by Caroline von Fluegge-Chen
Europe seems to host the greatest number of pediatricians who recommend that, in order to avoid pressure on their underdeveloped bodies, newborns and infants should lie flat on their backs in a stroller and not be carried. Yet, laying a young infant on his back alone in a stroller may be physically and emotionally stressful, and can be developmentally inhibiting. Being carried or worn in an upright position with proper leg support is not only developmentally sound, but often preferable to mothers and babies alike. Upright carrying optimizes the physical, emotional and intellectual growth of your baby.
Infant Spine Development
Our spines are not perfectly straight, even though they may appear so from the front or back. When you look at a person from the side, four slight curves are visible, forming an elongated S shape. These curves help keep us flexible and balanced. They also help absorb stresses placed on our bodies through our daily activities, such as walking, running and jumping.
We weren’t born with these curves. Normal curves of the spine develop gradually, as a means of adapting to gravity. At birth, babies are in a state of flexion, still curled up, with their spines in a natural, long C-shaped (convex) curve. At first, a baby does not have the strength to hold his head up, nor the balancing curves in his spine to do so. But gradually, as the muscles in his neck get stronger, he begins to lift his heavy head against gravity, and a curve starts to develop in his neck (the cervical curve) to help balance his head. When your baby starts to creep and crawl, the lower back (lumbar curve) and the muscles that support it develop. It takes about a full year for your baby to attain these curves in his spine.
The Stresses of Lying Flat
Laying your young infant flat on his back stretches the C-curved spine into a straight line, against its natural shape. Research shows that keeping an infant’s spine straight is not a sound physiological position. In addition to stressing the baby’s spine, it can also negatively influence the development of the baby’s hip joints.
Infants who lie frequently on their backs in a stroller may end up with plagiocephaly (deformed skulls, flattened on the back or side) and deformed bodies with poor muscle tone. Research backed by the American Academy of Pediatrics states that, “with prolonged immobilization on a firm mattress or a flat bed (as in a stroller), the constant influence of gravity flattens the body surface against the mattress producing positional disorders and infants with decreased muscle tone.”
Existence in Containers
This does not mean that laying the baby flat for a couple of walks around the block in a stroller is going to wreak havoc on your baby’s physical development. But the truth is that the average Western infant between 3 weeks and 3 months of age is carried little more than two and a half hours a day. Babies spend most of their time in containers, such as car seats, cribs and strollers. The West has diverged from eons of child rearing, and we have gotten to the point of letting objects determine our babies’ sense of contact, rather than us.
The Fetal Tuck
Newborns are virtually impossible to stretch out unless wrapped or swaddled. When you place an infant flat on his back, his thighs will usually be pulled up toward his chest, or when sleeping, straddled and bent in a frog position. The fetal tuck, the natural position of babies, is the most calming and the most adaptive.
Infants use less oxygen, which conserves energy and wastes fewer calories. They digest their food better. Also, we have more efficient temperature-regulating cells and more fat on the back sides of our bodies, so when we hold our infants stomach-to-stomach, we are protecting all their receptor and vital organs.
The instinctual flexed widespread legs that an infant maintains when picked up, coupled with the palmar and plantar reflexes that help an infant cling to his mother, suggests that infants’ little bodies are adapted to be carried upright and oriented toward their mothers.
By holding your baby with his knees flexed flat against your chest and supporting his bottom, you are supporting your baby in the natural position that his body instinctively assumes to ensure that he is comfortable, warm and safe.
The Trouble with Car Seats
Strollers that position a baby in a somewhat upright position (such as in infant car seats) may be gentler on the baby’s C-shaped spine, in that they do not stretch it flat. But car seats are not a much better option for transporting your little one. Research by the International Chiropractic Pediatric Association shows that they are not the ideal transport for your infant when not in the car, due to “restricted postural options which can impact your baby’s developing cranium and spine.”
By keeping the spine in a C-shaped configuration, these contraptions can actually prevent the natural curves from forming. Babies can have a hard time acquiring adequate muscle strength to hold up their heads if they don’t get much of a chance to experience gravity.
Positive Physical Development
When infants are held upright, they are allowed to practice compensatory movements, enhancing muscular strength and allowing for more control over their fine motor skills. When the mother walks, stops or turns, an infant’s body naturally works against the pull of gravity to maintain his position.
