Hoods, head rests and supporting little heads.

IMG_0388Babies are both fragile and tough in equal measure, and this is why we are always told to “support” baby’s head. But, how and where should this support come from? As a consultant and a sling librarian one of the most common questions I am asked is “will that support her head”?

As with all safe sling use, the first thing we must consider is TICKS. Taking the first two items from this list, any sling should ensure that the baby is held tight against the wearer, remaining visible to the wearer always. Furthermore, the carrier should fully support the baby’s spine. If a sling is worn so that baby’s head is tucked inside it can make it tricky to see them. Therefore, if you are going to use this method, only the pass on side away from a baby’s head should ever be used – no fabric should ever obscure their face. However, a sling that is worn tight and providing support all the way to nape of the baby’s neck will provide all the support they require. For example, with a pre-tied stretchy wrap the passes should cross at the nape of their neck, with third layer coming to this point too. It should not be necessary to cap their head for support; although I understand some babies like the security it provides them (while others detest it completely and will fight it).

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We are told to support their head because it is disproportionately large when compared to the size of their body (at birth it is already half the size of an adult’s head) and is roughly the same size as their chest until around two years old. Although, the head is well developed (to allow for brain development and growth), the muscles of the upper spine are not as well developed and take time to develop. The upper curve of the spine, the cervical curve, develops first and can be seen developing in infants from around 6 weeks.

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jshapeBut surely, a baby’s head will loll backwards if not supported. Not necessarily, the spine is an amazing invention and by ensuring a baby is fully supported and has a pelvic tuck (being held in their natural foetal/ m shaped position, with knees above their bottom, it is impossible for head to loll as the vertebrae stop it. This image from Sheffield Sling Surgery shows just how supported a baby is simply by being held in the correct position, without the need for anything supporting behind the babies head. Try it yourself by completing a full squat with your feet flat to the floor, bottom lower than your knees and not ‘supporting’ yourself with your hands. The minute you rock out of the squat you will be able to tilt your head fully back but not while in the squat positon. This is another reason having the carrier tight is important, by preventing a baby from slumping (and compromising their airway) they also can’t rock out of the squat. The first place anyone should consider adjusting for a baby that has a lolling head is their pelvis – the spine after all is all connected to one and other.

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Another issue to consider when ‘supporting’ a baby’s is head, is that the carrier does not prevent movement. In the event of danger, even small babies can normally move sufficiently to try to remove or reduce the threat. But it is not just cradle carries where babies head is held fixed by a carrier. Unfortunately, the weight of their head can force the chin onto chest and obstruct a baby’s airway. This is most common in cradle carries. Carriers that have high-flat elasticated sides, as well as forcing chin onto chest by encourage even more curling of the spine, also can cause rolling towards the wearer. Both of these mean that the ability for baby to move their head away from trouble is restricted. It is for this reason, that most ‘bag style’ slings and cradle carry positions have been removed from sale or removed from instructions. Many carriers extol the benefits of their ‘headrests’ but if the baby can’t move their head (often due to ill-fitting carriers) then this head rest could be dangerous.

 A ‘headrest’ is a strange term, as the head should ideally rest against the carrying adult. Further support behind the head is of course possible in many carriers, or with a supplementary hand, but it should not come at the expense of freedom of movement. Nicola Lawson, The West Yorkshire Sling Library

IMG_5249The final element to consider is the use of ‘sleep hoods’. Although, they can make a novice sling user more feel more comfortable when their baby is asleep, they should never be fastened on both sides to that the baby cannot move their head or so that the flow of oxygen to baby is compromised. In hot weather, it is also harder for baby to cool down if they are being covered too. The temperatures of ‘covered’ baby’s, whether in car seats, pushchairs or carriers, can quickly increase.  If hoods are fastened in such a way, it impossible to keep baby in view, it is impossible to check on their well being.

I know that hoods, passes and head rests can help sling users feel more confident but they should never be at the detriment of safety. A gentle hand if leaning forward should be sufficient. If it isn’t, the carrier needs adjusting and fitting correctly. This is what your local sling professionals are here for, so just ask. You can find your nearest consultant/library by visiting Sling Pages.

