Why We Don’t Recommend a Forward-Facing Carry

by J. M. Cavanagh, staff, Babes in Arms

(revised Feb. 14/11)

When I am out and about with my family, or having a break by myself, I often see parents or caretakers wearing a baby facing away from the wearer’s body. Many babies seem to really enjoy this position, and parents often want to use this position as long as they can. However, based on a number of factors, we recommend that babies should always be facing the body of the person wearing them. Here are some reasons why:
As humans much of our body is still developing after birth. At birth our eyesight isn’t top notch yet; we don’t have kneecaps made of bone (they are cartilage until age 3 to 5); we can’t manage without someone to care for us; and our spines are not straight. Well, our spine is never truly straight — it has a slight curve to it at both ends, like a drawn out “S”. At birth, babies’ spines are a convex curve, or a long open-ish “C” shape. They straighten as we get stronger and bigger. When a baby is carried facing in, in a “froggy,” half lotus (a yoga pose, basically crisscrossed legs, but still sitting on bum, not sitting on legs) or seated position, with the bum lower than the knees, this convex curve is kept. But when a baby is in a facing-out position, not only is the spine straightened, it can actually become concave, the opposite of convex.
What is this like? Because an adult breastbone (which the baby is held against in this position) is quite hard, we can imagine that this position, legs dangling with back to the parent’s chest, might feel similar to being an adult in a climbing or safety harness, unable to really move or readjust your body, with your back against a wall.
Something to be taken into account when thinking about the spine, is that it determines the function of the nervous system, and the nervous system controls all body systems. Therefore, a nervous system stressed by a compromised spine will affect the body’s overall ability to be healthy. Having baby in a facing-out position runs the risk of putting undue stress on baby’s spine, which can lead to a medical condition called spondylolisthesis. Spondylolisthesis is defined as the forward slipping of a vertebra on the one below it. Basically, when a person’s back is forced into an unnatural angle, especially with the added stress of gravity, the vertebra in the back can become compressed and slip. A young baby’s spine and back muscles are not actually developed enough to bear all of baby’s body weight. Compare this to a facing-in position in which it is possible to place baby’s knees higher than their bum – for newborns, in a supported squat, or for older babies, with legs coming around the parent’s waist – where baby’s weight is spread across their bum and things instead of being held by their lower spine.
For me, one argument in particular against forward facing carries is especially compelling. While the studies I am quoting for this paragraph were done on adults, the possibility that there is even a chance the same effects could happen to a baby in a carrier where their legs are dangling must give us pause.
The University of Texas Medical Branch Hospital has done a couple of studies on orthostatic intolerance in astronauts, and on safety harnesses used by workers, or others needing fall protection. Many employee safety organizations have also done such studies. They have found that when a person is suspended in a safety harness, with legs dangling relaxed beneath their body, it seems comfortable; and actually the test subject never really experiences any discomfort. Then, in as little as three minutes they start feeling warm. Often the next symptom is unconsciousness, the next sometimes death. This is called suspension trauma. Most of the time the trauma isn’t as severe as death. In the best case scenario, no permanent damage is done; but it can lead to nerve and or tissue damage, sometimes in as little as five minutes, and sometimes permanent.
Let me reiterate that to my knowledge the above research has only been done on adults, the worst damage occurring when the person is dangling with their legs hanging freely under them in a relaxed position, and that these are worst case scenarios, unlikely to happen to a baby if only because the person carrying the baby would hopefully notice something was wrong before it could get that bad. To my knowledge there have not yet been any studies on the subject of babies being carried in a similar position. As an added concern for the legs-dangling position in general,  thinking of baby boys in particular, there is the concern that their weight is resting on their crotch, a position that seems to cause discomfort for quite a few baby boys based on our observations.
Thinking of the wellbeing of the parent or wearer, when baby is facing out, it also changes the weight distribution for whoever is carrying baby, placing the weight on your shoulders instead of the core of your back. You should never lift or carry weight with your shoulders, as it can quickly lead to discomfort and disalignment of the vertebrae. For mom this change in weight distribution also puts a lot of pressure on her pelvic floor: baby’s weight is pulling her forward, away from her centre of gravity, causing her to lean back to compensate. This in turn causes her to push her hips forward, which does not allow her to give her pelvic floor proper muscular support – right at the time her pelvic floor should be regaining strength.
One of the common reasons I am told by parents that they want to be able to carry their baby facing out is that the baby “likes it,” and seems to want the stimulation. The problem with this is that facing out can often lead to over-stimulation for baby. Unfortunately over-stimulation is not always crystal clear for us to recognize as parents — what seems like happiness, excitement and engagement in baby may be over-stimulation, and upon placing the over-stimulated, seemingly happy baby facing-in in an ergonomically correct position many times we see the baby go straight to sleep.
When facing out, baby can hear the voice and the heartbeat of the caregiver or parent, and can smell that the caregiver or parent is there, but can’t see them. This may be disconcerting for baby. Add to that all the other sounds and sights, many of which may not even be clearly in focus, and disconcerting can quickly become overstimulated and overwhelmed.
All of this said, some babies are more likely to crave interactivity and periods of stimulation. For short periods, as an alternative to a forward-facing position, we recommend a seated cradle position in a ring or pouch sling for babies with good head control who cannot yet sit on their own; a hip carry in a ring or pouch sling for babies who are able to sit on their own; or a high back carry for babies with good back strength who can bring their legs comfortably around the body of the parent wearing them. Each of these positions will support baby’s back in its natural curvature, spread their weight through their bum and thighs and allow them to alternately see their surroundings and retreat toward the safety of their caregiver’s chest or back, while keeping baby in the wearer’s centre of gravity, allowing them to maintain proper posture.
So with all of these concerns, why bother wearing our babies? Why not utilize a seat or carrier so we don’t have to worry about any of these problems? Well, besides the fact that there are concerns over safety and health issues with baby spending extended amounts of time in these carseats and on hard surfaces, wearing your baby is good for them. It just needs to be done correctly — and knowledge is power. The optimum way to carry your baby is chest to chest, facing in, in a “froggy” position or supported squat, a half lotus (a yoga pose, basically crossed legs, but still sitting on bum, not sitting on legs) or in a seated position, with the bum lower than the knees. Also, baby’s bum should always be above your belly button in order to keep their weight within your centre of gravity.
There are many benefits for babies. When in the seated position, with the legs lower than the knees, your baby is basically doing the tummy time that doctors recommend occur daily – just in your arms. Building brain synapses, muscle development, nerve development, and hip development, just like if they were lying on their tummy on the floor. This position is also often used to correct minor birth trauma, like hip dysplasia. Neurological development happens the way it should, because of the continued contact, touch and motion which mimics the time baby spent in the womb, turning what has the possibility to be an alarming environment into one that feels familiar and safe. A baby that is worn instead of spending the majority of the day lying flat or at a slight angle is also less likely to end up with a flattened head. Carrying baby helps with bonding; helps baby regulate breathing, temperature, and heart beat; helps enhance learning and social development and emotional health; can lessen crying and colic; allows baby mild stimulation through interacting with the person wearing baby; and enables the wearer to have their hands free.
J. M. Cavanagh
As sort of an afterthought, I just wanted to add that this article is in no way meant to be me saying you are a bad parent. I believe that we all do the best we can with the information that we have available to us. Please take this as a sharing of information, rather than a judgment. My oldest child is 9 years old, I didn’t have this information when she was a baby; I did wear her in a bad carrier, facing out. She is okay, but I wish someone had told me why it could be dangerous.
Works Cited and Bibliography
elcosh.org/en/document/590/d000568/will-your-safety-harness-kill-you%253F.html

