Baby Wearing for Premature Babies

As a nationally certified Happiest Baby on the Block educator, I think that baby wearing is a great way to nurture your preemie, and I approach this topic as I do all the Happiest Baby training: parents need to know why wearing their baby is helpful and why correct technique matters so much.  The government’s Consumer Product Safety Commission has a short list of safety recommendations for baby wearing, but they do not explain why they should be followed nor do they explain the benefits of using wraps or slings for any baby.  There are many websites that either explain all the benefits, sell you products, or help you find a trained educator in your area.  But none seem to take a look at the special needs population.  My guess is that in this litigious age they don’t want to take responsibility for accidental misuse with the most vulnerable population.  Neither do I, but as a professional, it seemed an important topic to cover.  So let me say up front that I am not instructing you on how to wrap your baby or which carrier to use, but I will highlight specific considerations for the parent of a special needs child that wants to use baby wearing safely after they have been cleared by their pediatrician to do so.

The reasons to consider baby wearing are numerous.  The deep emotional connection between adult and baby (dads and caregivers can and probably should try wearing babies), the movement stimulation for balance and self-soothing, and the support for nursing are fairly obvious benefits.  Baby wearing can even help your little one sleep better Baby Wearing For Better Infant SleepThere is substantial research that babies need the stimulation received when moving inside a progressively tighter womb, and even passing through the birth canal.  These experiences are huge sources of tactile, vestibular, and propriocpetive input (touch, movement and pressure) to the sensory system.  Premature birth with a C-section delivery deprives a growing brain of that information.  Preemies have no alternative but to gain more learning outside the womb after birth.  I think baby wearing a preemie correctly and frequently is possibly the most powerful thing that you could do to give them this missing sensory input.

An important but less obvious benefit is that the baby who is worn correctly is one more baby that isn’t resting his head flat on a mat or strapped into a carrier for more than 30 minutes.   As an occupational therapist, I have treated too many toddlers whose infant siblings have been wedged in carriers for my whole session.  Every session.  And they are probably in there much longer and more frequently than those 45 minutes.  When I am the occupational therapist treating a child, the physical therapist and I often struggle to figure out how to get special needs children into safe and dynamic  positions that do not put them at risk for positional plagiocephaly (flat head caused by positioning).  You just cannot do tummy time all day.

The family of a special needs infant can still use baby wearing and foster all those wonderful experiences.  But please consider the following issues and get professional advice if possible:

• Position your baby tightly, so that she doesn’t slide around as you move.  Recheck and re-position after nursing.  Many wrapping fabrics stretch, so that must be considered.  But tight doesn’t mean compressed.  If your child has a history of respiratory problems, difficulty expanding their ribcage or filling their lungs when lying flat, you really need to clear any tight wrapping with your pediatrician first.
• Make sure you can see your baby’s face and your baby can see you.  You would never cover her face with a cloth in any other position, and so make sure that the wrap/carrier never covers her face.
• Preemies and low-birthweight newborns may be too small for the structured front-facing carriers, or take a while to develop the necessary head control.  Use a wrap for a more custom fit, and one that fits both of you well.  Never use a back carrier for a medically fragile infant.
• Only use the upright or vertical position with their chin up; the cradled or horizontal hold puts a medically fragile or very young child at greater risk for struggling to clear their airway.  A word about seeing your child struggle to breathe: they can be getting less air but not gasping at all!  Compression of their ribcage or airway can be just enough that they slowly become unresponsive.  This means that you watch their face, their color, their respiratory rate, and their activity level.  If you are really tuning into them, you know what “bad” color looks like, and what is normal for them.
• Baby wrap advocates often recommend the warmth of wrapping, but just like swaddling, you want to match the fabric, your activity level and the length of time you wrap with the environment.  Medically fragile babies lose heat rapidly but they also cannot get rid of excess heat, and sleeping too warm is a risk for SIDS (sudden infant death syndrome). Choose your wrapping based on logic.
• Think before you move.  Even with a well-wrapped infant, bend from your knees and be very aware of your movements and anything else you carry.  But that is not where movement concerns end with NICU graduates.  Special needs infants can sometimes become overwhelmed with the normal movement of a busy parent, or the common noises of daily life.  Sensory sensitivity doest just disappear once they are out of the NICU.  Some babies just can’t handle being that close to the blender to make your smoothie or listen to lost of talking.  A child who can’t handle the typical stimulation from an all-day wear deserves respect.  Watch for signs that he is shutting out stimulation or becoming fussy after lots of movement or location changes.  Your baby will still get the benefits of baby wearing for shorter or quieter periods, and his tolerance should increase over time.  And don’t fear swaddling, even though some baby wearing sites will show an awful swaddle with the legs jammed together.  A correct swaddle doesn’t restrict any leg movement and is approved by the American Pediatric Association.  Again, if you understand the swaddle and use it correctly, it is as safe as well-planned baby wearing.
• If you are exceptionally concerned about using baby wearing techniques, ask either your pediatrician or an occupational or physical therapist that works with your child for some advice that pertains to your baby before beginning to use a wrap.