The force of gravity is a positive element in infant development. It allows them to learn to hold their heads up and keep their bodies balanced.
Discord with Upright Carrying
So why do some still claim that the horizontal position is better for your infant in her first months of life? This argument is often rooted in the assumption that the upright position may be stressful to his underdeveloped spine and pelvis.
Although some pediatricians are advocates of natural parenting, many don’t have much hands-on experience with baby carriers. They might be acquainted with the upright carriers from the eighties and nineties with their typical lack of adequate head/neck support and tight or chafing leg holes, leaving babies to dangle from the crotch due to complete lack of leg support. Perhaps they have seen so many babies facing out when carried upright that they assume all upright carrying is non-supportive.
The first two images on this page are perhaps the carriers that many doctors imagine and classify as unsafe or harmful. Both are non-physiological-carrying devices. These front-facing carriers, unlike wraps, slings, mei tais and soft-structured carriers, do not provide proper leg support, which can make the pelvis tilt backward and place babies in the dangerous “hollow back position.”
Swaddling and Hip Dysplasia
Although there are myriad psychological, emotional and physiological benefits from the swaddling style of the Navajos, there is clear evidence that swaddling the legs so that they are bound together and not allowed to flex at the knee or hip has led to hip abnormalities. By not allowing the head of the femur to sit in the socket, the socket often does not develop properly, causing developmental dysplasia of the hip (DDH).
Carrying a young infant in the horizontal position with legs together in a baby carrier (like a sling or a wrap) provides adequate spinal support, but it is not the optimal position for hip development or prolonged carrying. This is especially true if there is congenital dysplasia present in the infant.
The American Academy of Pediatrics released a review of swaddling under Van Slewen in 2007, which reaffirmed that infants’ legs should not be tightly swaddled. In 1965, the incidence of DDH was high in Japan when a swathing diaper was used widely by the population. Eight years later in 1973, Japanese doctors advised mothers to avoid “prolonged extension of the hip and knee of infants during early postnatal life.” Soon afterward, experts reported a marked decrease in infants with DDH.
Supporting the Legs
Upright baby carriers that support the legs, carrying a baby as a mother naturally would in arms, do not compromise a baby’s spine or hips. When an infant’s legs are flexed and straddled, the instinctive position that his little body assumes when picked up, the head of his femur (bone of the thigh) fills out the hip socket (acetabulum). The hip socket is filled most evenly when the legs are pulled up to roughly 100 degrees and spread roughly 40 degrees at the same time. DDH does not occur when an infant’s legs are supported. Actually, this is the position that doctors advocate as treatment for babies with hip dysplasia.
Interestingly enough, babywearing is customary among the Netsilik Inuit people. Netsilik mothers don’t use papooses, but instead carry their infants in their amautis of their parkas. The babies assume a seated straddling position on their mother’s back inside their coats. No studies indicate prevalence of either DDH or spondylolisthesis in this northern Inuit babywearing group. Their hips and spines develop normally.
A mother, using either her arms or a simple piece of cloth, supports her baby’s legs in a f0lexed (knees bent), abducted (away from midline) position, supporting the hips and the spine. Instead of fabric at the crotch, which contributes no leg support, or swaddling the legs, which is too restrictive, ergonomic carriers put the baby in the position that supports the legs just as a mother’s arms would. The flexed abducted position is what infants are hardwired to assume when picked up. It is what nature intended: legs spread around the mother’s hip, back or torso, with knees bent in a seated position.
Proponents of horizontal positioning in early infancy may be concerned with whether the infant actually receives adequate levels of oxygen while being carried. According to Dr. Maria Blois, premature infants placed in an upright position on their mother’s chests had improved respiratory patterns, more regular than in an incubator.
Blois’s study also showed “reduced episodes of sleep apnea [temporary cessation of breathing] and bradycardia [slowing of the heart rate]. Transcutaneous oxygen levels do not decrease, indicating that oxygen saturation is not compromised.” These studies were done on premature infants, some weighing as little as 3 pounds, placed upright on their mothers’ chests. The preferred position for these tiny babies is upright, usually secured by a piece of cloth. If the upright position is safe for a 3-pound preemie, it doesn’t make sense that it could be harmful to a fullterm newborn.
