Part I: A Caution Regarding Correct Positioning of Your Baby in Light of Recent Government Warnings Part II: What is the Best Way to Carry Our Newborn Babies? Part I: Correct positioning is extremely important for the safety and comfort of your newborn. Often parents assume that if the baby has difficulty breathing, he will fuss or cry. The majority of infants will protest if they are struggling to breathe; however, newborn babies, babies born prematurely, infants with low tone or developmental delays may not communicate their distress. When cradling a newborn in a carrier it is important to make sure the infant is positioned properly. The baby should not be curled tight chin to chest because this position partially closes the baby’s airway. WITH CORRECT POSITIONING THERE SHOULD ALWAYS BE AT LEAST ONE FINGER’S WIDTH OF SPACE UNDER THE BABY’S CHIN. This recommendation is for infants 0 to 4 months of age, or until a baby achieves good neck and head control. An infant should be repositioned if there is any sign of respiratory difficulty. Symptoms include: rapid or labored breathing, grunting or sighing with every breath and/or restlessness. Please use common sense and monitor your baby frequently no matter their age or weight. With good wishes for safe babywearing from ERGObaby. For further information read the article by M’Liss Seltzer below. M’Liss Seltzer is a former NICU nurse, mom to two, and an avid babywearing advocate and teacher. She has been doing research on oxygenation levels in newborn babies. CORRECT POSITIONING For the Safety & Comfort of your Newborn Often parents assume that if the baby has difficulty breathing he will fuss or cry. The majority of infants will protest if they are struggling to breathe; however newborns, babies born prematurely or infants with low tone or developmental delays may not communicate their distress. When cradling a newborn in a carrier it is important to make sure the infant is positioned properly. • Baby should not be curled tight chin to chest because this position partially closes baby’s airway. (With correct positioning there should always be at least one finger’s width of space under baby’s chin.) • Sling fabric should not be draped across baby’s face. For slings made from thin, airy fabrics please check the airflow of the fabric by placing it over your own nose and mouth. No matter how breathable the fabric looks, if it is difficult for you to breathe through the fabric it will be difficult for baby as well. • Baby should not be rolled so that his face is pressed tightly against the parent’s body. Position baby’s face upward when he or she is not actively nursing and when nursing ensure that baby’s nose is not blocked. An infant should be repositioned if he is having any sign of respiratory difficulty. Symptoms include: rapid or labored breathing, grunting or sighing with every breath and/or restlessness. NOTE: The positioning recommendations in this article are for infants 0 to 4 months of age or until baby achieves good neck and head control. Once baby has good head control the neck muscles are generally strengthened sufficiently to support baby’s airway, even if baby becomes slightly curled or slumped in a baby carrier (or car seat, swing, bouncer etc.). However, please use common sense and monitor your baby frequently no matter his age and weight. Happy and safe babywearing! CRADLE HOLD POUCHES AND CLOSED TAIL SLINGS The amount of modification necessary, in order to position the infant correctly in the pouch, will depend on the depth of the pouch used as well as the size of the baby. Usually once baby weighs between 8 and 12 pounds modifications are no longer necessary. Pulling more fabric against the parent’s chest and/or moving the pouch seam slightly behind baby’s back can change the depth of the pouch. Equal amount of fabric is in front and in back of baby Fabric in back of baby is pulled high on mom’s chest and his bum is centered on the pouch seam. and the pouch seam is centered on baby’s lower back. If necessary a thin, folded receiving blanket can be used to raise baby higher in a pouch or closed tail sling. The blanket is placed behind baby’s back but not behind baby’s head. To keep baby centered on the folded blanket it is often easier to spread out a receiving blanket, place the second folded blanket on top and then center baby on the folded blanket. Pick baby up placing baby and blankets into the sling. For a deep pouch, and/or when placing a tiny newborn in a sling, a support pillow or folded towel may be necessary. The pillow or towel should be placed behind baby’s head and back. To make a pillow using a towel first fold the towel then roll each end tightly toward the middle. The towel should measure approximately 12” long and 6” wide. (Instructions on how to roll a bath towel can also be found at www.newnativebaby.com.) The depth of the pouch and/or the size of the baby will determine whether a bath towel or hand towel should be used. New Native support pillow, folded bath towel, and folded hand towel. Pouch too big for mom and baby is hanging low. No Mom is using a smaller size pouch and support pillow is support pillow under baby. under baby. RING SLINGS One of the most common mistakes new moms make with ring slings is to try to put the baby in parallel to the rails. Which ends up basically folding the baby in half. To correctly position an infant in an open tailed sling start with the baby in more of a tummy- to-tummy position, with trunk perpendicular to the rails, and then slide baby down into the sling by lowering his upper body sideways. Baby's body should lie diagonally across the width of the sling, with head nearer the outer rail