Oh boy. Here it comes! My post on forward facing out (FFO) in a baby carrier. This is a pretty hot topic. It rivals that of vaccines, circumcision, epidurals, etc. I'm not posting this in order to get into a debate. I'm not asking for you to talk me out of what I believe. This is an informative post with research & facts. As with any topic, you can take from it what you would like and use what best fits your worn baby and situation.
I'm always open & honest so let me start there! I wore my first two children FFO in ring slings. Legs folded up inside. When I ventured into wraps with my second son, I followed an online tutorial on how to use a wrap to FFO your baby. I never wore him like that as it just didn't feel right to me. However, when I started teaching babywearing classes in 2006, I taught how to wear your baby in a ring sling and wrap FFO. I had decided that all other babywearers did it, so it was okay right?! Then, I went through extensive babywearing training in 2010. I left Utah and never taught FFO again. Our third child has never been FFO.
As a certified babywearing educator, my goal is for babies to be worn safely and properly. While I appreciate the common remark of "I just want all babies to be worn," my training goes beyond that. Ask any car seat technician if they want people to just use a car seat or if they want it used safely and properly. If a car seat isn't used appropriately, babies can sustain injuries, from minor to life threatening. The same applies to babywearing.
The anatomy of your child is something you should learn about. It isn't really taught to us, but it is very important when picking a carrier. First, we'll start with hips!
Your sweet newborn babe has arrived. He stays all curled up whether asleep, getting his diaper changed or in his car seat. He knows that his hips and knees need to be bent. And here's why: The hip joint of your new baby is actually cartilage. The International Hip Dysplasia Institute shows it very well.
Illustration of an infant hip joint that’s still developing. The brown areas represent dense bone, where the grey areas represent soft, pliable cartilage
Illustration representing an adult hip joint. Note how the grey areas that were present in the infant joint are now completely replaced by hard bone.
For a baby's ball & socket joint to harden properly, the best positioning is with knees up at belly button level and hips bent. This is known as the spread squat position. This is also the position that a baby normally takes all by themselves.
(Images from Babywearing Institute)
Dr. Ewald Fettweis, a pediatric orthopedist from Germany, wrote, "When parents position their babies they should try to approach this optimal state and especially avoid everything that counteracts it. In many cases it is not apprehended that, through unfavourable influences on the child’s body, well-developed hip joints can turn into damaged ones.” Dr. Henrik Norholt, a leading researcher on the effects of infant carrying, states, "In order to guarantee an ideal hip development, it should be strained as little as possible during the development period." According to Dr. Evelin Kirkilionis, founder of an independent German research group on human ethology (FVM), "A stretching in the hip joint is even forced, which - especially in the first 4 months - must be regarded extremely critically for the development of the hip joint. Such a stretched position is unphysiological at this age and means that the femur head is not centrally guided into the hip socket, and that a malformation is promoted." Another professional that explains the importance of hip positioning is Dr. Thomas Oberst from Germany. He states that it is “ideal when the baby [can slumber] with spread legs and bent knees in its carrier bag.”
What does all of that mean for babywearing? Simply put, a carrier should support baby's natural spread squat position for proper hip development.
Overloaded yet? Sorry, but there's more anatomy talk. Now, let's discuss your baby's spine and proper development there. The human spine develops in three stages. When your babe is new and squishy, they are in fetal tuck. Their spines are rounded, almost like a 'C.' This is called total kyphosis. Once baby gains more core muscle control, the spine curvature begins its change. It is completed as baby sits unassisted, crawls and then walks. The developing spine needs protection just like the hips do.
What does that mean in regards to babywearing? The carrier should properly support the different developmental stages of the spine without undue pressure or forcing the spine into an unnatural shape.
And, the human body is all connected! According to Prof. Dr J. Büschelberger,specialist in orthopedics, "The spine and the pelvis are connected to the hip joint by the sacro iliac joint. The movements of the spine directly influence the movements of the pelvis, as well as the other way around. When the child can round his / her back, the pelvis tilts forward slightly, which makes a healthy development of the hip joints possible. Here parents should note that a baby’s back is rounder than that of an older child. If the child’s back is kept straight or even pressed into a hollow back, then the pelvis tilts backwards, which can have a negative influence on the development of the hip joints."
Now, besides the anatomical information on FFO, there's 2 other factors to consider. These have to do with your child's ability to see & their instinctual "turning in" when they need comfort. I often hear the statement, "My baby wants to see what is going on." The first few months of age, baby can only see a couple of feet in front of them at the most. By the time your baby can see well, he'll be ready for a hip carry or periodic high back carry. When a baby is over-stimulated, uncomfortable or unhappy, they turn in towards the person carrying/holding them. This line of defense is taken away when they are positioned FFO in a carrier.
Now you're really overloaded huh?! Let me touch on one more thing that people like to say to me when I give information on FFO - "The International Hip Dysplasia Institute says that carriers MAY cause hip dysplasia. It doesn't say that they do." Actually, the article says, "Some types of baby carriers and other equipment may interfere with healthy hip positioning." The definition of the word may from Merriam-Webster:
a archaic : have the ability to
I've read lots of other "warnings" that use the word may:
- Smoking By Pregnant Women MAY Result in Fetal Injury, Premature Birth, And Low Birth Weight.
- Taking more than the recommended dose MAY cause liver damage.
- Using this cleanser MAY discolor fabrics.
Besides picking at wording, many are under the same belief that I was - if the product says it can be used, then it is safe, right? Well, there are aftermarket car seat accessories that are NOT safe for use. And although some car seats are labeled forward facing for children 1 year of age and 20 pounds, it is well known that it is safer to keep your child rear facing for as long as you can. I could go on and on, but I think you get my point!
So, as a parent, the best you can do is inform yourself and then you make a decision on what fits your family.