The Ultimate Guide to Babywearing Safety: Safety of the Infant’s Airway and Babies Who Should Not Be Worn

This is Part 8 in our series on Babywearing Safety. You can find our other posts here.

Newborns have immature and underdeveloped muscles. If you press your own chin onto your own chest, you will notice it is quite uncomfortable, but you are still able to breathe. A newborn does not have the same muscle development as an adult- this position can actually impede the airway to a degree that hypoxia (lack of oxygen) or asphyxia (no oxygen) can occur. Babies in this position have died, although it is very rare.

Although the problem mostly concerns newborns, medically fragile babies with respiratory compromise or babies with poor muscle tone are also at risk.

This is the most serious danger to the baby while babywearing, but it is avoidable.

A close, high upright carry is the easiest way to keep the airway clear.

The problem occurs mostly in a position known as the “cradle carry” where the baby is cradled lying down in a carrier much as they would be in arms. Any position which forces the baby into a c-shaped position with the spine bent and the chin on the chest is problematic, however. This article is an excellent guide to safe infant positioning. Baby Wearers International also has a position on infant sling safety here.

The simplest way to avoid this very serious problem is to remember TICKS (see here).

A safe newborn cradle carry is an advanced babywearing topic. If you are new to babywearing, then use a tummy-to-tummy position instead. Positional apoxia and asphyxia is much less likely in this position and achieving the TICKS guidelines is very easy. The tummy to tummy (upright) position is also great for newborns as it decreases reflux, promotes bonding, is ergonomically more comfortable for parents and helps babies sleep longer.

A calm and happy newborn with a good head and neck position.

Most babies can be worn, after all they need to be carried about somehow. However, occasionally an infant is too medically fragile to withstand being moved. Typically these infants are hospitalized. Some medically fragile children are able to be worn in front carries where their respiratory function can remain under constant observation, but they may be too fragile to be worn in a back carry. Your own common sense, instinct and guidance from medical staff will advise you of your child’s needs.

Children with NG tubes, oxygen lines, IV lines, hip braces, casts and other medical equipment have all been worn in slings: see an experienced sling group, vendor or babywearing educator if you need assistance trouble shooting your carrier with your child’s medical equipment. A supportive online community, such as Babywearing Buy Sell Swap is a good place to start.

Positional asphyxia and apoxia is the most serious risk to the infant while babywearing, however it is easily avoided in the upright positions using TICKS. Cradle carries can be safe for newborns, but they are an acquired skill. The TICKS guidelines should be followed.

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