Evidence continues to increase on the practical and emotional benefits of babywearing, both to parents and their children. Among many other benefits, babywearing can help parents bond with a new baby, and facilitate both breastfeeding and the care of the baby’s older siblings.
Babywearing also has benefits for society at large. Children are more securely emotionally attached and there is evidence of a link between the reduced incidence of postnatal depression and babywearing. In this new book, Rosie Knowles explores all these advantages, along with the practicalities of how to babywear and babywearing culture. She demonstrates how a clearer understanding of babywearing, and the attachment parenting philosophy as a whole, can ultimately lead to a happier, healthier society.
Why Babywearing Matters for Babies
Being carried (in arms or in a sling) is normal human behaviour. It is the relationship of closeness and loving touch, as well as the supportive position adopted in confident carrying that matters most, not the type of sling or the fabric. Let us examine in more detail how carrying helps babies to thrive.
The majority of research into the effects of touch and skin-to-skin contact has been done with premature and small babies. Medical studies continue to show that early skin-to-skin and close contact (kangaroo care) improve outcomes for tiny babies. A UNICEF-funded review of 2010 states: ‘This evidence is sufficient to recommend the routine use of KMC for all babies under 2kg as soon as they are stable. Up to half a million neonatal deaths due to preterm birth complications could be prevented each year if this intervention were implemented at scale.’1
The World Health Organization (WHO) recommends the frequent use of slings as part of kangaroo care ‘for almost every small baby’ and illustrates how simple wraparound slings can be used to facilitate skin-to-skin contact between premature babies and their parents.2 There is no reason why every maternity hospital should not encourage immediate contact between mother and child and more and more NHS trusts are beginning to adopt the principle. One of the 2015 World Health Organization Sustainable Development Goals is to reduce maternal and infant mortality by up to 75 per cent, and kangaroo care will be vital in achieving this target.
The research into kangaroo care has helped us to understand that full-term, healthy babies experience the same positive effects of being carried as their premature counterparts.
Emotional effects
Being carried helps to meets baby’s strong need for a sense of security and attachment. Keeping baby close facilitates the parent’s speedy response to their needs, thereby building trust.3 Stressful situations and the frequent, prolonged release of cortisol and adrenaline can be harmful to the developing brain, but this can be countered by prolonged close contact. If parent and child have been separated for any length of time due to medical procedures, incubation, illness or caesarean deliveries, this aid to bonding is particularly valuable. Fostered and adopted children can benefit too; carrying allows the steady creation and consolidation of a new attachment.4
‘The feeling of being completely helpless is still fresh in my mind, I just love though how wrapping them instantly stops the crying and more often than not they will just peacefully fall asleep.’ Katie
Physical effects
Skin-to-skin contact helps to regulate heart and respiratory rates. This is important for children who are unwell, as it results in fewer cases of bradycardia and tachycardia,5 as well as helping to settle erratic breathing. Close contact is known to enhance growth and weight gain in premature babies and newborns. Cortisol levels remain low when babies are held close, enabling them to conserve energy that can be used for growth and development.6 Skin-to-skin plays an important role in establishing early breastfeeding, and babies given early close contact are breastfed for longer than their counterparts.7,8 Skin-to-skin in the first hour after birth, with milk expression, has been shown to significantly increase the volume and speed of milk production for infants with a very low birthweight (compared to those who had a delayed start of 1-6hrs).9 Breastmilk is babies’ normal biological food, and is perfectly adapted to their immature gastro-intestinal systems. It contains valuable disease-fighting antibodies, reduces the incidence of respiratory and ear infections and reduces the risk of diarrhoea (compared to formula-feeding). Breastfed babies seem to be more protected from dental caries, eczema and some childhood cancers, and are less likely to be obese. Therefore, anything that encourages breastfeeding is to be supported.
Babies are unable to regulate their own temperatures effectively. An adult’s skin will respond to baby’s proximity and alter its own temperature, helping to reduce fever or increase warmth in babies who are skin-to-skin. A parent’s naked skin can raise or reduce the infant’s temperature by as much as one degree10 and a parent’s skin can respond to the differing temperatures of twins placed on either side of their chest!
