family in spain sunnyOne of the most common “controversies” in the babywearing world is the issue of babies being carried in facing out positions. This means babies being held with their backs to their carer, facing the world, rather than facing the person who is carrying them. Opinions vary widely among manufacturers and parents and even among professionals. Many babies do very much enjoy being held in positions where they can see the world, so why all the fuss? Is there any need for a fuss at all?

What are the advantages of world-facing?

Babies do enjoy seeing the world, especially once they are a little older and have mastered head control and wish to be more involved with their environment, rather than sleeping or snuggling in as they did when they were very little. Curiosity often coincides with increased motor co-ordination and greater periods of awake and interaction time. This is often the point at which families begin holding their babies in positions that give them greater visibility. Instinctively, they tend to support their little ones in very gentle positions that still ensure good hip and spine support; cradled in arms with chin off chest, or held in semi-seated positions with back curved against parent but hips held in flexion, as if sitting in a bowl. facing outThese positions protect the natural anatomical curve of the immature spine and do not straighten it uncomfortably.

As babies grow, their muscle strength increases and fatiguability decreases, alongside greater coordination and gross motor skills. This allows slowly improving head and neck and upper back control (with less drooping or wild flailing) as their spines gradually begin to uncurl. Furthermore, as their focal length improves and visual acuity rises, the world becomes very interesting! There are stages in baby development when babies seem to arch away in arms a lot; this may be related to a desire to see more, but may also simply be attempts to hone upper back strength, in preparation for turning skills and rolling over. This is very common around ten to twelve weeks. Babies may also arch when they are tired, if they have reflux, if they are frustrated.

In-arms holding is responsive, which is the key issue; if baby makes a protesting movement or noise, the carer responds and moves the baby to help it to become calm again. Also, parental arms get tired and baby is easily moved to another position, this may often be on the shoulder facing parent again for a while. Such reactive carrying in-arms, with changing facing-in and facing-out positions, is of great benefit for honing development and also to encourage learning about the world from a safe and comfortable position.

This all sounds great, so what’s the problem with using a sling for this?

What are the hazards of facing out?

brainIt is important to remember that young babies are not ready for prolonged and intense interaction with a very sensory-overloading environment; they have not yet learned how to process the bombardment of information their brains are receiving. They have not yet discovered how to “filter out” the irrelevant for a more focused look at the world, (a skill that we take for granted) so this can be very tiring. Being able to turn away from the noise and bustle and fall asleep (to process information) is important. A facing-out carrier holds a baby in a fixed position for a prolonged period of time. The duration of this time is entirely dependent on the parent; they are unable to see their baby’s face to pick up early cues of tiredness or distress or breathing difficulties, and they are less able to feel subtle shifts in baby’s body signalling discomfort or a need to change positions. Babies can easily be left in carriers for much longer than they would be held in arms.

Babies are intensely social creatures and learn to regulate and control their emotions from interaction with their parents and watching their faces. Social referencing (also known as triangulation) is very important in the first year and well into the second. A child will often decide how to react to a new experience after it has looked to its carer; it will be less likely to touch something dangerous if the carer reacts in an upset way. Potentially scary experiences can defused by turning the head to see a parent remaining calm, or to receive comfort and reassurance, and vice versa. In a structured carrier worn facing out, it isn’t as easy for a baby to twist around to see the parent’s face for reassurance or to be able to seek comfort.

parent facing pramMany pushchair makers now include parent-facing positions as standard, as this is believed to encourage and improve language skills and bonding. (It is worth noting that there is no formal evidence to suggest that our children are any slower at language acquisition than previous generations who did not use facing-out means of transport, however, anything that promotes bonding and communication is to be encouraged.)Sleeping

Furthermore, the world-facing positions do not provide any safe sleeping positions (all respected manufacturers say babies must be turned around to sleep; this is often missed in the small print) as there is no head support in this carry. A heavy head that is unsupported by a parent’s chest will droop forwards, putting baby’s chest under slight compression and pressing the chin downwards, potentially compromising the airway.

This is why the majority of respected sling manufacturers suggest that babies under 4months should not be carried facing out. Before this, babies simply are not developmentally ready.  Beyond this age, they should not be held in carriers facing the world for longer than twenty minutes to half an hour or so. (Some manufacturers say facing out from 3 months up, some say from 5months up). I think it depends on the child’s personal developmental stage and there should really be no rush.)

