[00:00:00] Dr. Alicia: Welcome to the pregnancy for professionals podcast. Today, we're speaking with Sam Bright and Megan Tennant, pediatric physiotherapists. And our topic is babywearing. We'll discuss the benefits of babywearing both to parents and to their infants, as well as some safety recommendations and positioning pieces.
[00:00:15] We also have a couple of great downloads for you and for your patients or clients in the show notes. So make sure to check those out.
[00:00:22] Hey, it's Dr. Sarah and Alicia here, and you are listening to the pregnancy for professionals podcast. Our goal is to bring forward evidence-based information from all disciplines, supporting pregnant people through their journey, to becoming new parents from physicians to midwives, nurses, to physiotherapists and everyone in between.
[00:00:41] Make sure to fill out the quick survey in the show notes to let us know which topics you are interested in learning about, and to make sure we are serving you our maternity care provider. Well, don't forget the information on this podcast is for educational purposes only, please consult with your team and your community for individual medical decisions that [00:01:00] need to be check us out on Instagram at pregnancy for professionals to find informative and educational posts for both of you and that you can use for your.
[00:01:12] All right, Sam and Megan, thank you very much for joining the Pregnancy for Professionals podcast. We are going to chat a little bit today around babywearing. Now I'm going to be honest, I use baby wearing for both of my kids, but I honestly used it more of a transportation. Yeah. And a convenience piece as opposed to a parenting tool. And as I was looking into some of the research around this to prepare for today, I really realized that actually, maybe we should be talking to our soon to be parents about using babywearing actually to improve outcomes for them and for their baby. So today we're going to kind of focus, mostly on those pieces of the puzzle.
[00:01:51] We'll chat a little bit about the benefits of baby wearing the evidence behind that, which had a little bit about how we can do that safely through the first kind of six to [00:02:00] 12 months and what we need to be cautious about and guide our patients and clients on. And then we'll chat a little bit about the three main types of baby wearing.
[00:02:07] So the ring slings, the wraps and the what's it called again? Team? Yes, structured carrier. Thank you. So that's what we're going to shout about today, so we will just get right into it. So why don't we start talking a little bit about the benefits of babywearing. If you guys want to start, we can talk about the benefits to baby, and then we can talk about benefits to the parents.
[00:02:32] Megan: Absolutely. So it has been pretty well established in the research benefits to baby. A lot of that actually being research done in the NICU that kangaroo care but and then gone from there, but that baby wearing can have such a benefit to baby just from that attachment, that bonding regulation of the nervous system. Any of those things there's great evidence of obviously babies undergoing neonatal absence syndrome. But it actually really has massive benefits that baby wearing that [00:03:00] kangaroo care, skin to skin contact really helps with what happens in baby physiologically.
[00:03:05] So helping to fill their heart rates, so their breathing, improving feeding outcomes. All of those things have been really well established, especially in their very young baby, the premature baby. And again, maybe babies who might be substance exposed as well.
[00:03:17] Dr. Alicia: Yeah. And there's been some good studies around the kangaroo care, which is that kind of clothes, skin to skin with parents in premature babies around decreasing morbidity and mortality, decreasing sepsis and improving feeding and weight gain in those kind of first few months while they're in the NICU. So I think that's, you're a hundred percent, that's really well-established. And we're just starting to look at some of those other pieces. So I know I came across an article around attachment in input in a population. Sometimes struggles with attachment with their babies. And so this was a study that was done, I think a couple of years ago, not that long ago.
[00:03:49] And it looked at very young moms and it looked at comparing babywearing for starting at two to four weeks of age. So the control group was reading an hour a day to your [00:04:00] baby. And then the study group was, it was an RCT. The study group was babywearing for an hour, a day for three months. And then it looked at kind of attachment through this global development infant global developments. And I don't know that it was statistically significant, but there was a generally a pretty good correlation with increased baby wearing with increased attachment. And the groups that didn't do the baby wearing had more of that kind of disturbed attachment. So it was really interesting to see that, especially in that group, which may be a little bit more challenging. And we're going to chat a little bit about more about infant crying as well and how it can make that a little bit less. And I wonder if that's a part of the piece that if the babies are crying, it's easier to attach to them as well.