Regular close skin contact is believed to help babies regulate their circadian rhythms and distinguish between night and day sleep. We all know that babies sleep well when carried in arms; even more so when motion and noise is involved. Their heart rates slow and breathing stabilises when they are rocked.11 Babies sleep where they feel safe and secure, and they remain calmer and sleep more deeply and for longer periods when held close.12,13
Carried babies seem to cry less. The 1986 Hunziker and Barr study14 suggested that extra carrying, initiated prior to an expected peak of crying at six weeks, eliminated the peak and reduced the amount of crying significantly and steadily from three weeks of age. However, this data was not replicated in two further studies with similar trial designs. Studies into carrying and colic do not show a significant difference in the frequency of episodes of inconsolable crying and colic between babies who are carried and those who aren’t. However, a comparative study15 of London parents (reduced time in close contact, slower to respond to cries, more likely to feed according to schedule), Copenhagen parents (providing more interaction and responsiveness) and parents offering ‘Proximal Care’ (prolonged close contact, quick to respond to crying and feeding on demand) showed that the London babies fussed and cried 50 per cent more than the Copenhagen or Proximal Care babies, who just fussed rather than cried. Presumably this is because they trusted that their needs would be met without the need for loud crying. Parents who are close to their children pick up on irritable cues before they become full-blown howls; crying is the last stage of communication. Less crying may enhance the parent-child dyad’s mutual bonding and understanding of each other, and gives more time for ‘quiet absorption’, a state that promotes learning and positive interactions with the world.
Such is the power of close contact that babies are able to handle painful procedures with less distress and cry less in response to such stimuli.16 (Take your baby for his vaccinations in a sling!) Babies with excessive wind can be hard to soothe, but the motion of being gently rocked in arms or a sling often helps to bring up air or to settle an unhappy child.
The symptoms of gastro-oesophageal reflux are often eased by upright positioning, and there may be a reduced risk of ear infections as a result.17 Affected babies may prefer to sleep upright, and a sling can make it much easier for a parent to meet this need. Furthermore, the spread-squat position of knees above the bottom helps to relax the puborectalis muscle, which aids bowel elimination. We in the Western world have higher rates of bowel dysfunction compared to those who squat for toileting; studies are examining why this is.
The motion experienced by a baby in a sling allows the vestibular balance apparatus to develop more rapidly than in babies who are often motionless in a seat or on the floor. Being moved around enhances a baby’s opportunity for motor development and builds their muscle strength. It improves neck and head control, but is not a substitute for ‘tummytime’ (when head-lifting is against gravity).
Close skin contact encourages the development of maternal antibodies to pathogens on baby’s skin, which are then passed on through the milk, helping to protect baby from these microbes.18 Ensuring a low level of cortisol in the blood (by frequent touch and reduced stress) may enhance immune function.
Carrying in the natural physiological spread-squat position, and correctly designed slings that encourage this, can help prevent hip problems in children at risk of hip dysplasia. This is discussed in more detail in Chapter 6. Babies who are carried are also at reduced risk of plagiocephaly (the flattening of the skull bones at the back of the head from prolonged periods lying on the back, more common since the ‘Back to Sleep’ campaign).19
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Lawn JE et al, op.cit.
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Baronel L, Lionetti F. Attachment and emotional understanding: astudy of late adopted pre-schoolers and their parents.Child Care HealthDevelopment. 2012; Sept; 38(5).
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Parker LA et al. Effect of early breast milk expression on milk volume andtiming of lactogenesis stage II among mothers of very low birth weightinfants: a pilot study.Journal of Perinatology. 2012; Mar;32(3):205-9.
Ludington-Hoe S. Breast infant temperature with twins during sharedkangaroo care.Journal of Obstetric, Gynecologic and Neonatal Nursing.2006; 35(2):223-231.
Eposito et al, op.cit
Ferber et al. The effect of skin-to-skin contact (kangaroo care) shortlyafter birth on the neurobehavioral responses of the term newborn: arandomized, controlled trial.Pediatrics.2004; 113:858-865.
Messmer P et al. Effect of kangaroo care on sleep time for neonates.Pediatric Nursing. 1997; 23(4):408-414.
Hunziker UA, Barr RG. Increased carrying reduces infant crying: arandomized controlled trial.Pediatrics. 1986; May; 77(5):641-8.
St James-Roberts I, Alvarez M, Csipke E, Abramsky T, Goodwin Jand Sorgenfrei E. Infant crying and sleeping in London, Copenhagenand when parents adopt a ‘proximal’ form of care.Pediatrics.2006;117:e1146-e1155
Kostandy et al. Kangaroo care (skin contact) reduces crying response topain in preterm neonates: pilot results.Pain Management Nursing.2008:9:55-65
Tasker A, Dettmar PW, Panetti M, Koufman JA, Birchall JP, and PearsonJP. Is gastric reflux a cause of otitis media with effusion in children?TheLaryngoscope. 2002; 112:1930–1934.
Lawn et al, op.cit.
Turk AE, McCarthy JG, Thorne CH, Wisoff JH.The ‘back to sleepcampaign’ and deformational plagiocephaly: is there cause for concern?Journal of Craniofacial Surgery. 1996; Jan;7(1):12-8.