New babies need to lie flat, rather than being propped up on an inclined seat or ‘scrunched’ into a bucket-shaped seat. The lie-flat position allows them to breathe optimally and get all the oxygen they need, and it’s also the best lying-down position for encouraging their spine and hips to develop properly.
How does the lie-flat position help my baby’s breathing?
When your baby is lying flat in a pram, her lungs are not constricted and therefore her oxygen saturation (the percentage of haemoglobin-binding sites in her bloodstream occupied by oxygen) should not be compromised.
As your baby’s lungs are last to develop in the womb, it’s important that the lungs get all the help they can after your baby’s born. Studies have shown that a baby’s oxygen saturation can be affected, however, by lying in a position that isn’t flat.
Research carried at Bristol University and funded by the Lullaby Trust, the charity that campaigns for safer sleep for babies, suggests that putting a baby in a seating position with a 40-degree incline (typical of a car seat) “leads to significantly increased heart and respiratory rates, and decreased oxygen saturation”. In a lie-flat position, no similar negative effects were noticeable.
This doesn’t mean that you should never put your baby in a car seat – that would be extremely impractical for most of us. But, as Francine Bates, chief executive of the Lullaby Trust, says, we should keep a watchful eye on babies travelling in a car seat and avoid driving long distances without a break. Many new parents now stick to the 2-hour car-seat ‘rule’.
Most importantly, we shouldn’t use a car seat as a place for our baby can sleep. As, Dr Renu Arya, who led the Bristol University research when she was a Consultant Paediatrician at Great Western Hospitals NHS Foundation Trust, says: “Our findings support the American Academy of Paediatrics guideline that infant car seats should not be used as a routine infant sleep environment.”
How does the lie-flat position help my baby’s spinal development?
A lie-flat position helps the spine develop in the correct way, says Hannah Spink, Specialist Paediatric Physiotherapist at Bumble Bee Physio in London.
“For a baby’s spine to develop naturally in the way it’s supposed to, we should aim for a lie-flat position,” she says. “In a lie-flat position, the hips will naturally turn into external rotation and abduction, which is the point where the hips are contained within the socket. If you force a baby to sit up [in a pram or car seat], then you could potentially compromise that position.”
So, does this mean I need a pram with a carrycot?
It depends on the pram that you buy. If it doesn’t have a lie-flat seating option, then yes, you need a carrycot.
A carrycot is a lie-flat, bed-style carrier, specially designed for newborn, with solid high sides, a hood, a handle – and often an integrated sunshade and/or viewing panel.
Carrycots are most often bought as a separate unit from the pram itself. They attach via adaptors, allowing you to take them on and off the pram frame – and replace them with a seat unit when your baby is old enough to sit up in the pram.
What about a buggy with a cocoon?
Some buggies, such as the Babyzen YoYo or the Phil & Teds Vibe double buggy, offer a cocoon as their lie-flat option.
Similar in shape to a carrycot, a cocoon is typically smaller in size, narrower, with lighter, less rigid fabric/quilt-style sides. Cocoons are often attached to the buggy frame using clips, Velcro or hooks.
What if the pram has a fully reclining seat?
If you purchase a pram/buggy/pushchair that has a fully reclining seat which the manufacturer states is suitable from birth, then you won’t need an additional carrycot or cocoon.
We suggest you have a good look at the fully-reclined seat, before you buy, just to see how flat it really is. As paediatric physiotherapist Hannah Spink says, “The flatter the better – as flat as it can be!”
What about travel systems?
A travel system is a buggy frame that comes with a car seat that will fit on it. You may well be able to buy a compatible carrycot and seat unit, too, as part of a ‘bundle’.
If you opt not to buy a bundle, it can be tempting to put the car seat on the buggy frame and use it for prolonged periods of time as your ‘pushchair’ (it’s so easy to transfer your baby from the car that way).
But it’s important to note that car seats should not be used in this way for too long. The recommendation is that a car seat should be used for no longer than 2 hours.
At what age can my baby sit up in the pram seat?
You should wait until your baby is able to sit up by herself, as the NHS guidance states: “Pushchairs, also known as strollers and buggies, are only suitable for young babies if they have fully reclining seats, so your baby can lie flat. Wait until your baby can sit by themselves before using another type of pushchair.”
And ensure that you meet the buggy manufacturers’ minimum age or weight requirement before moving her on to a seat unit.