Preventing Ear Infections
Lying horizontally is not only a poor option for your baby’s spine, hips and cranium, it can also contribute to inner ear infections in infants. Gastric reflux of contents into the middle ear causes ear infections. Gastroesophageal reflux disease, or GERD, can be pretty prevalent in infants, as sphincters tend to take a while to fully close.
Parents of infants diagnosed with GERD are advised to carry them upright to ease the symptoms. When infants are placed lying in the horizontal position, not only are the symptoms exacerbated, but gastric juices can enter the immature eustachian tubes, making reflux from the throat into the middle ear more probable. The same may occur when bottle-fed infants are fed while flat on their backs. A slight upright tilt prevents milk from entering the middle ear.
The buildup in the eustachian tube can cause inflammation and a buildup of bacteria, and subsequently an infection. Wearing your baby upright can actually be a preventative measure against ear infections, and can help ease the symptoms of GERD.
Another benefit of carrying your baby is that carried babies receive a lot of vestibular stimulation, whereas lying babies do not. Our vestibular system helps us out with our sense of balance and our security in space. When a mother holds her baby, the baby moves back and forth with mom’s walking, and side to side from her swaying or rocking. Mom may stop and turn and reach to grab something, or she may move gently and smoothly. These varied movements force her baby to respond appropriately to keep himself balanced. All of these movements tune her baby’s vestibular system.
A stroller moves either forward or backward, offering movement on a single plane, and not very varied. When changed from the upright position and the containment of his mother’s arms to the horizontal position laying down uncontained, a baby may produce random movements and suddenly flail his arms and legs, as if to save himself from falling. This is called a baby’s Moro reflex. It acts as a baby’s primitive fight/flight reaction, and is replaced later in life by an adult’s startle reflex.
Carrying, rocking and swaying stimulate an infant’s vestibular apparatus and help them to feel secure in space. Most babies today spend most of their day apart from their mothers in a container or in a stroller, leaving them prone to vertigo, and a feeling of physical insecurity in space in general. Native Americans are typically very secure in space; they are actually known for their comfort with heights and apparently tend to have little problem working tall construction projects. Most traditionally raised Native American babies are swaddled or spend most of their infancy either in cradleboards or on their mothers’ hips, leading to enhanced vestibular development. Interestingly enough, the fear of flying and the fear of heights which plagues many of today’s adults can often be traced back to not being carried as an infant. Carried babies feel secure, and are less apt to develop space-related phobias.
Babies have reason to feel secure. They physically need to be in close contact with their mothers. They giggle and coo and drink in all of our expressions. Upright on mother, they are able to view the world unobstructed from a safe place and can learn about everything around them. Not only are babies better off physically when upright, but they are happier and calmer. In her book, The Vital Touch, Dr. Sharon Heller writes, “The more time that babies spend vertical, the more time that they are alert and calm. Even newborns that spend most of their time sleeping, stop crying and perk up when picked up and placed on our shoulder. Interestingly, how alert a newborn is relates to where he is. Upright in an infant seat, he is less alert than when upright in arms.… Vertical positioning as optimal in infants makes perfect sense. Think of how much time our infants spend horizontal—flat on their back in a crib or a buggy. Might this affect their alertness? There’s a good chance.… Researchers found that infants too young to sit independently learn more when placed in a vertical position.”
Stimulating the Senses
Not only can an infant learn about the world around her from all the different sights she sees, she is in the state of mind to do so. When an infant is calm but alert, that’s when all the information can permeate into her being.
“Our body is a sensual cornucopia where smiles, aromas and laughter mingle amid undulating caresses that put the entire sensory world at our baby’s fingertips,” writes Heller. “Our baby gets tactile or cutaneous stimulation from our skin touching hers and proprioception from the pressure of her limbs flexed into our body. She gets tactile, olfactory, and gustatory stimulation if we nurse, of our milk, and vestibular stimulation from the gentle stimulation of our movements and, when held upright, from her efforts to right her head and maintain her balance. She gets visual stimulation when she looks all around her, auditory impulses as we whisper endearments, and kinesthetic stimulation as we change her to the other side. When we put our babies in a container, especially if out of sight, all of this sensory nourishment is lost.”
