High & Tight
Not Chin to Chest
Frogged Legs
Back Support
Forward Facing
Positioning Links
Safety
The Dangers of Bag Slings
TICKS Guide for Safe Babywearing
Safety Links, Videos & Podcasts
The media spotlight was shone on babywearing following the recall (initially in North America but later extended to Europe) of two Infantino slings (the SlingRider and Wendy Bellissimo, right) in March 2010 and this inevitably led to a great deal of concern and discussion about the safety of slings and carriers. There was a tendency in some quarters to brand all slings dangerous after reports of the tragic deaths of several babies in the United States in the recalled carriers - this reaction, while certainly understandable, is misleading.Within the babywearing community there has been concern about the inherently unsafe design of bag style slings (such as the Infantino) for several years, following the research of babywearing educator and neo-natal nurse M'Liss Stelzer, but this issue does not apply to most slings and carriers. The main issue with bag-style slings is that, even if used according to the manufacturers instructions, it is virtually impossible to position your baby safely (more detail on Bag Slings can be found in the safety section below). Photos of bag slings in use in this article were taken by M'Liss Stelzer during her safety testing and are used with permission. If you own a bag style sling our advice is to stop using it immediately, especially if your baby is under 4 months old. Please do not sell it, return it to the shop or give it away - cut the strap so it is unusable by another parent and throw it away.
None of the slings either available to try at, or recommended by, Hereford Sling Meet are of the potentially dangerous 'bag style'. This of course does not mean that safety should be ignored when using non-bag style slings - just as you think about possible risks when placing a baby in a bed, cot or pram, so should you when using a sling or carrier. Positioning is important, not only for safety reasons, but also so that you can get the most from your sling and for the comfort of both parent and child.
Positioning
Provided you choose a reputable sling or carrier which is well made (see the buying guide for more info), it will come with comprehensive instructions which, if followed, allow you to carry your baby safely and comfortably. However there are a few general 'rules' which can help with this and do usually sort out the can't-quite-get-this-comfy niggles.
A common mistake when people first start using slings is that they are not tight enough. It isn't always immediately apparent if your sling is not tied properly, but a too-loose sling will start to sag and your baby will slump down in the sling over time. A sling should hug your child close to you so that their weight is supported by your whole torso - too loose and the weight pulls down which can make your back and shoulders ache. With most slings it is simply a case of tightening the sling more, the exception is Pouches which do come in different sizes and it is important to get the right size.
Not Chin to Chest - a baby should not be allowed to curl into what is referred to as the C-position, that is with their chin forced onto their chest, because a young baby does not
have the muscle control or strength to lift their head to keep their own airway clear. The chin to chest position compresses the airway (which is only the width of a drinking straw in a newborn baby) reducing or even blocking air flow and placing them at risk of Positional Asphyxia. This is a huge problem in bag style slings (left) due to the poor design, and also in infant car seats. A baby in a cradle or semi-reclined position in slings such as pouches and ring slings should be positioned carefully to avoid the sling folding them in half and there should always be a space of at least one finger width under your baby's chin. In an upright carry a baby's breathing can be hindered if the sling is too loose allowing them to slump, therefore ensure the sling is tight enough to hug your baby close to you. More information on positioning a newborn can be found here. Frogged Legs - a baby should be carried in a seated position, that is with their legs frogged so that their knees are higher than their bum, also referred to as the 'spread squat' position. This places the hips in the correct position and prevents the spine being weight bearing. In a carrier where a baby has their legs hanging straight down, the lack of leg support causes the pelvis to tilt backwards, hyperextending the back leading to the hollow back position - placing stress on the lower back which can cause spondlylolisthesis. When a carrier does not support a baby in a seated position the legs are forcibly straightened and the head of the thigh bone is not pushed into the hip socket which can prevent the hips developing properly leading to Developmental Dysplasia of the Hips (DDH). More information can be found in the links section below.
In a wrap it is important to ensure the fabric is spread across the buttocks and along the thighs right to the back of the knees. Soft Carriers (of the Tie-On or Buckle style, not high street front pack carriers) tend to naturally support a child in the right position, the exception are the ones which allow you to narrow the seat so that a tiny baby be carried with their legs out. It is important that you do widen the seat as the baby grows so s/he is supported properly. For an upright carry in either a pouch or a ring sling a babies bottom should be well down in the fabric, knees up and fabric supporting along the thighs. This position is more comfortable for the wearer as the weight of your child is wrapped around you and supported by your whole torso. When a baby has their legs hanging straight down, gravity naturally acts on their weight placing greater strain on your shoulders and back.
