Academic Journal of

Pediatrics & Neonatology
ISSN 2474-7521

Review Article

Acad J Ped Neonatol

Volume 11 Issue 5 - June 2022
DOI: 10.19080/AJPN.2022.11.555876

Copyright © All rights are reserved by Henrik Norholt

Babywearing Practices and Effects on Parental,
Child Physical and Psychological HealthHenrik Norholt1*, Charles Price2, Raylene Phillips3, and Joanna McNeilly4
1

The Somatosensory & Affective Neuroscience Group, Liverpool, United Kingdom

2

College of Medicine, University of Central Florida, Orlando, Florida, USA

3

School of Medicine, Loma Linda University, Loma Linda, California, USA

4

Center for Babywearing Studies, NYC, New York, USA

Submission: May 09, 2022; Published: June 06, 2022

*Corresponding author: Henrik Norholt, The Somatosensory & Affective Neuroscience Group, Liverpool, United Kingdom

Abstract
An increasing number of parents engage in extended daily chest-to-chest contact with their full-term healthy infants for several months
after birth as an extension of skin-to-skin contact in the early postpartum period. This practice is commonly known as “babywearing” (BW)and employs various carrying devices. The purpose of this review is to acquaint pediatricians and primary care providers with the numerous
studies of physical, behavioral and social effects of BW as well as the different types of infant carriers and safe practices. BW studies demonstrate
improved attachment and breastfeeding outcomes and infant sleep organization, as well as reduced maternal postpartum depressive symptoms
and infant crying. BW is likely to strengthen paternal caregiving engagement, associated with positive child outcomes. The spread squat position
for the hips during BW offers an optimal position for hip development and may prevent some forms of developmental hip dysplasia. BW may
reduce the risk of positional plagiocephaly, by decreasing the time infants spend in the supine position while also allowing for spontaneoushead movements. BW enables some mothers with short maternity leave to bring their infants to the workplace with limited interference in theirtasks. Numerous designs of infant carriers are described along with basic safety precautions. Pediatricians may be key influencers for parents inachieving the positive outcomes described in this review.
Abbreviations: BW: Babywearing; OT: Oxytocin; SCS: Skin-to-skin Contact; US: United States

Introduction
Parents expect pediatricians to provide evidence-based advice
about parenting methods. This review provides the scientificbackground for the increasingly popular parental practice of“babywearing” (BW). The term ‘babywearing’ is used here inplace of the medically recognized term “infant carrying” to reflect
parents’ likely language usage in the clinic.
BW is characterized by the infant being carried for an extended
period of time in an inward-facing spread-squat position on either
the caregiver’s front, hip or back.
BW may improve child psychological resilience as well as
ameliorate frequently encountered clinical challenges related
to infant sleep, crying and breastfeeding. BW may also improvematernal mental health as well as fathers’ early childcare
involvement and may allow mothers to return to work along withAcad J Ped Neonatol 11(5): AJPN.MS.ID.555876 (2022)

their infants. Physical benefits may include decreased risks of hip
dysplasia and positional plagiocephaly.

Background

The infant as a parent-clinger
The newborn infant has palmar and plantar grasp reflexes
that suggest clinging is a natural behavior. In addition, whenlifted while supported underneath the arms, the newborn infant
will instinctively flex the hips and knees and spread the thighs
in preparation for being placed on the mother’s body [1]. The
waist-to-hip ratio of females may also facilitate hip sitting position
for BW [1,2]. These instinctive and anatomical characteristics
suggest that humans are a parent-clinging species similar to otherprimates in that regard [2-4].

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Academic Journal of Pediatrics & Neonatology
Pediatric support of child resilience
There is an increasing pediatric understanding of sub-optimal
caregiving and environmental influences, resulting in child “toxic
stress” that may impair development of physical and mental
well-being [5]. At least one in five middle-class children will
have experienced three or more adverse childhood experiences.
The incidence for low-income groups is likely to be higher [6].
Approximately one in two adults will have an unresolved insecure
relational history with caregivers, which is likely to be passed onto
the next generation [7-9], evinced by estimates of up to 40% of
infants categorized as insecurely attached [10]. Increased physicalillness in adulthood has also been identified in individuals with
insecure attachment as infants. In a longitudinal study, adults
who exhibited insecure attachment patterns during infancy werefour times more likely to report physical illness at age 32 years,
compared to adults who were securely attached during infancy[11,12].

