Keep them close. Keep them safe!

In the wake of the reports from Australia of the tragic death of a newborn baby while being worn in a sling under his mother's clothing, I thought it was a good time to post a reminder of what safe babywearing consists of and what every current and future babywearer should keep in mind when using a sling or carrier.

Make sure:

• your baby is worn upright, facing in with their chest against your chest.
• their face is visible and close enough to kiss.
• their airway is clear and their chin is NOT touching their chest.
• the carrier you are using supports their natural stage of development.
• you check your baby frequently!
  
  

If you follow these recommendations, wearing your baby and being in harmony with them and their needs will be as natural as smiling at them.

I'd like to comment a bit on the media reaction and subsequent reactions of the public.

I want to point out that the sling was not ruled the cause of death. The cause was actually listed as undetermined and the sling (not mentioning brand, style or improper use) had to be considered a possible factor as that was where the death occurred. Some media articles have been much less balanced than the one I linked and are doing some fear mongering over slings in general which is not warranted. I was glad to read the clarity of the KidSafe SA comments regarding there being risks *if misused* however I was not so happy to see the bold headings state "Warning on baby slings after newborn dies" and subheadings read "Baby dies while carried in sling...Experts believe sling was a risk factor...Parents warned to monitor babies".

Yes, the baby died while in a sling. Yes, the medical examiners listed the sling as a possible factor. Yes, parents should always monitor thier babies.

No, this does not appear to be a repeat of last year's Infantino recall of a product with deadly design flaws. No, all slings are NOT dangerous.

The report of the actual incident took up no more than a few lines as very little information is actually provided but the bulk of the article is filled with flashbacks to the Infantino recalls and references to U.S. sling deaths. There is no balance with comparison to statistics (many times greater than for slings) of infant deaths in car seats, cribs or any other location they may be in when tragedy strikes. Comments from readers support a lack of accurate information on the history or safe use of slings and the willingness to be "educated" by media scare tactics as people state repeatedly how 'unsafe' or 'scary' or 'dangerous' slings look to them and how much safer babies would be in strollers or other devices detached from their mother's body (the opposite of what studies have shown).

What little detail of the actual incident was provided would indicate that this tragedy, if not caused by an undetermined medical issue with the newborn, would likely have been preventable with proper babywearing education. I do not want to point fingers at this poor mama who has suffered an unimaginable loss but whatever carrier she was using was clearly not used in a safe manner recommended by any certified babywearing educator. She wore him under multiple layers of her own clothing making it impossible to check on him easily, restricting his access to fresh air, covering his face and he was in that position, unchecked, long enough to not only pass away (which can happen VERY quickly) but also to be cold to the touch.

I'm sure that his mama wanted the very best for him. I'm sure she wanted to keep him close and secure. I'm sure if she had known better she would have done better.

As always, education is the key.

Please make sure you are familiar with all aspects of babywearing safety before purchasing or using a sling or carrier for your baby. A certified babywearing educator is trained to help you with all aspects of babywearing and any questions or concerns you have. Please find an instructor in your area or contact me if you'd like help. The Babywearing Institute also has an open forum where you can talk with certified educators if you cannot meet with one in person. We are very happy to help you keep your baby close and keep your baby as safe as humanly possible.

Great article on babywearing safety

This was written by Jan Andrea (Sleeping Baby Productions) at the 2010 International Babywearing Conference to summarize information presented by babywearing advocate and RN, M'Liss Steltzer. A printable version of the complete article can be found here.

Because the information is so extensive and critically important, I'm going to post the entire article here. Please note the information on the problems of overuse of infant car seats outside the car and all the problems they present (far more than carrying a baby in a quality fabric carrier).


Newborn and infant safety
Jan Andrea Heirtzler
sleeping baby productions


Key points:

• Car seats are for use to secure an infant when riding in a car. They are less safe than a baby carrier when used outside their intended purpose as car safety devices.

• Infants are safer in their caregivers' arms than left in a device (car seat, stroller, bouncy seat, crib,swing, etc.).

