Case Study 7: Gemma and Jacob

Background

Gemma contacted The Sling Doctor asking for advice on which sling she could use with Jacob.  Jacob had been born by emergency c-section at 34 weeks due to reduced growth.  He was 4’10” at birth but was gaining weight well and at the age of 5 weeks had reached 6’5″.  Jacobs weight, although much improved still put him below the minimum weight limit on most buckle carriers.

Jacob had been prone to vomiting after feeds so Gemma had been advised to keep him upright for 30 minutes after each feed. This meant that Gemma was spending a lot of time holding Jacob and was hoping a sling would enable her to be ‘hands free’ during this period.

Gemma had been warned that Jacobs positioning in the womb put him at increased risk of hip dysplasia which would need to be assessed in the future. Gemma wanted to take this into account when choosing a sling for Jacob.

Gemma had noticed that some slings and carriers have a minimum weight limit of 8lb and was concerned that some carriers might exacerbate any potential hip problems Jacob had.

The Consultation 

I talked Gemma through Babywearing safety focusing particularly on maintaining Jacob’s airway and optimum hip positioning.

Airway

I explained that newborn babies like to curl up as if they are still in the womb.  This positioning is ideal for their lower bodies but, as babies do not need to breathe in the womb, does not protect their airway.  To keep the baby’s airway clear in the sling it is crucial that:

  • Baby’s chin is kept off their chest; you should be able to get two fingers between their chin and chest.
  • Baby is not allowed to slump; the sling holds them close to the wearer and supports their back well, so that if you push them on the back gently towards you, they do not move.
  • Baby’s mouth and nose is unobstructed; e.g. from clothes, fabric or breasts.
  • There is good airflow around babys face.
  • The wearer continues to be aware of and monitor baby’s positioning in the sling.

Optimum Hip Positioning

Optimum hip positioning in a sling is a position where the ball (femoral head) of the ball and socket hip joint is held centrally in the socket (acetabulum) of the child’s pelvis.  This encourages the deepening of the socket which would decrease the risk of dysplasia. Optimum positioning in a sling will decrease the risk of hip dysplasia and actually mimics the effects of the Pavlik harness which is the current treatment for hip dysplasia.  In order to achieve this optimum positioning the following needs to be achieved:

  • The sling should support the baby from knee to knee.
  • The knees should be held higher than the baby’s bottom so that they are level with their belly button.
  • The baby’s pelvis should be tilted inwards so that their tailbone is pointing downwards.
  • The baby’s knees should not be separated more than is developmentally appropriate (see diagram).


For more information on hip dysplasia and Babywearing please see this informative article. 

Sling Options

I suggested that Gemma and Jacob could achieve safe positioning for his airway and hips in any of the following:

I suggested that Gemma and Jacob avoid buckle carriers for now because he is below the minimum weight limit and that they avoid narrow based carriers due to his increased risk of hip dysplasia.

Gemma was keen to see how each of the options worked for a small baby so I demonstrated all four options with a newborn sized demonstration doll. Gemma decided she would like to try the stretchy wrap herself and thought if she found it too hard she would try the caboo.  I talked her through how to use it and she managed to achieve optimum positioning with the demonstration doll.


Gemma was so happy with the stretchy wrap that she didn’t want to try the caboo or the woven wrap. Jacob was content so we agreed to try the stretchy wrap with him.


Gemma was able to get Jacob into the optimum positioning.  He automatically tucked his pelvis in as she picked him up so she was careful not to interfere with his hip positioning. His head and neck required a little more work but Gemma found that she was able to tuck the back of Jacob’s head in the cross-pass enabling him to have his head supported in the correct position without her hands.

Gemma decided to buy a stretchy wrap and was able to get next day delivery.  I will be happy to offer her reduced price follow ups and short sessions should she needs to more help with using the wrap or if she would like to explore her other options as Jacob gets bigger.

I wish them all the best in their Babywearing  adventures.