Be safer

With thanks to Dr Rosie Knowles of Sheffield Sling Surgery for allowing us to use her images and for proof reading this article before publication. Thank you to Suzie Young (registered Midwife) for reading through it too.

Safe sling use and the pressure to feed in a sling

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The arrival of a new baby is a joyous occasion and the desire to want to keep them safe is one that is at the forefront of a mothers mind. As mothers we do all we can from the minute we discover we are expecting (and before in some cases) to protect them. Keeping baby close to you can be one of the easiest way of helping mums know that baby is safe and this is why many parents will choose to use a sling with their baby.  Babies want and need to be held; they are biologically programmed to want to be close to their care giver.

Sadly though, there are risks when carrying a baby and it is crucial that we follow some simple safety guidelines. Special consideration should be a taken when carrying babies who were born prematurely, with a low birth weight or who have underlying medical conditions; however, it is also important to remember that carrying can be extremely beneficial to both baby and mother in these situations. Kangaroo Mother Care has been proven to have health benefits and to save lives and reduced length of hospital stay, and using a carrier can help attachment and bonding (especially important if mothers are suffering from PND). We must therefore acknowledge the risks of using a sling are outweighed by the benefits.

Changes in the carrying industry following the Infantino Slingrider recall in 2010 have looked to address many of the issues of carrying young babies and the increase in easily accessible trained babywearing support has become a much larger element of the carrying community. There has been an increase in regulation (primarily in USA) and  professionalism within the industry, with sling libraries and babywearing consultants now available across the country. As carrying has moved from a small niche audience to mainstream parenting, it is no longer unusual to see carriers on sale on the high street or to see parents using slings with their babies, toddlers and even preschoolers. Carrying our young is biologically normal. It allows us to meet the needs of baby while carrying on with our lives; whether this is looking after other children or simply getting out of the house.

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Copyright: lopolo / 123RF Stock Photo

It is this societal expectation to ‘get back to normal’ that leads many parents to want to do several things at once. One of the most frequently asked questions I am asked or read is: “Can I feed in it?” For many mothers, breastfeeding can be something they fear doing in public and want something to help them cover up, or to let them ‘feed on the go’. As a mother I understand this completely. As a breastfeeding peer supporter I understand the fears women have. As a society, we traditionally hold babies in arms in a cradle position (the need to support their head is drilled into us from when we are children) and this position is often associated with breastfeeding or seen as the main feeding position. Unfortunately, this position in a sling is dangerous if not done correctly. In arms a baby is supported and his parents are fully aware of what baby is doing. However, in a carrier their disproportionately large heads and weak neck muscles, combined with the weight of gravity and the bounce of fabric (as well as a feeling you are hands free) can cause babies chins to rest upon their chest. This has the potential to block their airway and sadly lead to positional asphyxia (similar effects can be caused by infant car seats).

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Copyright: lenor / 123RF Stock Photo

As a carrying consultant, I often tell mums that “if you need my help to feed in a sling, you aren’t good enough at one or the other”. I don’t mean this in a way to criticise the mother (although I know many might see it like that). Breastfeeding and using a sling are skills that need to be learned and trying to mix them can lead to frustration and a feeling of failure. As babies get older and feeding is better established combining the two is a natural link to make, but in the early days when baby and you are learning what to do, please do not feel you have to try, it is ok to sit and rest, to watch the feed carefully, to learn the signs of when your baby is full.

Copyright: North East Sling Library

13032095 - mother with baby in a slingIt is the risk of positional asphyxia when using a cradle carry position (typically in a ring sling or stretchy wrap carrier) that has led to it being removed from many manufacturer’s instructions, why I have only taught it twice (both in situations where upright and off-centred positions were not possible due to other medical complications and neither wanted to feed in the sling) and why a post on social media asking how to do it can lead to many having a meltdown at their keyboards. Unfortunately, there are slings that still have it in their instructions or which advertise breastfeeding position as a selling feature (often cheaper brands sold on ebay/amazon) and there are thousands of videos on YouTube– a quick search of the site brought up 2100 hits (over 3000 if you use the search term breastfeeding in a stretchy sling) – of various levels of detail clarity.

