|Being carried or worn in an upright position with proper leg support is not only
developmentally sound but often preferable to mothers and babies alike.
Europe seems to host the greatest number of pediatricians who recommend that, in order to avoid pressure on
their underdeveloped bodies, newborns and infants should lie flat on their backs in a stroller and not be
carried. Yet, laying a young infant on his back alone in a stroller is actually physically and emotionally
stressful, and can be developmentally inhibiting. Being carried or worn in an upright position with proper leg
support is not only developmentally sound but often preferable to mothers and babies alike. Upright carrying
optimizes the physical, emotional and intellectual growth of your baby.
Infant Spine Development
Our spines are not perfectly straight, even though they may appear so from the front or back. When you look
at a person from the side, four slight curves are visible, forming an elongated S shape. These curves help keep
us flexible and balanced. They also help absorb stresses placed on our bodies through our daily activities, such
as walking, running and jumping.
We weren't born with these curves. Normal curves of the spine develop gradually, as a means of adapting to
gravity. At birth, babies are in a state of flexion, still curled up, with their spines in a natural, long
C-shaped (convex) curve. At first, a baby does not have the strength to hold his head up, nor the balancing
curves in his spine to do so. But gradually, as the muscles in his neck get stronger, he begins to lift his
heavy head against gravity, and a curve starts to develop in his neck (the cervical curve) to help balance his
head. When your baby starts to creep and crawl, the lower back (lumbar curve) and the muscles that support it
develop. It takes about a full year for your baby to attain these curves in his spine.
The Stresses of Lying Flat
Laying your young infant flat on his back stretches the C-curved spine into a straight line, against its
natural shape. Research shows that keeping an infant's spine straight is not a sound physiological position. In
addition to stressing the baby's spine, it can also negatively influence the development of the baby's hip
Infants who lie frequently on their backs in a stroller may end up with plagiocephaly (deformed skulls,
flattened on the back or side) and deformed bodies with poor muscle tone. Research backed by the American
Academy of Pediatrics states that "with prolonged immobilization on a firm mattress or a flat bed (as in a
stroller), the constant influence of gravity flattens the body surface against the mattress producing positional
disorders and infants with decreased muscle tone."
Existence in Containers
This does not mean that laying the baby flat for a couple of walks around the block in a stroller is going to
wreak havoc on your baby's physical development. But the truth is that the average Western infant between 3
weeks and 3 months of age is carried little more than two and a half hours a day. Babies spend most of their
time in containers, such as car seats, cribs and strollers. The West has diverged from eons of child rearing,
and we have gotten to the point of letting objects determine our babies' sense of contact, rather than us.
The Fetal Tuck
Newborns are virtually impossible to stretch out unless wrapped or swaddled. When you place an infant flat on
his back, his thighs will usually be pulled up toward his chest, or when sleeping, straddled and bent in a frog
position. The fetal tuck, the natural position of babies, is the most calming and the most adaptive.
Infants use less oxygen, which conserves energy and wastes fewer calories. They digest their food better.
Also, we have more efficient temperature-regulating cells and more fat on the back sides of our bodies, so when
we hold our infants stomach-to-stomach, we are protecting all their receptor and vital organs.
The instinctual flexed widespread legs that an infant maintains when picked up, coupled with the palmar and
plantar reflexes that help an infant cling to his mother, suggests that infants' little bodies are adapted to be
carried upright and oriented toward their mothers.
By holding your baby with his knees flexed flat against your chest and supporting his bottom, you are
supporting your baby in the natural position that his body instinctively assumes to ensure that he is
comfortable, warm and safe.
The Trouble with Car Seats
Strollers that position a baby in a somewhat upright position (such as in infant car seats) may be gentler on
the baby's C-shaped spine, in that they do not stretch it flat. But car seats are not a much better option for
transporting your little one. Research by the International Chiropractic Pediatric Association shows that they
are not the ideal transport for your infant when not in the car, due to "restricted postural options which
can impact your baby's developing cranium and spine."
By keeping the spine in a C-shaped configuration, these contraptions can actually prevent the natural curves
from forming. Babies can have a hard time acquiring adequate muscle strength to hold up their heads if they
don't get much of a chance to experience gravity.