[00:04:43] Sam: Yeah, I think some of it articles around that crying piece as well and the evidence has come out from that is alongside the attachment and that regulation piece of breathing and heartbeat and things like that, that they can feel alongside, and also that kind of tightness position that they're so used to [00:05:00] in the womb. And as fast as the weeks that when they're coming out into those carriers and into, especially those laps that they feel secure, and when it comes to calming with quiet, you can move easier in it. That's right. We can move around. That was definitely something that came in the articles that we read was about the movement in the wraps as well for baby, especially when crying is something that we're looking at as well.
[00:05:20] Dr. Alicia: And then the other thing that there are definitely some studies done is it improves breastfeeding rates. So I think one of the kangaroo studies were looking at breastfeeding rates as well, one month, four months, six months out. It actually improved breastfeeding rates and we know breastfeeding is important. It's not right for everybody, not every family is going to be able to, or be interested in for a variety of reasons. But for those families who do hope to breastfeed and exclusively breastfeed baby wearing can be one of the ways that can help improve that. And whether it's through that skin to skin and that oxytocin release or just feeding while they're in the infant carrier, it's just easier. And so baby's able to just access that food more easily, drain the breast, [00:06:00] promote, increased milk supply. I suspect that's part of the physiology around that piece. Anything that you guys want to add around that breastfeeding rates?
[00:06:08] Megan: No, I think I read the same similar articles. So that was really interesting. Yeah. That's awesome.
[00:06:13] Dr. Alicia: So you guys are pediatric physiotherapy therapists, so I know a big piece of the puzzle is hip dysplasia in infants. So why don't you guys chat around that a bit?
[00:06:23] Megan: Absolutely. So there is some of the negative studies and so what might still be persisting sometimes in the back of our minds that from previous ways of babywearing have been regarding the hips in the same way that there still be some of this thing that we think about swaddling when it's done improperly the studies that show increased rates of hip dysplasia, with babywearing and swaddling is because of the type of swaddling, the type of baby wearing that was being done. So what's great is with this kind of last several years now where babywearing is becoming much more popular more and more studies are coming out saying no, absolutely with the right positioning, it actually [00:07:00] can benefit hip development. So it can actually lead to improved hip development as long as it's being done correctly.
[00:07:05] So from journals like the international orthopedics pediatric orthopedics, there's quite a few that have done studies specifically regarding developmental dysplasia of the hip. Not a ton specifically on babywearing only, but generally baby wearing is always one of the pieces at least studied regarding how to prevent and treat hip dysplasia in infants.
[00:07:24] And the they conclusion that's been drawn is if babies are positioned in a carrier or a sling or wrap with those hips in the wide abducted, position with knees above hips or in a brand new intent with the hips flex and knees up to the chest, then actually can lead to improved outcomes for hip development and for babies being treated with, for hip dysplasia, it can also lead to improved outcomes there because it's lots of time spent in that ideal wide abducted position that we're looking for when dealing with baby hip development.
[00:07:58] Dr. Alicia: Awesome. Thank you. [00:08:00] So why don't we chat a little bit about benefits to the parents and I'm not using mom's here because everybody can do baby wearing.
[00:08:06] And this is the, one of the things we did. We have I have a patient focused one, so we just did one around this thing for our patients as well. And we were talking about how this is such a wonderful way for partners to support the breastfeeding parent who sometimes can feel overtouched and just touched out and doesn't want to have the baby all of the time. So you know that the breastfeeding parent feed the baby, and then the other parent, the non breastfeeding parent can do the baby wearing and get that wonderful bonding and attachment as well. And give those benefits to the baby and give the breastfeeding parents a little bit of space so they can have a break because sometimes it is a full-time job. So let's chat a little bit about kind of the benefits to the parent who was doing the babywearing.
Benefits to Parents
[00:08:45] Sam: So as you said Alicia, I think it is because both partners can babywear. So it is really nice that parent who may be breastfeeding can step, like you said, go very touched out. And I think some of the benefits to parents as well is that they can move around a little bit more. When baby's [00:09:00] on, you've got both hands again. So I think the baby wearing positive, they're a huge from that point of view, but also, as we said as well, one thing and attachment piece is huge for parents. And I think also with babywearing, I think that some of the articles that we've read about is as baby gets bigger and you'll get stronger, it's every nice way to help your stance as well and feel like you're getting strong for yourself as baby's getting bigger and you're walking that little bit further and you can do some more phase less kind of flat path and do more activities with them with baby on yourself as well. Exactly more exercise classes and things. Definitely. And there's yoga and pilates classes out there with baby as well. And it just gives you the opportunity to do that when you're wearing baby as well, which is really nice, from a social point of view. Yeah.
