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A Science-Based View on Baby Carrying Positions - Facing In and Facing Out

In this guest blog written by Henrik Norholt, Chief Science Officer at Ergobaby Inc., we discuss some of the aspects of how a baby develops in the first year and how that may relate to ideal carrying positions. We hope that this will help you make informed choices on the carrier types and positions you will enjoy with your baby at every stage.

Need for Brain Stimulation

Let’s begin with validating the basic idea that it is good for a baby to be stimulated by parents and other caregivers. One of the key results of the great amount of research done on the baby’s developing brain is indeed how vital appropriate stimulation is. When the baby is born, the number of neurons in its brain corresponds to adults’. However, what is missing is the mind-boggling amount of connections that will eventually shape that particular baby’s personality and intelligence. These connections are formed by and are utterly dependent on the type of stimuli that the baby receives from the outside world.

Every experience the baby is exposed to will activate some part of the brain’s neurons. The more frequently a given experience occurs, the stronger the connections between the activated neurons become. As neuroscientists sometimes say: “Cells that fire together, wire together.”

However, just as there is no point in trying to teach a newborn how to ice skate, certain types of stimulation are more appropriate at specific developmental phases than others. To understand what types of stimulation are appropriate and beneficial, we need to look at the major developmental phases that a baby goes through in her first year.

Three Stages of Baby’s Development

In the first few months after birth, the baby’s main developmental task is the adaption to life outside the womb. A variety of basic functions have to be mastered: suckling, digesting, breathing, vocalizing, defecating, and seeing. These are initially demanding tasks and the baby, therefore, spends much of her time in what is called “adjustment states”: sleeping, drowsing, fussing, and crying. Occasionally, it is as if the baby surfaces and moves into the quiet alert phase, which is just that. The baby is quiet and looks around attentively and takes in the world. Or rather, the very immediate world, as the baby’s zone of vision is limited in the first few months to 20 to 25 cm/8 to 10 inches. Incidentally, this is also the approximate distance between your face and your baby’s face when holding your baby in your arms or breastfeeding.

1.) Age 2-3 Months

At around 2-3 months of age, the baby begins to actively seek out social exchanges with adults, using its glance and smile to attract attention and initiate conversations or playful episodes. The mother will normally respond with exaggerated facial expressions and using a high-pitched voice dubbed by brilliant child development researcher Daniel Stern as the language of “motherese.” Switched-on brave fathers will also try their hand with such conversations, once they realize how incredibly fun they can be.

2.) Age 2-6 Months

This marks the beginning of a phase, lasting about three or four months (age 2-6 months) where the baby is intensely interested in the human face. The baby’s game is all about learning the rules of human social interaction, reading and interpreting the great multitude of facial expressions that the mother, father and other caregivers will exhibit. In their quest to engage and bring joy to their baby, taking turns in communicating, the baby will also learn how to tolerate and regulate the excitement and sometimes frustration that builds up in each playful episode. These innocent-looking play episodes are neurologically vital in creating empathy, social and communication skills, a capacity for joy and the ability to tolerate stress.

3.) Age 6 Months+

From around 6 months of age, with the emergence of eye-hand coordination, the baby’s attention gradually switches towards the world of objects. The baby also becomes able to move about by initially crawling and sets out to explore the surroundings with its newly won capacity for movement. The primary caregivers (mom and dad) are no longer the baby’s center of attention as was the case in the preceding months. Their primary role becomes to help the baby decipher and interpret ambiguous situations where the baby feels insecure.

An illustrative laboratory test of this is when a baby has to cross a glass (transparent) covered hollow to reach a desirable object. The baby will check the mother’s facial expression; if her face expresses horror or uncertainty, the baby will not cross the hollow. If, on the other hand, the mother via her facial expressions encourages the baby to continue, she will do just so. The baby uses the caregiver to regulate her own emotions and behavior.

This is the phase where the baby learns to share attention with another person, following the direction of the caregiver’s glance and also enlisting the help of the caregiver to obtain objects outside of its reach, by pointing and checking if the caregiver is putting the attention on the desired object. The baby will also become emotionally attached to the primary caregivers (usually the parents) and begin to show signs of distress at separation and towards friendly advances from strangers, using the caregivers as “a safe base.”

How These Developmental Phases Relate to the Ideal Carrying Positions When Using a Baby Carrier


Front Inward Facing Position

For the first several months, the baby is more than content with being carried in the front position, facing inward towards the caregiver. From a developmental point of view, the baby’s primary tasks are related initially to adaptation to life outside the womb where it certainly does not need excessive stimulation. Quite the contrary, at the “social awakening” period at around 2-3 months, the baby’s main interest will be the human face, and here the front inward facing position will continue to be ideal for most babies as they will have a clear view of the caregiver’s hopefully exciting and stimulating face. The baby can also observe the caregiver’s face when she/he is communicating with others, providing the baby with learning experiences.

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. 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. Especially if the adult carrying the baby is a little vigilant to the baby’s signals, and aid the baby’s efforts to take in the world by turning appropriately to the side. 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.


