The Complete Guide To Baby Carrying

Crotch-dangling, hip dysplasia, and overstimulation . . . oh my.

A hot mess. There's no better way to describe the current state of the baby
carrying industry. New parents doing their own online research on carriers
will find an overwhelming number of choices and some very heated
discussions—but very little scientific or medical research. As we said, a hot
mess. So we decided to do our best to pull together all of the relevant facts,
theories, and opinions in one place. Herewith, our complete guide to baby
carrying.

First things first. Wraps, slings, and soft-structured carriers. What's the
difference?
"Though soft-structured carriers, slings and wraps all serve the same primary
function—to carry your baby on your body and leave your hands free—they are
all built differently," explains Onya Baby creator Diana Coote. "A wrap is a
long piece of fabric, measured in meters. There are as many ways to tie a
wrap as there are parenting styles. Both woven (non-stretch) and knit
(stretchy) wraps are available, each with its own set of pros and cons.

A sling is a simple, one-shouldered baby carrier that is essentially a loop of

fabric folded lengthwise to form a pocket. The wearer places the sling on one
shoulder and the baby in the fabric and they’re ready to roll. There are two
types of slings: ring slings, which offer adjustability for more than one wearer,
and pouch slings. Some pouch slings are adjustable, but most are not and
must therefore be properly sized for the wearer.

A soft-structured carrier (SSC) is a modern take on traditional Asian-style

baby carriers, in particular the Mei Tai and Onbuhimbo—except an SSC uses
buckles instead of ties. The beauty of the buckles is that it’s much simpler
and quicker to put on a SSC while still retaining the wide range of
adjustability for many different sizes of babywearers."

Got it. Is one category safer than the others?

For starters, "None is meant for carrying premature or low birthweight
babies," says pediatrician and AAP Fellow Dr. JJ Levenstein. But parents need
to be especially careful with slings. "The U.S. Consumer Product Safety
Commission (CPSC) is advising parents and caregivers to be cautious when
using infant slings for babies younger than four months of age. In researching
incident reports from the past 20 years, CPSC identified and is investigating
at least 14 deaths associated with sling-style infant carriers; twelve of the
deaths involved babies younger than four months of age.

As for soft carriers and wraps, the CPSC has received reports of two fatalities
associated with soft carriers—both due to positional asphyxia (one child
upright in the carrier with respiratory distress, the other face-down when a
parent fell asleep with the carrier on and the baby still in it); and 91 non-fatal
incidents due to falling from the carriers—caused by large leg holes
permitting the egress of the baby, failure of buckles or straps, or the adult
falling with the baby in the carrier, sustaining an injury."

What are the most important things to keep in mind, when choosing a
carrier?
"Make sure the carrier hasn’t been recalled and is in good shape," advises our
gear guru, Jamie Grayson of the Baby Guy NYC. "The carrier should be free of
defects and holes, and should have nice linear stitching with consistent
stitches," adds Boba co-founder Elizabeth Antunovic. "Test the buckles so
they click when you put them together. No rough fabrics or strange odors."

BabyBjorn advisor Dr. Amanda Weiss Kelly (Division Chief, Pediatric Sports
Medicine, UH Rainbow Babies and Children's Hospital) also points out that, "It
should be safe and easy for one person to take on and off by themselves.
Parents should also pick a carrier that is comfortable
for them.” Ergobaby founder Karin Frost agrees saying, "Parents should look
for a carrier that distributes the weight of baby evenly on their hips and
shoulders, which will allow for a much more comfortable carry." Frost also
suggests finding a carrier that will fit everyone who will be carrying the baby
regularly; that has adjustable soft padded shoulder straps and waist belts that
are fairly wide and don’t twist; that is adjustable to baby's growth; and that is
machine washable.