Pediatricians act as front-line guardians of healthy childdevelopment, as well as assume roles of leadership in devising
new and effective interventions. Thus, knowledge of evidence tosupport BW is appropriate for pediatricians.

The sensitive period for contact goes beyond the firsthour

A sensitive early postpartum period has been recognized
during which iatrogenic mother-neonate separation is strongly
contraindicated [13], influencing maternity ward practices
worldwide [14]. Increasing the amount of parent-infant physicalcontact beyond the immediate postpartum period through BW
offers a potential intervention pathway to secure attachment
which can also involve fathers. This intervention mode issupported by the growing understanding of an “extended sensitive
developmental period” [15-17]. During this period, both parents
and infant require an array of mutual body-based kinesthetic[18-21], tactile [22-33], olfactory [34-36], audio [37-40] andvisual [37,41-43] stimuli to develop optimum caregiving andutilize innate physiological co-regulatory systems. Oxytocin (OT)
appears to be one of the central hormones involved in the earlyshaping of both the expression of parental caregiving behavior aswell as infant development [23,44-47] and is released in response
to tactile stimulation [48-54].

Behavioral Benefits of BW

Several trials have investigated the effects of extended
mother-infant chest-to-chest contact beyond the first hour
postpartum with regard to infant socio-emotional and otheroutcomes such as infant sleep, infant crying, breastfeeding, andpostpartum depression, challenges frequently encountered inpediatric practice and sometimes difficult to manage. Handledunsuccessfully, these challenges may have long-term negative
developmental effects [55-61].

In some trials, the mothers engaged in a high degree of skin-002

to-skin contact (SSC) in order to maximize oxytocin release inmother and infant [62-65]. Other trials conformed to the current
popular method of BW where mothers and infants are fully
dressed [66,67]. Research in neonates suggests that the clothingbarrier exerts only modest and non-significant effects on relevant
outcomes, such as temperature regulation and longitudinal socioemotional development [24,68,69]. Hence, the clothed methodof BW may suffice for mothers uncomfortable with the idea ofextended SSC after the early neonatal period.

Parent-Infant Contact for Secure Attachment andResilience

A landmark study of the effects of BW included mothers withsocial risk factors known to affect maternal-infant attachment[66]. The mothers were randomly assigned to receive either asoft carrier for BW or a plastic seat-type carrier with a handle
for carrying and placing near the mother as needed. Evaluation
at age 3,5 and 13 months respectively demonstrated that themothers with the soft carrier had significantly greater maternal
responsivity scores and 83% of their infants demonstrated secureparent-infant relations, compared to the group of infants in theseat-carrier group (38%). Amongst the subgroup of mothers
who used the soft carriers on a daily basis, 93% of the infants
demonstrated a secure attachment pattern, demonstrating a doseresponse relationship.
Another study similarly provided high-risk teenage mothersin the U.S. a soft structured carrier and encouraged BW for one
hour daily for three months. A control group was given baby
picture books to be read to their babies. Relative to the control
group, the BW mothers and infants displayed significant morepositive interactions during the Still Face test, indicating increasedmaternal sensitivity, supporting infant social and emotional
development [67]. Employing an algorithm derived from the
Global Rating scales of Mother-Infant Interaction [70], BW infants
were found to be more likely to have a secure attachment andless likely to have disorganized attachment. A dose-response
relationship between duration of BW and secure attachment was
furthermore established [67].

A group of Canadian low-risk mothers of full-term infantsmaintained SSC daily during the first month postpartum [62]. In
comparison to the control group with negligible SSC-exposure, atthree months the SSC infants showed greatly accelerated socioemotional development during the Still Face test [71], responding
with behaviors normally expected at 6-7 months of age [72].
Such early-age Still Face test behavior predicts later healthy
parent-child relations [73-75]. A 9-year follow-up confirmed thisprediction, with SSC children displaying greater mother-childreciprocity, which is linked to improved stress regulation [76].

