What are the safety concerns of babywearing?

December 14, 2015

There are three primary concerns when it comes to babywearing: 1) Suffocation, 2) falls, and 3) user error/misuse. Below we use official entities as resources to define each concern, describe why it happens and recommendations to prevent such occurrences.

1) Suffocation

Positional Asphyxia and smothering are two scenarios that can lead to suffocation while babywearing.

Positional asphyxia can occur when the airway of an infant becomes pinched due to an abnormal position of the baby’s neck and/or body. A baby’s airway is very soft. Because of this, when the baby’s neck is bent too far onto the chest, too far back, or too far to the side, the airway can become compressed making it harder for the baby to breath. The Consumer Product Safety Commission (CPSC) has documented a risk of death from positional asphyxia particularly in infants younger than 4 months.
--Why does it happen? According to articles released by the Utah Department of Health, JPMA, and St Christopher Children’s Hospital, positional asphyxia most commonly occurs when an infant is put to sleep or falls asleep in an unsafe sleeping environment or in an unsafe position; however positional asphyxia can also occur anytime the infant’s neck is not properly positioned and the baby is not appropriately monitored.
--Prevention: “Babies positioned correctly should have their chin up, with nose and mouth free of any type of obstruction at all times,” said Eileen Tyrala, M.D., a general pediatrician at St. Christopher’s Hospital for Children in Philadelphia. Baby's head and neck are fully supported with two vertical finger widths between baby's chin and chest. “Infants [without consistent head and neck control] are especially at risk for positional asphyxia, and parents should frequently check their baby’s head and neck position to ensure they are correctly positioned.”

Smothering is the mechanical obstruction of the flow of air from the environment into the mouth and/or nostrils, for instance, by covering the mouth and nose with the material of a sling or clothing, or breast or skin fold.
--Why does it happen? According to CPSC, “in the first few months of life, babies cannot control their heads because of weak neck muscles. The sling’s fabric can press against an infant’s nose and mouth, blocking the baby’s breathing and rapidly suffocating a baby within a minute or two.”
--Prevention: CPSC recommends that parents and caregivers make sure the infant’s face is not covered and is visible to the sling’s wearer. If nursing the baby in a sling, change the baby’s position after feeding so the baby’s head is facing up and is clear of the sling and the mother’s body. Parents and caregivers should be vigilant about frequently checking their baby in a sling. CPSC regulations states babies 4 month and younger should be worn on the adult’s front and facing inward.

2) Falls

Falls can occur in two ways: 1) child falls from the carrier or 2) parent falls while child is in carrier.
--Why does it happen? A child falling from a carrier is typically due to improper use, improper fit or user error. A parent falling (with the child in the carrier) can be due to the adult losing balance, tripping over feet/uneven surface/object, or adult is physically or mentally impaired.
--Preventing falls from the carrier: Follow the instructions for wearing and review the Safety and Limitations of Use sections of the user manual. When loading and unloading the carrier, practice with a capable partner over a soft surface (bed, couch, etc) until you have mastered the moves and are in complete control at all times. Always have a hand on your baby, regardless of your ability. Never multitask or rush during the loading/unloading process. Prior to each use, you should thoroughly check the fabric and buckles for abnormalities and while fastening buckles, ensure that the buckles are clear of any obstructions—including the safety elastic, straps, etc—and listen for an audible click from both sides of the buckle to ensure both prongs are engaged. Baby should be centered, upright and snug in the carrier and properly fitted/securely fastened on the adult.
--Preventing parent falls with child in carrier: When moving about, always have a steady stance, hold the rails when walking up/down stairs, bend at the knees not at the waist. Be cautious when traversing uneven surfaces. Never participate in sporting activities. Never use alcohol, drugs or any substance that impairs your judgment or balance.

3)User error/misuse

User error is an error made by the human user in interacting with the carrier. Misuse is when the user interacts with the carrier in a manner that is against its official recommendations.
--Why does it happen? There are many reasons for user error or misuse while babywearing, here are a few examples: multitasking or being in a hurry while loading, unloading or wearing; not reading the instructions or watching instructional videos; external distractions (phone ringing, baby crying, dog barking, etc); impaired mental or physical functioning etc.
--Prevention: The Baby Carrier Industry Alliance makes a strong recommendation for parents to “read and follow all manufacturer’s instructions for use, and watch any [applicable videos].” Child safety experts at CPSC have “determined that parents with infants younger than four months of age, premature, low-birthweight babies, and babies with colds and respiratory problems should take extra care in using a [carrier], including consulting their pediatrician.”