Baby carriers

How do I use soft carriers and wraps?

Baby carriers can be helpful if you need to keep your hands free or wish to have your baby in contact with your skin. However, they can also be dangerous. Caregivers should use caution, especially when the baby is less than four months old and does not have good head control. When buying a carrier, make sure it is well made and can hold the weight of the baby, it is comfortable for you, and the baby is contented using it. It is important to know how to use it, so the baby’s face is visible and the mouth and nose are not blocked. There are several types of carriers, including wraps, bag carriers, ring slings, and backpacks.

A) When to use a carrier

A carrier allows a caregiver to carry a baby or keep the baby close without using hands. The first evidence we have of a baby carrier dates back 11 to 15 thousand years (Müller-Beck 1987).

Carriers can reduce the strain of carrying a baby on the arms, shoulders, back, and knees (Williams 2019). They have been shown to support bonding and increase breastfeeding rates at six months (Little 2021; Williams 2020).

Carriers can be helpful when:

  • Keeping a baby in skin-to-skin care.
  • Keeping a premature baby in kangaroo care.
  • You need your hands free to care for older children.
  • Dealing with household chores.
  • Using a large buggy on wheels is not practical.
  • The baby has the evening fussies.

 

B) Risks of some carriers

The U.S. Consumer Product Safety Commission (CPSC) describes all soft carriers that keep babies on their caregivers’ bodies as sling carriers (CPSC 2017).

Between January 2003 and September 2016, 159 incidents associated with carrier use were reported to the CPSC. Of these, 17 were fatal and 67 involved injury to a baby. The style and brand of carrier were not identified, making it more difficult for caregivers to choose among them. Deaths associated with sling carriers have also been reported in France and Australia (Bergouniuox 2015; Byard 2011).

The CPSC advises caregivers to be cautious when using carriers for babies younger than four months of age. Until the age of about four months, babies’ neck muscles are relatively weak and control of their heads is limited. This means babies under four months in a carrier may not be able to lift their faces away from the carrier in order to prevent suffocation. A baby can also end up with the chin touching the chest. This can block the baby’s airway. In both situations, the baby will not be able to cry for help.

C) Keeping your baby safe in a carrier

By four months, most babies can lift their heads and hold them steady when sitting. This is called head control. By six months, babies should have strong and steady head control.

If the baby is less than four months of age, in order to prevent breathing difficulties when using a carrier:

  • The head should be supported and not able to flop about when you move.
  • The baby’s face should be visible.
  • The baby should be checked frequently to ensure:
    • The mouth and nose are not blocked.
    • The chin is away from the baby’s chest.
    • The legs are not bunched up against the baby’s stomach, as this can restrict breathing.
  • The baby’s face should be slightly raised as though she or he were smelling a flower (the sniffing position).

To minimize the risk of hip abnormalities (hip dysplasia), the baby’s legs should be in the frog-leg position with the knees bent up and out from the hips. They should be supported and not dangle.

Do not use a sling carrier during activities that could lead to injury, such as running and cycling. Carriers that place the baby on the front of the caregiver’s body should not be used when cooking or drinking hot beverages.

D) Buying a carrier

If buying a carrier, you should ensure:

  • The carrier is well built and can hold the baby’s weight.
  • You understand how to use the carrier.
  • The baby is not at risk of:
    • Suffocation.
    • Falling out of the carrier.
  • The baby accepts the carrier; different babies like different styles or may not like any of them.
  • The carrier is comfortable for you to use (Brown 2018).

E) Types of carriers

While the safety commission does not differentiate between types of carriers, there are several styles:

  • Wraps
  • Bag or sack carriers
  • Ring sling
  • Backpacks

1) Wraps

Of the various types of carriers, wraps keep babies closest to their caregivers. They are commonly used in many countries. 

a) Front wraps

Front wraps are often used to provide skin-to-skin care for premature and sick babies.

A baby wrap keeps the baby:

  • Upright between your breasts.
  • Tummy to tummy with you.
  • With the head turned to the side with the cheek against your chest.

A wrap can be used over or under your clothes.

A premature baby is best kept next to the mother’s skin. If the baby is in skin-to-skin care, mothers often cover the baby and the wrap with a large shirt to cover the mother’s shoulders and arms.

Every mother and every baby are different. Try on various wraps to see which ones you and your baby like. They can be long pieces of cloth or tubes that are pulled over your head.

