Interview Turns to Lesson

Yesterday I had an interview for a nanny share. I met both moms and both newborn babies. The best part about interviewing has to be getting to cuddle so many newborns!

This particular interview went a little differently than I had planned however....

The families live in the same building. I went to the host family apartment, and the other mom brought her six week old son up in a stretchy wrap. Specifically, the Sleepy Wrap (now called Boba Wrap). This is a great carrier. I own one, and quite like it. It is an awesome newborn wrap. However, I could see that baby was poorly positioned in there. He was curled in a cradle carry, and his face was not visible. These are two very big babywearing cautions, but he seemed to be breathing easily, so I decided to let it go for the time being.

Our interview started, and everything was going great. The moms were awesome, and they seemed to like me. But then I started to hear something that frightened me. The baby curled in the wrap was having some breathing difficulties. He was taking short, half-breaths that were very loud. To me they screamed danger! However, to a first time mom it probably seemed just like another strange newborn noise. If you've ever had a newborn, you will know they make some funny noises. She thought that since she could hear him breathing, he was doing fine.

I interrupted the interview, and apologized if she felt that I was over-stepping. I told her I teach Babywearing 101 classes at a local store, and that I work with a few babywearing groups. "About his breathing," I said.

She interrupted to note that she could hear it. Not in any kind of malicious, back-off type of way, just casually observing.

"Yes. It sounds like he is having trouble breathing." Of course, that frightened her. She immediately pushed on his back and he stretched and squirmed a bit, but was still taking those half-breaths. I started talking about the dangers of cradle carries, and how we teach wearing upright, tummy to tummy. She attempted to move him, still in the wrap, more upright. It did help a bit. He took a giant, deep breath that clearly indicated his difficulties. Well, clearly to me, I'm not sure mom caught the deep breath. I asked if I could help, she said yes. I asked her to take him completely out so we could start over. Then, I asked her if I could touch him, and I washed my hands.

**If you notice a baby having breathing difficulties, always take baby completely out and start over from scratch.

She took baby out. He took another deep breath as he straightened, then started breathing normally. I gave my OK to try again.


The rest proceeded like any stretchy wrap lesson. I held the baby while teaching her how to tighten the wrap so baby could just fit in. I asked permission to touch mom before testing the tightness of the wrap. Then I taught her how to put him in a PWCC (pocket wrap cross carry), tummy to tummy, legs out, and face tilted up. Once back in, he settled down and fell asleep, breathing normally! Mom commented that he felt much more secure in that position too. Then we went back to our interview.



There were some firsts for me there. It was the first time an interview turned into a lesson, the first time I approached a mom outside of a meeting about positioning, and the first time I'd heard a baby make those noises in a stretchy wrap.

Luckily, everything turned out ok. And luckily mama was receptive to getting advice. Some people get defensive in those situations. It helps, if you ever come across it, to be self-depreciating and to always ask permission to help out, to ask permission to touch the baby (if necessary), and to ask permission to touch the mom. Mention your credentials, and tell them about your local babywearing group if you have one.

Swaddling and SIDS

So, I was looking back at some of my old documents, and found an essay entitled, "Swaddling and SIDS." It was dated March 2012, before I started this blog. I wrote it to answer a question that was starting to pop up more and more - "Is swaddling safe?" The conclusions are directed to the Newborn Care Specialist community, but it applies to anyone caring for a newborn. I thought it had some valid points, and I would like to share it. Please keep in mind that my sources are simply links from a year ago - don't be upset if one or more no longer works.

Question: If a client told you not to swaddle because the hospital told them not to, what would you say?

 This is a fairly new recommendation employed in some, but not all, hospitals. My research on the subject seems to point to this recommendation being more prevalent in the UK than in the US. The reason that swaddling is being advised against appears to be because of a link to SIDS and hip dysplasia/stunted growth. The fear being that incorrect wrapping leads to loose bedding in the crib, overheating from over dressing, too deep of a sleep that baby is unable to awaken from, and wraps that are tied too tightly. Parents have other reasons for eschewing swaddling too. Some worry about baby rolling over in a swaddle and being unable to save themselves from suffocation. Others want their baby’s to be able to suck their thumbs while they sleep. 

Swaddling and SIDS

There have been conflicting studies in regards to how swaddling effects SIDS. Some studies have shown that babies whom are correctly swaddled show lower rates of SIDS, other studies say that swaddling can contribute to SIDS. The truth is hard to know, especially since the causes of SIDS are still unknown. We only have statistical evidence on what lowers the risk. Everything can be done right, and babies still die of SIDS.

