Feedback on and reflections on the ergonomics of baby carriers and the child’s motor development.
In online texts about ergonomics and baby carriers, the terms “ergonomics” and “ergonomic” are used without clearly specifying how the child’s body rapidly develops during the first year of life and what is considered ergonomic at 3 months is likely not the same at 8 months. There is often a lack of description of how the child in the baby carrier should be able to switch between being active and resting by independently changing positions.
The tasks that arise in discussions about baby carriers and ergonomics are surprising, including the idea of striving for a “C-curve” of the spine up to 10 months of age, as well as the emphasis on avoiding hip dislocation even when the risk is almost non-existent.
Why this emphasis when the risk of hip dislocation usually does not occur at 3 months of age, especially if the child has learned to crawl? Usually, already after two to three months of age, there is little risk of hip dislocation. It is unclear from literature on websites whether manufacturers consider there to be a risk of hip injuries with “incorrect use” regardless of the child’s age. When you have an extremely wide hip position and the knees are at the same height as the buttocks, you need to consider the child’s age. When the child has good strength in the back, the knees may need to be lowered relative to the buttocks for the child to achieve a good pelvic position and a straight strong back.
A C-shaped back combined with the lack of head support is negative – a C-shaped back is a resting position where head support should be provided. When the child holds their head on their own, it should build a pillar of the body where the eyes look straight ahead and the neck is straight. A rounded back leads to weakness and a forward-leaning neck in an unnatural position.
A newborn baby has a C-shaped back and is often in a resting position close to the parent.
At three months of age, the baby has acquired a straighter back compared to when they were newborn, as well as control and balance of head movements. The baby starts using their hands to grasp objects. The activity level increases, and the baby begins to explore objects and communicate more.
An 8 month old baby is strong, can move around, and sit up on their own. They usually don’t want to stay in a resting position for too long. At this age, when a child is actively carried, they should not have a rounded back but rather a straight back with the head in line or slightly in front of it. Leaning back becomes too passive except when the child is resting. He or she should be able to switch between resting and being active.
A baby carrier should strive to resemble the way one naturally carries a child in their arms and address the baby’s needs for movement and development. A newborn baby is held against the adult’s body with their stomach facing the adult’s body in a resting position. A three- to five month old baby alternates between resting and being active. When aiming for active head control, we strive for a “pillar” posture rather than the C-shaped back of a newborn. When the child is upright, they support themselves using the muscles in their neck and back, and the child’s center of gravity is positioned above their support base. If the child sits with a rounded back, the center of gravity shifts behind the support base, making it difficult to control body movements because the child becomes weaker, “collapses,” and “falls backward.” It is important to position the child so that as they grow older, they can change positions and alternate between being active with a straight back and good balance, and resting securely against you as a parent. Often, larger infants from around 4-7 months sit on the parent’s hip and are carried with lower support as the child controls their own head and torso. An even older child is carried in various ways, facing forward, sitting on the hip, or being carried over the shoulder. In addition to the neck and eyes, it becomes important for the child to have a good pelvic position as they grow older. In an active position, the pelvis should be in a neutral position or slightly tilted forward. A backward-tipped pelvis leads to a rounded back and weakness. There are carriers where you can have a flat seat or a small cushion that helps the pelvis maintain a good position, avoiding tipping backward.
A position that occurs with a baby carrier is when older children are carried on the parent’s back. There is a difference between being forward-facing on the parent’s back and being forward-facing on the parent’s stomach. When the child is carried high on the back, so that the face is at the level of the adult’s head, the child can alternate between having a straight back and actively looking around and resting by laying their head against the parent’s back. In the forward-facing carrier, the child’s legs dangle and often hit against the parent’s legs. The child finds it difficult to support themselves with their arms, and it’s also challenging to lean back and rest. Carrying the child on the parent’s back makes forward-facing carrying natural – as long as the child is carried high enough. If the child is carried low – with its head at the level of the parent’s shoulder blades or back, the child cannot look straight ahead but needs to constantly look sideways. The child sits with a rounded back and cannot change its position. Therefore, it is better to carry high on the back.
