Henrik Norholt on February 02, 2011

Facing in? Facing out? A science-based view on baby carrying positions

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Ergobaby occasionally receives questions from well-intended parents asking if their baby can be carried facing outward when babywearing. Clearly, these parents wish to stimulate their baby as much as possible and engage it in the outside world at large. We will try to answer this question with the following scientific insights into child development that have been created over the past few decades. We will describe some of the aspects of how a baby develops in the first year which relate to ideal carrying positions and we hope that this will help you make good and informed choices on the carrier types and positions you will employ in your care for your baby.

Need for Brain Stimulation

Let’s begin with validating the basic idea that it is good for a baby to be stimulated by parents and other caregivers. One of the key results of the great amount of research done on the baby’s developing brain is indeed how vital appropriate stimulation is. When the baby is born, the number of neurons in its brain corresponds to adults’. However, what is missing is the mindboggling amount of connections which will eventually shape that particular baby’s personality and intelligence. These connections are formed by and are utterly dependent on the type of stimuli that the baby receives from the outside world.

Every experience the baby is exposed to will activate some part of the brain’s neurons. The more frequently a given experience occurs, the stronger the connections between the activated neurons become. As neuroscientists sometimes say, “Cells that fire together, wire together .

However, just as there is no point in trying to teach a newborn how to ice skate, certain types of stimulation are more appropriate at specific developmental phases than others. To understand what types of stimulation are appropriate and beneficial, we need to look at the major developmental phases which a baby goes through in its first year.

Four Stages of Baby’s Development

In the first few months after birth, the baby’s main developmental task is adaption to life outside the womb. A variety of basic functions has to be mastered-suckling, digesting, breathing, vocalizing, defecating, and seeing. These are initially demanding tasks and the baby therefore spends much of its time in what is called “adjustment states sleeping, drowsing, fussing, and crying. Occasionally, it is as if the baby surfaces and moves into the quiet alert phase, which is just that. The baby is quiet and looks around attentively and takes in the world. Or rather, the very immediate world, as the baby’s zone of vision is limited in the first few months to 8 to 10 inches. Incidentally this is also the approximate distance between your face and your baby’s face when holding your baby in your arms or breastfeeding.

At around 2-3 months of age, the baby begins to actively seek out social exchanges with adults, using its glance and smile to attract attention and initiate “conversations or playful episodes. The mother will normally respond with exaggerated facial expressions and using a high-pitched voice dubbed by brilliant child development researcher Daniel Stern as the language of “motherese .

This marks the beginning of a 3-4 month phase (age 2-6 months) where the baby is intensely interested in the human face. The baby’s game is all about learning the rules of human social interaction, reading and interpreting the great multitude of facial expressions that the mother, father and other caregivers will exhibit. In their quest to engage and bring joy to their baby, taking turns in communicating, the baby will also learn how to tolerate and regulate the excitement and sometimes frustration that builds up in each playful episode. These innocent-looking play episodes are neurologically vital in creating empathy, social and communication skills, a capacity for joy and the ability to tolerate stress.

From around 6 months of age, with the emergence of eye-hand coordination, the baby’s attention gradually switches towards the world of objects. The baby also becomes able to move about by initially crawling and sets out to explore the surroundings with its newly won capacity for movement. The primary caregivers (mom and dad) are no longer the baby’s center of attention as was the case in the preceding months. Their primary role becomes to help the baby decipher and interpret ambiguous situations where the baby feels insecure.

An illustrative laboratory test of this is when a baby has to cross a glass (transparent) covered hollow to reach a desirable object. The baby will check the mother’s facial expression; If her face expresses horror or uncertainty, the baby will not cross the hollow. If, on the other hand, the mother via her facial expressions encourages the baby to continue, it will do just so. The baby uses the caregiver to regulate its own emotions and behavior.

This is the phase where the baby learns to share attention with another person, following the direction of the caregiver’s glance and also enlisting the help of the caregiver to obtain objects outside of its reach, by pointing and checking if the caregiver is putting the attention on the desired object. The baby will also become emotionally attached to the primary caregivers (usually the parents) and begin to show signs of distress at separation and towards friendly advances from strangers, using the caregivers as “a safe base.”