One of the main reasons that swaddling has been linked to SIDS is the fear of loose bedding in the crib. However, swaddling done correctly leaves no loose bedding in the crib. A tight swaddle is the only swaddle that should be used. Teach the parents how to correctly do a tight swaddle to alleviate this fear. Hospitals have to play to the lowest denominator. They can not assume that a parent will try to learn how to correctly and safely swaddle a baby. Thus, they are forced to recommend no swaddling in case someone does it wrong. If their child is breaking out of the swaddle, recommend a ready made swaddler like a Woombie, Miracle Blanket, Loving Baby Swaddle, etc.

Overheating is another problem associated with swaddling and SIDS. The blanket is another layer. Keep the blanket in mind as baby is being dressed for sleep. According to the American Academy of Sleep Medicine, the optimal room temperature for sleep is a few degrees cooler than room temperature, somewhere around 65-70 degrees Fahrenheit. If you are not lowering the temperature or turning on a fan, than take a layer off before putting baby down. Babies can not control their own body temperatures anyway, and they certainly can’t take a blanket off if they get too hot. Using a breathable swaddle blanket like the ones made be Aiden & Anais that are made out of muslin or bamboo is a good way to keep baby from overheating. These blankets are exceptionally breathable, allowing for dissipation of heat near baby. As far as swaddlers go, Woombie is coming out with a breathable swaddler later this spring.

The lack of the ability to arouse from sleep when in respiratory or cardiovascular distress in some infants has been a factor in what many experts believe cause SIDS. The deeper a baby sleeps, the harder it is for them to wake up if in distress. Anyone who is familiar with swaddling knows that swaddling helps babies sleep better. Where though is the line drawn between helping a baby sleep better to promote growth and letting a baby try to sleep according to when they drop off to prevent too deep of a sleep? The job of the sleep trainer is to teach the infant how to self soothe to settle down after a natural arousal as happens in normal infant sleep patterns. If a baby is not showing signs of problems like sleep apnea, and is following the natural patterns of sleeping and feeding in an infant, than the addition  of a swaddle should not cause harm to the infant. However, according to a study published in the Journal of Pediatrics 2010, introducing a swaddle to an infant who was not routinely swaddled for the first few months has been shown to decrease arousability in infants, thus sleep trainers should avoid introducing a swaddle if a baby has not been routinely swaddled in the months since birth.

 Hip Dysplasia

Infant’s hip sockets are not fully developed at birth; much of the hip joint is made up of pliable cartilage that can be more easily forced out of place. Before birth, a hormone comes into play that makes mother’s ligaments stretchier to make it easier for baby to pass through the birth canal. Some babies are sensitive to this hormone, causing excessive stretchiness in their ligaments. In such cases, hip dysplasia becomes more prevalent. Hip dysplasia is also more likely in first born children (particularly girls), a baby born breech, and if there is a family history.

Incorrect swaddling can lead to hip dysplasia when the swaddle is too tight around the infant’s hips and thighs. While it is important to have a tight swaddle, tying a baby into a blanket is not recommended (Think of the Native Americans who tied their babies into papoose carriers. They had a 33% rate of hip dysplasia). The International Hip Dysplasia Institute teaches a method of swaddling that is hip-healthy (see hipdysplasia.org for more information). A swaddler like the Halo SleepSack, Woombie, and TrueWomb that allows for freedom of movement in the legs can help prevent hip dysplasia in infants. Also be aware of the effects that carriers like the Baby Bjorn have on infant hip health. If hip dysplasia is a worry for a family, than encouraging them to keep baby out of a swaddle during waking hours may be best.

Other Objections

I have heard before of parents who fear that their baby will roll over while in a swaddling blanket and be unable to roll back because their arms are strapped down. Newborns have no control over their muscles. If they were able to roll over even without a swaddle, they would not know how to roll back anyway. Once they are old enough to roll over, they will have more control of their muscles, and at that point it will probably be time to move them to a sleep sack or arms free swaddle anyway.

Some parents talk about how their baby prefers to have their hands nearby their face for comfort or sucking. In this case, suggest a one arm or arms free swaddle, but explain how the Moro (startle) reflex works to startle baby from sleep because of baby’s lack of muscle control. A swaddler like the Woombie or TrueWomb, that lets baby move their arms or have them across their chest rather than at their sides may be a better option here.