Positive Physical Development
When infants are held upright, they are allowed to practice compensatory movements, enhancing muscular
strength and allowing for more control over their fine motor skills. When the mother walks, stops or turns, an
infant's body naturally works against the pull of gravity to maintain his position.
The force of gravity is a positive element in infant development. It allows them to learn to hold their heads
up and keep their bodies balanced.
Discord with Upright Carrying
So why do some still claim that the horizontal position is better for your infant in her first months of
life? This argument is often rooted in the assumption that the upright position may be stressful to his
underdeveloped spine and pelvis.
Although some pediatricians are advocates of natural parenting, many don't have much hands-on experience with
baby carriers. They might be acquainted with the upright carriers from the eighties and nineties with their
typical lack of adequate head/neck support and tight or chafing leg holes, leaving babies to dangle from the
crotch due to complete lack of leg support. Perhaps they have seen so many babies facing out when carried
upright that they assume all upright carrying is non-supportive.
The first two images on this page are perhaps the carriers that many doctors imagine and classify as unsafe
or harmful. Both are non-physiological-carrying devices. These front-facing carriers, unlike wraps, slings, mei
tais and soft-structured carriers, do not provide proper leg support, which can make the pelvis tilt backward
and place babies in the dangerous "hollow back position."
Swaddling and Hip Dysplasia
Although there are myriad psychological, emotional and physiological benefits from the swaddling style of the
Navajos, there is clear evidence that swaddling the legs so that they are bound together and not allowed to flex
at the knee or hip has led to hip abnormalities. By not allowing the head of the femur to sit in the socket, the
socket often does not develop properly, causing developmental dysplasia of the hip (DDH).
Carrying a young infant in the horizontal position with legs together in a baby carrier (like a sling or a
wrap) provides adequate spinal support, but it is not the optimal position for hip development or prolonged
carrying. This is especially true if there is congenital dysplasia present in the infant.
The American Academy of Pediatrics released a review of swaddling under Van Slewen in 2007, which reaffirmed
that infants' legs should not be tightly swaddled. In 1965, the incidence of DDH was high in Japan when a
swathing diaper was used widely by the population. Eight years later in 1973, Japanese doctors advised mothers
to avoid "prolonged extension of the hip and knee of infants during early postnatal life." Soon
afterward, experts reported a marked decrease in infants with DDH.
Supporting the Legs
Upright baby carriers that support the legs, carrying a baby as a mother naturally would in arms, do not
compromise a baby's spine or hips. When an infant's legs are flexed and straddled, the instinctive position that
his little body assumes when picked up, the head of his femur (bone of the thigh) fills out the hip socket (acetabulum).
The hip socket is filled most evenly when the legs are pulled up to roughly 100 degrees and spread roughly 40
degrees at the same time. DDH does not occur when an infant's legs are supported. Actually, this is the position
that doctors advocate as treatment for babies with hip dysplasia.
Interestingly enough, babywearing is customary among the Netsilik Inuit people. Netsilik mothers don't use
papooses, but instead carry their infants in their amautis of their parkas. The babies assume a seated
straddling position on their mother's back inside their coats. No studies indicate prevalence of either DDH or
spondylolisthesis in this northern Inuit babywearing group. Their hips and spines develop normally.
A mother, using either her arms or a simple piece of cloth, supports her baby's legs in a f0lexed (knees
bent), abducted (away from midline) position, supporting the hips and the spine. Instead of fabric at the
crotch, which contributes no leg support, or swaddling the legs, which is too restrictive, ergonomic carriers
put the baby in the position that supports the legs just as a mother's arms would. The flexed abducted position
is what infants are hardwired to assume when picked up. It is what nature intended: legs spread around the
mother's hip, back or torso, with knees bent in a seated position.
Proponents of horizontal positioning in early infancy may be concerned with whether the infant actually
receives adequate levels of oxygen while being carried. According to Dr. Maria Blois, premature infants placed
in an upright position on their mother's chests had improved respiratory patterns, more regular than in an
Blois's study also showed "reduced episodes of sleep apnea [temporary cessation of breathing] and
bradycardia [slowing of the heart rate]. Transcutaneous oxygen levels do not decrease, indicating that oxygen
saturation is not compromised." These studies were done on premature infants, some weighing as little as 3
pounds, placed upright on their mothers' chests. The preferred position for these tiny babies is upright,
usually secured by a piece of cloth. If the upright position is safe for a 3-pound preemie, it doesn't make
sense that it could be harmful to a fullterm newborn.