Breastfeeding

The links between physical contact and oxytocin [50] as
well as between oxytocin and breastfeeding [77] suggest that
BW may support optimum breastfeeding outcomes. An Italian

How to cite this article: Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical and Psychological
Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology

study randomized 200 middle-class mothers to receive either
a commercial BW device or a pamphlet with information aboutbreastfeeding at discharge from the maternity ward. The BW
mothers were found to be significantly more likely to breastfeed
at two (72% vs. 51%) and five months (48% vs. 24%) andwere breastfeeding significantly more frequently [78]. A US
study randomized 100 low-income mothers to receive eithera baby carrier or be assigned to a wait control group. Parents
in the intervention group were significantly more likely to bebreastfeeding or feeding expressed human milk at 6 months
than control group parents (68% vs. 40%.) Exclusive human milk
feeding did not differ significantly between groups at 6 months(intervention versus control 49% vs 26%, P=,06) [79].

In a longitudinal observational study of London and Copenhagenparents, the daily duration of parent-infant contact correlatedwith decreased duration of daily infant crying. London parents
engaged in significantly less contact than Copenhagen parents,
and their infants were found to cry 50% more than Copenhagen
infants [81].

Canadian low-risk mothers who implemented daily SSC in
the first postpartum month were more likely to maintain breastfeeding at three months, compared to mothers in the control groupwith limited SSC [63]. Amongst low-risk London- and Copenhagenbased mothers, the duration of daily mother-infant physicalcontact was found to correlate positively with breastfeeding
outcomes at 12 weeks [81]. In Swedish breastfeeding dyads withsevere latch-on problems, SSC during breastfeeding enhanced
maternal positive feelings and shortened the time it took to resolve
severe latch-on problems [82]. By supporting increased durationof breastfeeding, BW contributes to decreased risks for a range ofphysical illness for both mother and child [63,80-82].

Infant Sleep

Recognizing a newborn’s subtle early hunger cues is an
important skill mothers learn with each new baby. Mother–infantphysical contact has been shown to predict feeding in responseto early hunger cues when mother–infant proximity (without
physical contact) did not [80]. Increased physical contact (which
BW provides) promotes more frequent breastfeeding, which helps
to establish and maintain mother’s milk supply and to ensure
optimal nutrition for baby.

Crying & Colic

Most mothers will respond intuitively to a crying infant bypicking it up and placing it chest-to-chest, while engaging inrhythmical rocking movements. Such stimuli resemble those an
infant will experience during BW, lending credence to a potential
BW impact to decrease infant crying.