A disadvantage of having the child on the back is a lack of eye contact. At the same time, an older child can more easily express their needs through sounds and movements when eye contact is not possible, depending on the child’s personality.
A collaboration on baby carriers has been established between Learn to Move and Runa Gustafsson, a psychologist who also works with body therapy Runa’s knowledge of the body, posture, and balance has naturally led her to observe children in baby carriers She has observed children and also the adult’s bodily movements when carrying the child. The adult’s movement patterns and their significance for the child are seldom addressed in facts about baby carriers and slings.
Read Runa’s wise thoughts on the effects of adult movement patterns on the child’s development:
How We Use Baby Carriers
When an adult carries a small child in a baby carrier, a complex movement pattern is underway. We need to pay attention to how this occurs as it has a significant impact on the child’s development. First, some background to begin with.
Background Introduction
Various thoughts, needs, and motivations lie behind parents’ choice to carry a child in a baby carrier, including the desire for physical closeness with their child and to develop a positive attachment. Another desire may be to have hands-free while carrying the child. There are different models of baby carriers on the market, including models where the child can be carried facing forward, i.e., the child’s face is outward without eye contact with their parent. Some parents choose to avoid this option because they wish to have eye contact with their child and also to protect the child from excessive visual stimuli. Articles about baby carriers that can be found online mainly focus on the ergonomics of the carrier, the discussion of whether or not to have eye contact, and the positive effects of using the carrier.
Some articles emphasize the importance of correctly using the child’s legs and hips in the carrier and clarify how the child’s legs should not hang straight down but should be in an M-position to promote hip health and the child’s developmental process, thereby avoiding hip instability. Centering the child in the carrier is emphasized. Several articles warn against having the child facing forward where they are leaning forward and the center of gravity is on the front pelvis, on the pubic bones, instead of on the sitting bones (ischial tuberosities).
There are articles and blog posts that highlight the importance of seeing one’s child, and especially that the child can see their parent for support, security, and validation. A small child hanging in a carrier and facing forward is not only subjected to an unnatural posture but also to intense visual stimulation. If this occurs in a stressful chaotic environment, the child cannot defend themselves. We adults can walk away if it becomes too burdensome.
Communication and Development
In 2011, Swedish television highlighted a scientific study by Suzanne Zeedyk on the importance of placing children in a rear-facing stroller, where the child and the parent can see each other. The study describes how this position promotes the child’s communicative skills and linguistic development. Through eye contact between the child and the parent, they can share experiences in their nonverbal and verbal communication, and the child receives help in interpreting internal and external stimuli. The child receives confirmation. This position does not prevent the child from seeing and experiencing the surroundings. The child can alternate between being able to see the parent and observing the surrounding environment. The key is the parent’s presence and attention. Moreover, this position allows the parent to more easily perceive their child and respond to the child’s expressions and behaviors, creating more security. It is easier to comfort and support one’s child through eye contact.
Furthermore, through eye contact, it is easier to see when something is happening, such as being able to see when a sleeping child is waking up, and as a parent, one can meet the child’s gaze and perceive the child’s condition, and respond to the child.
A significant dimension is missing
When it comes to articles and marketing that highlight baby carriers, I find a dimension that is missing. This dimension is essential and crucial for how the baby carrier can be used and how it affects the child. It is the significance of the adult’s own bodily movements and how they move with the baby carrier and the child and how this movement pattern affects the effectiveness of the carrier, and its impact on the child.”
Unfortunately, I have noticed that there are parents who use the carrier in a way that risks a negative development for the child. I have observed signs of stress reactions in children, and parents do not seem to be aware of how the physical and psychological interaction between them and the child can affect the child’s motor development and sense of security. Here, I will try to explain what I have observed and how I reflect on it, based on my theoretical and practical knowledge and clinical experience as a psychologist, body-oriented psychotherapist, and Rolfer®.