Back Support - a baby's back should not allowed to slump or curl. For slings such as Soft Carriers and Wraparound Slings this simply means ensuring they are tied sufficiently tight enough so as to support the natural curves of the spine and prevent slumping. In an upright position a young baby should also have their neck and head supported. When positioning a young baby in the reclined position it is very important that a baby is placed so that their bottom is in the deepest part of the sling so their back remains straight and they are semi-reclined rather than lying horizontally - a common mistake is to place the middle of the back in the deepest section which has the effect of folding a baby in half. This means the back is not supported and can cause respiratory problems (see the Not Chin to Chest section).
Forward Facing - many parents want to be able to carry their baby facing out and this is possible in several different slings, however there are some issues to consider.
- Poor Leg Support - there is insufficient support for a baby's body in the facing out position, in particular it is very difficult to keep a baby who is facing forwards with their legs-out in the proper physiological seated position (see the Frogged Legs section above). Their legs will naturally straighten and, particularly in a wrap, the fabric will work itself back until the baby is effectively supported by the crotch only, meaning the fabric will need to be adjusted regularly.
- Poor Back Support - when facing forwards a baby's back is not supported in its naturally slightly rounded state, instead it is straightened and the shoulders are forced backwards creating the hollow back position.
- No Head Support - babies frequently fall asleep while being carried and a baby carried in a facing inwards position can rest its head on the wearers body in order to sleep. However when facing forwards there is little or no head support should a baby fall asleep.
- No Eye Contact - a baby gains reassurance from being able to see your face and they learn about the world by reading your expressions. When they are tired or if they are in a very noisy or bright situation, they can turn their head into your body to shut out the world and gain a feeling of security. However, in a forward-facing position the baby cannot see your face and they can become overstimulated and overwhelmed by everything going on around them.
- Not As Comfortable - forward facing is not as comfortable for the wearer. When a baby faces outwards, their weight is pulling away from the parent and this can make your shoulders and back ache.
It is worth getting your child used to facing inwards when being carried or adapting the carrying position you use. The most common reason given for parents using the forward facing position is that the baby is 'nosy' and wants to see what is going on around them. There are other carrying positions that allow a child a view while still providing them with a place to retreat. A baby who can sit relatively well can be carried on your hip in either a pouch, ring sling or wrap. Another option is a high back carry in a Mei Tai or woven wraparound so that they can peek over your shoulder but can still shut out the world when they have had enough or want to sleep. Instructions for high back carries can be found on the Using a Sling page.
Hereford Sling Meet would not recommend the use of the forward facing position. If you have a baby who seems to dislike facing inwards come along to one of the monthly meets and try out some different slings and carrying positions.
Positioning Links
Strollers, Baby Carriers and Infant Stress by Elizabeth Antunovic (at Sleepywrap.com)
Infant Carriers and Spinal Stress by Rochelle Casses (at continuum-concept.org)
Wrong Carrying Methods - at Hoppediz.com
Baby Carrier Research - at Storchenwiege.com
The Frog-Leg Position - at Didymos.com
Expert Opinions on Carrying - at Didymos.com
Safety
The Dangers of Bag Slings
Although the babywearing community was pleased that the dangers of bag-style slings had been highlighted, and that the media coverage facilitated discussion on the issue, the U.S. Consumer Product Safety Commission (CPSC) warning of March 2010 did not specifically mention bag-style slings and subsequent reporting in the media led to confusion and some people thinking the slings they used with their babies were unsafe. While the risk of respiratory distress and oxygen deprivation is still present in other styles of sling and carrier (and is a very real risk in infant car seats), the main problem with a bag-style sling is that the design makes it virtually impossible to position an infant safely, not so with other styles.