In a randomized study of the effects of BW on infant crying,mothers in the intervention group were encouraged to engage
in extended BW when their babies were 4 weeks of age, whilemothers in the control group not given information about BW.
In this study, extended BW resulted in a reduction of daily infantcrying by 43% (1.23 vs. 2.16 h/d) at 6 weeks of age, when infantcrying normally peaks [83]. In a high-risk sample, at two months
postpartum, only 21% of carried infants had a regular daily
period of crying, compared to 52% in the control group, whose
mothers were issued a plastic infant seat at birth [66]. Thisfinding, however, could not be replicated in a similar study [84].
003Compared to being held by a sedentary mother, infants whose
mothers engaged in brisk walking immediately ceased crying andexcessive movements and furthermore demonstrated reduced
heart rate and increased heart rate variability, indicative ofphysiological calming [85,86].
Approximately 15-20% of infants may suffer from unsoothable
crying/colic [87,88]. BW by itself has not been shown to beeffective as a preventive [81,84] or therapeutic [89] approachto colic. At present, there are no generally effective therapies,
and the etiology remains elusive [57,90-92]. Infant frequent
feeders (>11 feeds/24 hours) are less likely to have daytime
sleep or cry problems at 4 months [93]. BW has been showed tofacilitate frequent and time-efficient breastfeeding [78,94] andmay therefore modify colic. The therapeutic effects of BW-related
vestibular stimulation merits further exploration [85].
Neonatal sleep regulation appears to underpin social andcognitive development. Improved socio-emotional and cognitive
outcomes at five-year follow-up have been identified for neonates
whose sleep/wake patterns are predominantly characterized byalternating between quiet sleep (as opposed to active sleep) andquiet wakefulness (unlike crying) [59]. The wide range of sensory
stimulation inherent in parent-infant contact [95-97] and infant
hormonal adaptation (notably oxytocin) [50] may influence
infants’ state organization during sleep [98].
A study of the effects of parent-infant contact on sleep infull-term infants using a within-subjects design, demonstrated asignificant, seven times increase in quiet sleep when 2-day-old
infants were held in skin-to-skin contact compared to being placed
separately in a cot [65]. Such early, more optimum sleep patternconfiguration may have long-term consequences since high levelsof quiet sleep at birth is a significant predictor for self-soothingat 12 months [99]. A study of parent-infant contact for pre-term
infants demonstrated that early SSC predicted significantly
improved sleep patterns and sleep efficiency at age 10 years [17].
Neonatal tactile stimulation in full-term infants has been shownto enhance circadian rhythms, and promote adjustment of restactivity and melatonin secretion rhythms in the nocturnal period[100]. Furthermore, providing rhythmical movement to bothpre- and full-term infants has been shown to positively influence
infant sleep-wake state organization (greater proportions of quiet
sleep and quiet alert states) [86,101-103] as well as behavioral
and physiological calming [85]. The natural movement of an active
caregiver can supply such rhythmical stimuli to a carried baby.

How to cite this article: Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical and Psychological
Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology
Maternal Mental Health

Physical Benefits of BW

Postpartum depression and anxiety affect up to 12-24% of
women in industrialized countries, with the highest prevalencein low-income mothers [104,105]. The negative long-term effects
on child development include deficits in cognitive and socioemotional development as well as behavioral challenges [106].
The American Academy of Pediatrics recommends that pediatricpractices incorporate recognition and management of perinatal
depression [106].

Hip Development and Hip Dysplasia

Consistent with the anxiolytic, stress-reducing and pro-social
parenting properties of oxytocin [23,44,107], SSC may alleviatematernal depressive [64] and anxiety symptoms and improveparenting behaviors [17]. Physiological markers of stress, suchas respiratory rate, blood pressure [108] and salivary cortisol[64], are positively influenced in mothers providing SSC. In an
online survey, repetitive negative thinking (a risk factor for thedevelopment and maintenance of various mental disorders) was
found to be significantly lower, and positive mental health wassignificantly higher while BW compared to overall levels in nonBW conditions [109]. Associations between early postpartum
depressive symptoms and breastfeeding outcomes have been
demonstrated [110,111]. The directionality of the association
is far from clear [112,114], but the hormonal effect of SSC is
known to improve breastfeeding outcomes, which then again may
improve depressive symptoms [23,114-116].
BW combined with daytime walks and participation inmothers’ support groups may constitute a low-cost intervention
against mild depression, given the documented effects of bright
light [117-119], exercise [120] and social support on depression[121,122].
Paternal Involvement

Fathers’ caregiving patterns towards infants tend to differ
from mothers’ with a greater emphasis on extrovert activities,
animating infant exploration of the outer world and providing
proprioceptive (rough and tumble) stimulation [123,125]. Fathers
may contribute to security of exploration, defined as “confident,
attentive, eager and resourceful exploration of materials andtasks, especially when a child faces disappointment [126].”
Fathers contribute uniquely to children’s cognitive, language
and social development [127-129]. Fathers’ brains appear
sensitive to caregiving experiences, with increased involvement
correlating with activation of care-related brain centers andoxytocin systems [130]. Father-infant SSC improves paternalrole attainment, increases paternal interactive behavior, andreduces paternal stress and anxiety [131]. Father BW enhances
amygdala response to infant crying, thereby promoting attention
to and accurate perception of infant signals. Interestingly andrelevant to intervention programs, the effects of BW were evenmore pronounced amongst fathers with more adverse childhood
experiences [132].