But according to Coote (Onya), the most important safety aspect is "making
sure that the manufacturer is in compliance with all safety regulations and
that the carrier’s design has been tested to passing in a third-party certified
testing facility. Because this is now law, all carriers on the market fit this
criteria, unless you purchase from a home-based manufacturer." Dr.
Levenstein concurs, saying, "Don’t buy one used or second hand." Levenstein
also adds that all babies should meet the specific weight requirements
outlined by each manufacturer. "Don’t purchase a carrier meant for an older
child, and assume your baby will “grow into it”—as the leg holes, support, and
structure may not be safe for a younger baby."

Okay. Now for the real hot buttons: Crotch dangling and hip dysplasia.
“Crotch-dangling” is a term that came about in the late nineties," says
Grayson. There was apaper written by Rochelle L. Casses, D.C., in which she
stated that incorrect baby wearing in a crotch-dangling-type-carrier could lead
to spondylolisthesis (a condition of the spine whereby one of the vertebra
slips forward or backward compared to the next vertebra) and possibly hip
dysplasia. But as it turns out, there is no scientific evidence that hip
dysplasia or spondylolisthesis is caused by carriers of this type.
Spondylolisthesis and hip dysplasia are much more problematic and prevalent
in countries where babies are swaddled tightly at the hips."

That's right, says pediatric orthopedic surgeon Dr. Timothy Radomisli of Mount
Sinai Hospital in New York. "There is absolutely no scientific basis for concern
about baby carriers. I've never seen any baby carrier injuries. In 20-something
years. Never heard of it." But what about thisdiagram that's long been posted
on the International Hip Dysplasia Institute website, illustrating that
BabyBjorn-style carriers are not recommended? "I think the diagram is pure
conjecture," states Radomisli. "To validate it, you'd need an outcomes study
comparing babies who wore different carriers. I've never seen a baby develop
dysplasia from a carrier. Current sonographic studies suggest dysplasia is
congenital, not developmental." Yep. "If a baby has the opportunity to flex his
legs at the hip, rather than his legs being “bound” together (as in tight
swaddling) he is not in a position to increase risk of hip dysplasia," chimes Dr.
Levenstein. (Editors' note: we were hoping to better understand IHDI's
position on this, but unfortunately director Dr. Price told us, "We'd rather not
make an additional statement.")

"A baby carrier can't cause hip dysplasia, but improper leg positioning is far
from ideal for babies who have it," says Antunovic (Boba). Well, yes. We
understand that it may not be an ideal position for a baby born with hip
dysplasia. But what about for healthy babies? "There is no risk for an
unhealthy or uncomfortable pressure on the child’s crotch in carriers
sometimes referred to as “crotch danglers,” states Dr. Kelly (Bjorn). "A baby’s
center of gravity (larger head and shorter limbs than an adult), body
proportions, and low weight, work together with carefully designed carriers
that ensures proper support of the head, neck and back to evenly distribute
baby’s weight. The only baby carrying practice that has been associated with
aggravating hip dysplasia is tight swaddling and papoose-style carrying,
where the child’s hips cannot move. All baby carriers, including front-facing
carriers, keep babies hips in the abducted position, allowing for free
movement of baby’s hips."

Well, it may not be dangerous, but it certainly isn't optimal says Ergobaby
Chief Science Officer, Henrik Norholt. "To have all the weight of the baby
placed on the groin and the legs left dangling straight down is simply not
optimum from a physiological developmental point of view. The best position
to promote a healthy development of spine and hip is the spread squat
position or “frog-leg position.” In fact, this is the very position that babies are
placed in a brace when hip dysplasia has been diagnosed, because the
position stimulates the optimum growth of the hip joints."

Hot button topic number two: inward-facing or outward-facing?

Everyone that we interviewed agrees that babies should face inward until four
to six months of age, when a baby has head and neck control. So, let's talk
about ages six months and up. Why the backlash against outward facing
carriers?

