Dear Nanny: Infant Positioning

*When I use the royal "we" in this post, I am often referring to the babywearing community.

Dear Nanny,

I was looking at baby carriers at Babies R Us, when a woman who was passing saw me holding a box for an Infantino carrier. She said not to buy that one because it is a "crotch dangler." What is a "crotch dangler" anyway? Are there really some carriers that are bad for baby? What kind of positioning should I be looking for?

Thanks for the help!

Concerned FTM

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Dear First Time Mom,

There are some carriers that are certainly not recommended, but only one type that I would categorically say to never use. I will talk about that type, the bag sling, farther down. The term "crotch dangler" refers to carriers that hold a baby with just a strip of fabric between their legs. Baby is hanging in the carrier with their legs dangling down. This puts pressure on baby's developing spine, hips, and pelvis. It is basically a not very nice term for front pack carriers, though some other types of carriers can have baby hang too. A carrier that a baby hangs in does not offer the ideal positioning. I say ideal because there has not been enough study done on baby carriers to say words like right and wrong in terms of positioning.  However, we do have enough research information to state that some positions have more benefits than others. I'd like to note that some people find the term "crotch dangler" to be offensive. It is better to use the term 'front pack' instead.

To understand what proper positioning is, we first must gain some knowledge of infant physiology. There are two main parts I am going to focus on: hips and spine.

The Infant's Spine:

Picture used without permission from here.

An infant is born with their spine curved in a C shape. This is so they can fit curled up in the womb. It takes more than a year for it to straighten out into an adult spine's S curve. To keep from from forcing baby's back out if it's natural curve, a baby carrier should support baby's back from all sides. Part of this comes from how baby's hips and legs are positioned. 

Zolowear Ring Sling

You can see in this photo how baby's spine is being supported in it's natural curve. Supporting a curved back doesn't mean the carrier should be loose however. Baby should be tight to the wearer so that they won't slump. Slumping can tuck baby's chin to their chest and reduce oxygen intake.

An Infant's Hips:

These two photos show the difference between how a baby's hips are supported in a carrier where baby's legs hang and in a carrier that provides support from knee to knee. In the first photo you can see how pressure is being applied to the hip joint. While this wouldn't really be an issue for an adult, a baby's bones are partially made up of cartilage. Cartilage is soft and flexible, pressure put on the soft cartilage in an infant's hip can cause hip problems. The second photo shows better hip alignment, thought the photo doesn't really illustrate the ideal position of knees higher than baby's bum. 

Research done in Germany, mainly by  Evelin Kirkilionis, points to the ideal positioning that is now used all over the world to teach babywearing. Ideal positioning has baby upright, tummy to tummy (really chest to chest, but it's called tummy to tummy), close enough to kiss, with baby's knees higher than his/her bum, in view at all times, with baby's chin at least two [of your] fingers width off of their chest, with baby tight to you, and baby's back well supported while preserving the curve of their spine. Baby should not be slumped, and baby's chin should not touch chest (to preserve oxygen intake).

This photo shows what the ideal positioning looks like for a newborn, 0-3 or 4 months (except baby should be higher, "close enough to kiss"):

Photo used without permission from here

This photo shows the ideal positioning for a baby 3 or 4+ months:

Photo used without permission from here

You can see in both pictures that the babies knees are well above their bums. They are supported from knee to knee. Their backs are rounded, yet they are tight to the wearer. Their chins are off their chests. Note that the newborn's legs are only spread as wide as their pelvis. Once they can naturally open up their pelvis, they can spread their legs more to embrace the wearer. I prefer to use wraps or ring slings with newborns, because they provide an easier, and often better, fit.

When babies are positioned like this, it is also more comfortable for the wearer. A baby that dangles throws off your center of balance, forcing you to compensate for the extra weight (think of how awkward you felt 9m pregnant). When a baby is positioned more ergonomically, they are stabilized by your center of balance. This takes pressure off of your shoulders and back. You can stand up straighter, carry heavier babies and you can carry for longer periods of time.

Most baby carriers offer ideal positioning, but the most popular ones that you often see in social media do not. Infantino does make some ergonomic carriers now. If you are on a budget, the ergonomic ones should be OK. There are better carriers out there, but those won't do any harm. 

Cradle Carries

The only carrier that can be said to be definitively bad is a bag style sling. zbag style slings have mostly been recalled due to infant death. They put baby in a cradle carry, which can force their chin to their chest and cause positional asphyxiation. Cradle carries are not a recommended position because of this. The only carrier that can do a safe cradle carry is a traditional, open-tailed ring sling. Bag style slings don't just tuck baby chin to chest. They also have elastic edges that close over baby's face restricting the amount of oxygen that gets to baby. They are also meant to be worn lower, so you can not keep a close eye on baby. These tend to resemble duffle bags.

Recalled Infantino SlingRider

You can see in the above picture how a bag sling tucks baby into a chin to chest position. Notice how she is actually using her hand to pull the bag open so you can see baby. A baby's face should always be in sight when in a carrier so that you can monitor their breathing and assess their comfort. Look at the difference between that and a proper cradle carry in a ring sling:

Sakura Bloom Ring Sling

Baby's face is clearly off of his chest - he has an open airway. He is being worn high and tight, so he is easily monitored and will not slump. I still would recommend an upright tummy to tummy in a ring sling, but a safe cradle carry is possible. Although pouch slings are safe to use in a hip carry for 6m+, I would not recommend using them for cradle carries. A baby can still easily be tucked chin to chest in a pouch sling.

Remember TICKS:
T: Tight. Baby should be tight to you to prevent slumping.
I: In view at all times. You should always be able to see your baby's face.
C: Close enough to kiss. Baby should be worn high on your body
K: Keep baby's chin off of their chest to prevent positional asphyxia, and keep baby's Knees above bum. Fabric should extend from knee to knee, and baby's knees should be higher than their bum.
S: Supported back. Baby's back should be supported in it's natural curve.

See my posts Types of Baby Carriers and When to Use Which Carrier for more information on baby carriers.

I hope this helps,

Katie

Resources and References:

http://jeportemonbebe.com/en/faq-category/positioning-baby-physiology

http://www.babywearingschool.com/drkirkilionis.htm - Info from Ein Baby Will Getragen, by Dr. Kirkilionis

http://www.hipdysplasia.org/Developmental-Dysplasia-Of-The-Hip/Prevention/Baby-Carriers-Seats-and-Other-Equipment/

Babywearing Safely and Securely, by Beate Frome