[00:09:45] Megan: And there's also some interesting studies in parents. I think a lot of them are done more for the birth, the birthing parent because of some of those postpartum mental health aspects but done there to determine whether that baby wearing are [00:10:00] particularly skin to skin contact, which again, baby wearing allows us to do really easily with hands-free and just, it gives you more time, you can do it. And there are some evidence that it can actually really help particularly some of those more lower risks birthing parents. With some of the postpartum anxiety, possibly some of that postpartum depression. Generally what I've seen is, what much more higher risk, much more severe cases less, but then there's the question of whether maybe these, they were lower risks and they had lower experience of those mental health symptoms because they did more babywearing. So I think that's still definitely a place that we need a lot more research, but there have been some positive studies as far as being able to potentially help with some of those early postpartum mental health struggles that moms and birthing parents can experience.
[00:10:43] Dr. Alicia: Yeah. And I think maybe I wonder if that some of that goes back to the decreased crying of the baby. Again, like if you feel like you can soothe your baby and you can meet their needs, you're going to feel much more comfortable with yourself and confident with yourself and therefore, hopefully your mood would be better. Again, those severe cases. Maybe not because that's going to [00:11:00] be, that's more a different realm, but but yeah, really interesting. The other one I was finding was, oh, about the crying. We forgot to talk about this. Unfortunately, there is no evidence that shows baby wearing can prevent colic or improves colic, which is a bit of a bummer, I thought, cause wouldn't that be lovely? So decrease the rates of crying, it decreases the the significance of crying except in those babies with colic, which was too bad. Yeah. And any other benefits that you guys wanted to chat about? I think you were talking about the parents or moms ergonomics. I'm not sure if we chatted a little bit about that, or if there's something more you wanted to add.
[00:11:36] Megan: I think some of that would just be more it's beneficial to the parent caring as one as they are wearing baby. We want to make sure, we're pediatric physios, so we are thinking about the baby when thinking about the little one. But honestly, so much of the research really focuses on the position of the person wearing the baby. Because again, if you are hurting your back or uncomfortable, or now your neck all tight, because even wearing baby and [00:12:00] properly, then the benefits would no longer outweigh the risks. I'm doing some, potential physical, not horrible long-term damage, but just being in pain.
[00:12:08] And if you wear your baby and then you're in pain after that's not going to make you want to wear your baby anymore. So there's lots of, I actually found a ton of research regarding, at times relatively, but regarding the parents' position and where what is better or worse for a parent? Generally more negative on something like a ring sling, which is more asymetrical, definitely more positive toward that more symmetrical whether they're carrying a wrap, nice and snug, or one of those structured carriers properly fitted with the baby's weight, distributed over the hips, as well as the shoulders, as well as the back in order for the parent to be as safe as possible and as comfortable as well.
[00:12:43] Dr. Alicia: And there's one other thing that you brought up that reminded me again, in terms of you guys being pediatric physios is plagiocephaly and torticollis and the, the benefits of baby wearing around that and the potential issues that we need to think about, especially if we're doing kind of ring slings or by [00:13:00] nature of us being parents and always our people and always being one-sided. Can you guys chat a little bit about those benefits and what to watch out for and what to think.
Plagiocephaly & Torticollis
[00:13:08] Sam: I think definitely coming back to ring slings, it's really important to remember to do it that way on both sides. We a very dominant on one side, we're very confident on one side. But that means that baby's head is always positioned in one position and we want to reduce the risk of that stuff.
[00:13:23] But and one of the benefits of baby carrying is having baby off the back of their heads or side of their heads. So with the wrinkling in particular, it's really important to switch sides so that you have got them on either side. So it's good for your shoulders and back also good for baby's positioning as well. What am I thinking about any of the other wraps or carriers just gently rotating baby's head. So they're not always facing to one side. Because sometimes we don't realize that babies have that preference until we talk about it or identify it and just gently rotating with them. And baby's head so that they're looking to both directions, not in the wrap or the carrier. Because we're pediatric physios, one of the biggest things that we recommend [00:14:00] babywearing for is to take the pressure off the back of their heads to prevent any of those flat spots.