Movement patterns – and their various dimensions
Several factors are important to consider when using a baby carrier. If, as a parent, you move stressfully, clumsily, quickly, jerkily, or with a swaying gait, it leads to initiating movement forces that cause the child’s legs and arms to move (rapidly) in different directions, which means that a force and stress move towards the child’s body, usually centrally towards the hips and spine, and it can become too forceful and difficult for the child to handle. The child may defend or protect themselves by resisting or tensing in various places inside the body to handle the stresses. There are children who hang “crooked” in the carrier (sometimes almost diagonally), making it more difficult, difficult, or impossible for the child to focus their eyes and head in a centered manner.
Walking less smoothly and not paying attention to how the child’s head is positioned and moving can put a great strain on the neck, with the risk of serious injuries or neck problems as a result, now and in the future. I have seen how children lie with their heads backward or to the side while the adult moves harshly and rhythmically. It can become a kind of shaking violence on the child’s neck and spine. The shaking can occur sideways or vertically (like bumps up and down), depending on how the adult moves. I have seen situations where the child’s neck could be broken. The small child becomes vulnerable and exposed in this position. I have seen children collapse, give up.
Most of us adults know how awkward and uncomfortable it can feel to dance with someone on a dance floor where it doesn’t feel good to dance with. Perhaps we step on each other’s toes and experience an unharmonious interaction, and within us, we wish the dance would soon end so that we can leave the floor. The small child cannot opt out; the child must endure, and one way to do so if stresses become too strong is to shield off. If this mechanism occurs frequently and for a longer period, it can lead to symptoms of stress and imbalance in the nervous system. I have seen children’s eyes and gaze be restless and tense, signs of stress in the autonomic nervous system.
Hands that embrace
Another important dimension to consider is not using a baby carrier instead of your hands. It is valuable to tenderly hold your little child with your hands or with one hand to support the child, embrace the child so that they can feel safe and experience the presence of the adult. The baby carrier should not replace hands and human holding. Instead, it can serve as relief for the adult, perhaps to make it easier to carry in terms of weight. Considering the carrier as a practical accessory where the child can simply hang freely while you do other things poses the risk of not being attentive to the child’s bodily position. Even a hand on or around the carrier is significant for the parent, to thereby receive more direct feedback from the child’s body. The early phase in a child’s life is built on feeling security and care, being able to rest safely in someone’s arms, and in this, develop based on their conditions, to develop in this embrace in their natural curiosity and playfulness. If the child feels insecure due to strong forces on their own body, the child devotes time and focus to endure, or to survive and handle a strong strain.
Breathing
Common during stress is to hold one’s breath, or to breathe quickly and shallowly. The rhythm of breathing is affected, and this can be perceived by the child. One can describe the interaction between the child’s body and the parent’s body as a kind of communicative dance, where the child experiences the parent’s outer and inner states so directly and nakedly. If the parent is stressed, moves stressfully, and is more focused on something other than being present with their child in the carrier, the child experiences this quality in a non-verbal way. The parent’s own bodily state is transferred to the child. The early phase in the interaction between the child and the adult is fundamental for the child’s development. It affects the child’s motor skills, emotional, psychological, cognitive, and linguistic development.
Development of balance
When using a baby carrier, one should consider that the child’s sense of center of gravity in their body and in relation to the effects of gravity in the gravitational field changes and becomes complicated. This ability to find one’s inner balance, mobility, and stability is a foundation for good posture and function – even before the child learns to walk. From birth and the first months, the child is deeply involved in developing their balance, such as developing balance reactions in all directions and fine-tuning balance.
Ergonomics
As mentioned earlier, articles online and marketing of baby carriers often focus on the concept of ergonomics. There are beliefs in the market about ergonomics and the child’s body that need to be questioned and discussed. In conversations with pediatric physiotherapist Ulrika Myhr, we have discussed the perspectives on ergonomics that appear online and on manufacturers’ websites, and reflected on how the function of the baby carrier can be developed to promote the child’s natural development. I refer to Ulrika Myhr’s article “Perspectives on and Reflections on Baby Carrier Ergonomics and Child Motor Development” with a brief summary of perspectives on baby carriers and ergonomics, see link.
When it comes to baby carriers and ergonomics, there is a need for scientifically independent research on how the construction of the carrier affects the child’s physique and motor development, but also on how parents’ movement patterns affect the child, and how interaction can occur and develop when using a baby carrier.