Copyright: lenor / 123RF Stock Photo

Therefore, when carrying a baby in a carrier it is important to take time to learn how to use your sling; to read the instructions (I know as parents life is busy but it is worth it), to practice tying it and to seek help/support if necessary.  When looking at buying a sling (a term I use for all carriers except framed back carriers but which is often most used for stretchy wrap carriers) ask yourself some simple questions:

  • Is it from a respected company?
  • Do they have up to date instructions and safety guidelines on their website?
  • Can you get in touch with them for support?
  • Has it been safety tested and is it made with child safe dyes?
  • Is the price too good to be true?

When using your carrier it is important to follow the TICKS guidelines. These were developed in March 2010 and have become the gold standard for safe baby carrying in the UK (North America often use the Visible and Kissable rule). TICKS seeks to provide 5 simple and easy to remember steps to keep baby safe by maintaining a clear airway: Tight, in view, close enough to kiss, keep chin off chest and supported back. One of the simplest ways of achieving these five steps are to keep baby in an upright position and babies can be carried upright from birth; a well-fitting sling will provide a newborn with the support they need for their head (being held upright also has the benefit of  helping babies with wind). But, being upright, can make it harder to breastfeed in a sling to begin with, although as baby gets older it gets easier – this biological upright feeding position can be easier for baby too.  Keeping baby visible allows us to easily monitor them, to make changes if necessary. Tying the carrier tight and ensuring it fully supports babies back not only helps them to feel secure (by creating a point of stability), it prevents them from being able to slump in the carrier.

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Carrying your baby in a sling is a wonderful feeling and can be extremely empowering to the mother (and other caregivers). Done safely, it can be the key in unlocking amazing adventures together or simply getting out of the house. Enjoy the freedom, the cuddles and take one step at a time. Do not think, that by putting baby in the sling they are fine by themselves, babies needs change with seconds. It should be an enjoyable shared experience but one where the wearer is fully aware of babies needs at all times. If in doubt, stop and ask for our help: that is why I and consultants across the country are here.

 


Where to find out more

http://www.cochrane.org/CD002771/NEONATAL_kangaroo-mother-care-reduce-morbidity-and-mortality-low-birthweight-infants

http://apps.who.int/iris/bitstream/10665/42587/1/9241590351.pdf

https://sheffieldslingsurgery.wordpress.com/2014/04/04/sling-safety-with-young-babies/

https://www.nct.org.uk/parenting/sling-safety

http://babyslingsafety.co.uk/

http://www.which.co.uk/reviews/baby-carriers-and-baby-slings/article/baby-carrier-and-baby-sling-safety/baby-carrier-and-baby-sling-safety-tips

What the flip?

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I spend lots of my time as a carrying consultant telling parents that they can flip the shoulder on their wrap,  wrap strap carrier and even pouches and ring slings. But why? What difference does it make and what an earth is the difference between an open and closed shoulder flip? Sometimes a the term shoulder flip is used to describe a pass which comes under arm and flipped back over shoulder to create a rucksack pass. In this blog we are looking at shoulder flips which spread the wrap over shoulder as seen in the photo to side of screen.

 

Shoulder flips serve many purposes and they reason for flipping the shoulder can effect which way you want to do it. (Photo with thanks to Emily Dickinson).

Reasons for flipping your wrap include:

  • Safety – it ensures we can keep baby visible by allowing clear airspace around baby
  • Comfort – by cupping the shoulder it helps distribute the weight of baby across a wider area. Many people find it less diggy than a ruck sack pass.
  • Tightens the top rail and removes slack
  • Lines of support by anchoring the wrap in place – that is to provide vertical lines in a carry that can help keep knees high. A horizontal line in rebozo or ring sling carries helps prevent the wrap going across the baby at an angle. 
  • Look – change the colour or contrast of your wrap. Great for wraps with different coloured sides or a right/wrong side.

