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.

Case Study 6: Nikki & Lucie

Background

When Lucie was a small baby Nikki wore her in a Baby Bjorn Carrier and got on well with it.  As Lucie grew bigger Nikki found she preferred to use the pram and later the pushchair.  They do not have car so get about by walking a lot. Now Lucie is a two year old she sometimes wants to get in the pushchair, sometimes wants to walk and sometimes wants Nikki to carry her.  Nikki often ends up carrying Lucie while pushing the pushchair, which she finds very uncomfortable.

Nikki contacted The Sling Doctor asking for advice on which buckle carrier to buy. She felt overwhelmed by the options and was not able to travel to one of her local sling libraries.

The Consultation

We met at Nikki and Lucie’s home and discussed their options. We discussed basic sling safety and the safety features on buckle carriers. I explained that Lucie would need a ‘toddler sized’ carrier and that the way in which toddler buckle carriers vary in several ways including:

  • The amount of padding
  • Where the waist belt sits
  • Whether the shoulder straps disconnect and if so, where
  • How many adjustment points there are and which direction the adjust in.
  • Whether you can cross the shoulder straps on your back
  • Whether you can wear the shoulder straps uncrossed (like a rucksack)
  • Whether there is a chest belt between the shoulder straps

Most of these points come down to personal preference for both wearer and wearee; there isn’t a ‘best carrier’ for everyone.  There is, however, probably a set of carrier characteristics that each person prefers.  A detailed comparison of buckle carriers has been written by my colleague Zoe at The Sling Consultancy.

There are so many toddler buckle carriers available to buy that I am not able to stock them all.  For the purposes of consultation I try to demonstrate the individual features and provide samples of at least two very different carriers.  I hope that this will help the wearer to work out which options suit them best and to become familiar with how to achieve optimum positioning in different styles of carrier.  This information should enable them to identify the features they want on their carrier, or at least a shortlist to take to a sling library.

I took Nikki a Toddler sized Connecta and a Toddler Sized Lenny Lamb Buckle Carrier.

The Connecta

The Connecta has no padding,  this means it folds up really small. The waist belt sits high up and the fabric of the main panel decends from it creating a deep seat for your child.  It has detachable shoulder straps so it is possible to cross the shoulder straps.  There is no chest strap but there is an accessory strap which is seperate but can be used like a chest belt.  It is often recommended as a cool and lightweight option, available in a wide range of appealing fabrics.

The Lenny Lamb Toddler Buckle Carrier

The Lenny Lamb Toddler Buckle Carrier has a padded and structured waist belt and shoulder straps.  The shoulder straps detach and there is an integrated chest strap. The waist belt is worn lower than that on the Connecta.  I originally bought mine because it was a good low budget option, however,  they have since increased in price and are comparable with others on the market.

Outcome

Nikki tried on the Lenny Lamb Toddler Buckle Carrier with a demonstration doll first.  She seemed to like it immediately and was keen to try Lucie in it.  Lucie happily obliged and got into the carrier.  Nikki described feeling shocked by how light Lucie felt in the carrier.  They both seemed very comfortable.

Nikki and Lucie also tried the Connecta but didn’t find it as comfortable.


Nikki was so impressed with the Lenny Lamb that she decided to buy one.  They were both happy with a front carry for now but might like to explore back carries in the future.

I hope they enjoy their buckle carrier and will be happy to provide reduced price follow up consultations on other uses,  such as back carries in the future.

Case Study 5: Katharine and Annabella

Background

Katherine and Annabella have enjoyed Babywearing since Annabella was a small baby. They have used both a stretchy wrap and a baby bjorn carrier.  Katherine found that despite liking the idea of the stretchy wrap, it was not very practical for meeting their needs and ended up reaching for the baby bjorn much more.

Both Katharine and Annabella have enjoyed using the Baby Bjorn, however, at the age of 8 months, Annabella has grown considerably and it has become progressively less comfortable.

Katharine contacted The Sling Doctor asking for advice on finding the right sling or carrier to help them continue their Babywearing journey.  She did not have a strong preference for a type of carrier and was happy to visit me at my home address which was ideal as we needed access to all of my slings.