Ergonomics and movement
As I now highlight perspectives on ergonomics regarding the child’s position in a baby carrier, it is essential to emphasize how ergonomic the carrier’s structure and technique may be, the importance of being aware of how you move with the child in the carrier remains How the parent’s own bodily movements affect the child and the interaction between them. This dimension must be central in its use.
The child’s development is an interplay between the child’s own abilities, the tasks the child receives, and the environment the child is in. Gravity and its field are an invisible force we often overlook, but its effects are very much present and alive when both the child and the adult move together. Even subtle signals are important in the child’s orientation towards staying upright and in interpreting internal and external signals. Here, we do not scientifically know how stresses in the form of movements affect the child’s ability and capacity Some children may cope with this, others may not. But I know that pediatric physiotherapists are increasingly seeing serious neck problems in small children. These problems may also be related to the use of a baby carrier with a negative movement pattern. Stressful movement patterns, therefore, constitute a risk factor.
With this article, I want to draw attention to the risks of not being attentive to the interaction between the parent and the child when using a baby carrier in motion. Becoming more aware of one’s own body’s condition and movement patterns is an important starting point for developing and promoting the child’s motor function and physical self-esteem.
Recommendations: Simple Guidelines
Here, I recommend some important simple guidelines to promote and develop a positive body awareness and movement pattern in adults who wish to use a baby carrier:
– Slow down, walk more slowly, softer
– Remember to breathe without stress
– Hold your child gently with your hands or with one hand, as primary support and holding
– Be aware that your body awareness and movement patterns matter when using a baby carrier
– Maintain eye contact for mutual communication
In conclusion, I want to emphasize the need for independent research on the effects of baby carrier use, both in the short and long term. According to reports, there is no research on baby carriers and the interaction between parents and children in a baby carrier. But until we obtain more scientific knowledge about the possibilities and risks of baby carrier use, based on my observations and clinical knowledge of bodily structure and posture, I emphasize the attention to movement patterns and their importance in the interaction between the child in the baby carrier and parents. This is to minimize harmful risks and instead promote positive development.
I suggest that manufacturers, in their marketing and user manuals, clearly emphasize and clarify this dimension. A salesperson in a store knowledgeable about baby carriers once said, “It’s just about putting your child in a baby carrier.” It’s not just about putting a child in a baby carrier. It’s a dynamic, complex movement pattern that occurs during motion and must be recognized as it affects the child’s well-being and development.
Stockholm August 29 2017
Runa Gustafsson Licensed Psychologist, Licensed Psychotherapist Certified Advanced Rolfer®
Runa Gustafsson has extensive clinical experience as a psychologist and psychotherapist, specializing in psychosomatics and the interaction between body and mind. Her knowledge and experience regarding early traumas and tension patterns in the body and mind are relevant to this article. Previously, within the county council, Runa Gustafsson worked as a child and family psychologist, focusing on language and communication development. As a Rolfer, she has extensive experience in how individuals’ early bodily tension and movement patterns shape their physical posture and balance, including their myofascial system, movement patterns, nervous system, and emotional development. Runa Gustafsson practices at her private clinic in central Stockholm.
At Learn to Move, we advise against using the Bumbo seat, as it can have negative effects on the child’s development. Bumbo seats are designed in a way that prevents the child from learning to sit with a straight back. When the child sits in a chair where it is supposed to hold up its head on its own, the back should be straight. In chairs where it is not expected to hold up the head itself but to rest, the child can lean back. The problem with the Bumbo is that while the child is expected to hold up its head, the design of the Bumbo seat prevents the child from sitting with a straight back and neck, which is normal – the back is normally a strong ‘pillar’. The seat in the Bumbo chair leans backward; it is not flat. The pelvis tilts backward, the back becomes rounded, and when the back is rounded, it becomes weak. It is impossible to learn balance in this position because you ‘fall backward’. Often, the child leans the head or the whole body to one side. A flat seat creates conditions for the child to have a good pelvic position and a posture where the eyes, neck, and vestibular system collaborate to program a fine posture with a straight back, activation of back muscles, and eyes in a horizontal position. In the Bumbo chair, the child either has to perform a “sit-up” using abdominal muscles or collapse with a rounded back.