“I most often use it to provide greater comfort for me. I love the way it cups the shoulder and spreads the weight.” (Suzanne Pearson, Sling Stars).

 

“It doesn’t dig in when you flip a shoulder, as opposed to ruck straps which can be diggy.” (Renee Jeffery, Close Enough to Kiss Magazine and Norwich Sling Library)

Open or closed?

In this image (courtesy of Rosie from the Sheffield Sling Surgery) you can see both an open shoulder flip on the left and closed on the right (as you look at screen). Both have helped to create space around the baby’s face and both are cupping the shoulders and spreading the weight of baby. But why do one over the other?

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Open Shoulder Flip

Open shoulder flips are quick, they can be achieved easily and help create that much needed clear space around babies face. They are not though secured in place and can come undone with movement.IMG_5246

They are a temporary quick fix solution securing it in place. By spreading the pass down her arm and folding the bottom suzanne openrail up again it also helps to make the wrap more comfortable for Jen to use. Here you can see the open shoulder flip in its full effect and how well it clears the space around baby’s face.

 

“It gives a clear airspace around the face in stretchies.” (Jacki Davenport, Director of Slinging London CIC).

Closed Shoulder Flip

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Closed shoulder flips are a secure flip, they cannot come undo and this makes them more suitable for longer period of carrying. They again help create a clear space around the baby’s face by creating a horizontal line with the top rail (yellow rail in this photograph of Rosie from Sheffield Sling Surgery.

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This helps tighten this rail too making the carry more supportive by removing slack.

 

The vertical line that is created (green rail in this case) provide support in babies knee pit and helps keep it raised for optimum positioning and comfort. Striped wraps can make working out which rail is which much easier with their clear contrasting rails. You can see in this photo the clear vertical line fro babies knee pit up to shoulder.

Finally

How you decide to flip your shoulders, if you decide to flip them at all, is up to you. They can make it much more comfortable for you, make it safer for baby and tighten the carry, as well as being aesthetically pleasing to look at. Next up, I will write a photo tutorial explaining two different ways to achieve a closed shoulder flip.

I” love how you can change the colour contrast of your wrap from just a shoulder flip (if your wrap has stripes or preference to the wrong side look)” (Natasha Wheeler, Carrying Consultant)

emily d open shoulder flip

Links and Thank You

Thank you to the three Slingababy trained carrying consultants who shared their photographs for this piece. Emily Dickinson of The Wirral Sling Library, Suzanne Pearson of Sling Stars and Dr Rosie Knowles of Sheffield Sling Surgery. Thank you to Jen and Baby Tessa for modelling for us too.

 

Professional courtesy and sticking to what you are trained to teach.

I am extremely proud of my profession. I am a teacher by training and practice. Although I no longer teach in a classroom teaching teenagers I do spend my days teaching new parents how to carry their children comfortably and safely. I am a Babywearing Consultant. I have spent several thousand pounds training, I attend regular continuous professional development, I have insurance costs and pay subscriptions to our voluntary professional body. I know my area of expertise is slings and carriers, baby handling and sling safety. I know where to draw the line. I know I am not a doctor. I do not give medical advice. Despite being a breastfeeding mum and breastfeeding peer supporter I know I cannot diagnose feeding issues. I know when to refer to those who do know more than me. I know my professional boundaries.

When I see posts dismissing what I and many others do it is extremely hard not to be offended. Unfortunately, a recent social media post, and then subsequent dismissive comments, by a well-known breastfeeding expert has caused upset to my profession. 

If you are going to share material that is not within your area of expertise it is only correct that those of us who do work in that area identify flaws and sign post to sources of help. How many of us would start a reply with the words “Oh Please”? Does it seem respectful? Non-judgmental or professional? I think most of us would agree it doesn’t. It appears rude and disparaging; especially when you are commenting on something you only have your own experience of doing (and when you have openly criticized the role of peer support in your industry). I was especially taken aback by this. It was certainly not the way I thought a respected International Board Certified Lactation Consultant (IBCLC) would start a reply.

