Safe babywearing: slings and carriers without worry

Why carrying is good, and why position matters

For many parents babywearing is the answer: your baby is close to you, often cries less, and your hands stay free. It is an age-old way of transporting a child and there is nothing wrong with it, quite the opposite. At the same time, carrying does place demands on positioning, and those demands are not optional, because a baby of a few months still has little head and neck control and cannot correct a restricted position by itself. The two things that genuinely matter are the airway and the hips. That sounds technical, but it comes down to a handful of checks you do within ten seconds and that soon become automatic. This article explains what those checks are, what the differences between the common carrying systems are, and what you are better off not doing while wearing. Once you have that basis, you can relax about the rest.

The TICKS rule in short

Internationally, safe babywearing uses the TICKS rule, and it is the standard that Dutch babywearing consultants and maternity carers work with too. TICKS is a mnemonic for five checks you run through at every carrying session: tight enough, in view at all times, close enough to kiss, keep the chin off the chest, and a supported back. The strength of the rule is that you can run through it in seconds, even when you are in a hurry or when someone else puts the carrier on. Print it out and hang it by the coat rack if that helps, certainly in the first months and certainly if grandparents or a babysitter carry too. Read the five points below through calmly first, then check them in the same order every time, so it becomes automatic rather than something you have to think about. Every single time, even if it went fine yesterday, because a knot can work loose and your baby is a little bigger each week.

TICKS point by point

• •Tight enough: the sling or carrier sits firmly, with no slack for your baby to slump into
• •In view: you can always see the face without having to move fabric or a chin aside
• •Close enough to kiss: with your head tipped slightly you kiss the forehead effortlessly
• •Chin off the chest: at least a finger's width between your baby's chin and breastbone
• •Supported back: the back rests against you in its natural curve, not slumped or arched

The airway always comes first

Of all the TICKS points the chin is the most important, and it is also the one that most quietly goes wrong. A young baby's airway is narrow and soft, and if the chin drops onto the chest that airway kinks shut without your child being able to do anything about it or even make a sound. So always keep at least a finger's width between chin and breastbone and check it again once your baby falls asleep, because that is exactly when the head sinks down. Make sure the nose and mouth are clear and never pressed against your body or a layer of fabric. Always carry a young baby upright and facing you; the so-called cradle position with the head downwards is the riskiest position there is. Glance at the face every few minutes, including while out and about. Trust what you see rather than the fact that your child is quiet, because with an airway problem silence is precisely the signal.

Hip-friendly carrying: the M position

The second issue is the position of the hips, and it matters most in the first year while the hip sockets are still developing. A good carrying position is called the M position: the knees sit higher than the bottom, the legs are spread, and the carrier supports from knee crease to knee crease. That way the head of the femur sits neatly in the socket and the joint grows as it should. A carrier that supports only the crotch and lets the legs dangle straight down does the exact opposite and is therefore not recommended. When buying, look at the width of the seat panel and whether it grows with your child, and check whether the manufacturer states recognition by a hip-healthy certification. If hip dysplasia runs in the family or your child is under review for it, discuss babywearing explicitly with the consultatiebureau or the treating doctor.

Warmth: you count as an extra layer

A carried baby lies against a warm body under several layers of fabric, which makes overheating a real and often forgotten risk. The rule of thumb is that the wearer counts as one layer of clothing, so you dress your baby more lightly underneath than you would if they were lying in the pram. Take a hat off indoors, because a baby regulates heat largely through the head. Regularly feel the neck or between the shoulder blades to check whether your child feels clammy or very warm; hands and feet are not a good gauge and almost always feel cooler. In winter, use a babywearing coat or a cover over the whole setup rather than a thick coat on your child, because a thick coat also disturbs the fit. In warm weather walk in the shade, drink enough yourself and offer the breast or bottle more often.

Wrap, carrier or ring sling: what suits when

There is no system that works best for everyone, and the difference lies mainly in ease of use versus adjustability. A woven wrap is the most versatile and moulds exactly to the body, but it takes practice and a few rounds of tying before it becomes routine. A stretchy wrap is comfortable for newborns and easier to learn, but goes too slack once your child gets heavier. A buckle carrier is quick to put on and handy for short trips and for partners who would rather not tie anything, but you do have to adjust it properly for height and width, and not every buckle carrier is suitable from birth. A ring sling sits on one shoulder, is ideal for short moments and for getting in and out quickly, but is less comfortable for long stretches. Choose what you will actually use, because the safest carrier is the one you can put on properly without fuss.

What not to do while wearing

Carrying frees up your hands, and precisely because of that the temptation is strong to add tasks that do not go together with a child on your chest. Do not cook with your baby in the carrier and do not carry pans or hot drinks, because you consistently underestimate how far your child sticks out in front and one splash of boiling water is enough for a serious burn. Do not cycle with a baby in a wrap or carrier; in a fall there is no protection at all and the setup also keeps your child strapped to your body. Never use a carrier as a substitute for a car seat, not even for a short distance, and always take your child out of the carrier for a car journey. Bend from the knees with one hand supporting your baby, not from your back. And do not walk down the stairs wearing a carrier with your hands full, because you can already see your feet less well than usual.

Adjusting, practising and getting it checked

Nearly every problem with babywearing comes from a wrong adjustment rather than a wrong product. Practise a new tie or buckle carrier the first time over a bed or sofa and with a second adult present, so you can work it out calmly without risk. With a buckle carrier, readjust the panel width, the seat height and the straps as your child grows, because the setting from three months ago is almost certainly wrong now. Have your technique looked at once by a babywearing consultant, by the maternity carer or at the consultatiebureau; many municipalities also run free babywearing clinics. Have your partner and your babysitter do the same, because they will use the same carrier on a different build. Finally, read the manufacturer's instructions on the minimum weight and on the age at which back carrying is permitted.

Getting comfortable and then letting go

After a few weeks carrying becomes second nature and you will run the five checks without thinking about them, which is exactly the point. Keep the habit of looking and feeling right after putting the carrier on, and doing it again the moment your child falls asleep or you zip up a coat. Inspect the carrier now and then for wear: stitched seams coming apart, frayed straps and buckles with hairline cracks are reasons to replace it, certainly for a second-hand one without instructions. Keep the manual, or keep a photo of it on your phone, so you can look up the settings as your child grows. If you notice your baby wheezing, breathing heavily or irregularly, feeling floppy or being unusually quiet while being carried, take them out immediately and assess their breathing. Call your GP, the out-of-hours GP service or 112 if in doubt.