This is Part 9 on our series on Babywearing Safety. You can find our other posts here.
A good baby carrier can encourage optimal hip, spine and neurological development. Here we discuss the positions which promote this development. Many babywearing advocates are concerned by Front Facing Out (FFO) positions in front pack carriers such as the Baby Bjorn. We will also discuss how much of a problem FFO can be.
A baby’s hips are relatively flexible and a position which encourages the natural “m-shaped”, frog-legged position keeps the hips flexed into a comfortable and developmentally appropriate position. A carrier with a wide-bodied base is ideal for this purpose. This site here clearly shows the optimal position in a good-quality, well designed sling. It also shows that narrow-based front packs such as the Baby Bjorn leaves the baby’s legs in a position which places pressure on the hips. For a discussion of front packs such as the Baby Bjorn, see here. A further discussion of baby carriers with regards to hip development can be found here and here.
In babies for whom there is a diagnosis, suspected case or family history of hip problems, correct positioning is very important. For all other babies, short periods without optimal positioning is probably fine. However, if you are in the process of choosing a baby carrier, then choosing one which promotes healthy hips is recommended.
Like hip development, optimal spinal development can be aided by a good quality baby carrier. An optimal baby carrier will support the developing infant spine in a straight rather than curved position (the infant curved or slumped in on itself or hyperextended outwards in some forward facing front pack carriers). Infant spinal development and babywearing is discussed here, here and here.
As in the case of hip development, in normal, healthy babies, short periods in a sub-optimal positioning is unlikely to cause long term problems, but when in the process of choosing a carrier, it is possible to combine comfort and ease of use for the parent with a baby’s optimal position.
Babywearing promotes neurological development and vestibular integration by constant stimulation. When babies become over stimulated, they can snuggle into the parent or carrier when they are facing inwards.
A number of common carriers offer the option of Front Facing Out and a proportion of babies prefer it. Front Facing Out has been associated with several problems. In front pack carriers like the Baby Bjorn, the positioning of hips, legs and spine as discussed is sub optimal, but it is possible to achieve a FFO carry with good leg and spine positioning in a wrap, some SSCs and mei tais.
The other problem theorized with FFO carries is overstimulation in an infant that cannot turn away. Although it is certainly possible for an infant to become overstimulated and it is true that unlike in a carry facing the wearer, the infant is unable to self regulate when this occurs, a parent who is responsive to the infant’s cues will notice this and change positions accordingly. Brief periods facing out if the baby is unsettled in other positions is reasonable. For further reading on this topic see here, here and here.
A further concern regarding FFO relates to the wearer. In this position, the baby is hanging away from the wearer’s center of gravity placing additional pressures on the pelvic floor and spine. This is one of the reasons why certain babywearing schools advocate against this position. The wearer can choose to use FFO, but should be aware of their own limits and muscular strength, particularly after childbirth.
Alternatives to FFO carries for babies who prefer it include hip and back carries. These allow the baby to self-regulate their stimulation levels and in a well-designed carrier promote optimal positioning of hip and spine.
Overall, there is no definitive proof that common front pack carriers cause significant damage to healthy babies’ hips, spine or neurological development. If you have a carrier associated with suboptimal positioning, then as long as you are following the TICKS guidelines, you can continue to use it if you and your baby are comfortable. If you are choosing a baby carrier, however, it is worthwhile to choose a carrier that can achieve both the TICKS guidelines and optimal infant positioning.