• Carriers that offer correct positioning are far safer than ones that promote incorrect positioning (i.e.forcing the baby's chin to his chest or awkward reclining holds).

• It is vital that caregivers be aware of their infant's breathing at all times.

• It's okay to wake the baby to take him out of the car seat. Deep sleep is a dangerous time for infants; SIDS invariably occurs during deep sleep, and other breathing difficulties are also a greater risk during deep sleep.

• Infants should always be visible and kissable in a carrier.

• Any carrier should hold the baby the way you would hold the baby in arms.

In the last 15 years, much has been learned about keeping newborns and infants under 4 months safe. The “back to sleep” campaign is responsible for a considerable reduction in SIDS and related deaths, for example. However, there is a great deal of research into infant physiology that still has not filtered into either popular knowledge or product design.

In 1995, a study was done on infants’ oxygenation levels in their car seats. Normal oxygenation levels – that is, the amount of oxygen circulating in the blood stream attached to red blood cells – range between 97-99% in a healthy term infant in optimal positioning. Any oxygenation level below about 90% is considered “hypoxia” –
the baby is not receiving enough oxygen, and brain damage can result if that level is sustained. Shockingly,healthy, full-term newborns placed in correctly positioned car seats had oxygen levels that went as low as 83.7%. In the hospital, such levels would bring teams of nurses scrambling to the infant’s rescue. While not all infants’ oxygenation levels reached such depths, there was a consistent finding that the longer the baby spent in the car seat, the lower their oxygen levels would go, until the baby was removed from the seat.

The study was repeated in 2005, with the same results. The conclusion in both studies was that babies shoulds pend the least amount of time possible in a car seat, and they recommended that car trips with new babies be kept to an hour or less, and that infant car seats be used only in the car, and not beyond that. And yet,these studies and others like them have gone almost completely unnoticed in the United States and Canada,and it’s not uncommon to see infants in car seats for hours on end, being moved from the car to a travel system to home without ever being removed from the seat. How much damage is being done to these infants while they seem to sleep so peacefully?

Hypoxia is known to cause damage to the developing brain. Infants who experience hypoxia will show more signs of ADHD, decreased IQ, delayed motor development, and impaired attention. If these conditions sound familiar, perhaps we are beginning to understand why, as more and more children spend their infancies in some form of baby seat, reclined and in a hypoxic state.

In addition to the hypoxia seen in healthy, full-term newborns, there is also a risk due to positional asphyxia. This unfortunately is not an uncommon cause of death in infant car seats. A newborn baby’s head is very heavy, and its neck is quite fragile in comparison. Newborns, especially but not exclusively those born prematurely or with respiratory issues, are prone to having their heads tip forward onto their chests,drastically narrowing the airway (which is about the width of a drinking straw) and blocking proper flow of air. This can cause hypoxia and even death, and is a risk in any baby containment device that places the infant in a seated position, including (but not limited to) car seats, baby swings, bouncy seats, and yes, even cloth slings,if the parent doesn’t follow positioning guidelines.

So, what do we do about this?

Knowledge is key.

Every parent and caregiver *must* be aware of their baby’s position and breathing at all times. Let me repeat that. Every parent and caregiver must be aware of their baby’s position and breathing at all times. Whether the baby is in a car seat, a sling, or even in the caregiver’s arms, he or she must keep an eye on the baby’s respiration and positioning. (This does mean that if you have a newborn and you must take a long car trip, it is best for one caregiver to sit in the back with the baby whenever possible, and stop frequently to allow the baby to recover from hypoxic episodes, which grow more severe and numerous the longer the infant is in the
seat.)

In a carrier, an upright, chest-to-chest position is best with newborns and infants under 4 months. In this position, the baby is aware of the caregiver's breathing patterns and vice-versa. (Human infants are programmed to take breathing cues from their parents, and often an abnormal breathing pattern is noticed subconsciously by the parent, who then rubs the baby's back, bounces, or sways, all of which will help reorganize the baby's breathing.) The caregiver is able to keep the infant's head in an optimal position, usually turned to one side, and this position is one that adults often adopt when holding a newborn without a carrier -- always a good sign that the position is a physiologically healthy one.

