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.

  • Dinesh

    Very interesting arguments. If you could provide some cross-references or some data in case or original research, that would go a long way in establishing the validity of the “science” based view.

  • Kristina Belova

    Can I translate this article in russian for my cite and point the author and the source of original article?
    Thank you.

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  • Karen B

    One word of caution when holding a baby over your shoulder — be SURE to use both hands to hold the baby. When our daughter was 6 weeks old, my husband was holding her facing him, with her head resting on his shoulder, and he used one hand to reach for something, so just one hand holding her for a moment. Well, she chose THAT moment to suddenly lurch back, and, since babies heads are heavy, compared to the rest of their body weight, she just flipped right over his arm and fell to the tile floor — ended up with a fractured skull. I was right there, and tried to catch her, but it all happened so fast. So…if holding a baby this way, best to do it when sitting down. If standing up, always make sure one hand is supporting the baby’s upper torso/head.

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  • hannah moran

    Soooo, can I face him outwards in your slings or not because he really really hates being inwards when outside.

  • Probabymom

    Just say it, yes or no, can we face the baby outward in your carrier. I could care less what your opinion is, I’ve done my research as well. I need a carrier that eventually allows my baby to see the world-facing outward where ALL babies I know eventually want to face. Also, it’s terrible for they’re development to constantly crane their neck to see what’s going on behind them. But that’s not in your article is it.

    • Milsey

      Me to!!! I guess it’s a No with all that fobbing off.

  • asylem

    Thanks for telling me what my baby wants. I’ll never buy your product with this type of article to a basically yes or no question. Ridiculous.

  • Milsey

    Is that a no then? To be honest I drifted off after the first paragraph. . .I am sleep deprived so forgive me! I just wanted to find out if you can face forward with an ergo. I go with what my baby prefers, which is facing forwards. He gets all upset and just tries to feed facing inwards and is freaked out on the back. All babies are different!!

  • Milsey

    Front-facing carriers

    Most of the mums we talked to mentioned that as their baby got older she became more interested in the world around her and wanted to be able to see and interact with other people. We received lots of feedback that the babies in our trial liked a carrier that gives them the opportunity to face the direction that the parent is walking.

    Some slings and carriers can be used like backpacks so that your baby faces forward, but there is some discussion on internet forums over whether front carriers with forward-facing positions offer correct leg and spine support for a growing baby.

    We were unable to find any published medical studies that suggest that front-facing baby carrying causes hip and spinal problems. The only types of baby carrier that have been shown to cause hip and back damage are Native American papooses and Inuit cradle boards. Incorrect swaddling is also emerging as a cause of hip dysplasia. In all three cases the infant’s legs are forced straight down and kept immobile for long periods of time.

    Well-designed front-facing carriers can provide adequate support for older babies

    We contacted the Royal College of Midwives to ask if this was an issue that they were investigating and were told that they were aware of no evidence to support the view that front-facing baby carriers cause hip and/or spine problems. They did, however, emphasise that proper support is most vital when the baby is unable to support the weight of his head – they recommended that you do not use the forward-facing position before your baby can hold his head and shoulders up on his own. Otherwise you should allow your baby to move his arms and legs freely and make sure the baby is not held in any stationary position for too long.

    We also discussed this issue with children’s product experts from other consumer organisations. Our Scandinavian colleagues were surprised that this was an issue, as it is not something that has come up in their countries, despite the fact that forward-facing babywearing has been common for 30 years. Scandinavians are enthusiastic babywearers and carriers with the front-facing position are common. The only issue our colleagues were aware of as a topic for debate was ‘how tight is tight enough?’ to wear your baby.

    Most of the comments against forward-facing baby wearing seem to stem from a German book by Dr E.Kirkilionis about baby-wearing, in which the author says that she saw a front-facing carrier with the baby’s legs hanging down and didn’t like the look of it, mostly because babies could become over stimulated, but also because of lack of support for the legs. That book is based on research carried out in the 1980s, which Dr Kirkilionis used in her thesis ‘Unfounded fear of postural damage by carrying’.

    Baby-carrier design has moved on since the 1980s – partly because of the concerns raised about correct support. Some manufacturers who offer forward-facing carriers are aware that this is an issue of concern for parents. They seek to calm their worries by working on product development with physicians who vouch that a forward-facing position is not detrimental to development once a baby is old enough to support the weight of her head and shoulders.

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  • Grizbare

    To all the people that didn’t read the instruction manual that comes with the Ergo Carriers (which can also be found online for any that are researching before buying),

    “…DO NOT WEAR THE BABY FACING OUT.”

    This can be found on the page with the bright red lettering that says “WARNING – FALL HAZARD” followed by a full page of all-caps warnings. Consider yourselves informed.

  • adastra7

    Long story short, you just spent $130 on this carrier and you can’t carry the baby facing forward in it. We bought another one that has a small sling under the baby’s buns to face forward and addresses any ergonomic issues for forward facing.