This article was first published in the Natural Parent Magazine, Issue 51, 2023, alongside this beautiful artwork by Leanne Crowe - and here with permission.
Early in 2023, the Academy of Breastfeeding Medicine released Protocol #37 for Physiological Infant Care and associated handouts (1, 2). This protocol filled my heart with joy and lifted my spirits. Of the 14 recommendations in the protocol, I was especially thrilled by recommendation number 10, which states:
“Encourage the safe use of baby carriers during the day to promote physical contact with the infant. Babywearing can help mothers manage daytime tasks while keeping the infant calm. Level of evidence: 1. Strength of recommendation: A. (pp. 163)”.
For those unfamiliar with the principles of evidence-based practice, level 1A evidence is the highest level of scientific evidence available, with the strongest level of recommendation (3). We now have the best proof for our brains, for what our hearts and millennia of parenting have always known – holding our babies close is natural and good for us.
What is physiology and physiological care?
Physiology is the science of life, the mechanisms of living things from cells to systems, the behaviour of the body, and interactions with the external environment (4). Physiological care supports normal human physiology and functioning hence optimises health and wellbeing.
In the case of early childhood, physiological care means understanding normal infant feeding, sleeping, and behaviour patterns then responding to our children in ways that align with, rather than pathologise, their physiology. Aligning our expectations with normal infant behaviour has benefits for both carer and infant wellbeing. This means families understand and anticipate that their infants will feed a lot, wake a lot, cry a lot, and need to be close to their caregivers, whilst developing strategies to support their family circumstances (1).
All 14 recommendations in the protocol for physiological infant care focus on connecting caregivers with their children and promoting responsive caregiving. The themes include: understanding normal infant physiology, co-sleeping and safe bed-sharing, encouraging babywearing, promoting breastfeeding, avoiding sleep training for the first year, supporting maternal sleep, development of a support network around the family, empowering caregivers to respond to the baby rather than a device or schedule, and advocating for parental leave (1).
These themes leave no doubt that it is physiologically normal for human babies to be close to their caregivers, and that babywearing is an essential tool to facilitate normal child and adult physiology.
How babywearing helps support physiology
Human babies are born completely reliant on their caregivers for survival and take years to develop the skills they need for independence. Continuous proximity and skin-to-skin contact with a caregiver help the infant adjust to the outside world (1). Keeping them close reassures them they are safe, allows their caregivers to respond to their needs, and supports their physiology and development.
Keeping our babies close supports human physiology in all manner of ways. Release of hormone cascades such as oxytocin supports carer and infant wellbeing and breastmilk production (5). Closeness supports regulation of breathing, heart rate and temperature, especially in children who are unwell or premature. Babies who are carried are shown to fuss and cry less (1). And when you need two hands to keep managing all the daily tasks, activities, and self-care requirements, what better way to do both simultaneously than by holding your child on your chest in a carrier.
Newborns are born without a functional circadian clock and babywearing as part of the busy day can help support them to discern day and night – daytime is for naps in bright, noisy active environments on the chest of a caregiver, while nighttime is for longer sleeps in dark, quiet, calm environments close to a caregiver (1).
Prolonged physical contact of the mother and baby via babywearing (and bedsharing) supports maternal responsiveness to infant hunger cues. Responsive breastfeeding also supports longer duration of breastfeeding. Extending this proximity into nighttime supports breastfeeding, facilitates maternal sleep, minimises infant distress, and reduces the incidence of sudden unexplained death of infants (1).
Encourage safe use of baby carriers
Babywearing must first and foremost be safe for both wearer and child, whether the child is awake or asleep. Primarily, the baby must be upright with their spine well supported so that their airway is not compromised. It is inevitable that a baby will fall asleep in a carrier, and parents may be reassured that babies may safely sleep upright and supported in a carrier, when recommendations for safe sleep usually involve their baby lying in a clear flat space on their back (6, 7).
There are two main approaches to safe babywearing principles of which I am aware and with which parents and caregivers must be made familiar.
The TICKS principles (8):
Tight – keep carriers tight enough to hug your baby close to you.
In view always – ensure you can see your baby’s face by simply glancing down.
Close enough to kiss – keep your baby’s head as close to your chin as is comfortable.
Keep chin off the chest –at least a finger width space under your baby’s chin.
Supported back – baby is upright, with back supported in its natural position, and their tummy and chest against you.
The Babywearing Practice SAFE acronym (9):
Secure – baby is securely attached to the carer’s body.
Airways – baby is upright, head is neutral, mouth and nose are unobstructed, chin is off chest.
Firm – baby is firmly held in the carrier, with no gaps between baby, carer’s body, or carrier.