Easier System Regulation
The mother/infant relationship actually provides physiological regulation of the infant’s autonomic system. A 1992 study showed that when an infant is taken away from his mother he experiences a “decreased heart rate, temperature decreases, sleep disturbances and EEG changes”—representing an impairment in the regulating processes of his own little body. Upon being separated from his mother, a baby’s immune system weakens. His body literally stops producing as many leukocytes. But when his mother rejoins him, he strengthens again. An infant’s body physically needs his mother present to help regulate his own body.
Roots of Misinformation
With all the studies demonstrating the clear physical benefits of carrying a baby upright on mother’s chest, it’s hard to understand a pediatrician’s ambivalence on the matter, or outright scorn when his patients choose to do so. Perhaps the reason for not supporting upright carrying is that they want to discourage mothers from “spoiling” their babies, or to prevent the mother and baby from getting too close or attached to each other.
Straying from wearing our babies may be linked to an old school of thought, dating back to 1928, when the famous behaviorist Dr. John B. Watson published The Psychological Care of Infant and Child, setting out to change the course of humanity and make infants independent, strong and tough. His theory was that we were all born basically a blank slate, ignoring any evolutionary hardwiring or any inborn biological tendencies, and that in order to “form” an independent child it was necessary to prevent the newborn baby from creating dependent habits. In other words, if you hold on to your baby, he will cling to you and never let go. He will be needy. Not only should you refrain from carrying your baby but you should withhold cuddling, kissing and rocking, too; if you show affection, your baby will come to expect it.
So many of our grandparents and parents were influenced by this mechanistic train of thought, pressured by the experts to believe that if they picked up their babies when they cried that they would create a tyrant of a child and become enslaved. Unfortunately this psychology has had a profound effect upon pediatric thinking and practice, and even pervades conversations between mothers and doctors today.
Evolutionary Need for Touch
Most mothers are still pressured to carry out the harsh parenting methods that were inculcated into our grandparents and our parents. Yet, these mechanistic methods only go back so far. Anthropologist James McKenna claims that today’s babies, more often in some container than in our arms, are “at odds with evolution.” “Virtually all of our biochemistry and physiology are fine-tuned for the conditions of life that existed when we were hunters and gatherers, in which babies were held by their mothers,” McKenna writes. “Our culture may be changing, but our evolutionary need for touch remains the same. Babies’ brains are designed to expect closeness and proximity—to be held for their safety, psychological growth, and physical growth, mental growth, to aid and stabilize their physiological processes and keep their immune systems strong. Touch is not an emotional fringe benefit. It’s as necessary as the air we breathe.”
Making Strollers the Exception
Even though most Western parents cannot conceive of life without one, strollers are not as gentle on an infant as we assume them to be. Placing an infant alone on his back for long periods of time is not how humans are hardwired to thrive. Lying horizontally in early infancy is not easier or less stressful on an infant’s spine, skull or neck. When a baby is upright on her body, a mother adjusts to all her baby’s movements, and he to hers, moving like dance partners. The two create a rhythm together, physically and psychologically, and move together in sync. Even the most state-of-the-art stroller can’t provide the warmth of a mother’s body, nor her comforting smell, the varied movement, and sensitive motherly responses. These are all so essential to her baby’s healthy growth and development, especially during such a critical period when his brain is growing more than any period in his life. No toys can match the joy that an infant gets from his mother’s face. The view of the fabric liner with which the manufacturer chose to line the stroller cannot compare to the rich environment a baby witnesses and observes when he moves together through the day with his mother.
Strollers are not “bad,” per se. To go further, baby wearing and strollers need not be mutually exclusive, as long as an infant is content and his cues are responded to when he signals that he needs to be held.
Laying babies flat on their backs in a stroller is actually not easier on their necks, spines, hips and minds. Nature intended for babies to be carried. Upright positioning, with proper leg support, is the preferable position for your infant and is gentle enough not to physically stress even tiny babies. A mother should trust her heart. By holding her baby close to her heart, she is not just choosing the most beneficial and physically supportive method of bringing her baby along with her, she is providing the optimal environment for his psychological and emotional growth.
By Elizabeth Antunovic – Featured in Pathways Magazine, December 2010
For more informative articles, see www.icap4kids.org.