How to hold your baby the right way

SINGAPORE - New mothers are often advised not to carry their babies too much, or the babies may get used to it and want to be carried all the time.

Do not spoil them, is the exhortation from many a well-intentioned grandparent. Closeness breeds neediness, so it is best to let the baby start learning how to be independent from birth, they may say.

Well, conventional wisdom can be wrong, and some experts advocate carrying babies close in a carrier or sling as much as possible, to help create a lasting bond between the mother and the little one.

Besides, this babywearing - a term coined by California-based paediatrician William Sears - allows the caregiver to be more in tune with the baby's needs, he said.

Research shows that babies benefit from what is called attachment parenting, of which a practice is babywearing.

This parenting approach also involves sleeping together in the same bed, for instance.

When babies are held often, they typically cry and fuss less, as they develop a more secure attachment with the caregiver carrying them.

One of the latest studies, published on April 18 in Current Biology, showed that infants, from humans to mice, instantly become calm and relaxed when they are held by their mothers.

Babywearing is also convenient as the caregiver is free to do other tasks while carrying the baby.

But there are factors to consider when choosing the appropriate carrier. Here is what to watch out for:

Age of baby

Babies younger than four months old need extra care when in a carrier.

Dr Arif Tyebally, deputy head and consultant at the department of emergency medicine at KK Women's and Children's Hospital, said baby carriers are generally safe for babies of all ages if used correctly.

But their use may pose a risk for very small babies and those younger than four months of age, as there is a risk of suffocation if the baby's neck should curl forward and cause obstruction to the airway, he added.

He said: "The safest time to use a carrier is when babies have good head and neck control, which would be approximately about four months."

Seek doctor's advice

Suitable carriers for babies from newborn to five months of age are those that allow them to be in a frog-like position, said Ms Fonnie Lo, manager for ParentCraft services and a lactation consultant at Thomson Medical Centre's ParentCraft Centre.

This is a squatting straddle position, which puts the baby's buttocks below his knees, allowing him to keep the curvature of his developing spine.

Young babies can also be in a carrier that allows them to be in a cradle position, added Ms Lo. This is the same position that the baby is in when he is being cradled in his mother's arms.

Ms Lo said a caregiver should check the baby often to make sure he is not in a curled, chin-to-chest position and that his face is not pressed against the fabric or the caregiver's body.

"Both of these positions can lead to suffocation and this can happen within minutes," she said.

"Ensure that you can see your baby's face or eyes in the sling and that your baby can see you too."

For this reason, bag-slings that are already banned in the United States should be avoided, said Ms Pearline Foo, co-owner of Baby Slings & Carriers.

Such a bag-like sling has a flat bottom, where the baby lies. This design is flawed as it curls the baby into a chest-to-chin position, Ms Foo said.

Seek doctor's advice

Seek medical advice before buying carriers for babies with medical conditions.

Babies who were born premature, or have special needs or low muscle tone may benefit from being carried in slings, said Ms Tan Siang Yin, paediatric physiotherapist at Kids Home Therapy.

By being wrapped snugly in a sling, they can feel their joints or limbs more. This will send sensory feedback to the brain and improve their joint position sense (proprioception) and control over their limbs, she said.

But caregivers should seek professional opinion before placing babies with hip dysplasia (loose hips) or premature infants in a carrier.

"As premature babies are smaller with less developed airways, an incorrect method of placement may increase the risk of suffocation," Ms Tan said.

Similarly, a doctor's advice is also needed for babies with medical conditions that affect breathing or any form of motor developmental delay, Dr Tyebally said.

The safest carriers, he said, are those that keep the baby in a safe position without obstructing their airways.

Consider the weather

Consider the weather

Choose a carrier that is suited to the weather here and one that can be adapted as the baby grows.

Some structured carriers may be heavily padded and thus not suitable for use in Singapore's hot weather.

Choose a material that is natural and breathable, such as mesh, instead.

A good carrier, Ms Lo said, should be able to support the baby in a squatting straddle position so that the hips are spread naturally apart to the sides with the thighs supported.

Ensure that it allows the baby's knees to bend at or above the level of the baby's buttocks as this allows the baby to move naturally, she said.

A carrier should be adjustable so as to accommodate the sizes of the baby and the user.

The sides of the carrier need to be close-fitting to the baby's body to avoid the baby sliding from side to side or falling out of it, Ms Lo said.

Lastly, the wearer should feel comfortable using the carrier.