[00:14:05] Dr. Alicia: And that's a great tip. And to extend that out to I'm talking to new parents about when you're putting your babies down in the bassinet or in the crib, or changing their diaper to alternate, the ways that you're doing it, because they're going to be looking at you because that's what they want to be looking at. So if you're alternating they're going to be naturally stretching both of those muscles, rather than getting one tight in one stretched out, which leads to torticollis, which can lead to plagiocephaly et cetera, et cetera. Yeah. Awesome. Great tip.
[00:14:28] Megan: Just one other things for professionals who are recommending to families about babywearing on that note, but just, it's been really nice thing to tell families if they're struggling with tummy time with a really new baby that babywearing can be a really nice way to get on their tummy, lifting their head to look at the caregiver. So it's a nice if you can give them as well it gets the baby off their head and it gets some of that tummy time in for those brand new babies at zero to two months range. So a really great test day. Hey it's okay. Why don't you try putting them in the carrier? That's also a great time, baby is working on their neck muscles. They're doing a good job. So that's always a [00:15:00] great catch for families as well.
[00:15:01] Dr. Alicia: Yeah, that's awesome. So why don't we move on to some tips and tricks. How do you talk to your clients around positioning babies? And Sam, I know you have a great resource for us that we'll put in the show notes.
[00:15:13] Dr. Alicia: So why don't you start off by talking about that and then Megan can chat a little bit about the hip positioning and ages and stages and how to manage that.
[00:15:21] Sam: Sure. So we recommend to our families the acronym, T.I.C.K.S. T.I.C.K.S. is actually, you can find it on Babywearing UK. And so it's come from some resources obviously from my accent that I have in the UK.
[00:15:32] And so ticks is a really nice acronym because the T stands for tight. So slings and carriers it should be tight enough to hug your baby close to you. As this is most comfortable for baby and parents, I think that's one of the biggest pieces. A comfortability piece of baby as well. And it means that babies don't slump down.
[00:15:47] So particularly in those rats and the wrinkling, that's really important to keep them tight. So babies don't shuffle down and they're kind of, hiding down in that wrap instead. In view at all times, I think is really nice to remind parents is that you should always be able to [00:16:00] see baby's face by simply glancing down and that the fabric or the carrier is not too close around them so that you have to open it up to check on them.
[00:16:08] Close enough to kiss is a really nice one to remember as well. And that baby's head should be as close to your chin as comfortable really. You're not grazing it, but it's right there to kiss baby's head. Keep the chin off the chest so, obviously. Historically some of that, around baby carrying, cautions around airways with babies. So keeping that chin off the chest means that babies shouldn't ever be curled in so their chin falls down onto their chest, as that can restrict their breathing. That's really nice to know that kind of keeping that chin up, especially in those ring slings and wraps and helps prevent any airway issue.
[00:16:37] And then the S in T.I.C.K.S. is for the supported back. So in an upright carry that babies should be held comfortably close to the wearer. The bare back is always supported in a natural position and their tummy and chest are against you, but they're not falling back away from the carrier at the time. And again, because if the sling is too loose, they can slump and then you rest that chin down on that chest.[00:17:00] And so T.I.C.K.S. we'll add a PDF into the show notes there, as Alicia said because it's a really nice acronym that we can all remember and just gives us some tips now on that positioning of baby.
[00:17:09] Dr. Alicia: Yeah. And a great download. You can just print off for your patients or clients and hand to them to remember as well. So that's, I'm finding that really useful. And then one other thing I just wanted to quickly chat on the evidence around slings. Any of the ones we're talking about are safe to use in newborn babies.
[00:17:24] The ones that we worry about are those ones that we can't adjust and tighten up. So they're almost like a big hobo bag that look really awesome. I got my colleague one for her, with her newborn baby before I realized this. And so those, the studies have, there've been a few, especially with premature babies, so those babies who haven't yet reached the corrected gestational age of 40, 41 weeks, of cardio respiratory issues because they cannot protect their airway in those. But as long as you're following the T.I.C.K.S. acronym any of the other carriers, it should be fine. And Megan reminded me, oh, this is she's going to talk about hip hip positioning, and also where you can find a list of [00:18:00] those hip safe slings.
