'Correct Positioning' by M'liss Stelzer
For the Safety & Comfort of your Newborn
M'Liss Stelzer R.N. & edited by Holly McCroskey September 2006
(used with kind permission)
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 placing 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.
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.
Pouches and Closed Tail Ring 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 (3.5kg and 5.5kg) 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 and his bum is centered on the pouch seam.
Fabric in back of baby is pulled high on mom’s chest 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 in 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.
Pouch too big for mom and no support pillow under baby.
Smaller size pouch and support pillow is under baby.
Open-Tailed 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.
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).
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.
The baby should be snug and supported in the carrier. To do this, pull gently, but firmly, on the
shoulder straps until the slack is taken up and the body of the mei tai is snug against baby’s back. 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 the parent’s back and tied.
Mei tai was not tied tight enough, baby started to slump and his body dropped deeper into the carrier body.
Baby properly supported by the carrier body and shoulder straps tied firmly across baby’s back.
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 (her tummy is moved against your tummy and she uncurls 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.
(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.)
- 'Correct Positioning' by M'liss Stelzer