and legs nearer the inner rail. This allows the baby's body to stretch out more, keeps the outer rail from flopping over the baby's face, and makes it easier to tighten the sling properly without completely altering the baby's position. If the baby is too “deep” in the sling pull on the tail of the sling, concentrating on the middle, until the pouch is the right depth to raise and straighten baby. (It will probably take some practice to determine the right height and depth.) Although it may not always be a totally hands-free position for the wearer, another position to try is to place baby with his head facing away from the rings. NOTE: Because premature infants have such low tone and extremely poor head control, it is important that a supportive surface be used in the sling. A folded and rolled hand towel, bath towel or the New Native support pillow should be used until baby has better tone (once baby isn’t as floppy). TUMMY-TO-TUMMY RING SLINGS To keep baby upright and supported against the parent’s chest tighten the top and bottom rails as well as the middle of the sling. The top rail is used to support baby’s neck and head. MEI TAIS Baby should be placed on the parent’s chest, the carrier brought up behind baby’s back and the shoulder straps draped over the parent’s shoulders. While supporting baby with one hand, reach back and grab one shoulder strap and with a firm, but gentle pulling motion, snug the strap until it is fairly tight. Repeat with the opposite strap. (This may also be done with one hand pulling both shoulder straps at the same time.) The shoulder straps should then be brought around and tied securely behind baby’s back. If there is enough length the straps can be crossed, brought around back and tied. Mei tai was not tied tight enough, baby started to slump Baby properly supported by the carrier body and and his body dropped deeper into the carrier body. shoulder straps tied firmly across baby’s back. WRAPS It is very easy to tie a wrap incorrectly so there is not enough support on the baby’s back. A good test is to wrap and then press a hand against baby’s back. If baby moves closer (their tummy is moved against your tummy and they uncurl some) then the wrap isn’t supporting baby’s back enough. The wrap should then be retied so that baby is in an upright/straight position instead of curled. ------ M’Liss Stelzer R.N. & edited by Holly McCroskey September 2006 ------ Thank you to Maya Wrap and New Native for funding, the many vendors and individuals for contributing carriers and donations, as well as all the mothers and their babies for their participation. Part II: What is the best way to carry our newborn babies? In many cultures this question does not exist, since babywearing traditions that stretch as far back as humans can remember are still in use today. But, as traditional practices and lifestyles become harder to maintain, and various manufactured baby-carrying devices become more and more ubiquitous throughout the modern world, this question has taken on new meaning. The developing newborn is seen to be a fragile and delicate life, one that requires the utmost care and attention. There is real concern that the newborn baby’s physical development could be negatively affected by being in this or that position for too long, or by being placed in a certain type of walker or a certain carrying device. ERGObaby understands these concerns and has worked hard to address them. The ERGObaby Carrier is considered by thousands of mothers, fathers and caregivers to be the ideal carrier for toddlers, but what about the newborn infant? In 2005 ERGObaby introduced the Original Infant Support Cushion. The Infant Support Cushion has a versatile design that, when used properly, accommodates infants soon after birth to the time when they are big enough to use just the carrier. After further research and feedback from mothers and fathers, ERGObaby undertook a redesign of the Original Infant Support Cushion to make it as easy as possible for our parents to position their babies correctly in the carrier. This new Infant Insert has built-in support and structure to ensure the baby is in the natural carrying position that has been used in cultures all over the world for millennia. This position also takes into account the research of experts who have studied the physical development of the infant from birth. In many of the oldest baby carrying traditions, infants are tightly wrapped against the body of the wearer, with legs tucked up and spread; straddling the waist, hips or back of the wearer. As the infant develops, the straddling becomes more pronounced and the tucked-up legs will slowly drop, but in the first few months this tucked-up, slightly straddling position helps to ensure proper hip development. According to Dr. Evelyn Kirkilionis, the author of the first known research on the effects of baby carrying on physical development: “…if the baby is sitting on the parent’s hip or is carried face to face, the baby has a leg position that is ideal for the healthy maturation of the hip joint. If the legs are bent more than 90° (about 100° to 110°) and spread approximately 90°, the femur head fits ideally in the hip socket. This favors its healthy development. Moreover, the body posture of the baby is not stationary. Through the movements of the parent as well as those of the baby, a constant stimulus is transferred to the child’s hip joint, which promotes circulation to the still-cartilaginous structures and supports their maturation.” i We would only qualify this by saying that the newborn infant does not usually achieve the 90-degree spread of the legs for, in some cases, several weeks. Until