IBCLC are in a highly privileged position; their title is a protected one. This means you cannot simply start calling yourself one. It takes years of training and recertification every 5 years. However, IBCLC have not always existed. They began after a loan from La Leche League International in 1985 in a move to professionalize the industry. The Lactation Consultants of Great Britain has an even newer history forming in 1994. Nobody would say a IBCLC has less importance than a Midwife, or Physiotherapist or any health care professional – but each would agree that they all have their own area of expertise. It is not necessary to see an IBCLC to breastfeed, but if having difficulties then it has benefits. IBCLC are trained to assess a feed in detail; for example, look at the structure of the mouth, transfer of milk, tongue function, suck and swallow of the baby.  In same way that a midwife is trained to care for a mother in the antenatal period, and to help deliver her baby and care for the mother and newborn in first few weeks postnatally. Their professional expertise though does not stretch to caring for a 2 or 3-year-old. Here, a health visitor would be qualified to help. Knowing where our professional boundaries and personal experiences lie, is crucial.

Babywearing Consultants do not have the luxury of a protected title. Currently, anybody can choose to call themselves one. It is only in the last few years that there has been a growth in our number and an increase in training opportunities. We are experts in our field.  There are moves to create national and international standards and a regulation of our industry. A move I wholeheartedly applaud.babi-logo-transparent It is why I already subscribe to the British Association of Babywearing Consultants (BABI). Babywearing Consultants are attempting to professionalize our industry in the same way IBCLC did in 1985. Just because we are still in the process of doing so does not mean our knowledge or expertise is any more or less needed than that of IBCLCs: we simply have different areas of expertise.

Babywearing is a millennia old activity. For as long as humans have needed to move, we have needed to carry our young. Our babies are born helpless; unable to care for themselves and completely dependent on their parent or care giver to meet every need. By carrying our young we are able to respond quickly and efficiently to their ever changing needs. All cultures have a tradition of carrying their young; although the methods vary widely. This tradition though has disappeared in the western world.  Skills traditionally passed from mother to daughter have disappeared. It is only in the comparatively recent past that there has been a resurgence in its popularity. Babywearing, like breastfeeding, became unfashionable. It has taken the growth in breastfeeding support: from peer to peer support through to IBCLC, and international laws around infant formula marketing to help increase breastfeeding rates. The growth of sling libraries and Babywearing consultants in the last 4 years is unprecedented. The increasing understanding of ergonomic baby carriers and availability on the high street is making it much accessible.

Newborn and small babies, and those with underlying health conditions, are particularly at risk when being worn in a sling when it is worn incorrectly. This is why the TICKS guidelines were developed in 2010. They have become widely accepted as best practice for safe Babywearing. Unfortunately, if not followed (or supplied) there is a risk of a baby suffering from positional asphyxia. Any internet search about safe Babywearing will bring up stories of where things have gone wrong. As a Babywearing Consultant it is my job to help teach parents how to minimize those risks.  I work step by step, in detail, focusing on the small things which make a big difference: tightening, safety, positioning, comfort. DSCF2830This is why Babywearing consultants suggested that if you are going to back carry a small baby (something that can be achieved safely if you know what you are doing), that you do seek support, especially if you have limited knowledge of carrying your children in a sling. To suggest we are not necessary is to oversimplify the issue. No, it is not necessary to always have a consultation but there are times and places where it is advantageous. I have helped parents carry babies born extremely prematurely, with Development Dysplasia of the Hip (DDH), Talipes, multiple births, breathing difficulties, congenital heart defects, genetic disorders and hyper mobility to name just a few. As well as parents who just want some 1:1 support to get it right first time. 

 

Dismissing the role, myself, and other Babywearing Consultants, has the potential to be fatal. Please, give us some common courtesy as well as professional respect. We will stick to teaching how to carry babies safely, and will point out if there are weaknesses with technique that could be dangerous. Let other professionals stick to their specialisms. This way we can work together to support new parents for the benefit of them and their babies.