Well, for one thing, it's awkward, says Antunovic (Boba). "The baby is not
embracing the wearer, which makes for an awkward load. The wearer usually
compensates by arching his back and holding his pointer fingers out for the
baby to grasp so that the he or she doesn't slump forward. And if the baby is
facing forward, weak infant abdominals cause your baby's back to arch,
leaving her legs, hips, and pelvis further unsupported. When you walk, your
baby then takes in the force of the movement, and the weight of his own body
on an arched spine. Although no formal studies have been conducted on the
relative positioning of babies in carriers, I'm confident that any extra pressure
on developing hips and spines is undue.

Dr. Barbara Minkowitz, Medical Director of Pediatric Orthopedics at Atlantic

Health Systems, agrees. "When the baby is facing away from the wearer, the
baby can not be held in the "human position," which is optimal for hip
development and child support. Human position is when the child's legs and
body are supported to allow flexion (bending at the hips and knees) and
abduction of the legs (spreading of the legs apart). While achieving this
position in the upright position, the back is automatically supported and able
to maintain its natural contour in the sagittal plane or natural alignment on
side view."

We also hear a lot of "overstimulation" claims with regard to outward-facing.

Absolutely, says Coote (Onya). "Over-stimulation of the baby is a concern. It
doesn't allow the baby to make the choice to turn away and take a break.
Many times, when a baby gets tired, he will bury his head in his mother or
father’s breast, getting comfort, warmth, quiet, and the ability to shut out the
stimulation of the world around him. Forward-facing carries remove this
option."

However, “It’s important once children are able to recognize that things are
going on in the outside world, to allow them to interact with that world at
their level of comfort," says Dr. Kelly (Bjorn). Yes, a little stimulation is okay
explains Dr. Levenstein: "Once older, facing outward provides appropriate
environmental stimulation for baby as his distance vision and interest in the
outside world is “fed” by turning outward when alert and awake. In addition, if
a baby is facing outward and is uncomfortable, a parent is close enough to
hear the fuss/crying, and that should signal to the parent to change position."
For an even better understanding of over-stimulation risks, we turned to the
developmental Ph.Ds at Seedlings Group. "Keep in mind that infants
communicate with their caregivers quite beautifully and we are hardwired to
respond," replies Dr. Aliza Pressman. "If an infant is overstimulated he or she
will cry and express distress. If the infant is not distressed, then all is well.
Especially after six months of age. It's important to keep in mind that all of
the research on kangaroo care applies to newborns, particularly those who
were born preterm."
Still, Ergo believes inward is best. "Sometime during the baby’s first year,
most babies placed in the front inward facing position will begin to turn their
head to get a better view of the action taking place behind them," says
Norholt. "Given the flexibility of a baby’s neck and the wide zone of vision that
eye movement allows for, the baby will in fact be able to take in quite a lot of
the surrounding environment. If this solution works for you, and your baby is
content, we strongly suggest that you keep your baby in the front inward
facing position."

Of course, as with most parenting concerns, the best strategy is to take cues
from your child. "It's up to parents to exercise common sense," says Grayson.
"If you think your kid is getting overstimulated while looking out, simply turn
him around."

Anything else parents should keep in mind when using a carrier?

"Be sure to keep the baby's face visible," advises Grayson. "Keep the airway
open—be wary of the “chin-to-chest” position, which can cause respiratory
issues. And be careful of extra fabric covering your child’s mouth and nose."
Frost (Ergo) adds that baby should be “close enough to kiss” and high on the
wearer’s body. Take it easy, says Antunovic (Boba). "Walking is great exercise,
but save the jogging, jumping, or high-impact endeavors for when you’re not
wearing your baby." Antunovic also reminds parents to watch baby's
temperature in hot weather and to check the carrier prior to each use to be
sure that there are no signs of fraying, tearing, seam-splitting or cracked or
broken buckles."

But at the end of the day, "the single most important predictor of positive
maternal and child bonding is maternal mental health," reminds Dr. Pressman
(Seedlings). "It's what makes each individual dyad (mother-child pair) work
together in their own unique 'dance' and nobody else need opine about it."

Amen to that.