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Forward Facing Out in a Baby Carrier

This article appeared in Issue 7 of The Natural Parent Magazine .  It is reproduced with their kind permission. 

Forward Facing Out in a Baby Carrier - what you should know.

Written by Jessica Richards, founder of Slingbabies, in Winter 2012

 
At first glance, a baby in a carrier is a beautiful sight. They are happy to be there, amidst many benefits for baby and wearer. But it's worth a closer look.

How does the way a baby faces in a carrier have an impact on them? What should we consider when choosing to face our baby in or out? Why is facing out considered 'normal' in the first place?

[Please note: photos posed by models and do not relate to the text right beside them]

Overstimulation:

Babies can't shut off as easily from outside stimulation as adults can. When facing your chest in a carrier, your baby is in a 'safe' spot to observe the world around them while sheltered from the weather, people, anything undesirable. If anything is overwhelming, baby can snuggle into you and retreat until she's able to process it. However, they are at the mercy of the outside world when forward facing out, so stimulus keeps pouring into their immature brain whether they like it or not. Baby eventually is unable to cope, and the negative effects can last for hours. We can often miss the distress signals until it's too late- clenched fists, kicking around, rubbing eyes, and straining round to see us.

 
Bendy babies:

Babies are born with their spine in a C shape, legs curled up. They are difficult to straighten out when very young, especially if they were breech for a long time in utero. So when tummy to tummy with mum or dad, a baby naturally pulls her legs up like a frog. This is called the fetal tuck. They don't develop additional curves in their spine until many weeks later, to cope with holding their head up and, later, supporting their torso weight and crawling. We need to keep this C shape supported, not force it straight in a carrier.

Babies instinctively snuggle into our chests- a perfect fit! When tummy to tummy, babies use less oxygen which conserves energy and waste less calories. The pressure of tummy-to-tummy helps babies digest their food better. It is the best position for thermoregulation because of reduced stomach exposure. We have more efficient temperature regulating cells and more fat on the back side of our bodies to keep that side warm. When we hold our infants tummy-to-tummy, we are protecting all the receptor and vital organs (Montagu, 1986, in Antunovic 2010)

When we hold our babies in-arms, tummy-to-tummy is the most common position we use. Our baby can touch, smell and see us as much as they need. They take great comfort from knowing we are right there- they have no concept of an independent self until many months later.
Furthermore, Antunovic (2010) says that the instinctual flexed widespread legs that an infant maintains when picked up, coupled with the palmar plantar reflex that helps an infant to cling to his mother, suggests that infants little bodies are adapted to be carried upright and oriented toward their mothers. We joke about our babies being little cling-ons, but it is nature's clever design in progress..

 
Out of balance:

A good, well designed carrier mimics how we hold our baby naturally in-arms. This usually means up high, snug and in close to your centre of gravity. Baby's legs wrap around the parent, knees up bum down in a gradually maturing version of the fetal tuck, just as they do in-arms.
When holding a baby like this, the weight is easy to bear and our body doesn't have to compensate much. We can babywear them in this position for long periods of time without discomfort for either party.
When facing outwards, baby's weight pulls away and down from us. Our back ends up compensating majorly as it tries to balance the strain. Let's be realistic: how many of us would hold our baby in-arms, forward facing down at our hips? It would start to get uncomfortable pretty quickly! Yet this is a 'desirable' position for facing out in popular brand frontpacks.

Crotch:

Although I see one or two in stretchy wraps, most forward facing out carries are done in a frontpack. These are quite difficult to adjust snug enough to support baby's weight, and have a slim area of distribution in the crotch. So the vulnerable genitals bear much more weight than intended- ouch! The same can be said for other baby recepticles such as walkers, exersaucers and jumpers- a lot of weight on the crotch for long periods of time.

 
Hips:

In young babies, the edges of the hip socket are made of soft cartilage like our ears. The younger they are, the softer it is. If the legs are stretched out straight or left to dangle down as they do facing out in a frontpack, the hip ball is encouraged out of the socket.

According to the International Hip Dysplasia Institute:
"The most unhealthy position for the hips during infancy is when the legs are held in extension with the hips and knees straight and the legs brought together, which is the opposite of the fetal position. The risk to the hips is greater when this unhealthy position is maintained for a long time. Healthy hip positioning avoids positions that may cause or contribute to development of hip dysplasia or dislocation. The healthiest position for the hips is for the hips to fall or spread (naturally) apart to the side, with the thighs supported and the hips and knees bent. This position has been called the jockey position, straddle position, frog position, spread-squat position or human position. Free movement of the hips without forcing them together promotes natural hip development."

This 'frog' position is the one encouraged by Slingbabies in conjunction with well designed carriers. With knees up higher than bottom, baby is supported in a seated position which encourages the hip ball down into the socket and keeps it there nicely.
But in a typical front facing carry, baby's legs dangle down uncomfortably. The edge of the crotch acts as a pivot point for encouraging the ball out of the socket. Unfortunately, many hip problems which may be caused or exacerbated by this effect, are undetected until later life when the person needs a hip replacement!

 
 
 
 
Spine:

When a baby is facing inwards in a proper carrier, their back is supported in a semi-rounded position which is beneficial for their development. However when baby faces forward in a carrier, their back is hollowed unnaturally. Their immature spine is not ready for this stress. Rochelle L. Casses (1996) and Pierre Rouzier (2009) warn that in some rare cases, the vertebrae ring can fracture, letting the vertebrae slip forward in a condition called Spondylolisthesis. When the disc slips forward, it traps the spinal cord, resulting in pain and spasms. This is usually only found in gymnasts and athletes who repeditively hollow their spine when bending over backwards. But imagine the hours per day a baby can accumulate, forced into the hollowed-back position with a spine too undeveloped to deal with that stress. It is not normal and likely to be very uncomfortable.

