Babywearing Forward Facing Out
By Sarah Whiting, VBE
(Note: Because narrow based carriers were predominantly the only way to wear forward facing out until recently, I will be addressing this type of carrier specifically throughout most of this post.)
To prepare for writing this blog post I googled, “why to wear baby forward facing out”, and I was bombarded with links for why NOT to do so.
“Hip Dysplasia: Why we should burn forward facing baby carriers”
“Nine Reasons Not to Carry Your Baby Facing Out”
“Babywearing: Why Forward Facing Isn’t For You”
“Better Babywearing: Why I Don’t Like Forward Facing Carriers”
Those are just a few examples. There is such a stigma surrounding wearing babes in a carrier forward facing out. Some of those carriers have been called “crotch danglers”, a negative and off putting term if I ever heard one. Narrow based carriers are predominantly associated with wearing baby forward facing out, but there are other carriers newer on the market that enable a more ergonomic way of babywearing in this position. There’s a perpetuated myth that wearing your baby in a narrow base carrier can cause Hip Dysplasia. So, there has been some negativity foisted upon the babywearing community, and that has resulted only in damaging the community as a whole. When we, the babywearing community, insist that forward facing out is dangerous or improper babywearing we exclude instead of welcome, and I know that we want to welcome all babywearers regardless of how they choose to wear their littles.
This issue of wearing forward facing out isn’t as black and white as it has been made out to be in the past. I’m so happy to see the babywearing community coming out of this exclusion and recognizing that FFO is indeed an acceptable form of babywearing and, when done safely, is not dangerous. Let us continue this and begin to educate caregivers on how to wear forward facing out safely, just as we do with all other forms of babywearing.
Is Babywearing Forward Facing Out Okay?
The simple answer is, yes. However, as with all other babywearing, there are safety tips to take into consideration. What are they? The biggest one is proper support of baby’s head and neck. Because baby’s head and neck are not supported while forward facing out, it is safest to be sure that baby has good head control before using this position. Typically that’s around 4-6 months old (which happily coincides with a baby’s natural desire to begin taking in the world around him/her).(1)
Next we want to be aware of baby’s spine. Make sure the baby carrier is properly fitted with adjusters so that baby’s spin is not overly curved.
We must also note that when/if baby is beginning to fall asleep they should be readjusted into an inward facing position for best head support and keeping an open airway.
After that we need to be aware of baby’s emotional needs. One reasoning by those against forward facing out is that baby will get over stimulated and they cannot turn into their caregiver when that happens. This is true, babies can get overly stimulated by their surrounding world and naturally turn into their parents to seek comfort and escape. This is easily dealt with by paying attention to baby’s signals. When it seems the world is beginning to overwhelm them, simply readjust so that baby is in the facing in position instead. One way to be proactive in this regard is to limit the time baby spends in the forward facing out position. Really, it is all about listening and watching for baby’s cues that will tell you what he/she needs.
When Is Forward Facing Out Not a Good Option?
If your baby has hip dysplasia or low muscle tone, or is predisposed to developing hip dysplasia it is not a good idea to wear baby in the facing out position.
I am not a medical professional, so everything I know about hip dysplasia as it relates to babywearing is purely internet research based. From my research, I know that hip dysplasia is developmental and can easily be missed, however most cases of hip dysplasia are caught during an infants newborn exam.(2)
“In babies and children with developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose in the socket and may be easy to dislocate.”(3) The treatment for hip dysplasia, or developmental dysplasia of the hip, is to position the legs in such a way that the thighbone is positioned in the hip socket properly. Narrow based carriers do not offer the proper positioning which is why they should be avoided for children who may or have developed hip dysplasia, but other ergonomic carriers do offer correct support when the seat or base of the carrier stretches from knee to knee.