Conclusion

Swaddling done correctly is a safe practice. The risks associated with SIDS are circumvented by a correct swaddle, and hip safe swaddling can be done with infants who are at risk for hip dysplasia. A light breathable blanket that is tightly wrapped, or a ready made swaddler can be used to safely swaddle a baby. Keep in mind the risks associated with overdressing and do not start swaddling a baby who was not swaddled in the first few months of life.

Author: Katherine, Certified Newborn Care Specialist, Certified Professional Nanny.

Recommended for Safe Swaddling:

1.      Aiden & Anais Swaddle Blankets: large, breathable, light-weight, easy to get a tight swaddle with

2.      Woombie: Allows for freedom of movement, easy to use, breathable version available this spring, convertible version available for an arms free swaddle

3.      TrueWomb: A lot of Velcro makes this a noisier swaddler, but it allows for freedom of movement, especially when concerned with hip dysplasia

4.      Halo SleepSack: Freedom of movement, convertible to a regular sleep sack, allows for freedom of movement

5.      Loving Baby Swaddle: No Velcro, snaps, or zippers, this is a wrap and tie/tuck method that creates an easy tight swaddle

6.      Miracle Blanket: Similar to the Loving Baby, simply wrap around baby for an easy to use tight swaddle.

Sources:

http://fsid.org.uk/document.doc?id=145

http://www.health.am/ab/more/swaddling-effects-could-pose-sids-risk-study/

http://www.ispid.org/swaddling.html

http://www.webmd.com/sleep-disorders/features/cant-sleep-adjust-the-temperature

http://www.parents.com/baby/sleep/tips/best-baby-sleep-tips/

http://www.hipdysplasia.org/Developmental-Dysplasia-Of-The-Hip/Hip-Healthy-Swaddling/Default.aspx

I am now a CPST!

I am pleased and excited to announce that I am now a Certified Passenger Safety Technician! I have the ability to inspect car seats for proper usage, install different types of car seats in different types of cars, and educate parents on how to install and use their car seats properly.

This certification involves taking a class (spanning several days) that goes over all the different components that may be involved in installing a car seat (different seat belt types, different LATCH attachments, different harnesses, etc). There are over a million combinations possible when installing a car seat in a car. A tech has to be able to understand the different components, and put them together to make a safe install. Then be able to teach the parents how to do it safely!

80% of car seats are installed or used incorrectly. To find a tech near you, or to become a tech visit http://cert.safekids.org/

About Ring Slings

Sakura Bloom Silk with 23mo

What it is:

A ring sling is a length of fabric threaded (or sewn) onto a set of rings. The fabric is looped over one shoulder and threaded through the rings on the other side – because it is a one shouldered carrier, it isn’t as nice for long outings with older babies. You can use it on either shoulder, and switch off if one gets tired. It is fully adjustable to provide support over the full length of baby – this makes it especially nice for newborn wearing. Aside from being fully adjustable for baby, it is also nice for sharing between different sized wearers. RSs are a poppable carrier, meaning that it can be worn sans baby, and baby can be moved in and out easily.

Ages:

Ring slings are great for newborns (my favorite newborn carrier), excellent for hip carries with 6m+, and awesome for frequent ups and downs with a toddler.

Great Brands:
There are many RS makers out there. If you found one you like, get reviews from experienced babywearers before buying, and make sure they comply with the testing standards going into effect this year. Sleeping Baby Productions, Sakura Bloom, Comfy Joey, Zanytoes, and Kalea Baby all make excellent ring slings. Zolowear (pleated shoulder) and Maya Wrap (gathered shoulder) are good too.

Carrying positions:

There are a few different carrying positions you can do with a ring sling.

Birth+: Tummy to Tummy, legs out (legs out is recommended, but you can do legs in with a tightly curled newborn). This is the basic carry, and can be adapted for breastfeeding in the carrier by loosening the fabric, and lowering baby to breast level. Tighten back up when baby is done.

Birth+: Off Center Tummy to Tummy, legs out. This is nice if you have a baby that likes to be able to see more, but has less head control – or needs a nap J.

