The Wrap in Physiotherapy Practice

H. Engel-Majer, Physiotherapist

The wrap – a hotly debated topic. Anyone walking through town with a child in a wrap gets either enthusiastic approval or indignant outrage from passers-by of every age. In my experience as a children's therapist and as the mother of a "wrap baby" myself, I see it as our job to guide parents in our practices and in children's hospitals towards carrying correctly. For many children, being carried is the best therapy there is.

Children With Congenital Hip Dysplasia Are in Good Hands in the Wrap

Evelin Kirkilionis has described in her work how children carried sitting sideways on their parent's pelvis automatically adopt the hip-spread angle that's optimal for treating hip dysplasia. In addition, the constant movement acts as a formative stimulus of the femoral head on the hip socket.

Experience shows that children with hip dysplasia who are carried frequently have fewer problems with posterior pelvic tilt than we see in children who wear a splint. Parents often report just how much the splint gets in the way during carrying or cuddling. Here, the wrap is an excellent alternative, which can be used preventively, or as an alternative to the splint in consultation with the doctor. Provided the carrying technique is done correctly, that is, since an incorrect carrying technique or carrier can also have a negative effect on hip joint development.

Delicate Newborns and Babies With Special Needs Can Make Up Some of the Security of the Womb in the Wrap

The delicate newborn has had to go without many weeks of security in the womb – so what comes next? Animal studies have shown again and again that physical contact is vital to survival! The positive effect on the immune system can be demonstrated in blood tests.

Observations at Johns Hopkins Hospital in Baltimore, USA, on thirteen severely growth-delayed children from troubled families confirmed that intensive, affectionate attention led to a marked weight gain. Many neonatal units have also learned that babies gain weight faster when they receive more physical contact. This is why kangaroo care has now become established practice, and baby massage is often carried out for the same reasons. It's hard to deny, then, that being carried is of enormous benefit especially for fragile, infection-prone premature babies.

Children With Central Coordination Disorders or Developmental Delays Receive a Wealth of Stimulating Input in the Wrap

These children's movement patterns deviate from the norm, often accompanied by abnormal muscle tone. So what happens to children in the wrap? The "stiff child" becomes softer and more supple through constant movement. This gives our therapy a considerably better starting point. Physiological movement patterns emerge more quickly during therapy and can be integrated into the child's spontaneous motor activity more easily.

The same applies to children with low muscle tone. They become more alert and more interested, and their muscle tone increases. It's especially important with these children for the therapist to check the child's posture in the wrap.

While being carried, children experience a wide range of stimuli beyond just movement. Put yourself in an infant's shoes for a moment: the typical infant of modern civilisation spends most of their time in a cot or pram – only a few stimuli reach the child. A wrap baby, by contrast, is constantly moved, held close, rocked; hears voices and noise; smells food cooking on the stove; feels the wind on their face. The brain continuously receives a wealth of information, without this overwhelming the child, because they have the security of a safe environment to fall back on. Rich stimuli within a safe environment are genuine developmental impulses for the brain.

"Wrap Babies" Develop Faster, and Are Calmer and More Content

As a child develops their motor skills on the ground, the time they spend being carried decreases accordingly. Remarkably, wrap babies' development proceeds faster and more smoothly, even though they spend less time lying on the floor. It goes against previous theories, but it's a developmental advantage that should particularly benefit our children with motor difficulties.

Another positive effect is how content wrap babies are. They sleep blissfully and sweetly in the wrap, are more even-tempered, and startle less easily. What a blessing for many a strained mother-child relationship. How often are our problem children also "screaming babies", further burdened by daily bouts of "gymnastics" at home? Not infrequently, a more content child makes for more effective therapy.

Finally, My Answer to the Most Common Objections

1. Objection: The child gets too spoiled.

Researchers from the Max Planck Society's research unit for human ethology observed families on the Trobriand Islands off the east coast of New Guinea. Other scientists did the same with the !Kung in Botswana and the Inuit in the far north of Alaska. They came to the following conclusion: unlike here in Western industrial societies, infants and toddlers in traditionally living cultures enjoy almost constant physical contact with their mothers, fathers, and siblings. Yet the little Trobrianders, !Kung, or Inuit don't grow into spoiled tyrants. On the contrary: they become independent earlier than their peers in the USA or Western Europe.

2. Objection: Being carried causes postural damage, since the child first needs to go through certain developmental stages lying on its back and front, and rolling over, before its trunk muscles are sufficiently prepared.

By that logic, children carried by indigenous peoples would show postural damage at higher rates – no one has ever demonstrated this. On the contrary, a study by Kirkilionis of 192 carried children found that the rate of postural abnormalities in these children was below the average percentage. This puts an end to any further theoretical debate.

3. Objection: Yes, but carried children in developing countries tend to lie on the back of a mother bent forward working in the fields

For this objection to hold, every indigenous people that carries their children would have to practise farming. The American author Jean Liedloff describes, in her book, a very different life among the Yequana people in the jungles of Venezuela, with whom she lived for several years.

4. Objection: But carrying harms the spine of the person doing the carrying.

For parents with a pre-existing back condition, this may well be true. But if carrying starts within the infant's first days of life, the person carrying generally adjusts to the growing weight without any trouble. It becomes harder if you only start carrying a baby at 7 or 10 months old. Here too, guidance from us physiotherapists on correct movement patterns for parents is helpful.

5. Objection: The child doesn't get enough air

Here too, experience disproves this claim. Wrap babies develop well and show no signs of suffering from chronic oxygen deprivation. Their contentment and calmness likewise point to healthy, restful sleep in the wrap.

In light of all this, the theoretical objections to the wrap are refuted by the experience of many cultures. Johann Wolfgang von Goethe already recognised this dilemma of our Western culture: "Nature never trifles; she is always true, always serious, always severe; she is always right, and the errors and faults are always those of man."