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Saturday, September 29, 2012

Dear Nanny: Why Not Face Out?

Dear Nanny,

I heard that facing out in a baby carrier is not good for babies. Is this true?

- Just Wondering


Dear Wondering,

A FFO (Front Facing Out) carry is not recommended for a few reasons:
  1. An overstimulated baby can't hide their face. Babies are learning and experiencing everything for the first time. It can be hard to take it all in sometimes (this is why toddlers often throw tantrums), so they get overwhelmed. When this happens they hide their face and close their eyes to calm down. A baby facing out has nowhere to go when they feel overwhelmed. It can be hard to tell if baby is getting overwhelmed while FFO – they won’t always cry or scream if this happens. 
  2. Babies take their cues for how to react by looking at their parents’ faces. If they can’t see your face they won’t know how to react, and they can’t get your reassurance. This is a critical learning technique. 
  3. *A FFO carry can not properly support a baby's rounded back or developing hips. Your baby’s spine won’t fully form into an S-shape until toddlerhood, and a rounded back cannot be supported by a facing out carry. Also baby’s hips are partly made of cartilage. Cartilage is elastic. If the legs and hips aren't properly supported, hip dysplasia can occur. Baby’s legs should be supported from knee to knee, with their knees higher than their bums.
  4. It's harder for the parent to assess baby's needs. When you can’t see your baby’s face, it can be harder to tell if they are getting tired, hungry, or restless. Harder, but not impossible. 
  5. It's harder on the parent's back than a FFI (facing in). A FFO position is not ergonomic for the wearer. Especially with a heavier baby. A baby facing in with a proper carry adds the weight to your center of gravity. While facing out, the baby’s weight throws off your center of gravity. 
  6. A newborn without complete head control should never face forward in a carrier, because of the stress on their neck and inability to keep their head upright. Not to mention that a newborn can't see more than a 8-12in in front of their face anyway.
*If you have a baby that is 3-6ish months old, you could use a ring sling and do a Kangaroo carry for a FFO carry that won’t strain baby’s developing body.

If you absolutely must do a FFO carry, get a carrier that offers good support. A CatBird Pikkolo or a Beco Gemini offer as much support as possible for a FFO in a SSC. Woven wraps can do FFO carries that support baby's hips too. FFO carries should only be done for a limited amount of time.

But my baby can't see well facing in!
Most babies won’t care. A baby who is used to facing out may have a harder time adjusting though. At about 6ish months you could do a hip carry in a ring sling, SSC, mei tai, or woven wrap. A hip carry gives baby plenty of things to look at. Another favorite is a high back carry with a mei tai, some SSCs, or a woven wrap. A high back carry allows baby to look over your shoulder, but they can still sleep or hide their face if they want. Young babies can be carried in high back carries in woven wraps, or burp carries in ring slings.


For more information on safe infant positioning, see my Infant Positioning post.

Sunday, September 23, 2012

The Pinch Test

A picture from Britax

Loose harnesses in a carseat can be very serious. In a crash a child can be ejected from the seat if the harness is too loose. That is why I am going to talk about the pinch test, a simple way of telling if your carseat straps are too loose.

How to do a pinch test:
  1. Buckle your child into their carseat. The child should be wearing regular clothing, not bulky sweaters or jackets. In a crash your child's clothing will compress, and if the straps are not snug enough they may be ejected from the seat
  2. Pull up on the harness by your child's shoulders
  3. Try to pinch the straps as shown in the photo above. Some people prefer to use three fingers instead of one to pinch because it keeps them from tightening the straps too much
  4. If you can easily fold the strap in half, than it is too lose - proceed to the next step. If you can't easily pinch the straps, then you are good to go!
  5. Grab the straps by your child's stomach and pull them up to remove slack. If your seat tightens the straps from the bottom (not because the tightener is at the bottom of the seat, but because it pulls in slack from the bottom) then skip this step.
  6. Pull the harness adjuster strap and try pinching again. If it is snug you are good to go, if not keep tightening until it is snug.

How to tell if the straps are too tight:
  1. If you can't put a finger under the strap it is too tight
  2. If you can put a finger under, but your child can't take a deep breath, it is too tight
It is not unsafe to have a harness too tight, just uncomfortable for your child.

Note: the chest clip should be buckled at arm pit level - too low or high can cause severe injuries in a crash.

A quote I love that details how tight a child's harness should be is: "A [carseat] harness should be as tight as the band of a woman's bra, and loose harnesses are about a useful as loose bras."

Saturday, September 22, 2012

Dear Nanny: Why Rear-Facing Until age 2?

Dear Nanny,

I read that children should rear-face in carseats until age 2. Why did the recommendation change? I have also heard of people doing "extended rear-facing." What does that mean? Thanks for your help!

- Carseat Confused


Dear Carseat Confused,

There was a study done in 2007 that proved that children under 24mo are 5.23x safer rear-facing than forwards facing. This study, along with others caused the American Academy of Pediatrics to revise their previous stand of 'rear to a year' in carseats. Now the official recommendation is that children should be rear-facing to at least two years old, or when they outgrow their rear-facing seat.

The study was done with children aged 24mo and under, so we do not now the exact data for how much safer a child is rear-facing past 24mo. 24 months is not an exact number. It is not the magic age that makes children safer. We would all be safer rear-facing in a car - but that would make it difficult to drive ;). This is where extended rear-facing (ERF) comes in.

A young child's body is very different from the adult body. The head is significantly larger, which puts strain on a small neck, and the bones (in this case, specifically the spine) and muscles are not fully formed. When rear-facing the forces from a crash are spread out more evenly over a child's body, meaning that the child's body is under less strain. Also, a child's head is much better protected while rear-facing, so the pressure that would cause a forward facing child's neck to snap is much lessened.

In Sweden, children are rear-facing until four years old, and then moved directly into a booster seat (side note, it is much safer to have a 4yo harnessed forward facing than in a booster seat). They have significantly lower rates of death and injury to children under 4 in cars than we do in the US. Many families in the US are picking up on this trend of extended rear-facing. When they buy a rear-facing seat, they get one with high height and weight limits so they can rear-face longer. These families are rear-facing until 3, 4, 5, and even 6 years old. This is around the time that the ossification of the spine is complete, which is why parents are choosing to do ERF so long.

I would like to note that rear-facing is only safe in a carseat that fits your child and your car properly. Check the fit of your carseat by finding a CPS (child passenger safety) technician near you at www.seatcheck.org. Most carseats are installed incorrectly, so even if you think you did it right, have it checked.

Here is a link to the study: http://fcs.tamu.edu/safety/passenger_safety/certified-tech/rear-facing2.pdf
And a link to the AAP's policy statement: http://pediatrics.aappublications.org/content/early/2011/03/21/peds.2011-0213.full.pdf+html
And here is a link to a great video by thecarseatlady.com: http://vimeo.com/thecsl/2011aap

- Katie