Many children who sit in Bumbo chairs become confused, and when they later try to sit on the floor, they have poor posture and weak muscles. They can’t balance. That’s why it’s better to put the child in a high chair before they learn to sit on the floor. In the high chair, you need to provide side support and back support to the waist from the beginning. The child learns to sit upright and practices moving forward and backward to maintain a straight position. Eventually, the child learns side-to-side balance, and finally, it learns backward balance.
The uphill/downhill slope of the seat makes it impossible to achieve good active sitting because the pelvis tilts backward, the back becomes rounded, and the child works against gravity or collapses. It prevents balance training.
Backward-leaning seat like on the Bumbo chair, rounded weak back, falling backward, impossible to sit with a straight back.
Walkers can be used for short periods on a few occasions but do not teach the child to develop. If used extensively, the walker is purely negative for the child’s development – both for motor skills and also for cognitive development. There is also a risk of accidents, which in some cases can lead to serious head and neck injuries.
In the walker, the child does not need to pay attention to its motor skills because there are no consequences of, for example, leaning the head or having a slanted body posture – the child does not fall. The child does not need to struggle and problem-solve to move forward under its own power. The lack of tasks to solve to control the body leads to the child becoming inattentive. Some children who have spent a lot of time in walkers have difficulty bearing weight on their legs when walking normally, and some walk with their heads tilted to one side. If the head tilt persists, the child may have programmed in “wrong” goal to strive for. During the first year, it is important for the child to learn that the goal of balance is to have a straight back and eyes on the horizontal plane, not to have the neck tilted and one eye higher than the other.
A new problem is that children spend many hours in walkers and do not lie on their tummys. This can sometimes lead to the child having poorer hand function because the hand needs to weightbear and push against the floor to increase wrist mobility. As a newborn, the hand is clenched – when the child crawls, the wrist bends backward while the fingers stretch, and the child increases its mobility and strength. Weight-bearing is important for the proprioceptive sense, that we feel the hand’s movements. Mobility is important for us to have a strong grip with a backward-bent wrist.
Children who have spent a lot of time in walkers and do not want to lie on their tummys often lie with fisted hands. If so, you need to play, train, and motivate the child to become stronger. When the child starts walking, it is not as natural to develop the foundation for good sensation and a strong grip in the hands.
Research shows that walkers delay both motor and intellectual development and can cause accidents. In Canada, walkers have long been banned; you can both end up in prison and face hefty fines if you sell or import a walker.
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Crawling is an incredible task that affects so many other things. Including muscle strength in the shoulders, arms, and hands. I was so happy at work the other day when my 3-year-old friend (with special challenges) learned to crawl. He could explore, disappear in a different direction than mom, choose who he wanted to go to, and play peek-a-boo behind furniture. Crawling is more tiring than walking – just try crawling for a few hours (most likely beneficial for anyone who texts on the phone most of the day – stretching the hand muscles)! This got me thinking about what I recently learned, that in Canada, baby walkers are banned. If you sell a baby walker, you can be fined up to $100,000 or get 6 months in prison! Why? 3 reasons: 1. Accidents, 2. Delayed and impaired motor development 3. Even more impaired than motor development is mental development. There is research about this. How can this be? Well, consider this: If a baby lies on its stomach and starts reaching out an arm to grab a toy, she can have new sensory experiences when she tastes the toy, feels the texture with her hands, or hears the sound and feels the weight when she bangs the toy on the floor. These experiences lead to curiosity and pushing boundaries to try to reach a little further, maybe starting to move sideways in a circle to find something new to explore, and get new sensory experiences and new learning – she might find a piece of paper that has so many other qualities than the toy. This leads to even more curiosity, and the baby pushes itself to be able to move forward, crawl, get under the chair – learn the meaning of the word ‘under’. The baby continuously engages in problem-solving, finding strategies, relating the body to the environment, how she can reach what she wants and learn new things. Motor skills lead to sensory experiences (perception) which lead to learning (cognition). In the baby walker, the baby ‘flies’ forward, doesn’t need to bear its own body weight, he sits and pushes a little with his feet. He doesn’t even need to keep his head straight with his eyes on the horizontal plane because he doesn’t fall even if he leans. If a toy is on the table in front of him and it falls down, the baby doesn’t see the toy and can’t pick it up, but continues to move forward. There is no problem-solving and no learning about how to relate the body to the environment. The baby doesn’t need to PAY ATTENTION in the same way as the crawler, and the baby doesn’t fall when trying to do things at the edge of what she can handle, and learn from mistakes and find ways to do it better next time. All this is something I take for granted, but the fact that there is research and laws in Canada that understand this is incredible! Sweden is far behind. Here, children also sit in so-called ‘ergonomic’ strollers – they should be banned! More on this later!