Dr Hayden Thomas, Chiropractor and spokesperson for the NZ Chiropractors Association states "A baby's delicate growing spine needs to be carefully supported in the correct position for age and stage of development. Abnormal pressures or movements and especially forcing their spine into a position it is not ready for may adversely effect the development of spinal curves, interfere with normal motor skill development and neural integration.

Parents also need to be aware of their own posture and ergonomics when carrying or wearing their baby to help prevent abnormal muscle tension and skeletal imbalance from a prolonged altered centre of gravity.

A specific concern for chiropractors is the development or worsening of hip dysplasias, scoliosis and spondylolisthesis that may arise with some types of carriers....A general rule for good neuro-musculo-skeletal development in infants is to keep the baby in natural positions for as long as possible, avoid sitting the baby until the strength and spinal curves develop naturally, encourage crawling and activity but do not push to achieve milestones early such as by using baby walkers or jumpers."

 
Marketing.

Knowing all this, why on earth would the 'forward facing out' feature be considered popular and even desirable in a carrier? It's all in the marketing, and it's been done brilliantly.

Frontpack manufacturers would have us believe that front facing out is the way to go. It is a main feature and selling point of their carriers, so much so that other better-designed carriers are not compared favourably because they don't forward face!

They have spent the last 40 years telling us it is normal, natural and something to look forward to. But (as with carseats) forward facing is a milestone best left alone!

Most of the front facing babies I see out and about look incredibly uncomfortable, and the wearer even more so. Yes there is tweaking that could be done to make it more comfy, but it is often too late- people are put off babywearing after the baby outgrows the forward facing weight limit, as they have a sore back from it!

I would much rather those babies be tummy-to-tummy in the frontpack so they are protected from the outside world and can enjoy the benefits of being carried.

 
But I still really want to forward face him out/ he likes it/ how about just for a little while?

Some babies do go through a stage around 4 months old where they want to see the world around them. Limited periods of forward facing can satisfy this curiosity. But so can a back carry with a woven wrap- and you get the bonus of totally free hands and front!

Many well-designed carriers have a method to forward face out your baby so it's less uncomfortable for him, though unfortunately it will still pull on your back.

It involves tilting the hips or folding up the legs to create that desirable 'rounded back' and flexed/abducted hips in a seated position, instead of the starfish look we are used to seeing.

With a wrap you tie as normal (i.e. Front Pocket Cross Carry for a stretchy wrap, or the Front Wrap Cross Carry for a woven wrap), put baby in and spread the fabric strips knee to knee. Hold baby's hips and tilt them back to raise the knees up above the bottom and stick the feet up and out. Spread the wrap even more to support this new 'seated' position.

You can do the same in a Mei-tai. In a Ring Sling or Pouch Sling the legs and feet are tucked up in front. Many babies sit quite happily like this for long periods of time, (even sucking their toes!) although you'd want to give them a break occasionally.

If you want to continue using your frontpack until you get another carrier, here's a quick temporary fix: a thickly folded flat cloth nappy placed in the crotch area can help spread the legs apart more and provide a slightly seated position.

Bear in mind that gravity still works against the wearer even if baby is comfy now, and they can still get overstimulated by their surroundings, so try to limit forward facing periods to 15 minute blocks at the most.

Forward facing out is a position to be used with caution and awareness. Many babies may be ok and seem to show no ill-effects (and it's certainly preferable to being stuck in a stroller), but it is impossible to know some of the long term effects until much later in life. Frustrating when it could have been avoided!

Tummy-to-tummy is where babies instinctually love to be. Let's keep it that way and know we are doing the best for our babies' physical and emotional development while we carry them.

 
Please see www.slingbabies.co.nz , www.thebabywearer.com and www.hipdysplasia.org for more information on baby carriers and hip development.

Jessica Richards is the founder of Slingbabies, a non-profit organisation for education in safe babywearing. She is a trained Primary teacher, has taught ECE, and is a La Leche League Support Leader. She has 3 amazing children aged 3, 5 and 7, and a very tolerant husband!

References:

Antunovic, Elizabeth (2010) 'Strollers, Baby Carriers and Infant Stress' http://www.bobafamily.com/research/strollers-baby-carriers-and-infant-stress/

Casses, Rochelle L. (1996) 'Infant Carriers and Spinal Stress' http://www.continuum-concept.org/reading/spinalStress.html

International Hip Dysplasia Institue (2012) 'Baby Carriers, Seats and Other Equipment' http://www.hipdysplasia.org/Developmental-Dysplasia-Of-The-Hip/Prevention/Baby-Carriers-Seats-and-Other-Equipment/Default.aspx

Thomas, Dr Hayden. (2012) New Zealand Chiropractor's Association- 'Statement regarding front facing in baby carriers'

Rouzier, Pierre (2009) 'Spondylolysis and Spondylolisthesis' for Relay Health, in Summit Medical Group http://www.summitmedicalgroup.com/library/sports_health/spondylolysis/


Credits: Photos 1-4 Shannon Taylor and baby Alex.
Photos 5-6 Cally Hutchins and baby Emmett.

Two positioning images and quote used from International Hip Dysplasia Institute with kind permission.

Quote from NZChiropractors Association / Dr Hayden Thomas used with kind permission.

 
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