A carrier should be ergonomically designed to distribute the baby's weight across the user's hips, with very little weight on the shoulders, Ms Lo said.

Position baby correctly

Position baby correctly

Avoid putting a young baby in a forward-facing position in a carrier.

Ms Lo said it is best not to have young babies under four months of age face outwards.

Their dangling legs could stretch the hip capsule - the ligament that connects the top of the leg to the pelvis - potentially causing hip dysplasia or hip dislocation, she said.

"The posture of the trunk also tends to become strained as the baby is forced to be in a very upright position when the straps are pulled from the front over the baby's shoulders to press the shoulders back," she said.

"This forces the spine into a weight-bearing position and might cause injury to the baby before he has the muscular support to do so on his own."

Ms Tan said it is best to put the baby in a forward position only after six months of age, when the hip joints are more developed and stable.

But caregivers still need to ensure that blood flow to the lower limbs is not impeded by a relatively narrow crotch area, as the major blood vessels run right in front of the hip joint, she said.

"Hence, if the baby is getting too big for the carrier, it is time to change to a carrier with a broader crotch support, or avoid putting them in a forward-facing position totally."

Mind Your Body looks at some popular types of baby carriers

1. Structured carrier

A structured carrier is like a harness around the torso and under the crotch that straps a baby to the body.

It typically has a waist buckle and shoulder straps as well.

A soft-structured carrier moulds well around the baby's back and wraps around snugly, leaving no gap between the carrier's body and the baby.

Hard-structured carriers tend to have thicker padding. Rigid carriers create spaces between the baby's body and the carrier and do not hug the contour of the spine.

"Try to avoid putting young babies in rigid, hard-back baby carriers," advised Ms Fonnie Lo, manager of ParentCraft services and a lactation consultant at Thomson Medical Centre's ParentCraft Centre.

These carriers do not support the baby's natural position.

2. Ring sling

The normal spinal curvature for children under the age of six months is one where the lower spine curves outwards, rather than inwards, said

Ms Lo. She also advised parents to avoid buying carriers with a narrow crotch that lets the legs dangle.

"Apart from being uncomfortable, it does not ensure proper hip development," she said.

In a carrier, the baby's hips should be allowed to spread to the sides and his thighs should be supported by a wide base, such that he is in a frog-like position.

"Free movement of the hips with good thigh support promote natural hip development," said Ms Lo.

Ms Tamara Wong, president of The Chiropractic Association (Singapore), advised: "Look for the structured support-style carriers with wide, well-padded straps and sturdy fabric to distribute your baby's weight evenly and save your shoulders, neck, and upper back from strain."

Structured carriers typically cost more than a wrap, a long piece of fabric used to tie the baby to the adult.

A soft-structured carrier can cost about $140 to $250.

2. Ring sling

A ring sling is made up of a piece of fabric that is threaded through two rings to form a loop.

It can be worn like a sling bag across one shoulder.

It may be padded or unpadded at the shoulder.

Some people like it because it is easy to use, looks nice and is light.

But it has its pitfalls.

"The imbalanced weight distribution will cause strain on different parts of your body," said Ms Lo.

Ms Wong added that the one-shoulder support can quickly become uncomfortable for the caregiver, especially if the child weighs more than 6kg.

A ring sling can cost about $90.

3. Mei Tai baby carrier

3. Mei Tai baby carrier

A Mei Tai carrier is made up of a square or a nearly square piece of cloth with four thick straps - one coming off each corner.

It originated from Asia and has long been used in China to carry babies.

There are different ways of using the Mei Tai carrier, one of which is to use it like a backpack to carry an older baby on your back.

Choose a carrier with wide straps as one with thin straps will place the baby's weight on your shoulders only, said Ms Lo.

A Mei Tai cotton baby carrier can cost about $160.

4. Wrap

Also known as a wraparound, this is a long piece of fabric that you can use to tie the baby to you.

It can be wrapped snugly around the body of the baby.

The traditional wrap or sarong-type carrier has been around for centuries, said Ms Wong.

"But the weight distribution can be uncomfortable for the baby unless the baby is very small and light. Being compressed for long periods in a sarong-type carrier is not ideal."

Ms Lo pointed out that while carriers made of cotton are more comfortable, they are not stretchable.

You will have problems in your movement if you have tied the carrier too tightly or loosely."

A stretchable wrap can cost about $70.

joyceteo@sph.com.sg

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