Positioning and Safety

High & Tight
Frogged Legs
Forward Facing
Positioning Links

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. None of the slings sold or recommended by Big Mama Slings are of the potentially dangerous 'bag style' (more information can be found in the safety section below). 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 so that you can get the most from your sling and also for the comfort of both parent and child.

All slings and carriers 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.

High & Tight - when in an upright carry the lowest point of your baby (their bum) should be at or above waist level so the top of their head is as close to your chin as is comfortable. A baby sitting too low will start to pull on your shoulders and back. This is also true of a cradle carry in a pouch or ring sling. As a baby grows it becomes difficult to keep them high enough as, due to their longer body, their head would be in your face at the correct height, or would be too low on your body with their head under your chin. It is at this point that back carries tend to be more comfortable.

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. As can be clearly seen in the photo (above), the baby's head is close to the wearer's chin and (s)he is hugged in close.

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. This places the hips in the correct position and prevents the spine being weight bearing. 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 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.

Limited research has been done on this issue, therefore suggestions that poor positioning where the baby's weight is supported by the base of the spine can lead to hip dysplasia and spinal problems while sounding perfectly possible, are unproven. However, from a baby's point of view it certainly seems logical that being fully supported in a seated position would be far more comfortable than dangling by the crotch with the legs hanging down. More information can be found in the links section below.

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 - this can seen in the photo (right). When positioning a young baby in the cradle carry it is very important that a baby is placed so that their bottom is in the deepest part of the sling - 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.

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. Firstly the level of support for a baby's body is poor in a facing out position. It is very difficult to keep a baby who is facing forwards with their legs-out in the seated position (the exception to this are carriers, such as the Pikkolo (left), which are designed to allow a forward facing position). 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. The back is also not supported in its naturally slightly rounded state, instead being forced against the wearer, and the head is not supported should a baby fall asleep. Secondly, 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. Finally, 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 possible to carry a slightly older baby (with good head and neck control) facing forwards with their legs in, often referred to as the 'kangaroo' or 'buddha' carry (right). This is possible in several types of sling including a pouch and ring sling and the baby is supported in a seated position, however the concerns about over-stimulation still apply and a baby should be carefully monitored and turned to face the wearer should they show any signs of becoming overwhelmed with their surroundings. This position is also not as hands-free and so the wearer should always have a hand free to support their baby.

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 (left) or woven wrap so that they can peek over your shoulder but can still shut out the world when they have had enough.

Many manufacturers advise against a forward-facing position and we would suggest that this not be used as the main carrying position but infrequently and for short periods of time only.

Positioning Links
As previously mentioned, research in the area of positioning in slings is minimal and that which has been conducted is mostly in German.
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


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 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. Providing the guidelines for safe positioning are followed, other styles of slings and carriers are perfectly safe. M'Liss Stelzer's extensive research into the dangers of bag slings can be found on the Baby Sling Safety site.

The main risk occurs when a baby is forced into the chin-to-chest position as this 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. It is important that there is always at least a finger width space under a 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. In a cradle carry a baby must be positioned carefully so as to prevent the baby curling chin-to-chest. Another risk is of a baby rolling in towards the parent and being smothered by the fabric of the sling, again this risk is substantially greater in a bag style sling. More information on safe positioning for young babies can be found in this article 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 back
In 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.

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Safety Links, Videos & Podcasts

Newborn Positioning - excellent and detailed description of proper infant positioning in all type of slings

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. 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.