forwards, keeping your legs flat on the chair seat, to get your symphysis pubis (the front pelvic bone) to touch the back of the chair. Those of us with lovely flexible hips who can do the Buddha position easily will find this a doddle, but others of us will find it a little sore as the ligaments get strained. You can release this tension instantly by bringing your knees up above the level of your bottom, and this will often tuck your pelvis inwards, bringing a little curve to the base of your spine. This position you have created is called the M shape, for obvious reasons, and is the ideal position, supported knee to knee with bottom a little lower. There are a few circumstances where this standard recommendation may not be appropriate, and more care will need to be taken, such as children with hyperextension conditions, or achondroplasia for a start. If you are at all unsure, do see your local sling and carrier consultant or ask for advice from trained professionals. We are always happy to help with tailored advice! For more information if a narrow based carrier will harm your child’s hips, see my “Healthy Hips” article.

2) What if my carrier seems to be no longer knee to knee?

There are usually several factors to consider here, depending on the age of your child.

Firstly, is your young child sitting in the M shape, with their bottom sitting deeply in the panel, and knees raised up with pelvis tilted? This often makes a big difference to how young children sit in carriers, and you may find it instantly makes things more comfortable for you and your child, especially if the panel has also previously felt too short. It is worth taking your time over positioning your child really well and may extend the life of your carrier for some time.

Older children who can stand and walk do not need the same level of support and will be fine if the carrier offers them good thigh support. It should keep them in a comfy seated position with lower legs bent at the knee, at right angles is fine. Older children have more muscle strength and co-ordination, and can help to grip on, so they do not need full knee to knee. They need more space and freedom to move, and will want to get down more often anyway! In this photo the sling is not reaching to the kneepit but to mid-thigh. Just make sure there is no digging in of the fabric along the thigh, and no pinning of knees with wrap fabric passes.

Secondly, is your child central in the carrier? I find that people have a tendency to hold their children slightly off centre when in arms, and then bring the panel up from that place so the child remains in a similar off-centre position. This will mean that one leg is less well supported than the other, and can lead to leaning and discomfort. Keeping a child central will often improve comfort both for your child, and for you.

Thirdly, is your child comfortable or not? Older children may be able to tell you, but for younger ones, our role as parent is to be caring and careful, and aware of non-verbal communication. Sling users usually worry (in the early stages with small babies) about over-spreading hips, as babies cry when they are uncomfortable, and children vary in their hip flexibility. This is why many carriers are “cinched” in when they are too big. Always listen to your child. If they are comfortable, and happily able to move their legs at the knee, and legs do not seem to be dragging down but are well supported, you may not need to size up just yet.

Fourthly, is your child growing taller as well? This may be more of a problem than the width of a sling if a child has a very long body and is able lean back too far from a panel that is too short. If your child leans back too far they may unbalance you. Keeping yourself and your child safe is more important than being knee to knee.

If your child is happy in their current carrier, that is good news. If they are not, and legs seem to be dangling unsupported in more of an A shape, or they are able to lean back, it may be time to consider another, bigger carrier. It might help to look in the mirror to assess your child’s leg position and how much back support they have.

3) Is it unsafe to use a carrier that is too small?

It depends on the child, and the parent! As I have pointed out in my Healthy Hips article, there is little evidence that a “narrow” seat will be harmful to any child beyond the age of six months, and even before then, the risk is low. So an older child, especially when they can bear their own weight on their legs, is not at risk of damage from not being perfectly knee to knee. They may not be as comfy as they could be if the carrier is very small and they end up with legs dangling in an A shape (this could be tiring for a child, and lead to red marks on the inside of the thighs). Let your child be your guide. I usually suggest that a carrier that supports at least to mid-thigh and allows a comfy seat with knees at right angles or a little less for older children, is fine to use.

Many big brand carriers such as Beco, Boba, Ergo and Manduca to name just a few, say that their carriers are safe to use well into toddlerhood, long after some people would feel their babies were too big for them (they are all formally safety tested). Sometimes it can seem that people are in a hurry to move out of a “standard” size carrier, before it is really necessary. Again, check your positioning, and do get some help from your local sling consultant/peer supporter/library/sling meet if you are unsure. One size does not fit all, some babies are big, some toddlers are small, some parents find bigger carriers more comfy for them, some parents find smaller carriers work better for their frames. Each carrier has its own specifications too. Some are narrow, some are short-panelled, some are wide, some are tall, some have buckles that insert very low and can squash baby thighs, etc. It is all dependent on the individual situation, and what works for one baby and parent may not work for another. Skill levels vary too, as does child compliance – a contented baby may be happy for the parent to take the time to maximise positioning, others may resist.

If you have a half buckle, or a meh dai, there are ways to tie the shoulder straps to come beneath the child’s knee, to further extend the width of the support offered by the panel itself.

4) Is it unsafe to use a carrier that is too large?

This is a more complex issue. The crucial issue to consider is child safety, based on the ABC and the TICKS guidelines. A child should not be invisible inside a carrier that is too tall, as this could be a risk to their airway and their breathing. This is one reason why many carriers have inserts, to raise children higher up the panel so their faces are visible at all times and chin can be kept off chest. I would rather see a child that was in a carrier slightly too short in the body, than in one that has too tall a panel.