The Consultation

We discussed the problems Katharine was having with her existing slings:

The Baby Bjorn

Katharine was finding that although they both liked  a front, chest to chest carry in this carrier, after about 10 minutes it began to hurt her lower back and was no longer a sustainable option.  I explained that the Baby Bjorn does not support the hip tilt (bottom tucked in, tailbone pointing down) in the way many other slings do.  This causes the child to have a straight back which means that their weight is carried further away from their wearer.  In more ergonomically designed carriers the child’s pelvis is tilted which allows their back to curve around the parent (see diagram below).

This positioning means that the child’s head automatically falls towards the parent and their weight is carried closely. This is similar to the difference between carrying a load with outstretched arms or hugging it close to you. When a sling or carrier is correctly fitted it should not feel like you are carrying your child, rather, that your weights are combined and you are heavier.

While babies are still relatively light the weight distribution provided by the Baby Bjorn may not be a problem for the wearer, however, as the baby gets heavier a different carrier, designed to hold the baby as seen above, will be more comfortable.

The Stretchy Wrap

Katharine and Annabella had not got on very well with this sling when Annabella was a newborn, finding the length of fabric overwhelming and too time consuming to be used regularly.  While stretchy wraps can be used beyond six months, if the child is heavy, and/or the stretchy wrap very stretchy, they would need to have additional passes added to the traditional three layer carry.  Given that Katharine and Annabella had not got on well with the three layer carries it seemed unlikely that more layers would be an attractive proposition.

Katharine was keen for Annabella to be able to look around but still wanted to be able to make eye contact while she was in the sling. We agreed hip carries would be ideal for this but that any carrier should also have the option of a chest to chest carry to minimise back strain.

We explored the following options:

1) Woven wrap (such as a Kokadi) tied in a Coolest Hip Cross Carry.

2) Ring Sling (e.g. Amazonas) worn on the hip or the front.

3) Mei Tai (e.g. Hoppediz) tied on the hip or the front.

4) A Buckle Carrier (e.g. Ergo 360) worn on the front or the hip.

I demonstrated each of the options then Katharine chose to practice the woven wrap and buckle carrier option.  She was drawn to the beautiful fabric options of the woven wrap and was able to tie the Coolest Hip Cross Carry effectively but decided it was not fast enough to meet her and Annabella’s needs.

We explored buckle carriers in more detail.  I had a Manducca, Ergo, Boba 4g and Beco Gemini available for exploration.  We quickly worked out that having the option of crossing the straps on her back was going to make using the carrier more comfortable for Katharine.  This is not an option with the Boba 4g so we ruled it out. The remaining carriers all had detachable straps but different parts of the straps were adjustable.  Katharine was naturally drawn to the Beco Gemini as its padding made it more closely resemble the Baby Bjorn Carrier. Once confident with the demonstration doll Katharine was able to put Annabella in the carrier and cross the straps on her back.  She was surprised by how little she could feel of Annabella’s weight and was able to get her into an ergonomic position, with her knees higher than her bottom and her pelvis tilted as below.


Annabella seemed to like being in the sling, but it was apparent that she would soon outgrow it, her knees sticking out a couple of inches on both sides.  We agreed it would be sensible for Katharine to buy the next size up. I would recommend the carrier which is most similar most similar to the Beco Gemini, this is the Beco Toddler which is available from Slumber-Roo with a 10% discount when you quote the code SL10-SLINGDOCTOR.


Katharine and Annabella took advantage of my Model deal which also entitles them to a reduced price follow up consultation.  I would be happy to provide further consultation on the use of the new carrier and perhaps, later,  how to back carry in it.  I wish them both all the best in their Babywearing adventures.

Case Study 4: Amy and Molly


Background

Amy contacted the Sling Doctor and asked for a consultation for her and her daughter Molly who was two weeks old.  Amy had been discussing the benefits of skin to skin contact with her midwife and was keen to try Babywearing despite also feeling  overwhelmed by all of the options and safety advice.  She hoped the skin to skin contact would help with breastfeeding, enable her to get jobs done around the house and aid Molly’s physical and emotional development.

