Babywearing for all abilities

This article was first published in the Natural Parent Magazine, Issue 56, 2024. This beautiful artwork of a mother with a child in a gorgeous rainbow ring sling is by Kim Hubball - and here with permission.

People and families are all different. We come in all shapes, sizes, preferences, beliefs, abilities, and more. With the Paralympics in full swing as I write, the competence and capabilities of all humans is on display for all of us to see and respect.

As a physiotherapist, I support people and families from all walks of life to move well and stay well, so they can get the most out of life (1). Families have members with a variety of abilities, across domains such as sensation, sensory processing, cognition, fine motor, and whole-body movement. From a personal perspective, my own family is on a journey of discovery given my husband’s recent diagnosis of Motor Neurone Disease (MND). We are determined to figure out how we can still make the most of his changing abilities and create wonderful memories together.

For optimal health and wellbeing, we all need holistic care that respects our unique personal and family situation. Sometimes, however, support may restrict access to valuable parenting tools such as babywearing, due to deficit-focused approaches.

A recent advertisement for World Down Syndrome Day 2024, challenges us at a societal level to assume that people with Down Syndrome can live their lives to the full, instead of imposing restrictive assumptions that restrict independence. This campaign asks us to consider that if assumptions become reality, then “assume that I can, so maybe I will” (2).

It is my view that this approach would benefit everyone. This article explores an asset-focused approach and assumes that people of all abilities can benefit from babywearing as a parenting tool to support their families.

Understanding abilities

People and their abilities are not defined by their diagnosis. The International Classification of Functioning, Disability and Health (ICF) Framework is a biopsychosocial model which focuses on what a person can achieve and helps us to understand how a person’s condition impacts on their health, context and community activities (3). The framework outlines the interaction between three components (4):

• Body functions and structures

• Activities and participation at individual and societal levels

• Personal and environmental factors at a contextual level

No two people with the same diagnosis function in the same way and therefore have different needs. To understand abilities, diagnosis must be considered alongside these components to describe the problems that people experience with their condition.

Body functions and structures

This component relates to the human form of the individual.

• Body structures are our anatomical body parts, such as organs and limbs.

• Body functions describe how these body parts work together as a system, across our physiology and psychology.

• Any problems with these body functions and structures are called impairments (4).

To give a babywearing example, someone might have an impairment of shoulder pain, reduced range of motion, or muscle weakness, which impacts on the way they move their arm.

Activities and Participation

This component refers to what actions the person performs with their body and how they complete these tasks.

• Activities include a task or an action by a person, such as dressing, bathing, walking, or cooking.

• Activity limitations are difficulties a person has performing a task (4).

To continue our example with shoulder pain and weakness, a person has trouble reaching their arm above their head which means they have trouble putting on a carrier.

• Participation describes involvement in a life situation.

• Participation restriction describes a problem a person may have with a life situation (4).

In our example, not being able to easily don and doff a carrier alone means a person may decide not to go on a bushwalk with their baby. This means we consider both individual and societal influences on the person’s abilities.

Personal and Environmental Factors 

This component describes the physical, social, and attitudinal environment in which people live and conduct their lives (4). In other words, how the person and their surroundings support them to live their lives and access their communities. These factors may facilitate or be a barrier to function and include such things as products, technology, social support, services, physical environment and more (3).

In our example, the person may ask for help from a friend or family member to don and doff the carrier, so that they can go for a bushwalk with their baby.

What does that mean?

In summary, an impairment in a person’s body structure or function can result in them experiencing activity limitation and participation restriction. Considering the person’s unique circumstances and environment can support them to overcome these issues and live life to the full.

In families with small children, babywearing can be one of the environmental factors that facilitate function for a carer. As with other activities, sometimes carers may need to modify the task, adapt the equipment, or seek the support of others to don and doff the carrier to safely carry their baby.

Child and carer considerations 

There are many considerations for both carer and child, and sometimes there may be conflicting needs to be met. Regardless, let us assume that babywearing can be helpful, once obstacles have been identified and possible solutions have been explored. Considerations can be physical or psychological in nature. The possible combination of factors for the carer-child dyad is endless. Rather than attempt to address them all, some will be contemplated here, and you are invited to reflect upon your own situation and how babywearing may be adapted to help.

Physical factors

The babywearing example we used above highlights a common musculoskeletal issue of shoulder pain that impacts on the ease of using a carrier. There may be many other physical body functions and structures that impact on ease of using a carrier. These include pain, limb difference, fine motor function, muscle strength, joint range of motion, splint or brace use, walking aid or wheelchair use. Or maybe there is a sensory factor to consider such as vision or hearing loss.

Sometimes the physical impairment is for a child, for example wearing a brace for hip dysplasia, which may mean facing inward in a broader based carrier is more comfortable than facing outwards.

Neurodiversity and psychological factors

All families can benefit from babywearing, including those with neurodiverse family members. Children who are carried have been shown to cry less (5). Physical proximity supports the release of the feel-good hormone oxytocin, the benefits of which for psychological well-being, healing, and managing stress are also well-documented (6).

Perhaps a carer may need to use additional equipment, such as ear plugs or headphones if they are particularly sensitive to noise and a crying baby is too much auditory input. Or perhaps a child benefits from the ability to snuggle into their carer when they are feeling overwhelmed and need a break from sensory stimulation.

Carrier considerations

There are several considerations for selecting an appropriate carrier. These may include dexterity, comfort, assistance available, comprehension, attention, time available, personal preference, confidence, cost, and who else will use the carrier. Perhaps certain fabrics need to be chosen to ensure the comfort of the dyad, including no labels or irritating tags.

More fiddly carriers such as wraps, ring slings, and meh dais, may require significant dexterity, comprehension, or attention for some people. Some people may just prefer the simplicity of a buckle fastening. People with pain may find a back carry more comfortable, however this may require additional range of motion, confidence, and support to adopt.

Modifications may be made to the carrier or the technique to accommodate for the impairment. A carer may be able to safely modify their carrier, for example a cross brace to join the straps of a half buckle or meh dai. A person may also amend the way they don and doff the carrier, for example, using the t-shirt method for bringing the straps of a buckle carrier over their head, rather than the method that requires them to lift their arms above their head.

Some people may wish to carry their child all day, others just for naps, others just to go to the shops or get through tricky times of the day. Regardless of considerations, there are many options to try that may be adaptable to suit each family’s unique circumstances. Open communication is key to ensure that everyone is aware of the family’s need for support, goals, activities, and context.

Summary

Babywearing is an incredible parenting tool. Let’s assume that all carers can safely use a carrier with appropriate supports if they wish. We can facilitate function for families by selecting a suitable carrier with consideration for impairments, activities, and personal circumstances, to ensure that babywearing options can be explored by all families.

If you are not sure how to proceed, or if your family has complex needs and you need additional assistance, please seek the support of a knowledgeable health professional to incorporate babywearing into your parenting toolkit.

Kato x

References

1.       Australian Physiotherapy Association 2024, https://choose.physio/what-is-physio

2.       World Down Syndrome Day 2024,  https://youtu.be/9HpLhxMFJR8?si=1wHRD20hCRhFFLbo 

3.       International Classification of Functioning, Disability and Health (ICF) 2022, https://www.icf-elearning.com/

4.       Physiopedia 2024, https://www.physio-pedia.com/International_Classification_of_Functioning,_Disability_and_Health_(ICF) 

5.       Hunziker, U. A., & Barr, R. G. (1986). Increased carrying reduces infant crying: A randomised controlled trial. Paediatrics, 77(5), 641-648. https://doi.org/10.1542/peds.77.5.641 

6.       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