As for the width and knee to knee… here is a photo to illustrate the difference. A carrier that is too wide will make a child’s legs stick out straight, or he will strain against the fabric to bend his knee (which may lead to red marks, even if no voiced complaint at the time). He may feel some strain at his inner thigh if he cannot bend his knee in this hip-extended position (see the chair illustration above). Sometimes it can be suggested that the panel could be “cinched in” with something like a webbing belt, or a ribbon, etc and this may, if there is no alternative, make the carrier much more comfy as he is now able to bend his knee in the M shape. However, this will invalidate the warranty of the carrier and place strain at the waistband.

Also, by bringing the knees up higher, the angle that the hips need to open at the groin is reduced, as the joint is able to rotate more easily. *Please note that this is a hack that is rarely recommended ; if it is not in the instructions it will invalidate any warranty.*

Summary

Every parent, child and carrier combination is individual, and needs assessing as such. Many carriers that are not knee to knee may well be able to be used for your child for longer than you might expect, so there may not need to be a great rush to size up. Buying new carriers for many is great fun – if you are going to buy something too big for your child to grow into, do ensure it is comfortable for them, and not too tall. You may have more time in your current carrier than you think, to give you time to find the next carrier (if needed).

But what about the Superman Sleepy Nico at the start? Is it OK?  I think we can all agree that the little SuperBaby will be OK to enjoy his special carrier for a while longer yet.


The Pelvic Tuck

What is the pelvic tuck or scoop?

I am often asked by carers who want to carry their children safely and comfortably “what is a pelvic tuck and how do I do it?”

Babies are born with gently curved spines, and usually prefer to rest in this tucked posture when they are relaxed. Arching the spine and “starfishing” can (for some) be an attempt to communicate discomfort or distress. Sleeping and relaxed babies can usually be found with their knees drawn up into a comfortable “M shape”; this is normal behaviour, and it is how most babies rest on their parents, perching on the broad secure base of the carer’s forearm. From this broad base, babies’ chests can be properly supported against the parent’s body, thereby avoiding slumping over and restricting airways.

This “squat” positioning also helps to encourage healthy hip development. Studies have shown that the rates of hip dysplasia are lower in communities that carry children on the hip or back frequently, as the posture adopted for this promotes optimum growth of the hip joint. (see here for more information on hip dysplasia and slings).

The pelvic tuck/scoop technique of encouraging a child to sit in a position that creates a “J shape” (from the side) or an “M shape” (from the front) in a carrier is therefore very helpful. Such positioning is more comfortable, more respectful of anatomy, and also helps preserve open airways. The aim is to raise the knees up, allowing the bottom to settle downwards into the classic “M shape”.

pelvic tuck and m shape

When demonstrating, I suggest that carers imagine they are scooping two curls of ice-cream towards themselves with both hands; and then repeat this action as they hold their child’s thighs gently between thumb and fingers. Another way of thinking about it is to imagine they are holding two glasses of water in front of themselves, and then pour the water out away from them.

This rotates baby’s femoral head in the socket. The photos and videos below show this in action.

Creating this broader base seat for a younger child will also help to make a narrow base carrier more comfy and feel more stable and supportive. A simple scarf can be used to support the legs in this “M shape” once the pelvis has been tilted and knees raised above bottom.

sling faq pelvic tuck professionals training

The pelvic tuck is less important for older babies and toddlers; as children get older, the ability to actively move around in the sling becomes more important while they are awake. The key thing is to ensure they are comfortable and their legs are not dragging down or tiring them; the carrier no longer needs to be knee to knee for older children.


Stretchy wrap photo tutorials

Stretchy wrap photo tutorial guide (two way stretchy wrap)

A step by step stretchy wrap photo tutorial guide; this is a two-way stretchy wrap. Two-way stretchy wraps stretch along their width and their length.

The key to success is in preparation; getting the tension right before baby goes in, and ensuring their position is right before spreading any fabric. This helps to avoid slumping or slipping. It gets easier with practice! Click on the images to make them larger for easier viewing.

If you have a very small or premature baby, or one who is keeping themselves very tightly tucked and isn’t opening their hips at all, please see your local sling professional for some extra support for using your stretchy wrap.

Below is a video for how to take baby out without needing to untie the wrap each time, making it very convenient.

Here is a video of the same technique, with the shoulders being flipped afterwards.

Here is a short video of the pre-flipped shoulder.

How to take a baby out of a stretchy wrap simply, without retying. This makes it very easy to leave on and just pop baby back in later.

If your baby seems to slump over or is deeply asleep, here is how to “unfurl” them so their chest rests safely against yours.


You can find information about other types of carriers in our Guide to Slings (with photo tutorials for a woven wrap front carry and a ring sling carry).


back carry with a rucksack carrier

Back carry with a rucksack carrier photo tutorial - "walk like an Egyptian"

Learn how to safely do a back carry with a rucksack carrier with this "walk like an Egyptian" method.

The straps are worn like a rucksack and the chest belt remains done up at all times. Each arm is threaded out of the shoulder straps one by one; first one comes up and forwards, the second comes down and back, like the “walk like an Egyptian” move.

Baby should be old enough for back carries in your buckle carrier that fits them well. Read more about this here.

Please see your local carrying consultant or sling library for help if you are unsure. It is wise to practice with some help and in front of a mirror the first few times!


Front carry with an Integra Baby Carrier tutorial

Front carry with an Integra Baby Carrier tutorial (cross straps)

Our front carry with an Integra Baby Carrier tutorial (cross straps) with an older baby will help you feel confident, safe and secure.

With a newborn to about four months, please use the included accessory strap to cinch the panel at the base. (This will have the effect of making the panel narrower and shorter so it fits around your baby's body.)

This method applies to any waistbandless carrier where the panel hangs straight down from the webbing like an apron.