Front Outward Facing Position

However, a few babies will clearly signal through protests that the front inward facing position is no longer suitable to provide adequate visual stimulation. It is as if they are communicating – “I want to see the whole world.” If the baby is able to hold up her head, which is very likely to be the case at this stage, it might be moved to the back or hip positions or front outward facing, as long as the baby is supported ergonomically.

However, we only recommend front outward facing for very short periods of time in calm and well-known, preferably (well-known for the baby) environments, and as long as the baby has head and neck control and their chin can clear the top of the panel when facing out.

And please note, that a baby’s appetite for front outward facing may very well be a passing transition phase she/he goes through. You can experiment continuously with putting your baby front inward facing and see how she/he reacts to it. Many of the babies that go through a period of wanting the front outward facing position have been reported to return to a preference for the front inward facing position after a few weeks.

Switching From Front Outward Facing

Babies can easily become over-stimulated and overwhelmed, so while in the front outward facing position, if your baby becomes agitated or fussy, we recommend switching back to facing inwards or to try the back or hip positions. Also watch out for signs that your baby is being mesmerized or sucked into the surroundings without being able to disengage, as this is often a sign that the baby feels insecure and therefore needs to continuously monitor the situation, instead of simply tuning out and seeking the reassurance of snuggling up to the caregiver. Babies respond well when they can see their caregiver and parents can see more of their cues when they can see their baby’s face. Front outward facing for long periods of time is not recommended as it can interfere with the parents’ ability to respond to and communicate with their babies.

When your baby is in the front outward facing position, she is cut off from having a clear view of the caregiver’s face. This is especially problematic in the newborn phase, where the interactions with the caregiver’s face are vital for the optimum neurological development of the baby’s brain.

But also in the months succeeding this period, the baby will be referring frequently to the caregiver’s face for interpreting ambiguous situations. Not being able to refer to the caregiver’s face can create unnecessary stress in the baby and if happening repeatedly, may compromise its basic capability to regulate stress reactions, which in the long run can become detrimental to mental and physical health in adulthood.

Frog-leg Position

The best position to promote a healthy development of spine and hip is the spread-squat position or “frog-leg position,” as some call it. In fact, this is the very position that babies in a brace are placed when hip dysplasia has been diagnosed, because the position stimulates the optimum growth of the hip joints. 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. That’s why we only recommend facing baby out in a carrier that fully supports a seated or spread-squat position.

Front Inward VS. Outward Facing

Another reason we only recommend the front outward facing position for very short periods of time is for the comfort of the parent. When the baby is front outward facing, there may be additional strain on the caregivers’ back as it is more difficult to carry a load that is facing away from you. For this reason, please use the ergonomic front outward facing position for short periods of time, switching to the hip or back carry positions if you begin to feel strain on your lower back.

The vast majority of babies will be entirely happy to be held in the front inward facing position past 6 months of age, many even up to 12 months, and this is the optimal position we recommend.

The age where some babies may protest being carried front facing inward can vary greatly, mirroring the great variation in both the innate temperament of babies, but also in their immediate environment. In the case of the environment, some parents go through challenging times during their baby’s first year and these may be utterly unrelated to the baby. A tense family environment is likely to make the baby seek the comfort and safety of her caregivers and focus on that incredibly important relationship before it begins to take in the world. To fail, for whatever reason, to provide a safe family environment and at the same time try to naively force independence on the baby prematurely by carrying front outward facing may be detrimental to a child’s healthy development.


Back Position 

The back position is normally employed when the baby becomes too heavy to be carried on the front or on the hip. For most parents, this happens at around 10 kg/22 lb when the baby is around one year old.

 

The Optimal Carrying Position

The key basic understanding required for determining which carrying position is optimum is that a normal healthy baby’s development always goes from initially requiring great amounts of physical closeness and parent/child interaction towards greater independence and curiosity towards the world at large. But please bear in mind: the baby’s gradually increased exploration of the world at large needs continuous support by the caregiver. And that support is ideally provided by the baby being able to use the caregiver’s face as an active interpreter of a huge amount of completely novel and hence potentially stressful situations. Therefore, in most circumstances, the baby is best off by facing you.

It is for all these reasons that we strongly urge you to carry your baby front inward facing as long as at possible, whether the baby is placed on your front, hip or back. Under the specific and special circumstances described in the above, you can also resort to carrying your baby in the front outward facing position for shorter periods of time.

The message is to follow your baby’s lead. We acknowledge that parents know their babies best, so choose the position that works best for you and your family, taking in the above considerations.

This guest blog was written by:
Dr. Henrik Norholt is a member of The World Association of Infant Mental Health. He holds a Ph.D. from the LIFE faculty of Copenhagen University and is a resident of Copenhagen, Denmark. He has been studying the effects of baby carrying as it relates to child psychological and motor development through naturalistic studies since 2001.

He is actively engaged in the study of current and past research into baby carrying through his large international network of family practitioners, midwives, obstetricians, pediatricians and child psychologists.

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