This article was kindly shared by Rosie Knowles from Sheffield Sling Surgery.
Rosie trained under Lorette Michallon at the Slingababy School, has done courses with the UK School of Babywearing and is a medical adviser for Trageschule UK. She is one of the founders of the popular Sheffield Slings group, a GP, and a mother of two.
Sling use for very young babies (birth to four months) is becoming increasingly popular around the more developed world; a practice that has in fact been universal for thousands of years. Families that live in extended communities or “villages” are usually able to share well-honed, tried and tested knowledge down the generations and provide easily accessible advice and support. This kind of local support is much harder to come by in our more fragmented societies, which means we often turn to books or the internet to fill the gaps in our knowledge and provide us with reassurance we are doing it right. Unfortunately, sometimes these sources of information are out-of-date or incorrect, and can lead to problems with the use of any kind of baby equipment. Manufacturer instructions can be slow to be updated with new “best-practice” guidelines and YouTube videos can often be misleading and miss out important information.
Why bother with a sling at all if there are any risks?
There are many benefits to using a sling with a very young baby; in fact. many hospitals use them in the practice known as “Kangaroo Care”, and there is much evidence to suggest this skin to skin contact between mother and newborn (especially premature babies) can confer great benefits to both. The baby gains assistance with their physiological regulation of breathing and heart rates, temperature control is improved, and the contact helps to establish breastfeeding and promote more rapid growth compared to babies who are not held as close for as long. Furthermore, the baby will feel more secure in their developing relationship with his caregiver, due to the time spent in close contact. The caregiver may find that he/she is able to bond with her baby, due to the increased release of oxytocin, and post-natal depression may be reduced. Being able to be “hands-free” can really make a difference to a family’s ability to get around with their new baby, keeping them active and engaging with normal life.
The key is to know how to use the sling in a safe and secure way, just as you may practise learning to ride a bicycle, or drive a car. Familiarity and practice make perfect. Many parents choose to use a stretchy wrap for their tiny baby, as they are very soft and snuggly, very respectful of baby’s natural position, and easy to take on and off again. Others may use a less structured and very adjustable ring sling and some will choose to use a supportive but rigid buckle carrier. Others will use a bag-shaped sling as they have seen it for sale and seen it marketed as suitable from birth…
All baby equipment should be used safely, and it is an unfortunate fact that sometimes things are not fit for purpose, or the instructions that come with equipment are inadequate.
How can I ensure I am using my sling safely?
Use your sling in a safe way
A good sling should mimic the natural, in-arms upright position for carrying babies, ensuring the caregiver can see and sense the baby at all times, and thus able to be quickly aware of and rapidly responsive to any changes.
I see a lot of parents with newborn babies wanting to learn how to use a sling, and this diagram is the first thing we look at.
ABC is the basic first-aid mnemonic, and also begins with AIRWAY. Babies’ heads are heavy and it takes time for their muscle strength and tone to develop enough to hold up their heads and support their own airways; until then, it is our job as parents to be as caring and careful as we can. A baby’s head should be resting against the caregiver’s chest, with the windpipe straight, not curled over. A good guide is at least two fingers being able to fit beneath chin and chest. Air should be able to circulate freely and the face should not be obscured by fabric, or buried within cleavage. Baby’s cheek can rest against parent’s chest, and hands should be accessible to their mouths.
BODY POSITION is important to protect the airway as well. The upper body should be supported against parent’s chest, to ensure no slumping (this is why carriers should be tight, to make sure that babies do not roll up into a ball). The pelvic tilt into the M shape with knees higher than chest will help support baby’s back as well as being very comfortable. The back of the head should be supported where possible to avoid backwards lolling. The pelvic tilt and using a rolled muslin cushion can be helpful if babies resist head support.
COMFORT comes last – I would rather see a child in an uncomfortable carrier that was safe, than fast asleep slumped into a tight ball or folded over in a cradle carry, however comfortable it is. However, you and your child are likely to enjoy and appreciate a carrier that is pleasant to use, fits well and does not cause back pain.
I would never recommend any kind of lying- down position in a carrier, especially where the back of the head is bent forwards to compress the airway and a child is thus not able move its head freely to clear any blockage. Breastfeeding is usually safest done in upright positions for this reason, and a child who falls asleep feeding in a sling should always be brought back into this safe position, to protect airway.
In summary, the safest position is an upright one that meets the TICKS guidelines – Tight, In View, Close enough to Kiss, Keep Chin off Chest, Supported Back.
Use a sling that is safe
Make sure it is fit for use; no holes, no loose stitching, no broken buckles, for example. Avoid slings that have been recalled (for example, two makes of bag slings have been recalled due to tragedies). If you are unsure, do ask around for other people’s experiences.
Get help and advice
There are many, many sling communities in the UK, sling consultants like myself who offer one to one sessions where you can look through the options and practice using a carrier safely, sling libraries with trained peer supporters where you can try out slings and get some advice, and sociable sling meets that will serve a “village” purpose for parents to share their growing knowledge/personal journeys and offer support. Don’t rely on books/pamphlets/the internet – be armed with education and take advantage of the experience you will find in your local resources.
If you are unsure, do find your local sling professional – we are always happy to help.