Preventing Ear Infections
Lying horizontally is not only a poor option for your baby's spine, hips and cranium, it can also contribute
to inner ear infections in infants. Gastric reflux of contents into the middle ear causes ear infections.
Gastroesophageal reflux disease, or GERD, can be pretty prevalent in infants, as sphincters tend to take a while
to fully close.
Parents of infants diagnosed with GERD are advised to carry them upright to ease the symptoms. When infants
are placed lying in the horizontal position, not only are the symptoms exacerbated, but gastric juices can enter
the immature eustachian tubes, making reflux from the throat into the middle ear more probable. The same may
occur when bottle-fed infants are fed while flat on their backs. A slight upright tilt prevents milk from
entering the middle ear.
The buildup in the eustachian tube can cause inflammation and a buildup of bacteria, and subsequently an
infection. Wearing your baby upright can actually be a preventative measure against ear infections, and can help
ease the symptoms of GERD.
Another benefit of carrying your baby is that carried babies receive a lot of vestibular stimulation, whereas
lying babies do not. Our vestibular system helps us out with our sense of balance and our security in space.
When a mother holds her baby, the baby moves back and forth with mom's walking, and side to side from her
swaying or rocking. Mom may stop and turn and reach to grab something, or she may move gently and smoothly.
These varied movements force her baby to respond appropriately to keep himself balanced. All of these movements
tune her baby's vestibular system.
A stroller moves either forward or backward, offering movement on a single plane, and not very varied. When
changed from the upright position and the containment of his mother's arms to the horizontal position laying
down uncontained, a baby may produce random movements and suddenly flail his arms and legs, as if to save
himself from falling. This is called a baby's Moro reflex. It acts as a baby's primitive fight/flight reaction,
and is replaced later in life by an adult's startle reflex.
Carrying, rocking and swaying stimulate an infant's vestibular apparatus and help them to feel secure in
space. Most babies today spend most of their day apart from their mothers in a container or in a stroller,
leaving them prone to vertigo, and a feeling of physical insecurity in space in general. Native Americans are
typically very secure in space; they are actually known for their comfort with heights and apparently tend to
have little problem working tall construction projects. Most traditionally raised Native American babies are
swaddled or spend most of their infancy either in cradleboards or on their mothers' hips, leading to enhanced
vestibular development. Interestingly enough, the fear of flying and the fear of heights which plagues many of
today's adults can often be traced back to not being carried as an infant. Carried babies feel secure, and are
less apt to develop space-related phobias.
Babies have reason to feel secure. They physically need to be in close contact with their mothers. They
giggle and coo and drink in all of our expressions. Upright on mother, they are able to view the world
unobstructed from a safe place and can learn about everything around them. Not only are babies better off
physically when upright, but they are happier and calmer. In her book, The Vital Touch, Dr. Sharon Heller
writes, "The more time that babies spend vertical, the more time that they are alert and calm. Even
newborns that spend most of their time sleeping, stop crying and perk up when picked up and placed on our
shoulder. Interestingly, how alert a newborn is relates to where he is. Upright in an infant seat, he is less
alert than when upright in arms. ... Vertical positioning as optimal in infants makes perfect sense. Think of
how much time our infants spend horizontal - flat on their back in a crib or a buggy. Might this affect their
alertness? There's a good chance. ... Researchers found that infants too young to sit independently learn more
when placed in a vertical position."
Stimulating the Senses
Not only can an infant learn about the world around her from all the different sights she sees, she is in the
state of mind to do so. When an infant is calm but alert, that's when all the information can permeate into her
"Our body is a sensual cornucopia where smiles, aromas and laughter mingle amid undulating caresses that
put the entire sensory world at our baby's fingertips," writes Heller. "Our baby gets tactile or
cutaneous stimulation from our skin touching hers and proprioception from the pressure of her limbs flexed into
our body. She gets tactile, olfactory, and gustatory stimulation if we nurse, of our milk, and vestibular
stimulation from the gentle stimulation of our movements and, when held upright, from her efforts to right her
head and maintain her balance. She gets visual stimulation when she looks all around her, auditory impulses as
we whisper endearments, and kinesthetic stimulation as we change her to the other side. When we put our babies
in a container, especially if out of sight, all of this sensory nourishment is lost."