004

Postnatal practices may influence the risk of late hip dysplasia.
The spread squat position for the infant’s hips when BW is an
optimal position for hip development, while swaddling in the
opposite position with the hips and knees extended increases therisk of hip dislocation [133-136].

Physical examination alone is an unreliable method for
detecting infantile hip dislocations, and dislocations without risk
factors are more likely to be detected after the age of three months[137,138]. A large majority of hip dysplasia cases go undetectedduring childhood and are initially diagnosed during adolescenceor early adulthood as acetabular dysplasia [139].
It remains unknown whether these cases of acetabular
dysplasia are the result of inadequate hip development during
early infancy, or deficient growth during later in childhood.
Nonetheless, the only opportunity to influence this process isduring early infancy when the hip is pliable and developing rapidly.
Hip ultrasound studies have shown that a deeper acetabulum inearly infancy correlates with improved hip development during
growth [140].

The optimum position for acetabular development isachieved with the hips flexed 100° to 110° and each hip abducted
approximately 40° [135,136]. This is approximately the position
achieved by the Pavlik harness and by BW when infant’s buttocks
are below the knees and the thighs are spread around the mother’s
torso (Figure 1).
This optimum position for hip development may explain why
cultures that carry their babies in the spread squat position during
early childhood (BW) have very low prevalence of hip dysplasia
and low risk of adult hip arthritis [141].

Anatomical and biomechanical studies have verified that the
spread squat position is optimal for hip development [142]. This
is often referred to as the “M-position” with the knees higher
than the buttocks (Figure 2). However, the effects of intermediate
positions are still unknown. Anatomical studies of infants havedemonstrated that increased hip flexion requires less abduction
for the hips to be centered in the acetabulum. As the child grows,
more abduction is accompanied by decreased hip flexion tomaintain the femoral head in the center of the acetabulum (Figure
3).

Cranial Shape and Plagiocephaly

There has been a significant increase in positional
plagiocephaly in children throughout the world since the early
1990’s [143]. The benefits of the “Back-to-Sleep” campaign forprevention of Sudden Infant Death Syndrome are well known.
However, this campaign was a likely contributor to the rise inprevalence of positional plagiocephaly, which has gone from 0.3%
in 1974 to up to 47% [144,145].

How to cite this article:
Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical andPsychological Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology

Figure 1: Infant hip position when carried on a female caregiver’s hip.

Figure 2: The infant spread-squat position or “M-position”.

Figure 3: The natural development of an infant’s carrying position in the first year.

005

How to cite this article: Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical and Psychological
Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology

In general, repositioning is recommended as first line therapy
for infants younger than four months or for infants with mild
to moderate asymmetry. Infants who are given activities that
promote spontaneous physical movement have decreased risk forincidence and severity of plagiocephaly compared to infants who
spend more time in the supine position [146]. There is a limited
time window for repositioning treatment, as about 80% of cranial
growth occurs before the first 12 months of age [147]. Helmet
therapy is recommended for infants with severe deformational
plagiocephaly or if moderate plagiocephaly persists after 4-6
months of age [143,148,149]. A major limitation to helmet
therapy is related to cost of the cranial orthoses and need to wear
the helmet 23 hours a day for a minimum of 3-4 months duration[148]. There are other limitations of repositioning treatment,
including the need for frequent repositioning and increased prone
positioning during periods of wakefulness. Non-compliance may
be one reason why approximately 30% of infants who receive
positional therapy continue to have some level of skull deformation
at six months of age [150].
BW may be a useful practice to reduce the risk of positional
plagiocephaly because upright BW decreases the amount of timethat babies spend lying on their back or being in a position where
their head is resting on a flat surface [151]. After developmentof head control, carried infants may spontaneously change
head position during the natural movements of the mother.
This potential for improved psychomotor development may
also benefit children with psychomotor delays associated withexcessive duration of supine positioning [152].

