Crotch dangler? No such thing! (see article)
Okay. Now for the real hot buttons: Crotch dangling and hip dysplasia.
“Crotch-dangling” is a term that came about in the late nineties," says Grayson. There was apaper written by Rochelle L. Casses, D.C., in which she stated that incorrect baby wearing in a crotch-dangling-type-carrier could lead to spondylolisthesis (a condition of the spine whereby one of the vertebra slips forward or backward compared to the next vertebra) and possibly hip dysplasia. But as it turns out, there is no scientific evidence that hip dysplasia or spondylolisthesis is caused by carriers of this type. Spondylolisthesis and hip dysplasia are much more problematic and prevalent in countries where babies are swaddled tightly at the hips."
That's right, says pediatric orthopedic surgeon Dr. Timothy Radomisli of Mount Sinai Hospital in New York. "There is absolutely no scientific basis for concern about baby carriers. I've never seen any baby carrier injuries. In 20-something years. Never heard of it." But what about thisdiagram that's long been posted on the International Hip Dysplasia Institute website, illustrating that BabyBjorn-style carriers are not recommended? "I think the diagram is pure conjecture," states Radomisli. "To validate it, you'd need an outcomes study comparing babies who wore different carriers. I've never seen a baby develop dysplasia from a carrier. Current sonographic studies suggest dysplasia is congenital, not developmental." Yep. "If a baby has the opportunity to flex his legs at the hip, rather than his legs being “bound” together (as in tight swaddling) he is not in a position to increase risk of hip dysplasia," chimes Dr. Levenstein. (Editors' note: we were hoping to better understand IHDI's position on this, but unfortunately director Dr. Price told us, "We'd rather not make an additional statement.")
"A baby carrier can't cause hip dysplasia, but improper leg positioning is far from ideal for babies who have it," says Antunovic (Boba). Well, yes. We understand that it may not be an ideal position for a baby born with hip dysplasia. But what about for healthy babies? "There is no risk for an unhealthy or uncomfortable pressure on the child’s crotch in carriers sometimes referred to as “crotch danglers,” states Dr. Kelly (Bjorn). "A baby’s center of gravity (larger head and shorter limbs than an adult), body proportions, and low weight, work together with carefully designed carriers that ensures proper support of the head, neck and back to evenly distribute baby’s weight. The only baby carrying practice that has been associated with aggravating hip dysplasia is tight swaddling and papoose-style carrying, where the child’s hips cannot move. All baby carriers, including front-facing carriers, keep babies hips in the abducted position, allowing for free movement of baby’s hips."
Well, it may not be dangerous, but it certainly isn't optimal says Ergobaby Chief Science Officer, Henrik Norholt. "To have all the weight of the baby placed on the groin and the legs left dangling straight down is simply not optimum from a physiological developmental point of view. The best position to promote a healthy development of spine and hip is the spread squat position or “frog-leg position.” In fact, this is the very position that babies are placed in a brace when hip dysplasia has been diagnosed, because the position stimulates the optimum growth of the hip joints."
Hot button topic number two: inward-facing or outward-facing?
Everyone that we interviewed agrees that babies should face inward until four to six months of age, when a baby has head and neck control. So, let's talk about ages six months and up. Why the backlash against outward facing carriers?
Well, for one thing, it's awkward, says Antunovic (Boba). "The baby is not embracing the wearer, which makes for an awkward load. The wearer usually compensates by arching his back and holding his pointer fingers out for the baby to grasp so that the he or she doesn't slump forward. And if the baby is facing forward, weak infant abdominals cause your baby's back to arch, leaving her legs, hips, and pelvis further unsupported. When you walk, your baby then takes in the force of the movement, and the weight of his own body on an arched spine. Although no formal studies have been conducted on the relative positioning of babies in carriers, I'm confident that any extra pressure on developing hips and spines is undue.
Dr. Barbara Minkowitz, Medical Director of Pediatric Orthopedics at Atlantic Health Systems, agrees. "When the baby is facing away from the wearer, the baby can not be held in the "human position," which is optimal for hip development and child support. Human position is when the child's legs and body are supported to allow flexion (bending at the hips and knees) and abduction of the legs (spreading of the legs apart). While achieving this position in the upright position, the back is automatically supported and able to maintain its natural contour in the sagittal plane or natural alignment on side view."
We also hear a lot of "overstimulation" claims with regard to outward-facing. Absolutely, says Coote (Onya). "Over-stimulation of the baby is a concern. It doesn't allow the baby to make the choice to turn away and take a break. Many times, when a baby gets tired, he will bury his head in his mother or father’s breast, getting comfort, warmth, quiet, and the ability to shut out the stimulation of the world around him. Forward-facing carries remove this option."
However, “It’s important once children are able to recognize that things are going on in the outside world, to allow them to interact with that world at their level of comfort," says Dr. Kelly (Bjorn). Yes, a little stimulation is okay explains Dr. Levenstein: "Once older, facing outward provides appropriate environmental stimulation for baby as his distance vision and interest in the outside world is “fed” by turning outward when alert and awake. In addition, if a baby is facing outward and is uncomfortable, a parent is close enough to hear the fuss/crying, and that should signal to the parent to change position." For an even better understanding of over-stimulation risks, we turned to the developmental Ph.Ds at Seedlings Group. "Keep in mind that infants communicate with their caregivers quite beautifully and we are hardwired to respond," replies Dr. Aliza Pressman. "If an infant is overstimulated he or she will cry and express distress. If the infant is not distressed, then all is well. Especially after six months of age. It's important to keep in mind that all of the research on kangaroo care applies to newborns, particularly those who were born preterm."
Still, Ergo believes inward is best. "Sometime during the baby’s first year, most babies placed in the front inward facing position will begin to turn their head to get a better view of the action taking place behind them," says Norholt. "Given the flexibility of a baby’s neck and the wide zone of vision that eye movement allows for, the baby will in fact be able to take in quite a lot of the surrounding environment. If this solution works for you, and your baby is content, we strongly suggest that you keep your baby in the front inward facing position."
Of course, as with most parenting concerns, the best strategy is to take cues from your child. "It's up to parents to exercise common sense," says Grayson. "If you think your kid is getting overstimulated while looking out, simply turn him around."