[00:18:02] Megan: Awesome. Yeah, as I mentioned, we're talking about evidence is that if you can position babysits appropriately in a carrier, there is no increased risk of hip dysplasia with baby wearing. In fact, there might be a benefit to hip development. As long as baby's positioned correctly, so there's basically two ages we want to talk about in those early stages at zero to two months, that brand new baby in that physiological flection position in a baby carrier, whether it's a sling or a wrap or a structured carrier, we want baby in that beautiful flex position. So knees flex right up to the chest hips, fully flexed. That's a perfect position. So the carrier needs to be sure to be able to put baby in this position again, making sure a beautifully flexed, but that chin is off the chest as Sam explained for safety. But as far as the hips goes, their hips are maximally flexed, knees maximally flexed, baby all curled up. That's perfect in those early stages. As baby gets past that two months range, they starting to [00:19:00] open up, they're starting to experience some extension coming out of that newborn flection position now is when we want to make sure that we're starting to create the M shape with the legs.
[00:19:09] So when baby is in a carrier and again, same thing. Moreso for the wrap and a structured carrier, it's a little harder to do it in the ring sling. But you want to make sure that those babies legs are fully abducted so really wide at the hip and then the knees slightly higher than the hips, if you can, so their legs from bottom to top should make that M shape with their bum kind of that point in the middle of the M. And with the different types of carriers, I'm going to give the resources a beautiful picture there as well. The hip dysplasia Institute has a great picture of that M shape and a baby in a carrier.
[00:19:41] That's a great resource to provide to your clients or your families as well. For the older babies two months. And depending on the baby for some babies can get into that position and that's two months, sometimes it's more three months or four months before they're, you can really comfortably get them in that nice M shape. But if you're not in that M shape, nice and slack, hips and knees [00:20:00] flexed so that we're making sure that the legs are not hanging straight down. It's that straight down positioning that can cause poor head development and potentially again, in the evidence that's been shown to potentially increase the risk of hip dysplasia. The resource for where to find those carriers is hipdysplasia.org. It's the Hip Dysplasia Institute. They've undertaken a lot of research. They collated all the evidence together as well, on what might be a beneficial carrier. There's probably a hundred on there, so it's not really specific. But they have a list of what they call hip healthy carriers and both wraps and structured carriers. And I think even some ring slings are in there as well.
[00:20:34] Dr. Alicia: Great. And we'll put that in the show notes and another piece, which we might get to later, but you were talking about in our patient focus podcast around switching from, in those structured carrier, switching from facing internally to facing externally. And that's an important milestone piece in terms of hip development. So do you mind broaching on that?
[00:20:52] Megan: Sure. Yeah, so parents always ask us this too. Like when can I turn my baby forward? Kids, obviously it's happening throughout and into toddlerhood, but it's a really [00:21:00] important stage from the zero to six month range. So that's why we prefer babies and we recommend babies stay in that rear facing. So don't turn to forward facing until at least six months. The reason being, it's a lot harder to get the hips in that M position when you're forward facing. The carriers, do their very best, but generally it's a lot harder to get the knees above the hips in a forward facing position. And so that's why at that six month mark, it starts to be a little less of a concern. The hips have done a lot of really good development. And at that point in order to be able to face forward and have their legs hang down a little bit more, we still want them wide abducted, but we're less concerned about the knee being higher than the hips when they hit that stage.
[00:21:39] Dr. Alicia: And another thing that we just want to, it's important for all of us to remind our patients and clients around is safety when using baby wearing. Those sleep deprived parents often don't necessarily think about everything. And so just reminding them, if you're drinking coffee or hot beverages or you're boiling water or you're cooking, or you're using sharp knives, don't do that while baby wearing. Cause we all make [00:22:00] mistakes. And Megan, I know you were saying in our last podcast, in terms of, even walking up those stairs in those first few weeks, right? Our core is different. Our centers of balance are different. So just reminding parents that if they're baby wearing, just to be conscientious of that and using the railing to help support themselves upstairs, et cetera, et cetera. So that's some pieces that I don't often talk to people about with babywearing, but I think there's a really good reminder just to make sure that everybody's doing it safely, cause toddlers, those arms are very long and they can grab all kinds of stuff. So just being aware is important. Why don't we chat quickly about the three major classes of baby wearing. And we'll add that kind of the hip dysplasia list to the show notes. So you don't have to go into specifics. People can check it out if they want more information or print that out for patients.