articlealley.com/article_801539_6.html

Effect of Forces on the Growth, Development, and Maintenance
of the Human Body, BARNEY F. LEVEAU and DONNA B. BERNHARDT;
Physical Therapy December 1984 vol. 64 no. 12 1874-1882

Craniofacial Pain: Neuromusculoskeletal Assessment, Treatment and Management,  By Harry J. M. Von Piekartz

Neuro-developmental treatment approach: theoretical foundations and principals of clinical practice, By Janet M. Howle

Baby Spine Development, Bridget Coila

medcyclopaedia.com/library/radiology/chapter12/12_1.aspx

Infant Carriers and Spinal Stress, by Rochelle L. Casses, D.C.; 1996 by The Liedloff Society for the Continuum Concept; continuum-concept.org

Hensinger, R. N.; Spondylolysis and Spondylolisthesis in Children and Adolescents; Journal of Bone and Joint Surgery, August 1989 71A: 1098-1107

Baby Wearing – Suggestions for Carrying Your Baby: A Chiropractic Perspective;  Jeanne Ohm, DC; ICPA, Pathways to Family Wellness, Issue #10

Why Wear Your Baby?; Sharon Reuven;  ICPA, Pathways to Family Wellness, Issue #05

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26 Comments »

  1. Another reason facing in is important is that it helps to secure early attachment with mum, especially if there has been any form of separation or bonding deficit at birth

  2. Isabel Said:

    Just a note – I FFO in a pouch sling, so baby is in a lotus position, they’re just looking out at the world! If I’m reading your article correctly, FFO in a pouch (or ring sling or wrap) should be fine.