Superficially it might seem that bag slings are very similar to a shallow pouch or a ring sling however that is not the case. The key features of a bag-style sling are a flat bottomed deep pouch with slanting sides, an elasticated or gathered top and a single narrow strap which is worn across the body. Some designs also have a harness inside to secure a baby in a fixed position. Bag Slings are difficult to adjust in two ways - it is not possible to adjust the depth of the pouch (as you can with a ring sling) and also it is very difficult to adjust the height that the baby sits or lies on the wearers body (left). There are several different bag and bag-esque slings on the market and so far only the Infantino slings have been recalled.
possible that a baby suffering respiratory distress could go unnoticed. The gathered top of the sling also means that, unless the top of the sling is regularly opened, a baby may not get enough fresh air (left) and the build up of carbon dioxide and lack of oxygen can lead to hypoxia which can have long-term effects. Because of this issue, the manufacturers of many of the bag slings on the market have added a mesh panel to the sides of the sling which can increase airflow around the baby however the other safety issues still apply and there are plenty of the old style bag slings still in circulation.The curved design of bag slings cause a baby to be forced into the chin-to-chest position which can partially close their airway causing them breathing difficulties and this risk is highest for (although not exclusive to) babies under 4 months, especially those born premature or with low birth weight. M'Liss Stelzer's extensive research into the dangers of bag slings, including oxygen saturation testing carried out on babies while in the Infantino SlingRider, can be found on the Baby Sling Safety site. More information on safe positioning for young babies can be found in this article, also by M'Liss Stelzer, at TheBabywearer.com - Correct Positioning for the Safety and Comfort of your Newborn.
TICKS Guide for Safe Babywearing
In response to the CPSC Warning, the Infantino recall and the ensuing media storm, The Consortium of UK Sling Retailers and Manufacturers prepared press releases and produced safety guidelines which can be found on the Baby Sling Safety site.The TICKS rule is an acronym-based checklist to promote correct and safe positioning in slings and carriers. The full document can be downloaded at the Baby Sling Safety site or viewed by clicking on the image below.
Tight - slings and carriers should be tight enough to hug your baby close to you as this will be most comfortable for you both. Any slack/loose fabric will allow your baby to slump down in the carrier which can hinder their breathing and pull on your backIn View At All Times - you should always be able to see your baby's face by simply glancing down. The fabric of a sling or carrier should not close around them so you have to open it to check on them. In a cradle position your baby should face upwards, not be turned in towards your body
Close Enough To Kiss - your baby's head should be as close to your chin as is comfortable. By tipping your head forward you should be able to kiss your baby on the head or forehead.
Keep Chin off the Chest - a baby should never be curled so their chin is forced onto their chest as this can restrict their breathing. Ensure there is always a space of at least a finger width under your baby's chin.
Supported Back - in an upright carry a baby should be held comfortably close to the wearer so their back is supported in its natural position and their tummy and chest are against you. If a sling is too loose they can slump which can partially close their airway (This can be tested by placing a hand on your baby's back and pressing gently - they should not uncurl or move closer to you.) A baby in a cradle carry in a pouch or ring sling should be positioned carefully with their bottom in the deepest part so the sling does not fold them in half pressing their chin to their chest.
Back to Top
Proper Infant Positioning in a Baby Sling - an excellent video from Babywearing Educator Meg Barry
Mothering Radio Babywearing Special - an hours special discussing the CPSC warning and babywearing safety (NOTE - this was recorded before the Infantino recall). Guests include M'Liss Stelzer and Glenda Criss-Forshey, President of Babywearing International
Newborn and Infant Safety - excellent information which covers car seats as well as slings, from Jan Andrea at Sleeping Baby Productions
Not All Slings are Created Equal - from Jan Andrea at Sleeping Baby Productions
Safety Links, Videos & Podcasts
Proper Infant Positioning in a Baby Sling - an excellent video from Babywearing Educator Meg Barry
Mothering Radio Babywearing Special - an hours special discussing the CPSC warning and babywearing safety (NOTE - this was recorded before the Infantino recall). Guests include M'Liss Stelzer and Glenda Criss-Forshey, President of Babywearing International
Newborn and Infant Safety - excellent information which covers car seats as well as slings, from Jan Andrea at Sleeping Baby Productions
Not All Slings are Created Equal - from Jan Andrea at Sleeping Baby Productions
What Exactly is a Bag Sling? - from Nurture Baby
Is Babywearing Safe? - From Babywearing International
Babywearing Safety Facebook Page
Safe Babywearing - from The Babywearer
Not All Slings are Created Equally - US baby sling & carrier manufacturers speak out on baby sling safety warning and Associated Press article.