Baby walkers delay a child’s development and should be used in moderation.
Confusion in the definition of an “ergonomic” stroller
For all parents looking to buy a stroller, it’s important to consider factors that are important for both you and your child. Unfortunately, it’s common for non-ergonomic strollers to be marketed as ergonomic, creating confusion for consumers. Here’s some information about the seating position in “sitting strollers” – that is, how well the child sits.
Sitting is defined as an active upright sitting position where the child has a flat seat with the buttocks and legs as support surface and where the torso and head balance in a straight upright position above the support surface. When the seat leans backwards, the whole body becomes part of the support surface – it’s a resting position without strength and balance.”
The timing of when a child starts sitting varies, as it is related to the child’s motor skills. A child who, while lying on their stomach on the floor, begins to move around in place, not crawling but shifting in a circle, and rolling from back to stomach, generally has the strength to sit in a stroller without having full balance in a seated position. To achieve full balance while sitting, the child needs to practice sitting, and the stroller can assist with this. Even if the child sits still, the stroller moves, allowing the child to develop balance reactions to become even more stable.
A flat seating surface promotes good posture and alternates between activity and rest
In the stroller, the child should alternate between sitting upright with good posture and lying down to rest when tired. När barnet sitter rak behövs inget ryggstöd, ibland behövs ett bälte i lår-bäcken vinkeln för att ge stabilitet. Barnets motoriska förmåga och vagnens utformning påverkar barnets sittställning. The key to sitting upright with good posture is that the stroller has a flat seating surface. This allows for a proper pelvic position, which in turn creates a straight back. The back is straight when viewed from the front or back. When viewed from the side, it has a curvature, a lumbar lordosis, a curvature in the opposite direction in the thoracic spine, and a cervical lordosis. This is a natural curvature. However, sitting with a rounded “C-shape” or “poor posture” results in weakness—similar to bending a stick or pen, the rounded part becomes weak. With a rounded back, discs are compressed, and ligaments in the back are stretched. Adults experience back pain from sitting this way. The determining factor for sitting upright is the position of the pelvis. A posteriorly tilted pelvis results in a C-shaped back, and one sits as if doing a sit-up on an incline. A neutral or anteriorly tilted pelvis results in a straight back with normal curvature. One stays upright with muscles in the neck and back, which are the natural postural muscles. The feet should either have a flat support surface or, as the child gets older, the footrest can be folded down. Folding up the footrest in a seated position affects the pelvic position, causing it to tilt backward, and the back becomes “rounded.” The same thing happens with a so-called “hammock seat.” Even there, the pelvis tilts backward, and the back becomes rounded. En vanlig plan sits är bäst för barnets sittställning.A flat seat is best for the child’s sitting position.”
Resting position and footrest
When the child wants to rest, it wants to change position and open up the angle between the thighs and the back. Just like adults, it wants to straighten up when resting. Therefore, it is advantageous if a stroller can have a flat seat where the backrest can be reclined to various angles without affecting the seat. When sitting, the feet can either be straight ahead on a flat seat or hang down if you lower the footrest as the child gets older. Some seats tilt the child in a single position, either forward or backward. Then the child cannot change position naturally, and when sleeping, the feet are up in the air. This is unnatural for all of us and is not necessary.
Here you can download pictures of ergonomic and non-ergonomic strollers.
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