Special Considerations

Molly was born at 36 weeks gestation and, at the time of the consultation, weighed 5 pounds and 11 ounces.  This meant that she was too small to safely use any of my buckle carriers, even with the newborn inserts.  As with all young babies Molly’s positioning needed careful attention to ensure it was not obstructed in anyway.

Consultation

I met Amy and Molly at their home where we discussed their background, the benefits of Babywearing and safety considerations.  Given Amy and Molly’s circumstances I had taken three options for exploration:  A Woven Wrap, a Stretchy Wrap and a Close Parent Caboo.

Woven Wrap

Probably the most versatile of carriers, a length of woven fabric designed for Babywearing can be used safely with a tiny baby.   Because the fabric is not stretchy,  one layer is very supportive, making it one of the coolest options. Most of the single layer carries require retying each time it is used however, and the skill acquisition required can feel a bit overwhelming.

Stretchy Wrap

The stretchy wrap, is a length of stretchy fabric which can be pretied around the wearers body before they position the baby in the carry they have created.  It is simpler to use than a woven wrap and the multiple stretchy layers mean that the baby can be taken in and out of the wrap without re-tying each time.  Multiple layers can also make it a bit too warm and parents can find the length of fabric a bit overwhelming.

The Close Parent Caboo

The Close Parent Caboo is made of the same fabric as a stretchy wrap but has been constructed to fit in to the wearer without them having to wrap them selves. It is fully adjustable by feeding the fabric through two sets of metal rings which sit just above the wearers hips. The baby sits in the carrier just as she would in a stretchy wrap meaning that it can be used to preserve the child’s natural back, hip and leg positioning.  Like the stretchy wrap, it can still feel a bit hot but it benefits from not requiring as much skill aquisition. Unlike other, more structured, carriers the lower weight limit is 5 pounds, meaning that this was a reasonable suggestion for Molly.

After discussion I demonstrated the use of the Stretchy Wrap,  Amy liked the way the demonstration doll looked in the wrap and appeared to feel confident that it was a secure option but she was a bit concerned about how long it would take her to feel confident about using the wrap alone.  She wanted something she could use straight away with minimal learning. We agreed that the Caboo was the best option and Amy tried it out with the demonstration doll.


Once she felt confident with the doll we tried with Molly herself, who appeared quite content in the sling.

Outcome

Amy decided to buy A Close Parent Caboo and managed to get a next day delivery.  As she has received a full consultation from me I will offer reduced price follow up consultations to her in the future, either for help with the caboo or for learning new skills like breastfeeding in the sling or exploring other Babywearing  options as Molly grows. It was lovely to meet Amy and Molly and I hope they enjoy their Babywearing adventures.

Double Layer Stretchy Wrap Carries 

I have previously written about Single Layer Carries in a Stretchy Wrap.  These can be made safe if the baby is light enough, or the wrap supportive enough, to hold the baby in position and prevent them from slumping. 
 When your baby becomes too heavy for one layer of stretchy wrap to support them adequately you can move on to double layer carries.  These have the benefit of added support while remaining cooler than the traditional three layer stretchy wrap carries.

Safety

As with the single layer stretchy wrap carries please make sure baby is well supported by the wrap, their airway is visible and clear, they are not slumped and their chin is off their chest at all times.  

 Semi Front Wrap Cross Carry 

This carry involves one wrap pass and one cross pass.  I believe the combination of wrap and cross passes makes the carry more secure than two wrap passes or two cross passes would be. It is tied at the shoulder with a Slipknot. I found my Slipknot was more ‘slippery’ with a stretchy wrap so you may find it needs extra tightening. The Slipknot is useful for being able to easily tighten after the baby is secure. 


Backwards Semi-Wrap Cross Carry

The passes used in this carry are the same as in the Semi Wrap Cross Carry but the way this carry is tied gives you an inbuilt head support for your baby and replaces the shoulder Slipknot with a hip/back located flat reef knot.  It is not as easy to pass excess slack though a reef knot as it is a Slipknot but it is not difficult either. 

Once you feel your baby is no longer adequately supported by two stretchy wrap layers please move on to three layers or a woven wrap!