0-2(ish)mo: Burp Carry. Baby over your shoulder – this is nice if you have a baby that likes to see, or hates tummy to tummy (though that’s usually because positioning is off). Requires a little more skill, but easy enough to learn

0-3m: Cradle Carry – FOR ACTIVE BREASTFEEDING ONLY, when baby is done nursing, return them to an upright position immediately. Cradle carries are not safe for newborns – it tucks them chin to chest and can cause oxygen desaturation, or even positional asphyxiation. It is possible to do a safe cradle carry in a ring sling, but it is tricky and requires some skill.

3-6mo: Kangaroo Carry (Buddha Carry). Baby is facing out, sitting in the pouch, basically folded in half, with their feet nearer to their face (but in the pouch). Baby leans back against you. Facing out is not recommended for long periods of time.

6m+: Hip Carry – this carry can be started once you naturally begin to hold baby on your hip, about the time they learn to sit (around 6m). This is probably the easiest RS position.

Toddlers: Back Carry - this is for short periods of time with toddlers only. It is basically scooting baby around to your back for a few minutes. I use it to change other baby's diaper or to do a couple dishes.

Toddlers: RUB - Rings under bum is basically the woven wrap carry, 'ruck under bum' but with rings instead of a knot. This is a deceptively trickier carry that should only be attempted by someone skilled at doing back carries in a woven wrap.  Requires a long RS.

Ring Sling Tips and Tricks (from Heather, VBE at Babywearing International of Chicagoland):

These tips are for a baby being worn tummy to tummy, legs out.

1. Before you put her in, set it up- check that it's loose enough that you can pop her in and not bunched at the rings.
2. Put the rings on the upper part of your shoulder, near the outside (i.e. not close to your neck, if it's close to your neck you may find it rides to your neck when you tighten).
3. Spread it wide across your back. Put her over your shoulder (opposite the rings), then drop her in.
4. Tighten it from your back to your elbow (what this does is makes it more snug... otherwise when you pull the rings they'll end up at your bellybutton, lol).
5. Put her in the seated squat position, and (assuming the rings are on your right), pull the material snug across her back towards the rings so the slack its near the rings.
6. Take your right hand and reach under the rings, to her belly, and reach down and grab the material and pull it up as high as you can between you and her- to her bellybutton if possible.  Either now, or as you are tightening, if you lean forward a little, you can help get the babies tush into a really deep seat this way.
7. When you start to tighten, instead of giving it a huge yank, pull it close to the rings, at the top rail (the rail near her neck), middle in 1-3 spots across, and bottom rail (rail near her legs). Repeat as needed. If you give it huge yanks you're likely to have the material bunch up in the rings.
8. Pull the top rail area out to the front and center of your body, and the bottom rail out to the front and to the right of you (if you get the idea).
9. If it seems like the material is hard to pull through the rings take your left and and very gently lift her up, just a touch, so her weight isn't working against you tightening the rings.
10. If you see an area that is still loose (let's say the rails are tight but loose at her back- find the area of the tail that correlates to that area (i.e. the middle) and just tighten that area.  
11. Goal is to have the rings in the corsage area of your chest. If it ends up higher or lower, that's fine if it's comfy. :) If you're short, there might not seem like a lot of room between baby/rings/your shoulder, and unless you plan to grow, there's not much you can do about that. :)
12. Her seat lower than her knees, arms in or out is fine if she's awake and has head/neck control.  Try and give the knees/feet an "up and in".  This is where you can gently push their legs up into a more deep squat position.  It will help give them a better seat and also increase their comfort.  Check to make sure you still have good knee to knee coverage.
13. You can use the tail behind her head to make little pillow if she falls asleep, or pull the top rail up higher as needed.
14. If you find that the rings are a little lower than you like (or your tail is long) you can wrap the tail through/around the rings to make it more comfy if she happens to be close. As long as the rings are laying relatively flat and comfy, it's fine.
15. A lot of babes cry if they don't have a good seat or the RS isn't high enough. I think with RS's it's a game between figuring out tight enough (to be comfy) and too tight (and having certain brands ride off your shoulder and up your neck).

Helpful Videos:

It is much (much!) easier to learn from videos than it is from written directions. Some companies send a DVD along with the carrier, but quality varies among companies.

There is also a ring sling playlist under my name on youtube – kbaby261: https://www.youtube.co/playlist?list=PLnY6xmQAvtsomiL_2zxHN1MtMfqsljzI3&feature=mh_lolz

The videos on my list include videos on threading, positioning, different carries, and how to nurse upright or in a cradle carry.