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Can premature babies also be carried in a sling?

Carrying petite children and especially premature babies in a sling is still rarely done by many parents. Uncertainties about whether you are allowed to, can and how play a major role here.

Julia Pötsch, the founder of cocoome, and I, as a pediatric physiotherapist and babywearing consultant, feel it is important to explain how a premature baby should be carried in a sling. We also want to give parents and relatives the confidence and courage to be able to carry these small, delicate babies in particular.


Table of contents:


When do we start talking about premature babies?

A newborn is a baby born in the last 4 weeks of pregnancy. The period covers pregnancy weeks 37 to 41.

If a child is born before the 37th week of pregnancy (37+0), it is referred to as a premature birth. Particularly relevant groups to be mentioned here are

– Premature babies under 32 weeks’ gestation
– Babies with extreme immaturity under the 28th week of pregnancy
– By weight Premature babies under 1500g (very low birthweight)
– Babies with an extremely low birth weight of less than 1000g

Too early in the world – too bright, too loud and all that…

If a baby is born prematurely, its maturation process in the womb is interrupted. This often results in adaptation disorders, muscular weaknesses, immaturity of the lungs and even an immature nervous system.

Many premature babies are placed directly into an incubator after birth, which more or less imitates an artificial womb. Later, when all the parameters are right, it is transferred to a heated bed.

In most cases, they are also connected to devices that monitor the heart rate, pulse and oxygen saturation.

The premature baby is born into an environment that is far too bright, noisy and stimulating for him. These can lead to a sensitivity to stimuli as well as to an increased triggering of muscle reflexes and external reflexes. Gravity and boundlessness are also a novelty. Due to the growing narrowness of the uterus, it was able to orientate itself well as to where the top, bottom and lateral borders are. Without boundaries, both newborns and premature babies cannot orient themselves. As the sense of touch is much better developed than the sense of sight at the time of birth, babies initially perceive their surroundings primarily through their skin. As soon as they are able to orient themselves in space by means of a boundary, their body tension (tone) also adapts accordingly.

As soon as a premature baby is stable enough, no longer needs any technical assistance to breathe, is drinking and gaining weight adequately, has reached a certain weight, can maintain its temperature, the laboratory values are correct and there is no further medical reason why it should not be discharged home.

Premature baby in a sling
Premature baby in a sling

Physiotherapy supports arrival in the new world

Adjusting body tension and finding a stable position on the back, stomach or side is a real challenge even for newborns.

For premature babies, whose body systems (breathing, motor skills, sensory and nervous systems) are not yet fully developed, this is an even greater challenge. If they come into contact with gravity too early, premature babies can develop compensatory postures and movements due to their immature muscles. This can lead to asymmetries in the torso or head shape as well as hyperextension tendencies.

From a physiotherapeutic point of view, the primary goal is therefore to provide the premature baby with as much relief as possible so that it can become better accustomed to life with gravity and thus have a better chance of optimal development on the sensorimotor (perception and movement) and psychoemotional (cognitive and emotional) levels.

There are various options here:
Positioning and restraints allow the child to find motor rest and thus get to know its body. Postural asymmetries and head deformations are also avoided by positioning the child in different positions, including on the side and on the stomach.
Osteopathic and craniosacral techniques are used for relaxation.

Techniques from respiratory therapy are used to improve breathing functions and activate the patient’s own breathing.
For larger premature babies, sensorimotor support also plays a major role, i.e. being able to perceive themselves and their environment better.
The premature baby needs appropriate postural control in order to be able to hold itself stable in the room on its back, side or stomach. This is practiced with the child on different surfaces, both soft and hard. Depending on the firmness of the surface, the child must stabilize its torso in order to be able to lie on its back or stomach.

Tolerance for movement and shifts in balance are also taught in physiotherapy.

Skin contact such as touching, gentle pressure and massage help the premature baby to feel its own body and orient itself in its environment.

Premature babies are also babies from the start

Carrying a premature baby in a sling offers protection, warmth and security. Anthropologically speaking, human boys are baby carriers. There are some indications of this. If you take a closer look at the anatomy of a newborn baby, you can see that the legs are bent and slightly apart in both the supine and prone positions. This posture is called the squat straddle posture. This squat-spread posture is a suitable starting position for a human infant to hold on to its mother’s body. The abduction angle of a newborn is 45° and is always associated with a hip flexion of 100°. The child also shows this hip position when lying on its stomach. The extent of movement is similar in premature babies.

When picking up and lifting, babies automatically (reactively) adopt the squatting and spreading posture in anticipation of being able to hold on to their mother or father immediately.