How Do these Developmental Phases Relate to the Ideal Carrying Positions When Using a Baby Carrier?

For the first several months, the baby is more than content with being carried in the front position, facing inward towards the caregiver. From a developmental point of view, the baby’s primary tasks are related initially to adaptation to life outside the womb where it certainly does not need excessive stimulation. Quite the contrary, at the “social awakening period at around 2-3 months, the baby’s main interest will be the human face, and here the front facing inward position will continue to be ideal for most babies as they will have a clear view of the caregiver’s hopefully exciting and stimulating face. The baby can also observe the caregiver’s face when she/he is communicating with others, providing the baby with learning experiences.

At some point in time, the baby will itself actively signal by simply turning its head and making active efforts to look out at the outside world or protesting that the front facing inward position is no longer suitable to provide adequate stimulation. If the baby is able to hold up its head, which is very likely to be the case at this stage, it might be moved to the back or hip position.

On the rare occasion one comes across babies who at two months of age are very interested in the outside world and protest being held in the front position, facing inward, our advice to parents has always been to simply put such a baby in the back or hip position, provided the baby is able to hold up its head. Other babies may be entirely happy to be held in the front position facing inward past 6 months of age, some even up to 12 months

The age where this happens can vary greatly, mirroring the great variation in both the innate temperament of babies, but also in their immediate environment. Some parents go through challenging times during their baby’s first year and these may be utterly unrelated to the baby. A tense family environment is likely to make the baby seek the comfort and safety of its caregivers and focus on that incredibly important relationship before it begins to take in the world. To fail, for whatever reason, to provide a safe family environment and at the same time try to force independence prematurely is detrimental to a child’s healthy development.

The back position is normally employed when the baby becomes too heavy to be carried on the front or on the hip. For most parents, this happens at around 22 lbs (10 kg) when the baby is around one year old.

The key basic understanding required for determining which carrying position is optimum is that a normal healthy baby’s development always goes from initially requiring great amounts of physical closeness and parent/child interaction towards greater independence and curiosity towards the world at large.

When a baby or child is having problems achieving the expected independence, it is virtually always because some aspects of the earlier developmental phases have not been completed and the baby is trying to get these completed before moving onto the next step. Parents may think that they are smarter, but in this case, the baby absolutely knows best.

Other Benefits of Facing Inward

Why else are we hesitant to recommend a carrying position where the baby is carried on the front, facing outward? First of all, we do not find the position ideal from a physiological point of view. The best position to promote a healthy development of spine and hip is the spread squat position or “frog position, as some call it. In fact, this is the very position that babies are placed in in a brace when hip dysplasia has been diagnosed, because the position stimulates the optimum growth of the hip joints. To have all the weight of the baby placed on the groin and the legs left dangling straight down is simply not optimum from a physiological developmental point of view. Choose a carrier that keeps the baby in the “frog position.”

The second aspect of the front facing outward position is that the baby is cut off from having a clear view of the caregiver’s face. This is especially problematic in the first 6 months, where the interactions with the caregiver’s face are vital for the optimum neurological development of the baby’s brain. But also in the months succeeding this period the baby will be referring frequently to the caregiver’s face for interpreting ambiguous situations. Not being able to refer to the caregiver’s face will create unnecessary stress in the baby and if happening repeatedly, will compromise its basic capability to regulate stress reactions, which in the long run can become detrimental to mental and physical health in adulthood.

The message is follow your baby’s lead. Carry her (him) in the front position, facing inward, until she signals that she would like to see more of the world, at which point you place her in the back or hip position. You will have achieved the maximum benefit of Babywearing.

Henrik Norholt

Dr. Henrik Norholt is a member of The World Association of Infant Mental Health. He holds a Ph.D. from the LIFE faculty of Copenhagen University and is a resident of Copenhagen, Denmark. He has been studying the effects of baby carrying as it relates to child psychological and motor development through naturalistic studies since 2001.

He is actively engaged in the study of current and past research into baby carrying through his large international network of family practitioners, midwives, obstetricians, pediatricians and child psychologists and shared his insights with the subscribers to Ergobaby’s blog.