Eyeline – baby is in view, and you can see them easily.
If you are unsure or need help with safely fitting your carrier, you may wish to connect with your local babywearing meet, other babywearing families, or a babywearing consultant for support to keep your baby close and safe. If you are a health professional, I implore you to learn more about how you can support families to use this beneficial parenting tool and encourage you to become skilled in safe babywearing across a variety of carrier types. If this is beyond your scope or interest, it would be beneficial to know where you can refer families to get the support they need to safely use baby carriers.
Embedding the evidence for physiological care of our babies
Nurturing connection and responsive relationships between babies and caregivers have benefits for all of us - individuals, families, communities, and society. The evidence base is there. Our challenge now is to embed these recommendations into how we support caregivers to keep babies close, no matter what their family circumstances might be.
One might think that we can all stand down now, that articles like mine in magazines like The Natural Parent no longer have a place when eminent health professionals such as those in the Academy of Breastfeeding Medicine are publishing protocols like this with such high levels of evidence to recommend connected and responsive parenting for our babies. However, evidence-based practice integrates the best research evidence into clinical expertise combined with consumer values. Clinical expertise refers to the clinician's experience, education, and skills, while the consumer brings their individual concerns, expectations, and values (10). Studies suggests that it can take up to 17 years for evidence to be incorporated into practice (11).
Let us fast-track this process of evidence-based connected parenting, by embracing these nurturing recommendations and sharing them far and wide, encouraging clinicians and families to follow their hearts, and support caregivers to keep their babies close. I encourage you to read and promote these documents (1, 2).
Families do not need products or services that are designed to separate caregivers from their money and their children. Our babies need us – it is as easy and as difficult as that.
Kato x
References
1. Zimmerman, D, Bartick, M, Feldman-Winter, L, Ball, HL & the Academy of Breastfeeding Medicine 2023, ‘ABM Clinical Protocol #37: Physiological Infant Care – Managing Nighttime Breastfeeding in Young Infants’, Breastfeeding Medicine, vol. 18, no. 3, pp. 159-168. <https://abm.memberclicks.net/assets/DOCUMENTS/PROTOCOLS/Physiologic%20Infant%20Care%20Protocol%2037.pdf >
2. The Academy of Breastfeeding Medicine 2023, Physiologic Infant Care: Supporting Breastfeeding, Sleep and Wellbeing, The Academy of Breastfeeding Medicine, accessed 8 June 2023, <https://abm.memberclicks.net/assets/PatientHandouts/English_ABM_Physiologic%20Infant%20Care%20Handout_Protected.pdf>
3. Physiopedia 2022, Grades and Levels of Evidence, Physiopedia, viewed 8 June 2023, <https://www.physio-pedia.com/Grades_and_Levels_of_Evidence>
4. The Physiological Society, What is physiology?, The Physiological Society , viewed 8 June 2023, <https://www.physoc.org/explore-physiology/what-is-physiology/>
5. Uvnas-Moberg, K, & Petersson, M 2005, ‘Oxytocin, a mediator of anti-stress, well-being, social interaction, growth, and healing’, Zeitschrift fur Psychosomatische Medizin und Psychotherapie, vol. 51, no. 1, pp. 57-80. https://doi.org/10.13109/zptm.2005.51.1.57
6. Red Nose Foundation, Red Nose Six Safe Sleep Recommendations, Red Nose Foundation, viewed 8 June 2023, <https://rednose.org.au/article/red-nose-six-safe-sleep-recommendations>
7. The Lullaby Trust, Safer Sleep Advice, The Lullaby Trust, viewed 8 June 2023, <https://www.lullabytrust.org.uk/safer-sleep-advice/>
8. The UK Sling Consortium, Baby Sling Safety – the TICKS rule for safe babywearing, The UK Sling Consortium, viewed 8 June 2023, <https://babyslingsafety.co.uk/>
9. The Babywearing Practice, SAFE babywearing, viewed 8 June 2023, The Babywearing Practice, <www.babywearingpractice.com.au>
10. Sackett, DL, Rosenberg, WM, Gray, JA, Haynes, RB, & Richardson, WS 1996, ‘Evidence based medicine: what it is and what it isn't’, British Medical Journal, vol. 312, no. 7023, pp. 71-72. https://doi.org/10.1136/bmj.312.7023.71
11. Morris, ZS, Wooding, S & Grant, J 2011, ‘The answer is 17 years, what is the question: Understanding time lags in translational research’, Journal of the Royal Society of Medicine, vol. 104, no. 12, pp. 510 – 520. https://doi.org/10.1258/jrsm.2011.110180