To Sling or Not to Sling

Updated: Jun 16, 2020

Every parent’s desire is a contented babe.

Every parent also wants to make sure their babe is safe.

In trying to juggle the needs of your baby with the demands of running a family in today’s busy world, parents can be confused with the vast array of baby products being sold – what is safe and what is not?

Baby wearing devices such as slings and baby carriers are often used by parents to help get things done while keeping baby happy. The downside to this common practice is that there have been deaths (sadly, one recently in NSW) and injuries here in Australia and overseas. 1 , 2

So it is important, when parents are thinking about a product such as these, they are able to make an informed decision based on the best evidence available. Kidsafe SA describes baby slings as pouches or strips of fabric secured over your shoulders and usually worn across your front and baby carriers as soft padded carriers worn on your front, back or hip.

Image courtesy of Kidsafe SA

Slings that place baby in a curved position with chin to chest

should not be used. Babies can asphyxiate lying with a curved back with chin to chest position which can cause pinching of the airway and airway obstruction. This is called positional asphyxia.

We pose some questions below for parents to ask so they can assess the pros and cons and decide if using these products is right for them and their infant.

Is the product I am choosing safe?

Most people assume all nursery products sold in retail stores must be safe. Unfortunately many of these products do not have Australia New Zealand Mandatory standards, nor is there rigorous and specific research to show the efficacy or, importantly, the safety of these products. Some slings and baby carriers may be certified under European or US standards but there is no Australian standard for them.

When choosing a sling or baby carrier, whether new or second hand, it is important to consider (but not in any specific order):

Taking baby to ensure it is a safe fit – it should be appropriate for baby’s age, weight and size
Asking to see how it works – the seller should be able to demonstrate how to use it
Ensuring the product comes with detailed instructions on how to use it
If it is described as “womb-like” or “cocoon” – this shape places baby in an unsafe ‘C’ or chin-to-chest position
Whether a framed carrier suits your height and size. It is also important to make sure it has enough depth and support for baby to allow movement and for even distribution of baby’s weight. Check if the leg openings are not too large to allow baby to slip out or too tight which could chafe.
That the folding frame joints are safe and will not trap or pinch little fingers. Check for sharp edges, rough surfaces or points which might hurt baby and that there is sufficient padding to protect baby’s face from bumps or hitting the metal frame
If it has sturdy straps, heavy duty fasteners and material – if second hand, ensure it has no tears or fraying, and the fasteners are still firm

Ensure the restraining straps will fit over baby’s shoulders to prevent falling out
Look for a broad hip or waist strap to take weight off your shoulders and stop sideway movement of the carrier
Be able to adjust straps with one hand

What are the potential benefits or risks for this product?

Slings and baby carriers, where used safely, may be of benefit to both carer (usually mum or dad) and bub. Having baby close while doing “everyday tasks, such as housework, are easy to get done with baby in a sling … baby happily snuggles into you, either sleeping or watching her surroundings”[3] may help promote bonding and breastfeeding as well as the motion of walking or rocking helping baby sleep. Slings and carriers can also alleviate the weight of baby off your arms and back.

Parents sometimes choose to use a sling in the belief it may help with reflux or when a baby is ‘grizzly’. However, there is little scientific research supporting or refuting the benefits of these products.

Unfortunately, we do know there are significant risks to baby if these devices are not used correctly. These include non-life threatening situations such as baby falling if not restrained properly, neck injuries or fingers being trapped in folding joints and, if incorrectly wrapped, the risk of hip dysplasia.

Without sufficient supervision, baby can also quickly suffocate if their face is pressed against the fabric or your body or slowly suffocate if he lies in a ‘C’ shape position with his chin on his chest.

Caution is suggested when using slings for all babies, so it recommended that if baby is premature, their paediatrician or physiotherapist is consulted before using one of these. These devices are not suitable for babies:

under four (4) months old
with low birth weight
with breathing problems
with low muscle tone or other medical issues

What is baby doing in this product?

It is critical that you are vigilant when using a sling or baby carrier. It is important to check regularly if baby:

Image courtesy of Kidsafe SA

· has their face covered, is in the chin-to-chest position or lying in the ‘C’ position

· is grunting, wheezing or taking quick, laboured or whistling breaths

· has a grey or bluish tinge to their skin

· is fussy, restless or squirming

· is in difficulty even without making any noise or movement

· has their thighs straddling your body and their hips in an ‘M’ position to reduce the risk of hip dysplasia

· is in danger of falling because your movement has loosened the sling/carrier

· can be injured due to wear and tear on the sling or carrier

Should you use the sling for breastfeeding, it is imperative to understand that baby can be put into a dangerous position as their face can become covered and he needs their head supported. Breastfeeding is not a “hands-free” activity and baby needs supervision at all times to ensure their airways are kept free.

Am I using this product safely – for baby and for me?

For baby

Check whether you:

· hold baby with at least one arm at all times until he is firmly positioned in the sling or carrier while fitting your sling or carrier on yourself

· position baby in an upright position with the natural curve of their spine and the back of their neck supported in a natural position so their tummy and chest are against you

· ensure baby’s chin is up and away from their body, as the chin-to-chest position can close their airways

· can see baby's face at all times and that their face remains uncovered by clothing or with any material or the sling on your body

Image courtesy of Kidsafe SA

· make sure baby's hips are in an ‘M’ position, so their thighs are straddling your body

· know baby can get into and maintain a sitting position on their own before placing on your back in a carrier or sling

· do not use framed carriers before baby is at least four to five months old. Before this age, their neck may not be able to withstand jolts and he may be injured

· are careful when doing things that could be dangerous when carrying your baby in a sling such as holding hot drinks, cooking, running after another child or any activity that distracts you from regularly checking on your baby.

· check for wear and tear to the product like ripped seams, frayed straps or loose fasteners each time before use

For me

When wearing a sling or baby carrier, I will:

· Have someone assist me the first time

· Follow the manufacturer’s instructions for safe use

· Be alert for:

o My own safety

o Things that may fall or splash on baby (e.g. hot drinks or cooking)

· Check my activity has not loosened the sling and changed baby’s position

· Be aware the sling can affect my centre of gravity and movements so will

o Walk and stand tall with my knees bent a little bit to take some of the weight

o Take short steps to assist with balance

o Keep my shoulders low and back and check that shoulder straps and chest clips cross between my shoulder blades

· Always bend from the knees, never from the waist, to prevent the baby from falling out. If bending down, make sure the baby cannot reach other hazards, such as hot drinks on a bench.

· When the sling or carrier is being shared between caregivers, always take the time to adjust the sling for their comfort as well as baby’s safety

… and finally

Remember and follow the TICKS rules:

T — Tight: Slings or baby carriers should be tight enough to hug your baby close to you. I — In view at all times: You should always be able to see your baby’s face by simply glancing down. C — Close enough to kiss: By tipping your head forward you should be able to kiss your baby on the head. K — Keep chin off the chest: A baby should never be curled so that their chin is forced onto their chest as this can restrict their breathing. S — Supported back: The baby’s back should be supported in a natural position so their tummy and chest are against you.