Not only the pelvis, hips and legs, but also the spine is adapted in its shape and function to being carried. In contrast to an adult spine, which has an S-shape, the infant spine is still straight and the torso appears bent overall in a C-posture. This develops with an increase in motor activity.

When the baby begins to actively hold its head at around 8 weeks, the cervical spine stretches. At the beginning of the seal and crawling stage, the cervical spine becomes more and more lordotic (stretched). The lumbar spine in the lower area is brought into increased extension with straightening for standing and walking. Premature babies can also adopt this position from the very beginning.

Carrying premature babies in a sling has many advantages

Babies are carriers from birth and therefore premature babies even more so. Carrying a premature baby in a sling therefore has many advantages. The need for closeness and skin contact gives the baby a feeling of security and protection. This allows it to calm down and relax. The sling gives the premature baby the protection and security it needs to calm down. By limiting the baby in the sling, the premature baby is given orientation and security. This often regulates the breathing and heart parameters as soon as the child feels skin contact.

The bonding hormone oxytocin is produced through constant skin contact between the baby and the mother. It is also known as the “love or bonding hormone” and supports the bond between parent and child. At the same time, it has a stress-reducing and pain-relieving effect and thus ensures well-being, relaxation and restful sleep. Oxytocin also has a positive influence on nutrient storage and cell growth. This promotes the development of growth and healing processes.

The distribution of tension and pressure in the sling also has a positive effect on the baby’s body tension. Movement and balance experiences are initiated via the carrier. This prevents head deformations that can occur in the supine position. At the same time, the squatting position in the sling promotes hip maturity. At the perceptual level, the baby begins to feel itself better and can thus better develop its ability to regulate itself.

Premature babies in slings – the overall condition plays an important role

For premature babies, the overall condition of the baby plays an important role. Babies can only be carried with or without a monitor when all vital signs are stable enough and there is no medical reason not to do so.

Premature babies with a body weight of less than 1800g should not be placed in the spread-squat position, as the spread angle in the sling may be too great. Lighter babies are carried in a so-called Buddha position in the sling. It should always be checked in advance to what extent it is already possible to spread the hips or not.

Babies are also carried on neonatal wards in both woven and elastic slings. Parents are advised and trained by qualified professionals.

Premature babies in slings – what should be considered?

If a premature baby is carried in a sling, the sling should be firm enough from a physiotherapeutic point of view to provide the premature baby with sufficient stability and support so that it does not sink into the sling. The sling replaces the baby’s missing muscle corset with an optimal tying technique. When tying with the elastic sling (preferably a firm one such as the cocoome sling), the child can be placed in its natural squatting position, which it also shows in the prone position. The sling then adapts ergonomically to the baby’s torso and hips. With the third layer, which offers additional stability, you can also provide additional support via the soles of the feet if the baby needs it.

The elastic sling is a better choice for babies who tend to stretch. It fits like a second skin. Even babies who are over-excitable or over-sensitive (especially in the neck area) can tolerate being carried in a sling more relaxed due to the pressure distribution over the whole body.

Babywearing advice is the be-all and end-all here

To ensure that carrying premature babies works well and safely right from the start and that the premature baby feels comfortable in the sling, I strongly recommend consulting a certified babywearing consultant with additional training in “Carrying premature babies”.
You can find information about babywearing consultants in your region at babywearing schools such as the TrageberaterAkademie, Die Trageschule® Austria and Switzerland, Trageschule Hamburg, Trageschule Wien, Trageschule Schweiz, Trageschule ClauWi and Trageschule FTZ Babytragen.

Bandage line

Premature baby in a sling
Premature baby in a sling


Anne Kohl
Pediatric physiotherapist and babywearing consultant in private practice in the Deutschlandsberg district

Click here for another article worth knowing about babywearing and babies:

Eva Vogelgesang: IBCLC breastfeeding consultant, babywearing consultant, head of nursing at the pediatric intensive care unit in Saarbrücken. She regularly holds lectures and workshops on carrying premature babies in the DACH region ->
Heike Gratzei: freelance pediatric physiotherapist and works in the neonatal intensive care unit of the LKH Hochsteiermark, Leoben site
Michaela Schelldorf: Head of the Babywearing Consultant Academy, Germany
Many thanks to the three experts who supported me with their knowledge.

Evelin Kirklionis: A baby wants to be carried-Köselverlag
Sabine Hartz; Ulrike Höwer, Birgit Kienzle-Müller: Babys im Gleichgewicht-Urban&Fischer
Antje Hüter-Becker; Mechthild Dölken: Physiotherapy in pediatrics
Ute Hammerschmidt; Janine Koch: Guide to physiotherapy in pediatrics[/vc_column_text][/vc_column_inner][/vc_row_inner]

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