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