Are Outwards Facing Carry Positions Safe?

The South London Sling Library believes that there are benefits to using any sling or baby carrier, provided that it’s used safely.  A safe carrier protects a baby’s airways and supports their head and spine appropriately for their age. It holds them securely without risk of falling.  This applies to almost all well-made slings and carriers on the market, and there is currently no proof of actual harm caused by using any particular style of carrier with a healthy baby, provided that it is used appropriately for a baby’s developmental stage and abilities, and the basic safety essentials are attended to. For a useful checklist of the important things to look out for in a safe carry in any sling or baby carrier, see The T.I.C.K.S. Rules for Safe Babywearing.

However some carriers or carry positions may not offer the best levels of support and comfort for baby or parent. In particular there is a lot of debate amongst advocates of regular baby carrying and manufacturers of baby carriers relating to the suitability of outwards facing carrying positions. There are various reasons why they may be not as suitable (for baby or parent) as parent facing positions, but disagreement about whether they should be avoided completely.

Unfortunately very little research has been done to specifically examine the physical and psychological effects of different carrier/sling positions on a baby. Again it’s important to note that there is currently no evidence of actual harm caused to healthy babies by outwards facing carry positions, but existing knowledge about babies’ physiology and development added to experiences of parent comfort can be used to argue for the greater suitability of parent-facing carrying positions that fully support a baby’s thighs.

The Case Against:

Experts recommend that for optimal hip stability in the first year (and beyond) while a baby’s hip sockets are forming and hardening, a carrier should provide support for a baby’s thighs with the knees held higher than the hips and only the lower legs hanging down (the ‘M’ position). This is especially important during the first 6 months of development and for children with a family history of hip dysplasia or similar problems.  It’s also the naturally most comfortable position that a healthy baby will normally adopt when they are being carried upright in their parent’s arms, and aids optimum positioning of the pelvis and spine.

In our experience, outwards facing carrying postitions in almost all carriers will not support a baby’s thighs to the level recommended and will allow their weight to hang down and away from the parent’s centre of gravity. With the weight supported mainly over the shoulders this will usually have the effect of dragging uncomfortably at the parent’s shoulders, encouraging an unnatural and uncomfortable posture. This effect is exaggerated in carriers without suitable lumbar support.

Carriers that offer ‘Buddha’ type outwards facing positions (such as ring slings and pouches) do allow a baby’s weight to lean back into the parent, and facilitate a suitably abducted hip position for the baby. However if not used carefully these positions may prevent free movement and potentially restrict blood flow, as well as there still being possible concerns about the positioning of the baby’s spine. We therefore recommend very careful positioning of a baby’s legs when carried in this position, and don’t recommend using this position for extended periods.  An alternative to the completely outwards facing Buddha position is a side-seated position that can more easily offer good positioning for baby’s spine and space for their legs and feet whilst allowing them to see the world.

The following is a very useful article, written by a GP to explain hip development and hip dysplasia and how this relates to carrying: Healthy Hips – busting some myths. Recommendations on better hip positioning from the International Hip Dysplasia Institute may be found here: Hip Health in baby carriers, car seats, swings, walkers, and other equipment.

It is also very important that the back, neck and head of newborn and young babies is fully supported. Outwards facing carry positions are never suitable for babies under 3 months who do not have the upper back and neck support to fully and comfortabley support the weight of their own head in an upright position whilst being carried.  The lack of head support may be an additional comfort problem for older babies should they fall asleep in an outwards facing position.

Outwards facing positions in baby carriers do not support the natural curve of a baby’s spine in the same way as inwards facing positions, and (depending on the parent’s shape) baby may be forced into a backwards-curved spine position. Babies best fit against their parents when facing towards the parent’s body.

Long periods in an outwards facing position can be overwhelming or overstimulating for some babies. At times babies find inwards facing positions more reassuring as they can see their parent and easily turn away from strange situations if they are not comfortable.  An inwards facing position on the front, back or hip also allows baby to more easily sleep with their head supported, and a suitable hip or back carry position will also allow a baby to see the world over their parent’s shoulder/s.