There is also the issue of hip and spine positioning in facing out positions. Most facing out in slings is done with “narrow-based” carriers, as very few high street options offer wider, more ergonomic seats that protect the gentle curve of the spine and promote healthy hip development in the world facing position. Most babies find their backs are held in straighter positions than ideal, with their legs hanging straight down from their hip sockets in this narrow shaping. While there is no formal evidence that choosing a narrow-based carrier will cause any harm to a baby who has healthy hips with normal sockets, there is a small percentage of babies who do have developmental hip dysplasia that are missed at their routine checks. These babies will benefit enormously from the ergonomic seated M shape position that allows their joints to be held in the optimum angles for healthy blood vessel growth and nutrient provision, and often this positioning is all that is needed to correct mild cases of hip dysplasia. It is worth weighing up the risks and may be better to choose a carrier that holds a baby more optimally if you decide to face baby out. Additionally, it is more comfortable for a person to be seated on a broad based hammock shaped chair rather than perched astride a narrow padded beam, and babies are no different.

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Carrying a baby who is sitting high up against the carer’s body with the centres of gravity closely aligned is much more comfortable than carrying one who is low down, far away, and suspended from the carer’s shoulders. The parent’s body does not form part of the support structure of the carry when facing out, so much of the work of carrying has to be done by the upper body, rather than the core postural muscles. Centres of gravity diverge further when held facing out in narrow based carriers. Put simply, carrying facing out in this style of carrier is often uncomfortable.

Ok, so what can I use to carry my curious child optimally?

It is common among parents who are considering using a sling to look for options that offer world-facing positions. This position is what is often seen in the media and is widely advertised; it may be more pleasing to see happy babies looking directly at the camera rather than away from it, which can be better for marketing purposes. As it is so visible, it becomes the “norm” and carriers that offer this option are often perceived as “better.” 

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Many parents believe that babies need to be given the opportunity to face the world as much as possible for the stimulation, rather than looking at their parent all the time. Sometimes this belief can be be a marker for low self-esteem in a parent; that they just aren’t interesting enough, when in fact, for many well-attached babies, their parent is their most beloved sight. This is especially true if parent and baby are attuned and the parent is responsive and communicative and able to engage happily in play with their baby. Babies are often able to pick up on unhappy or uneasy feelings in parents and can be reflexively resistant to close contact, creating a negative spiral. Lots of in-arms carrying, skin to skin, and just time spent together can be very helpful with this.

Sometimes babies may begin to resist being carried in their parent-facing positions – they may have come to associate the sling with sleeping which they don’t want to do, and they may want to be able to see more. 

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To achieve a good view while the child remains parent-facing, and ensure access to the world, try carriers with broadly angled straps that don’t get too close to the face can be very useful, or ones that can be tied carefully for good visibility. As children grow in co-ordination, they need less head support and often enjoy having their arms out of carriers (with the panel reaching up to the armpits for safety and support.) It is surprising how far a child can turn round to see when they can move their shoulders! 
JUNOlo-38Hip carriers and ring slings will hold a child “off-centre” or laterally on the hip, for a great vantage point, and they will still be able to turn towards their parent for conversation or rest. Back carrying can be another very useful way for a curious child to see the world coming towards them. Most structured carrier makers will suggest sitting-up age to be the most appropriate time to begin to think of this option, and it is not hard to do on your own. Your local sling library or consultant (www.slingpages.co.uk) will be able to help you learn.

If you have a baby who is developmentally ready for facing out in a carrier and has stable hips, then I think it is just fine to give it a go! Your local sling library will be able to show you some options and talk you through which may be the most comfortable for you. Trying the carrier out first for a period of time at home is very useful to see if it really does work for you before you buy; advice from the internet is no substitute for real life trials.This period of “fussiness” doesn’t usually last long, as babies grow in co-ordination they are happier and many babies who once resisted facing in are very content a few months later in a carrier that is more comfortable with greater longevity.

In summary, facing out can be a great deal of fun for parent and child, if done sensitively and thoughtfully, with consideration to the child’s anatomical development and comfort; look for those carriers that take your baby’s comfort as seriously as yours. Try to pick a carrier that will hold baby optimally for most of the time, some come with specially designed bucket seats and others will widen for facing in and back carrying.

Age-appropriate facing out for those who enjoy it is great, when done safely! Your local sling library can be found at www.slingpages.co.uk.

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