Potential Benefits
Parenting in the workplace
Only about half of the 185 surveyed countries live up to therecommendation of the International Labour Organization ofminimum 14 weeks of statutory maternity leave [153]. The UnitedStates (US) currently provides 12 weeks of unpaid maternity
leave, which is the lowest level of support amongst OECDcountries [154]. In the US, the length of maternity leave has beenfound to negatively influence breastfeeding outcomes [155,156],
the quality of mother-infant interactions, and infant attachment
outcomes [157], as well as maternal mental health [158].

Bringing a pre-crawling baby (<age 7 months) to theworkplace in an infant carrier is one potential interim solution
to short statutory maternity leave. To date, 2,100 US infants in
200 companies, spanning 30 industries have been brought towork through formalized parenting-in-the-workplace programs.
Outcomes include higher staff retention rates, earlier return to
the workplace (mitigating temporary workers costs), increased
morale and teamwork, higher dedication to employer (impacting
long-term productivity), and increased breastfeeding rates [159].

Products, Practice and Safety
Types of Carriers

The styles of carriers fall into several groups that may becharacterized as wraps, slings, structured soft carriers, and others(Figure 4).

Figure 4: Types of commercially available infant carriers.

1.
Wraps: A traditional type of carrier that consists ofa broad swath of fabric that is wrapped around the mother andinfant in various configurations. Using a wrap requires somelearning but constitutes a relatively inexpensive and adjustable
method for BW.

2.
Slings: Fabric carriers that are easily stored, quick to use
and easily adjusted. This type of carrier can be useful for infants
and toddlers who may be up and down frequently. However, therisk of suffocation may be increased if an infant is in a side-lying
006

position or if the head becomes covered.

3.
Structured soft carriers are the most widely usedcommercial products. These are also called buckle carriers andcome in a wide variety of sizes, materials and prices.

4.
Other types of carriers include varieties and mixtures ofwraps, slings and soft-structured carriers. Some provide a wideband of support or a seat underneath the infant’s buttocks. Frame
pack carriers are specifically designed for hiking.

How to cite this article:
Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical andPsychological Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology

Positioning and Safety
Caution should be advised, or BW should be discouraged,
when infants have a respiratory infection, during breastfeeding,in extreme weather conditions, for infants with sleep apnea or
low motor tone, or when the caregiver is impaired, or uses drugs,
alcohol, or cigarettes on a regular basis (Figure 5).

Figure 5: Safety guidelines.

Figure 6: Airways, breathing and circulation precautions.

007

How to cite this article: Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical and Psychological
Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology

The carrier should support the infant from knee to neck. The
infant’s legs should be supported from the knee and held in an
M-position where the knees are higher than the baby’s buttocks.
Sideways position of the infant in a sling is associated with thegreatest risk of suffocation. In addition, this position holds thethighs together similar to tight swaddling; therefore, this position
should be avoided. When using any baby carrier, the standard
ABC’s of Airway, Breathing, and Circulation can be used to mitigate
potential risks for the infant and the wearer (Figure 6).
Some BW devices enable front facing forward of the infant.
This position is controversial, as it tends to place the infant hips
extended and with limited abduction in a suboptimal position
for healthy hip development during early infancy [160]. The
infant’s social referencing to caregiver’s face (regulating infant
stress to novel stimuli) is also prevented, possibly leading tooverstimulation and elevated stress levels for young or sensitive
young infants [161]. For infants desiring to face out, several
carrier designs now exist that support a relatively ergonomic
position in the front facing forward mode. Current manufacturer
recommendations are to place infants in the front facing forward
position no earlier than at 5-6 months of age.

Risks of BW

The injury-related risks associated with BW are generally frommisuse of the product or from old or faulty carriers. However, trips
and falls of the wearer may occur due to the added weight of theinfant or because of improper distribution of the infant’s weighton the wearer. Drops and falls of the infant are most common
during placement in or removal from the carrier. When the infant
is larger, reported injuries are more likely to be related to cooking,and bumps from furniture and corners [162].