The following is a great, easy to read yet fully referenced article about why a parent-facing spread-squat position is more suitable than an outwards facing one: Facing Inward or Outward – The Physiological Aspects and there are some very clear photos of recommended positioning here: Babywearing Institute

The Case For:

Babies have been carried in outwards facing, harness style carriers for over 30 years without this being associated with ongoing postural problems.  The limited research currently available suggest that using this style of carrier according to the manufacturers instructions is unlikely to cause your baby actual physical harm (unless there is a genetic predisposition to hip dysplasia), and many parents find that their 3-6 month old babies love to face outwards to look at the world while being carried.

In our professional experience, there are a minority of babies who go through a stage where they will not tolerate facing their parent whilst being carried.  Symptoms of this are very different from the more common wriggling, pushing and arching of the back that many babies make as they are developing upper back strength in preparation for rolling, sitting and crawling.  A period of preferring to face outwards usually coincides with a baby being at the specific developmental stage of having improved distance vision and awareness of surroundings but a lack of upper back and neck control needed to engage fully with their environment.  This phase usually passes once the baby is able to express themselves more effectively, and/or the next physical milestone (usually rolling or sitting unaided) has been reached.

In recent years major baby carrier manufacturers have been addressing the problems of narrow harness type carriers and the greater parent discomfort of outwards facing carrying positions. The seat area of newer models of the better quality mainstream front carriers is becoming wider to better support a baby’s thighs, and additional waist and lumbar supports are being added to protect parents’ backs.  A few new carrier designs can even offer support for an optimal ‘M’ shaped seating position when the baby is facing outwards.  To avoid over-stimulation many carrier instructions do remind you to take baby out of the carrier and/or change positioning if baby seems at all uncomfortable or agitated.

Our Personal Experience:

In my experience, outwards facing carry positions are definitely not as comfortable for the carrying adult, and have held my babies in positions that I imagine cannot be the most comfortable for them either.  Both my children loved being able to see the world at around 4 months, showing no signs of overstimulation, and I tried different outwards facing positions for very short periods with both of them. Though I don’t feel that I harmed them either physically or psychologically by doing this, I found that we were all much happier and much more comfortable for much longer when I used a well-supported, parent-facing hip or back carry position where they could see the world over my shoulder/s.

If you’d really like to try an outwards facing carry position, we’d recommend that you try it in a carrier with a seperately fastening waist – to give sufficient lumbar support for you – and in a carrier that supports baby’s thighs so that their legs are not dangling. Do ensure that your baby is able to fully support their own head comfortabley – this varies from baby to baby but is usually by about 3-5 months. Don’t use these positions with heavier babies or for longer periods of carrying and do change to an inwards facing position if baby needs to sleep or seems at all unsettled or uncomfortable. We’d always be happy to show you recommended parent-facing hip and back carrying positions that allow your baby to see the world and that are more suitable and more comfortable than outwards facing positions.

Links to more views:

Some baby carrying advocates feel very strongly against outwards facing carrying positions, yet many parents feel that their babies enjoy spending short periods of time in these positions. I’ve tried to find some articles about this issue that will help you to make your own decision.

Articles about baby hip health can be found here:Hip Health in baby carriers, car seats, swings, walkers, and other equipment (from the International Hip Dysplasia Institute), here: A Ride on Mother’s Hip (by Dr med. E. Fettweis, Orthopedist, ret. head physician, Aachen, Germany), and also here: Anatomically Correct Natural Sitting Position (a very well referenced article from the Ergobaby website).

This article (from Dr Maya Pande) gives a view on the effects of outwards facing carrying on a baby’s spine: How Carrying your Baby Front Facing Out Affects The Spine

This interesting article gives warnings about using harnesses that allow the legs to dangle. This is aimed at adult safety harness users, rather than at babies in baby carriers, but it is interesting to note the recommendation that for longer periods a harness that supports the upper legs in a more horizontal position should be used: Will your safety harness kill you?

This article gives some views for and against using this style of carrier may be found here:

A good article on carrying positioning and alternatives to outward facing carries can be found on the Ergo website here: Facing in, Facing out; a science based view on baby carrying positions and also here: Revisiting Facing In/Facing Out.

Another fairly objective view on facing out is given here on the Catbird Baby website: Why we make carriers that allow your baby to face forward

And here are a few more reasons why facing outwards positions aren’t recommended as so good for baby or parent from the carrier manufacturer Boba: Nine Reasons Not to Carry Your Baby Facing Out, from the website Sling Guide: Why Sling Guide Does Not recommend Facing Outwards and here: Why I Don’t ‘Do’ FFO

© 2011 South London Sling Library

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