What I check as a paediatric physiotherapist

Am I carrying my baby right?

Have you wondered whether you are carrying your baby right in the sling or carrier? It is one of the questions I hear most in clinic. And it makes complete sense: babywearing is more and more common, but not all carriers, nor all the ways of putting them on, are the same.

Carrying well does not mean doing it perfectly. It is about taking care of a few details that make the difference to how your baby breathes, how their hips sit and how their back develops. I explain them step by step, without jargon.

What is ergonomic babywearing?

Babywearing is ergonomic when it respects your baby’s natural posture, and yours too. In other words, the carrier adapts to your baby’s body, not the other way round.

In practice, you can recognise it by three things:

A back in a “C”

Babies have a rounded back. A good carrier supports it that way, with the fabric firm, without forcing it straight.

Legs in an “M”, or “frog” position

The legs are apart and the knees sit a little higher than the bottom. The fabric seat reaches from knee pit to knee pit (from the back of one knee to the other), so the weight spreads across the whole bottom and the legs do not dangle.

Tummy to tummy, and high

Your baby faces you, with their chest and tummy against your body. So high that you can kiss the top of their head.

Why does the “M” matter so much? A baby’s hips develop better with the thighs bent and apart. Keeping the legs together and straight for long periods in the first months is associated with hip dysplasia. Carriers do not cause dysplasia, but not all of them hold the hip in a good position. That is why a wide seat matters so much.

What are the benefits of babywearing?

When babywearing is ergonomic, the benefits go far beyond having your hands free:

Bonding and less crying
Postural and sensory health

More calm and closer bonding. Contact makes them feel safe. Babies who are carried tend to cry less and sleep better.
Helps prevent a flat head. They spend less time lying on the same spot, and that helps prevent positional plagiocephaly.
Stimulates their balance. Your movements stimulate their vestibular system, the sense that helps them find their way in space.
Supports communication. Having you close, face to face, makes it easier to exchange the looks and sounds that lie at the root of language.
Supports breastfeeding. Continuous contact makes feeding on demand easier.
Less time in bouncers and seats. It is an active alternative to these “containers”, which limit their movement.
And for you: you get your arms back without stopping caring for them. With an ergonomic, well-adjusted carrier, your back need not suffer.

That said, as a physiotherapist there is one thing I always insist on: babywearing adds, but it does not replace the floor. Your baby needs tummy time and the freedom to move on a firm surface. That is where they develop their motor skills. The ideal is to combine the two through the day.

How do I know I am doing it right? The TICKS rule

There is a very simple checklist. It is called TICKS, it was created by the UK Sling Consortium and it is recommended by child safety organisations such as RoSPA and The Lullaby Trust. Go through it every time you put your baby in:

Tight and snug
In view and close enough to kiss
Chin off the chest, back curved
Hips in an “M”

T – Tight

The carrier should be snug, hugging your baby against you. If you rest your hand on their back and press gently, they should not slump or shift towards you. Loose fabric lets them slide down and curl up, and that can make breathing harder.

I – In view at all times

You should be able to see their face just by looking down, without moving any fabric. Nothing should cover their nose or mouth.

C – Close enough to kiss

Their head should be so high that you can kiss their forehead by tipping your head forward a little.

K – Keep chin off the chest

Check that at least a finger fits between their chin and their chest. If the chin rests on the chest, the airway can partly close.

S – Supported back

Their back stays in its natural curve, with tummy and chest against you, without slumping or twisting.

To these five I always add a sixth, as Pathways.org’s guide suggests: healthy hips, with the knees higher than the bottom and the legs in an “M”.

If they fall asleep, check the T, the I and the K again. That is when the head can drop forward. Babies under 4 months are the most vulnerable: they cannot yet control their head well and cannot correct their position by themselves.

How to carry them as they develop

In babywearing, the milestone matters, not the age. Every baby has their own pace, and months of difference between one and another are normal. If you want a guide to what is usual at each stage, there is the milestones by age guide.

Not yet holding their head up

Approximate age: Up to 2–4 months
How to carry them: Only on the front, upright and facing you, with the head well supported. This is the stage when the chin needs watching most.

Sits without support

Approximate age: According to the WHO, between 3.8 and 9.2 months; often around 6
How to carry them: Time for a carrier on your back: they now hold their own sitting posture.

Walks

Approximate age: Second year
How to carry them: Babywearing is still useful for rests, but give priority to their independence and movement.

To start from birth, your baby only needs to reach the minimum weight the carrier’s maker states. If they were born premature or with a low birth weight, ask first.

And until when? There is no age limit. It depends on what you and your child need. If you carry them from small, your back will get used to the extra weight little by little.

What to avoid

Facing out: no
Always tummy to tummy

Non-ergonomic carriers, the so-called “crotch danglers”: they have a narrow seat that leaves the legs dangling and forces the back straight.
Bag-style slings, in which the baby ends up folded with their chin sunk on their chest.
Carrying them facing out. The Spanish Association of Paediatrics advises against carrying babies facing outwards, and the International Hip Dysplasia Institute recommends carrying them facing in for at least the first six months. If they want to see more, the best option is the hip or the back, when they are ready.
If you breastfeed in the carrier, when you finish put them back upright and high.
Carrying in risky situations: in the car, on skates, while cooking near the hob or hot liquids, or wherever you could fall. Always choose comfortable, safe shoes.
Wrapping them up too warmly. Your heat and theirs add up. On hot days, carry them for shorter spells.

And three tips that help a lot day to day: bend at the knees, never at the waist; alternate the side they rest their head on each time you carry them, to prevent positional muscular torticollis; and take breaks when they, or your back, ask for one.

When to get advice before babywearing

In some situations it is better to have an individual assessment before you start babywearing or change position:

If your baby was born premature or with a low birth weight.
If they have hip dysplasia or a “click” in the hip has been noticed at check-ups.
If they have plagiocephaly, torticollis or always turn their head to the same side. Here I tell you more about congenital torticollis.
If you notice their muscle tone is low (they feel very “floppy”) or they have breathing problems.

Often you can keep babywearing, adapting the carrier and the position to what your baby needs.

A word of reassurance

Babywearing well is learned. It is hard the first few times, and it is normal to have doubts. You do not have to do it perfectly: just go through the TICKS rule each time and watch your baby. If they are calm, breathing well and you can see their face, you are on the right track.

If you have doubts about how you carry them or about their development, you can ask for an assessment. We look at it calmly.

Sources

Asociación Española de Pediatría (Spanish Association of Paediatrics). (2015, revised 2019). Porteo de los bebés. En Familia. enfamilia.aeped.es
Pathways.org. (2025). Guide to babywearing: When to start, types, and safety tips. pathways.org
UK Sling Consortium. The T.I.C.K.S. rule for safe babywearing. Shared by NHS Grampian. birthingrampian.scot.nhs.uk
The Lullaby Trust. (2026). Slings and carriers: The research. lullabytrust.org.uk
RoSPA. Baby slings. rospa.com
International Hip Dysplasia Institute. Baby wearing. hipdysplasia.org
WHO Multicentre Growth Reference Study Group. (2006). WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatrica. https://doi.org/10.1111/j.1651-2227.2006.tb02379.x
Vaidya S, Aroojis A, Mehta R. (2021). Developmental dysplasia of hip and post-natal positioning: Role of swaddling and baby-wearing. Indian Journal of Orthopaedics. PubMed Central, PMC8688658. https://doi.org/10.1007/s43465-021-00513-3
Ayuntamiento de Madrid (Madrid City Council), Casa Grande. Porteo ergonómico en casa. madrid.es

This information is for guidance only and does not replace an individual assessment by a professional.