Tuesday, 1 October 2013

FFO & Narrow Seated Carriers: The Myths And The Facts

by Tami Grosset

This blog post has been doing the social media rounds recently and I'm saddened by the amount of airplay this scare mongering, unbalanced yet passionate post has been getting. Even Motherwise posted it as an 'evidence based' article to enable parents to make informed choices.

What has been further frustrating me is that this other blog post, which is very well written, balanced, researched and equally passionate has been getting far less airplay despite the fact that it is actually far more helpful for parents who wish to make informed decisions based on actual information, rather than fear.

The first post was written by a mother whose child has DDH. The second by a medic and experienced babywearer/babywearing educator.  I am an adult who was born with DDH, a mother of a child with DDH and an experienced babywearer/babywearing educator. I feel well placed to speak on this topic. I sort of combine the passion for and personal connection to the DDH condition and the experience and understanding of babywearing avdocacy.

There are many great blog posts about forward facing out (FFO) including this one from Boba, this piece that M'Liss (a babywearing veteran) wrote for Mothering and this item from the Babywearer's Circle. They all offer great advice based on information about what we know about the developing infant hip joint, developmental hip dysplasia and the modern treatments for children who suffer from the condition.

These images from the International Hip Dysplasia Institute show very nicely how hips can be supported by the use of a wide seated carrier and how a narrow seated carrier is deficient in this support;

Clearly narrow seated carriers are not ergonomic and are not designed to support healthy and natural infant hip development. I would always recommend a wide seated ergonomic carrier to parents who are looking to purchase their first carrier, or a replacement for their current carrier.

So what's bugging me? The claim that narrow seated carriers and FFO actually causes developmental hip dysplasia..... and that's all it is, a claim. There has been no research to say, without a doubt, that narrow seated carriers and FFO has actually caused DDH (developmental dysplasia of the hip).

I would certainly discourage anyone with a family history of hip dysplasia or loose joints, from using a narrow seated carrier or a carrying position that allows the legs to lie close together/straight, as in FFO or as in this image from the IHDI;

On the left the baby's legs are held together by the sling which is not an optimal position for hip development. On the right the baby is seated in a wide M position, a fabulous position for hip development.

If there is a potential familial disposition towards this condition it would be worthwhile to consider a few different ways to support healthy hip development. Using an ergonomic wide seated carrier is one way. Cloth diapering, or using two disposables, also supports good hip development as the bulk of the diaper forces the legs into a wider froggy position. If using a swaddle blanket, following safe swaddling techniques will also help to protect the flexibility of the hip joint and its natural development. This clip from IHDI shows how this can be done;

If you are using a narrow seated carrier and are concerned about your child's hip joints but really can't afford a new carrier then maybe consider using a scarf or shawl to create a knee to knee spread, as in this post by the Canadian Babywearing School. Or perhaps check out the Babywearing On A Budget Facebook group, where carriers can be found for no more than $100.

The main things to remember are;
  • babywearing will NOT cause your child to develop hip dysplasia
  • if there is a family history it might be best to consider more ergonomic options
  • FFO is a position that should be used only with babies who are able to sit unaided and who are awake
  • if using a FFO position be attentive to baby's cues and turn baby to face inwards when signs of overstimulation become apparent
  • FFO can be often be uncomfortable for the wearer since the weight of the baby and gravity will pull at the upper torso
  • ergonomic carriers generally have a higher weight limit than narrow seated carriers so whilst an Ergo Baby or Beco Gemini might be slightly more expensive than a Baby Bjorn or Snuggli the ergonomic carriers will almost certainly have a longer user life (and will also hold their value better when you come to sell as used)
You're probably wondering why I'm apparently arguing FOR the use of narrow seated carriers and FFO. To be honest with you I am not. I am arguing for babywearing. A worn baby is a happy baby, is a secure baby, is an attached baby. It is better that a baby is worn with care and attention, than not worn at all and we should, as the babywearing community, welcome, support and educate all babywearers however they wear their bubs.

Do you have a Baby Bjorn, Snugli or other type of narrow seated carrier? Does your infant like to be worn FFO?
Please don't stop wearing your child!

If your child has healthy hips and no genetic traits as described above then


  1. I have a snugli for grocery shopping and a ring sling for around the house. I've used these with all my kids and have never had an issues, I'm a mom of 4. I do use cloth diapers and there legs never dangled like the picture.

  2. But here I am 20 years later with mild hip dysplasia!!! I was swaddled tight & worn in a narrow carrier as a baby, you've said it yourself that a wider carrier is better & the cost of a wrap is cheaper than the $10000+ per hip replacement & 3 months off work I am now going to need to be replaced within the next 10 years! I wear my daughter even still at almost 2, there are safer ways to do so that don't cost an ergo or manduca!!!

  3. I am sorry, Anonymous, that you've been so affected by hip dysplasia. I think, however, it's incorrect to blame it on the carrier you were worn in. I wasn't worn or swaddled. Yet I required extensive surgery to correct my hips as a baby and am waiting on an appt with a specialist regarding some hip pain I've been experiencing at 43. My son was worn in ergonomic carriers and was only safe swaddled. He still spent the first year and more of his life in harnesses, spicas and braces and had a couple of surgeries to correct his hips. There are also a great majority of adults who were worn in narrow seated carriers who did not go on to develop hip dysplasia. As I said in the above post, there is no research to support a connection with narrow seated carriers and hip dysplasia.

  4. And this is completely beside the point but in Canada we have free health care.