Three Classifications of Carrier
[00:22:41] Sam: Sure. So we have, as we've been talking about is the rings slings, the wraps and the more structured baby carriers. So those ring slings are more of those kinds of woven, the things that come to one side as we've already discussed, and there's many wraps out there The Moby wraps and Beluga wraps as well. There's lots of different [00:23:00] bands that we can refer to that as hip dysplasia Institute that we recommend to check those, and most brands that carry it are on there. So there's no huge concerns around those wrap pieces there it's more just lacking advising parents to look up exactly how to wear them, because even between the brands with quite a lot of difference about how we pop them on ourselves and how babies should look, in each sling. So definitely from that point of view, YouTube is a great resource for parents on that positioning piece and those ring slings. With the wraps, it's also good to just note the difference with the stretchier wraps and making sure parents are changing that as baby grows. With the structured carriers again, that main brands, so the ones that you're finding in that shops in town. Also you can double-check on that hipdysplasia.org and resource and the structured ones are definitely good, but it's a lot of education for parents when they start to, as we've already said, kind of position into that forward facing, but also when you come in some of these structured cows, you can actually put baby on your back as well. And sometimes mom's and [00:24:00] partners really benefit from at that back time because it takes the pressure off the front. So it can, if you are struggling with lower back pain, sometimes the back riding is really nice in these structured carriers. But again, just recommending to parents that we follow the same T.I.C.K.S. principles even on the back, particularly in those hip position as well. Sometimes it's almost a bit easier to get the abduction position when we're back wearing, because naturally you're coming around. But it's really nice way in those structured carriers are just having a slightly different position that kind of forward facing into parent or partner. That external facing as well, and then having them back. So the structured carriers offer a lot more variety and what Megan I have used is definitely more wraps and slings, and I've first few newborn stages and then moved on to that carrier. And later down the line.
[00:24:41] Dr. Alicia: Yeah, and I did the same. And I think just a reminder to all of us care providers is that there are experts. Most of the baby stores have people who fit wraps every day and so recommending to patients and clients to actually go in and try them on and make sure it fits you properly. Cause it may not be the best, on Amazon, your Amazon [00:25:00] product, but you know what, it may work the best for you and your partner may need a different one. So just I think it's really important for us to remember that. And there's also baby wearing experts in every single town. So if you do have a patient or a client who's struggling to find something that works well for them, maybe mentioning them to reach out to someone in their community that can I help them with that because it is, it actually is a role, which is perfect. That is a great, I think recap of babywearing around the evidence, different types of wraps and what we need to think of from a safety point of view and an ergonomic point of view, both for babies and the parents, where can people see your social media? Because you guys have a great site and have all kinds of amazing videos on this topic, but many others related to kids physio. So where can they find you guys?
[00:25:43] Megan: We are @ Island Kids Physio on Instagram, we are @IslandKidsPhysio on Facebook. Generally Facebook is our Instagram similar. So if you follow this one place, you see our content. And then yeah, our kidsphysio.ca as well, if you want to check us out online. There we are on [00:26:00] the Victoria clinic. If you're looking for us specifically, if you're local, but there are also some other Island Kids Physio clinics in other places in the country.
[00:26:07] Dr. Alicia: Yeah, and reach out to kids physios because pediatric physiotherapy is a specialty and kids can write the benefit from it. I know a bunch of my patients have seen you guys for torticollis and mild plagiocephaly and it's been tremendously helpful.
[00:26:20] And so I think there's a lot of things that we as providers don't necessarily know about, which is the whole point of us doing this Pregnancy for Professionals podcast is recognizing the importance of interdisciplinary and collaborative care when it comes to our patients and our clients, and check out our @PregnancyforProfessionals Instagram, cause we're going to be posting some of your great videos. So that's an easy way to find it and share it to your own personal social media pages, if you guys have a patient forward page. Great. Thanks guys.
[00:26:47] Megan: It's a pleasure.