When a carrier is used to recline an infant in what we consider a cradle hold, it is vitally important that the baby's head still be in easy view of the parent, and close enough to kiss. The baby's neck should be straight down to his pelvis, and while it is okay for the spine and legs to curve gently (because infants are naturally curled up), it should never be at a more extreme angle than one would see with the baby held in arms. In any carrier, a good test of whether it is correctly positioned is to bring one's arms up around the baby in the carrier as though it weren't there. If there is significant movement, then the carrier needs to be adjusted so that they mimic an in-arms position as much as possible.

It should be clear by now that "bag sling" style carriers (those with a hard bottom, and curved and elasticized tops) are never a good choice for carrying a newborn. The flat bottom tends to allow the infant to roll towards the parent (and this can occur even with an internal harness), creating a risk of suffocation, while the shape of the carrier forces the infant's head onto his chest. In addition, the closed top keeps the baby from being seen,so that if hypoxia does occur, the parent misses the signs, often until it's too late, and because the baby is so deep in the carrier, he is also at an increased risk of rebreathing carbon dioxide. The "bag sling" is really a perfect storm of hypoxia causes, and it should come as no surprise that the majority of "sling" deaths have occurred in this style of carrier.

Other safety considerations in baby carriers:

Any item that is made of fabric and that is used regularly is going to wear out some day, whether it's a favorite toy, blankie, cloth diaper, or carrier. This is also true of cloth baby carriers; there is no magic in a fabric when it's made into a carrier that keeps it from wearing out with use. All fabrics take a beating when they are weight-bearing, and when they are washed and dried repeatedly, the fibers will start to break down with time. For thick and sturdy fabrics, this may take years of heavy use, but for fabrics that are appropriate for slings and wraps, it make take less time, because the fiber threads tend to be thinner.

When using a sling, whether it's brand-new or a hand-me-down, please be sure to look over the entire length on a regular basis (such as after it's been washed and dried, or before you thread or put it on) to check for weak spots in the fabric. This would include areas where the fabric is pilly, where the surface appears fuzzy, or where you can see broken threads in the weave. Any carrier that has holes in it should be used with extreme caution, or preferably not at all, since a hole can easily develop into a full-blown tear with stress (such as when the sling is adjusted through the rings, or when a wrap is tightened). A well-loved carrier often has a lot of sentimental value, but it's better to use it for a blanket or child's lovie than to continue using it as a carrier after it shows signs of wear.

Conclusions:

It is not my intention in sharing this information to terrify parents. We do have enough to worry about as it is. However, the media seems very quick to jump on baby slings as the hazard of the week, while ignoring the very real hazards of leaving infants in their car seats and other such devices. The studies on infant car seats and hypoxia (below) all come to the same conclusion: leave the car seat in the car. While manufacturers have made it easier than ever to go through a whole day with the baby in the car seat (including travel systems and snap-on stroller bases), they are not doing so based on the available research (and why should they, when it would hurt their bottom line?).

Parents often assume that since a baby product is sold in a store, it must have been tested, but that really isn't true. Some products are, but the vast majority are not, as can easily be seen by the number of recalls that occur each year. Consider the number of cribs that are recalled each year, including finally the whole dropside crib category. Had they been rigorously tested, the recalls never would have been necessary, but infant products, like most others, are primarily "tested" by the public after they are released. There have been far,far more deaths in car seats, bath seats (the number one in terms of infant deaths per unit used), strollers,cribs, bouncers, and swings than in slings and other carriers, but you'd never know it from the way they were marketed and reported on.

Finally, a little fear can be healthy at times. If worrying about a baby's breathing makes the caregiver check him more often when he's in some kind of baby holding device, that's much better than just assuming he's safe and not checking frequently. Infants are on the whole remarkably resiliant (there are nearly seven billion of us on the planet, after all), but physiologically, we were not made to lie in plastic containers all day. Human infants thrive on touch, motion, and closeness with their caregivers, and it would be misleading to say that being held is "beneficial" to babies and their caregivers: it is simply what we are wired to do, and anything else is actually detrimental. A good baby carrier allows caregivers to fulfill their babies' needs and still go about their daily tasks with ease, and that is the real benefit.