    • Lindsay Said:

      You’re correct, this position addresses a lot of the issues Jenny has outlined in her article. The two issues remaining are the curve of baby’s back and the chance of overstimulation. If you are using this position for half an hour or less at a time and you’re conscious of these concerns, you should be fine.

  3. guest Said:

    well..what do you do if your baby only likes to be worn facing out and doesn’t like the lotus position…he likes to be able to kick…or he will not tolerate being worn…I only wear him occasionally and not for longer than half an hour to an hour..could this still be a problem? never was for his brother..just wondering if this is really a problem as you say..why more kids haven’t been hurt by this..since most carriers out there are for forward facing and that is what you see all the time for years…I know of no one with a child ill affected by this form of carry…just curious..because if this is true..makes me worry about all the babies out there past and present being worn this way..and also makes it hard for those of us with babies who won’t tolerate being worn any other way…

    • Lindsay Said:

      Thanks for the questions and comments! Some alternatives to the forward facing carry are discussed here on our YouTube channel: http://youtu.be/yZiuc6qgvJI. Some babies are indeed trickier than others to find a carrier for, that they actually like and are comfortable in. I do know a few people who have had to try up to eight-ten different carriers before finding the one both they and their baby really like. It’s not common, but it happens. Often when parents come in to the store and say their baby doesn’t like facing inward, it turns out they have only tried it in a front-pack style carrier where baby’s legs are dangling. Babies are very rarely happy facing in in these carriers and seem to be uncomfortable due not only to legs dangling but also the structure of the carrier near their face. Not saying this is necessarily the case for you as I don’t know what you have tried, but it’s a common situation we observe.

      As for how babies and children have been affected by being carried this way – it’s a loaded question. It is something that is only just beginning to hit public and medical consciousness as carriers become more popular and the Baby Carrier Industry Alliance seeks to create safety regulations for carriers. The research into ideal positioning solidly points to “knees higher than bum,” “back in a supported C-curve,” “high up and chest to chest” as the ideal, though to my knowledge there have been no studies on the consequences of carrying a baby forward-facing-out with legs dangling. In my opinion it’s one of those cases where, if we know the risks, we can make decisions ourselves as parents. I have a hunch that there are also fewer negative consequences from the forward-facing-out position than we might expect to see because it is not a very comfortable position for the parent or caregiver so babies aren’t worn this way for very long periods of time or until they’re very old. If we consider what the negative affects could possibly be – some mild malformation in the hips, stress on the back, possibly stress in the baby’s brain as they develop due to overstimulation – do you know anyone who has checked their baby for these affects? How would we see them and know if they are there? Baby may be fussy, have their back out of alignment, suffer some hip issues later in life, but how many parents will connect that to their front pack carrier? See what I mean? A bit tricky to pinpoint.

      I hope that the video helps with some ideas for alternatives to a forward facing carry! It is definitely a concern for a lot of parents but interestingly, the vast majority of the parents I know who have worn their baby facing in, in an ergonomically correct position, from the beginning, have never noticed or mentioned that their baby did not like it. The overwhelming majority of parents I know whose babies “will only tolerate facing out” (I quote this because I do hear it often) have been wearing them in front pack style carriers.

      All the best,
      Lindsay

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  22. ” I have carried both of my boys facing outwards and they are just fine. I say to mothers everywhere educate yourself on such topics and then decide what’s best for your baby. Also do not let anyone judge you or make you feel like a bad mother for not carrying your baby inward. Mothers need to stop judging each other. It does no good for anyone involved. We are our childs best teacher and I believe we teach them it is ok it judge and discriminate when we exhibit such behaviors against other mothers. We should use one another as allis not punching bags. Every child and every parent are different as long as what you are doing is not morally or ethically wrong you are fine. So do what is right by your child and ignore those who judge you.


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