As far as low muscle tone, or hypotonia, is concerned, the safety considerations are the same as a newborn. A child’s muscle’s need to be strong enough to fully support their head/neck when worn facing forward. Along with that, hypotonic babies do not have the muscle strength to combat gravity and thus narrow based carriers may not be ideal for their hip development. Wearing babies with hypotonia in a more ergonomic carrier with full very specific support is still recommended, and you can read more about that in an anecdotal post (real life experience is often very helpful) written by a babywearing consultant at The Practical Possum.(4)
When Is Forward Facing Out Babywearing Helpful?
When I was first introduced to babywearing I learned that forward facing out was bad for babies after I had attempted it once or twice using a Snuggli carrier when my son was about 3 months old (don’t worry, I supported his head, but he did have incredible head control very young). I was so new to babywearing, and there was no local community at the time. My information and knowledge was solely gained from one friend and the internet.
My son never wanted to be carried facing inward, not even in arms (without a carrier). He needed to face the world, to see everything and take it all in. I remember walking with him to the mailbox and carrying him cradled in my arms so that he was angled outwards. I remember, when he was older, carrying him facing outward on my hip. For most outings he ended up in a stroller because carrying a baby facing out in arms without the help of a carrier is awkward and my arms would easily get tired. (I later discovered that carrying a baby in arms facing me put much less strain on my arms and was much easier.)
Years later he was diagnosed with autism and sensory processing disorder (SPD). (This is not to say that every baby who insists on being carried facing out has either ASD or SPD, but looking back I can see that this was the case for us.) SPD is very complicated and is comorbid with many different diagnoses, and simply a diagnosis of SPD is not a reason to wear facing out. Some children with SPD very much need to be able to hide from the overstimulation of the world and so wearing them facing out would be too overwhelming for them. However, some children with SPD are more sensory seeking and need much more stimulation than the typical child, and this is when forward facing out babywearing could be very useful. (The evidence to support this is currently purely anecdotal.)
There are other special needs that might require forward facing out babywearing. For example, FFO might be what works best with medical equipment that a child may need. The main point is that forward facing out has a time and place, and for some may be exactly what is needed.
Aside from special considerations, wearing an older infant forward facing out can be a perfectly acceptable way to allow baby to explore the world around them. The key is to simply be aware of baby’s signals so that you know when they may need to be readjusted into an inward facing position. Hip carries are also wonderful for this purpose, and allow a baby to turn in towards their caregiver on their own.
Carriers That Allow the FFO Option
It used to be that the carrier people thought of for forward facing out babywearing was a narrow based carrier. However, not only are there more options these days, some more traditional carriers can also be used for forward facing out babywearing. Ring slings and woven wraps can be used for FFO carries, particularly using the buddha (kangaroo) carry. Along with those two options, other carriers available are the Ergo 360, the Bjorn One, the Lillebaby carriers, Catbird baby carriers, most narrow based carriers, and the Beco Gemini.
I want to conclude with a summary of some important points:
- Babywearing in the forward facing out position can be done safely.
- When using this position be aware of baby’s signals that they are getting overwhelmed or are unhappy with this position.
- FFO is sometimes THE best option.
- Though narrow based carriers are perfectly fine to use, there are now some more ergonomic carriers with FFO capabilities. Soft Structured Carriers are not the only carrier available for babywearing forward facing out.
Happy babywearing however you babywear!
BWI of Tucson babywearers wearing their babes in the Forward Facing Out position.
This is a great post about the FFO controversy: http://shopzerberts.blogspot.com/2013/05/the-forward-facing-controversy.html
Information on Sensory Processing Disorder: http://spdstar.org/what-is-spd/
- ErgoBaby: http://blog.ergobaby.com/2011/02/facing-in-facing-out-a-science-based-view-on-baby-carrying-positions/
- International Hip Dysplasia Institute: http://hipdysplasia.org/developmental-dysplasia-of-the-hip/infant-signs-and-symptoms/
- American Academy of Orthopedic Surgeons, Ortho Info: http://orthoinfo.aaos.org/topic.cfm?topic=a00347
- The Practical Possum: http://www.thepracticalpossum.com.au/babywearing-low-muscle-tone/