If you decide to use a wrap, make sure the baby is positioned correctly and safely. The legs should be bent outward, like a frog’s legs, and not be straight and the baby's head should be safely supported.  

b) Back wraps

Wraps can also be used to carry a baby on the mother’s back. Such wraps can be as simple as a piece of cloth. In many traditional cultures in Central and South America, Africa, and Asia, mothers work while carrying the baby in this manner and their babies appear to have a decreased risk of hip abnormalities (Gottlieb 1995; Graham et al. 2015).

2) A bag or sack carrier

This type of carrier places the baby in a bag or sack, which is a barrier between you and your baby. This type of carrier provides less head, neck, and back control and a baby can end up curled up in the bottom of the bag with her or his chin on the chest, making it harder for the baby to breathe.

Bag carriers should only be used once the baby has head control and enough back strength to stay upright.

Some bag carriers can be used on the caregiver’s back once the baby has good head control.

3) Ring slings

Ring slings are made of cloth and have a metal or plastic ring to hold the ends of the fabric and create a circle. This circle is placed diagonally around the mother’s body:

  1. Over one shoulder
  2. Down and across the mother's tummy
  3. Around the opposite waist
  4. Up around the back toward the first shoulder

The sling creates a hammock in front of the caregiver’s tummy to hold the baby. Ring slings can force the baby’s chin onto the chest and make it hard for the baby to breathe. If the hammock is shallow, the baby may fall out. Ring slings should only be used once the baby has head control. At this point, they can also be used to help you carry your baby on your hip.

4) Backpacks

A baby who has good head control and can sit can be moved to a backpack.

A backpack should have a thick belt, allowing the baby’s weight to settle on your hips and not on your shoulders. The advantages of a backpack over a carrier that keeps the baby on the front are:

  • Less strain on your back as:
    • The baby’s weight is transferred to your hips.
    • You are no longer leaning backward to balance the baby’s weight.
  • It is easier:
    • To see your feet and move around safely.
    • To do chores with your hands and arms as the baby’s body in not in the way.
  • The baby is freer to move her or his arms and legs compared with being in a wrap or sack.
  • The baby has a better view of the surroundings.

One study found that babies under the age of one in backpacks, when compared with babies in strollers (Mireault 2018):

  • Vocalized more.
  • Heard more speech from their caregivers.
  • Engaged in more speech with the caregivers.
  • Engaged in more visual scanning.

References

Bergounioux J, Madre C, Crucis-Armengaud A. Sudden deaths in adult-worn baby carriers: 19 cases. Eur J Pediatr. 2015 Dec;174(12):1665-70
 
Brown M, Digby-Bowl C, Todd SD. Assessing Infant Carriage Systems: Ground Reaction Force Implications for Gait of the Caregiver. Hum Factors. 2018 Mar;60(2):160-171
 
Byard RW, Gilbert JD. Infant deaths associated with baby slings. Med J Aust. 2011 Sep 19;195(6):321
 
Gottlieb A. Of cowries and crying: A Beng guide to managing colic. Anthropology and Humanism. 1995;20(1):20–28

Graham SM, Manara J, Chokotho L, et al. Back-carrying infants to prevent developmental hip dysplasia and its sequelae: is a new public health initiative needed? J Pediatr Orthop. 2015 Jan;35(1):57-61 

Little EE, Cioffi CC, Bain L, et al. An Infant Carrier Intervention and Breastfeeding Duration: A Randomized Controlled Trial. Pediatrics. 2021 Jun 30:e2020049717

Mireault GC, Rainville BS, Laughlin B. Push or Carry? Pragmatic Opportunities for Language Development in Strollers versus Backpacks. Infancy 2018: 4(16)

Müller-Beck H, Albrecht G. Die Anfänge der Kunst vor 30000 Jahren. Suttgart: Theiss; 1987 

United States Consumer Product Safety Commission (CPSC). CPSC Approves New Federal Safety Standard for Infant Sling Carriers. Bethesda: United States Consumer Product Safety Commission; 2017 Jan 11 [cited 2017 Oct 29]
 
Williams L, Standifird T, Madsen M. Effects of infant transportation on lower extremity joint moments: Baby carrier versus carrying in-arms. Gait Posture. 2019 May;70:168-174

Williams LR, Turner PR. Infant carrying as a tool to promote secure attachments in young mothers: Comparing intervention and control infants during the still-face paradigm. Infant Behav Dev. 2020 Feb;58:101413