When is a baby carrier not a baby carrier?

What can an ER visit teach us about baby safety?

Working on the front lines of everyday accidents, injuries, and fatalities means the ER is an excellent place to learn the lesson of prevention. Nothing is ever 100%, of course. However, the idea of prevention came full circle for me when I heard this story.

A family removed their infant and infant seat from the Uber and put them both down on the sidewalk while getting the rest of their belongings from the trunk. When putting the baby and seat down, they lifted the blanket and checked on the baby. Ahhh, sleeping. Perfect.

They get everything into their apartment and then check on the baby again. Only this time, something was wrong. (FYI, if you're worried, it's okay to keep reading; this is not a fatality.) The baby's face and lips were blue, the head was at a severe angle to the right, and the seat belt was digging into the neck of the baby.

They reacted quickly, removed the baby, and the baby stirred. One called 911, and before you know it, they were all in the ER. The ER team ran several tests, and all seemed okay for this baby and the family.

Here's the thing: only one person on the ER team understood enough to ask, "Is the baby carrier you are referring to one that is worn on the body?" The family responded, "No, it's the kind you carry in-arm." Luckily, the ER team member pulled out their phone and found a picture of a car seat, one used outside of the car, and clarified with the family if this was the device they were using. It was.

Why does it even matter?

• How can we prevent accidents like this if there is a lack of clarity on what is happening in the first place?

• How can we learn about repetitive incidents and look for trends without precise data?

• How can we even suss out what the ER should ask - especially in a fast-moving, highly fraught scenario?

These questions are burning in my mind. Last year, a doctor shared their data dive in the form of epidemiological research. This means they looked at ten years of infant injuries in baby carriers that presented to the ER and attempted to derive some knowledge. Not a bad thing per se; if we can prevent injury, then great. The summary findings were presented to the AAP (American Academy of Pediatrics) during the annual conference.

The takeaways were that baby carriers are too loose and are not meant to be worn by men as they are designed for female bodies. (I am grossly oversimplifying the results here, so bear with me.)

When asked to clarify the different kinds of baby carriers used, including the in-arm holding of infant car seats used outside the car, the researchers admitted they could not parse the differences in carriers. At the time, it meant the data they presented was junk or not practical enough to gain clarity into the actionable preventable moment. What could I teach to a caregiver that I don't already teach?

Hearing about the family that presented to the ER this week, it became clear as day.

• The baby's positioning is an issue to be mindful of, no matter the device or location.
• The baby needs to be visible to the caregiver without removing something to access the baby quickly—no more moments of discovery.
• Whatever is assisting in the holding of the infant: infant seat, car seat, bouncy seat, arms, cloth-based carriers, etc. needs to support the infant properly and not be so loose as to introduce compromised airways and chin and chest slumping.
• No device, crib included, is a babysitter. A baby always needs a responsible caregiver to monitor and respond to them.

By the way, the above is a baby and device issue - not only a babywearing issue.

Families need clarity on what changes when a car seat is used outside the car. And how changes in the car seat from installed to in-arm might change their infant's position in the car seat. They need education that addresses using car seats as an infant seat (outside the car) and how that use poses risks.

The family in the scenario didn't know these things. When the ER team member asked questions, it turned out the Father was carrying the infant…and the straps were too loose. It was not a babywearing issue - but an infant-car-seat-used-outside-of-the-car issue.

Additionally, it's time to start talking to more ER staff to discuss improving the data captured when an infant presents to the ER with injuries related to a 'baby carrier.'

I started that talk this week. I got immediate pushback, which I expected, but that gave me insight into how to make the case going forward. I'm grateful for that, of course, but I wish the answer had been a simple, "Yes, let's do this."

It might be challenging to get enough ERs to commit to joining a new research study. 

It might be challenging to reach a consensus on collecting this data.

It might be challenging, to say the least.

But that doesn't mean it isn't worth pursuing. If you have some ideas, know someone who works in the ER (or you do), or know a nursing researcher who specializes in education and prevention interventions… share with me please.