the legs naturally open it is acceptable to place the infant with the legs in a squat position against the belly with feet close together or touching. When the still developing infant is carried facing away from the wearer’s body, or even horizontally in a sling, one can clearly see how all of the positive aspects related to the hip development described above by Dr. Kirkilionis are lost. Moreover, the outward facing position, or sling position, is far inferior to the coziness and warmth of facing into the parent or caregiver’s chest. This is often referred to as the tummy-to-tummy position, or, as ERGObaby calls it, “heart-to-heart”. Being able to see the face of the parent or caregiver is also important for the cognitive and emotional development of the baby, as well as interpreting social cues. Kirkilionis again: “Babies carried facing away from their parents are confronted with stimuli from the environment without being able to turn away when it becomes excessive. These children also cannot read the facial expressions of their parents to see how this information is to be interpreted. In the case of disturbing stimuli, babies cannot look at their parents’ faces to be assured that everything is still OK.” ii Some of the various wraps that are on the market also hold the baby in this tummy-to-tummy position and enable eye contact, but often lack the support, structure and ease of use provided by the ERGObaby Carrier and Infant Insert . Slings do not enable the tummy-to-tummy/heart-to-heart position. iii Small newborn babies can easily become engulfed in a sling to the point where they cannot be seen, and cannot see. Slings, as well as wraps, also depend on a certain competence of the wearer, and those unfamiliar with wearing them may use them incorrectly; unintentionally posing risk to their babies. Additionally, with slings there is not the same degree of eye contact and tummy-to-tummy/heart-to- heart closeness that can now be achieved with the ERGObaby Infant Insert . Before the ERGObaby Carrier attained the popularity it now enjoys, it was thought that slings were a better alternative to the outward facing carrier, in the sense that there was no pressure put on the developing spine. iv This is due to the fact that the baby is in more of a horizontal position in the sling, rather than suspended by the crotch with legs dangling and pressure put on the developing sacrum at the base of the spine. At birth the spine is shaped like the letter C, as it was in the womb. As the spine develops it acquires secondary curves in the base of the spine and the neck. These secondary curves begin developing from birth. According to Rochelle Casses in her paper entitled “Infants and Spinal Stress”: “A baby's spine is placed in a compromising position in many of today's popular carriers. If the carrier positions the infant upright, with the legs hanging down and the bodyweight supported at the base of the baby's spine (i.e. at the crotch), it puts undue stress on the spine which can adversely affect the development of the spinal curves and, in some cases, cause spondylolisthesis.” v The ERGObaby Carrier used with the Infant Insert address these very issues. In the ERGObaby Carrier the baby faces towards the babywearer with the back, sacrum and legs supported in an upright position. The Infant Insert has a bottom support cushion that is designed to support the natural curvature of a baby’s spine by encouraging a slight forward-leaning position with the pelvis tilted forward. There is also padding to support the back along the length of the spine. The position of the infant in the Infant Insert Heart-to-Heart is exactly the position that a baby would be in if carried with its bottom supported by both hands and the head resting in the chest with legs tucked-up and, if the infant is old enough, straddling the waist. An update from the editor of a new edition of the above quoted paper validates ERGObaby’s new design: UPDATE: This article was written in the 1990s when the all of the popular upright baby-carrier designs had the harmful characteristics described below. Today, several new and improved upright carrier designs are available. The gold standard for carrying your baby should be your own arms. In other words, an upright carrier should hold your baby the way your arms would, e.g., facing you with legs in a frog-like, spread-squat position with the baby's weight supported across the buttocks and thighs. —Ed. vi ERGObaby has worked hard to ensure that the design of the new ERGObaby Infant Insert supports the development of our newborn babies. We have researched the available expert opinions and analysis regarding baby carrying and physical development of the newborn baby. Based on this research we have designed the ERGObaby Infant Insert to position the newborn baby in a way conducive to its proper development. And, as always, we have taken into account the comfort of the parent or caregiver of the newborn baby. i Kirkilionis, Evelyn. “Child-Carrying History and Stories” trans. by Annika Kraal ii Kirkilionis, Evelyn. Mothering Magazine. N° 137 July August 2006. iii As we use the words here, sling refers to those carriers that are slung over one shoulder and hold the baby in a horizontal, or slightly inclined position; wrap refers to any number of carriers that comprise a piece of fabric that is wrapped around the baby and body, usually with the baby in an upright position. iv And, in fact, this is how we instructed customers to use the Original Infant Support Cushion, in the “cradle position”. v Casses, Rochelle. Infant Carriers and Spinal Stress. http://www.continuum- concept.org/reading/spinalStress.html. 1996. vi Ibid.