Easier System Regulation
The mother/infant relationship actually provides physiological regulation of the infant's autonomic system. A
1992 study showed that when an infant is taken away from his mother he experiences a "decreased heart rate,
temperature decreases, sleep disturbances and EEG changes" - representing an impairment in the regulating
processes of his own little body. Upon being separated from his mother, a baby's immune system weakens. His body
literally stops producing as many leukocytes. But when his mother rejoins him, he strengthens again. An infant's
body physically needs his mother present to help regulate his own body.
Roots of Misinformation
With all the studies demonstrating the clear physical benefits of carrying a baby upright on mother's chest,
it's hard to understand a pediatrician's ambivalence on the matter, or outright scorn when his patients choose
to do so. Perhaps the reason for not supporting upright carrying is that they want to discourage mothers from
"spoiling" their babies, or to prevent the mother and baby from getting too close or attached to each
Straying from wearing our babies may be linked to an old school of thought, dating back to 1928, when the
famous behaviorist Dr. John B. Watson published The Psychological Care of Infant and Child, setting out to
change the course of humanity and make infants independent, strong and tough. His theory was that we were all
born basically a blank slate, ignoring any evolutionary hardwiring or any inborn biological tendencies, and that
in order to "form" an independent child it was necessary to prevent the newborn baby from creating
dependent habits. In other words, if you hold on to your baby, he will cling to you and never let go. He will be
needy. Not only should you refrain from carrying your baby but you should withhold cuddling, kissing and
rocking, too; if you show affection, your baby will come to expect it.
So many of our grandparents and parents were influenced by this mechanistic train of thought, pressured by
the experts to believe that if they picked up their babies when they cried that they would create a tyrant of a
child and become enslaved. Unfortunately this psychology has had a profound effect upon pediatric thinking and
practice, and even pervades conversations between mothers and doctors today.
Evolutionary Need for Touch
Most mothers are still pressured to carry out the harsh parenting methods that were inculcated into our
grandparents and our parents. Yet, these mechanistic methods only go back so far. Anthropologist James McKenna
claims that today's babies, more often in some container than in our arms, are "at odds with
evolution." "Virtually all of our biochemistry and physiology are fine-tuned for the conditions of
life that existed when we were hunters and gatherers, in which babies were held by their mothers," McKenna
writes. "Our culture may be changing, but our evolutionary need for touch remains the same. Babies' brains
are designed to expect closeness and proximity - to be held for their safety, psychological growth, physical
growth, mental growth, to aid and stabilize their physiological processes and keep their immune systems strong.
Touch is not an emotional fringe benefit. It's as necessary as the air we breathe."
Making Strollers the Exception
Even though most Western parents cannot conceive of life without one, strollers are not as gentle on an
infant as we assume them to be. Placing an infant alone on his back for long periods of time is not how humans
are hardwired to thrive. Lying horizontally in early infancy is not easier or less stressful on an infant's
spine, skull or neck. When a baby is upright on her body, a mother adjusts to all her baby's movements, and he
to hers, moving like dance partners. The two create a rhythm together, physically and psychologically, and move
together in sync. Even the most state-of-the-art stroller can't provide the warmth of a mother's body, nor her
comforting smell, the varied movement, and sensitive motherly responses. These are all so essential to her
baby's healthy growth and development, especially during such a critical period when his brain is growing more
than any period in his life. No toys can match the joy that an infant gets from his mother's face. The view of
the fabric liner with which the manufacturer chose to line the stroller cannot compare to the rich environment a
baby witnesses and observes when he moves together through the day with his mother.
Strollers are not "bad," per se. To go further, babywearing and strollers need not be mutually
exclusive, as long as an infant is content and his cues are responded to when he signals that he needs to be
Laying babies flat on their backs in a stroller is actually not easier on their necks, spines, hips and
minds. Nature intended for babies to be carried. Upright positioning, with proper leg support, is the preferable
position for your infant and is gentle enough not to physically stress even tiny babies. A mother should trust
her heart. By holding her baby close to her heart, she is not just choosing the most beneficial and physically
supportive method of bringing her baby along with her, she is providing the optimal environment for his
psychological and emotional growth.