Acknowledgments:

This article would not have been possible without M'Liss Stelzer, RN, who brought these issues to the attention of the babywearing world way back in 2006. Her presentation at the 2010 International Babywearing Conference was excellent, and I hope to see it online soon. Until then, I wanted to make sure the information was out there in some form, and she inspired me to write this and see how widely it can be disseminated.

Sources:

CORRECT POSITIONING For the Safety & Comfort of your Newborn
http://www.thebabywearer.com/articles/HowTo/Positioning.pdf

A Comparison of Respiratory Patterns in Healthy Term Infants Placed in Car Safety Seats and Beds
http://pediatrics.aappublications.org/cgi/content/abstract/124/3/e396

The Effect of Chronic or Intermittent Hypoxia on Cognition in Childhood: A Review of the Evidence
http://pediatrics.aappublications.org/cgi/content/abstract/114/3/805

Oxygen Desaturation of Selected Term Infants in Car Seats
http://pediatrics.aappublications.org/cgi/content/abstract/96/2/288

Respiratory Instability of Term and Near-Term Healthy Newborn Infants in Car Safety Seats
http://pediatrics.aappublications.org/cgi/content/abstract/108/3/647

Safe Transportation of Preterm and Low Birth Weight Infants at Hospital Discharge
http://pediatrics.aappublications.org/cgi/content/full/123/5/1424

Simple Car Seat Insert to Prevent Upper Airway Narrowing in Preterm Infants: A Pilot Study
http://pediatrics.aappublications.org/cgi/content/abstract/112/4/907

Use of Seating Devices in Infants Too Young to Sit
http://archpedi.ama-assn.org/cgi/content/abstract/151/3/233

More carrier recalls

There have been two more carrier recalls recently. Everyone please remember to always check the structure of your carrier and keep your little on in a proper position to maintain their airway and support their bodies.

The first recall is for a ring sling made by a small Texas company called Sprout Stuff . They were a local WAHM business that stopped selling carriers in 2007. While it's unlikely that anyone locally would have one of these, it's still important to take a close look at carriers you may find 2nd hand or be gifted by a well meaning friend.

From online discussions and the picture provided, this appears to be a simple ring sling and there were no manufacturing defects noted in the recall. Well made ring slings are very safe carriers when baby is positioned correctly. In the case that prompted the recall, the limited information I've found suggests that the baby was not positioned correctly and/or was in a fragile medical state when he died.

The second recall is for the CYBEX 2.GO carrier made by Regal Lager. The carriers have a shoulder strap buckle that may break and cause a fall hazard. If you have one of these, please contact the company for instructions.

More warnings about the dangers of bag slings

The CPSC (Consumer Product Safety Commission) will be issuing an official statement or warning against the use of slings. The coming CPSC release will apparently not name a particular brand of carrier, which I think it should. It may simply lump all carriers into one group when, in reality, the problems are really with one particular style of sling - a bag sling like the Infantino SlingRider that forces baby into a chin to chest position and has a high risk for positional asphyxia.

There are MANY great carriers out there that can be used safely. While learning how to use any carrier safely is an important part of the equation, there just isn't a safe way to use a bag sling. They are poorly designed and simply shouldn't be used.
Please read my previous post about the Dangers of Bag Slings and follow the link to the research for more details.

Also, please check out Nurture Baby...Naturally. She has written a very clear post with pix showing the differences between a good ring sling and a bag sling.

If you have questions or concerns about a carrier you have, please feel free to contact me and ask me about it. If you know someone who has one of these slings, please point them here or to any of the linked blogs or sites for more info.


Wear your baby high and tight. Baby's head should be kissably close. The fabric of the carrier should be adjustable to fully support the baby. If you can't do these things with your carrier, please get some help to learn to use it or make sure it is a safe carrier.