Head injuries and striking of objects may result from a fall,
drop, or lack of attention to furniture and doorways. Additionally,wear and tear of carriers or buckle failure can add to the riskof sudden unexpected falls. Older, second hand, and poorly
designed carriers may contribute to the risk of injury [163].
Improperly tightened carriers can cause the carrier to be loose,
allowing the baby to slip out when the caregiver bends over.
The risk of suffocation and positional asphyxia are greater for
infants younger than four months, especially in the presence ofunderlying conditions, head covering, maternal smoking, andwhile breastfeeding (see Figure 5) [164,165]. These and otherreports emphasize the need to encourage parents to avoid holding
the infant too low, breastfeeding in the carrier, covering the head,or positioning so that the head cannot be seen easily. Parents
should also be encouraged to read instructions carefully, and tobe vigilant when placing the infant in the carrier or removing theinfant from the carrier.

Duration

The duration of daily SSC/BW depends on parental and infant
preferences. Positive outcomes for breastfeeding and infant socio008

emotional development have been found with approximately
one hour of daily BW [67,78]. However, a dose-response effecthas been shown for socio-emotional and resilience outcomes, soparents should be encouraged to carry as much as possible and not
merely limit carrying to transport situations [66]. Infant interestand desire for BW will normally decrease as the infant engages
in developmentally appropriate locomotion and environmental
exploration at around 6-7 months [161].
Additional guidance has been designed by the tradeorganization Baby Carrier Industry Alliance for safe Infant
Carrying [166]. In the US, The Center for Babywearing Studies
provides education and support for interested parents andproviders [167]. Certified BW consultants are available for parents
who need additional support.

Conclusion

Pediatricians can influence long-term health and well-being
by recommending simple interventions during early childhood
to improve parenting and infant outcomes. BW during the firstmonths of life is a simple, low-cost preventive intervention, which
may help pediatricians resolve several frequently encountered,intractable clinical challenges, including poor parental bonding,non-optimum parenting behaviors, early discontinuation ofbreastfeeding, parental postpartum depression, infant poor
sleep and crying, developmental dysplasia of the hip, positional
plagiocephaly as well as early-return-to-work-induced separation
issues for both parent and infant. For safety and comfort reasons,parents should be advised to employ ergonomically suitable
BW devices, which support both the caregiver’s and the infant’s
healthy posture, while protecting infant airways. BW promotes
the development of emotional connections between parents andtheir infants, thus supporting secure attachments and forming thefoundation for healthy relationships, which are known contributeto physical and emotional health and wellbeing throughout thelifespan. This simple, low-cost intervention at the beginning of life
has well-documented short- and long-term benefits for babies andfamilies and, thus, has the potential to benefit society as a whole.

Article Summary

The article summarizes studies of infant carrying/babywearing effects on child physical and psychological healthand describes types of carriers and safe practices

Conflict of Interest Disclosures (includes financial
disclosures): HN received consultancy fees from the baby carrier
manufacturer Ergobaby Inc. during the initial conception anddrafting of the article. HN had no conflict of interest during thecompletion of the drafting and critical revision of the article. At thetime of submission, HN owns a company engaged in consultancy,
design and brand development of baby carriers. Joanna McNeilly
receives income from educating babywearing consultants. The
other authors have no conflicts of interest to disclose.

How to cite this article:
Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical andPsychological Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876

Academic Journal of Pediatrics & Neonatology

Contributors’ Statement
Dr Norholt and Prof Price conceptualized and designed thearticle, drafted the initial manuscript, and reviewed and revised
the manuscript.
Prof Phillips drafted the initial manuscript and criticallyreviewed the manuscript for important intellectual content.
Ms McNeilly drafted the initial manuscript and reviewed andrevised the manuscript.

All authors approved the final manuscript as submitted andagree to be accountable for all aspects of the work.

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How to cite this article: Henrik N, Charles P, Raylene P, Joanna M. Babywearing Practices and Effects on Parental, Child Physical and Psychological
Health. Acad J Ped Neonatol 2022; 11(5): 555876. DOI: 10.19080/AJPN.2022.11.555876