Safety first! and why T.I.C.K.S is inadequate

The “only” thing that matters to me when I teach is safety. Whilst I do appreciate and understand the many facets of carrying (baby’s body, baby’s mind, person carrying’s body, person carrying’s mind, their relationship, their environment…) I have to trust that people will find the angle that matters to them, whether it aligns with my personal views and choices or not. The one thing I want everyone to prioritise is safety.

Having the “right” angle for the hips is no use if baby is slumping. Colour coordinating outfits and slings will not help if baby is not secure enough and falls off. You might know all the fancy finishes but can you reliably get baby off your back in a controlled way?

You may have heard of TICKS and if so you might wonder why the title of this blogpost is about its inadequacies…

When I teach the consultancy course, my students are usually already pretty fluent in carrying and the “rules”. I then ask them to tell me what TICKS stands for. 5 letters. 5 concepts? Do you know what they mean? Most people do not recall what they stand for…

Tight. If the carry is not tight, there is a risk of slumping for young/hypotonic babies and therefore potentially positional asphyxia, which could lead to death (pretty serious!). There is also a risk of falling off depending on how loose and where the looseness is.

In view at all times. This one has its limitations (back carries, vision impairment) but my understanding is that it is about monitoring and also about ensuring there is no hinderance to the airflow from covering, so again it is about breathing.

Close enough to kiss. Interestingly, this one is rather poetic but pretty unhelpful. Again, it doesn’t work when it comes to back carrying. Depending on your neck length and mobility, you may be able to kiss a baby who might already be too low, or unable to reach but there is no actual risk at that specific height (many posts where men carry lower and get a barrage of negativity when there may not be any reason to). So what’s the deal about height? I see several aspects. If baby is too high, it will make it difficult to navigate the space and will put your posture out of balance, this will increase the risk of fall. I consider the “safe” zone to be for the top of baby’s head to be under your chin. What’s the lower limit? When babies are small (prior to them having the ability to protect their own breathing), you want to ensure their breathing is above your squishables, so nose and mouth above soft tissues (breast, softer chests, fluffy clothing…). This means that if you have no squishables, you could carry lower… If baby gets in the way of your movement (legs hitting legs, or putting your posture out of balance for example), then it is too low for the “safe” zone.

Keep the chin off the chest. This one is very clear (at last!!) if baby’s chin goes onto their chest when baby does not yet have the ability to protect their own breathing, this may lead to positional asphyxia which as we discussed above could lead to death.

Supported back. This one is a repeat version of tight. Slumping risks are no jokes. I believe it was also the opportunity to bring information about upright carrying after the tragedies that happened in bag slings.

So in summary, TICKS is 5 letters that mostly encourage to protect breathing, babies not falling out and monitoring: 3 concepts.
I’m a big fan of simplifying. If you want to say 3 things, say 3 things.

but also……. there is so much more to safety! I would always encourage to risk assess: think of the changeability of the carrying and its individual components:

As the person carrying, you will be changing throughout the carry (mood, activity, patience, strength, and much more…).
The baby will also be changing throughout the carry and each baby is unique in its personality and physique (behaviour, activity, physical development, willingness to be carried, experience, etc…).
The sling will shift overtime. Fabric moves and stretches. Remember to adjust if necessary.
Depending on what you carry with and how you carry, you will find variations in secureness and easy access in case of emergency, etc…
And last but not least, the environment you are working in will have a big impact. Are you indoors or outdoors? Is it familiar? Does it change a lot? What is the ground like? What is the density of people and objects? The weather? etc…

So with varied risks come varied safety nets. Just like you adjust your walking alongside a toddler, you need to adjust your carrying awareness and responsiveness. Busy roads and empty fields do not get the same safety net…

Now, I don’t want to highlight the inadequacies of the TICKS guidelines without offering alternatives, so here is a model that CalmFamily and Slingababy have put together. Please find links at the end of this article for the printable pdfs and use freely as long as it is whole and with the credit.

This safety leaflet works as a traffic light: the reds are the most important parts to remember, the oranges are aspects to be cautious over, the greens are to do with positioning and comfort

If you were to only remember 3 words, make it the ABS: Aware, Breathing and Secure.

Aware: remain attentive and responsive. If it feels wrong, it is wrong. Remember babies need us to do the risk assessment!
Breathing: young babies are at risk of positional asphyxia. That’s when their airway can become obstructed by slumping. It’s a big deal and can end in tragedy, so make sure that baby’s chin is away from their chest and that they get plenty of airflow.
Secure: hold your baby until you feel you can rely on your carry. Make sure your baby is kept close and in a sustainable position. If baby is not secure, you must take action. Re-tie and re-adjust as necessary and if in doubt, get baby out!

The next part is about cautions and checks. It is the part where you apply common sense and apply your risk assessment. Remember, if in doubt, take action, increase your safety net, get baby out of the sling if it doesn’t feel right and you cannot adjust it to feel right.

The cautions:

Protect from the elements: that means if the weather requires protection, adapt it for your baby and the parts of their body that are covered (or not) by the sling.
Practice safe sling sleep: If you want to nap with your baby, remember that you won’t be aware so unless someone has taken over safety whilst you snooze, we suggest you get your baby out and explore safe sleep options.
Sober enough: if you are too tipsy/drunk to look after your baby, then you are not fit to carry.
Appropriate activities only: each situation is different. Risk assess, adjust your safety net, think of the potential dangers and explore alternatives
Regulate temperature: one layer of sling is one layer of clothing, on the parts of baby that are covered. Check baby for overheating in the nape of the neck. Favour natural fabrics and keep baby close.
Avoid over-stimulation: you know your baby and circumstances best. Remember that everything is new for babies and they can get overwhelmed easily. Stay responsive.

The checks:

Sling fit for purpose: is it in good condition? free of toxic dyes? age and size-appropriate?
For hazards around you: remember to always risk assess! Your environment might be changing all the time.
Everyone is hydrated: remember to drink and to keep baby hydrated too.
With a carrying professional if unsure: the internet is full of good intentions but sometimes the delivery or lack of understanding of individual needs can lead to inadequate support.

The final part is about positioning and comfort. Sometimes you may choose to dismiss some aspects for reasons that are true to you or you child (remember, it depends!).

Child development and comfort (aka Positioning):

Neck supported: young babies have low muscle tone and need help to support their heads up in a way that keeps their airway protected. This can be done with tilting their pelvis so their heads rest onto your chest or with soft cushioning behind their necks
Smooth material on the spine: if you have a wrinkled sling it might hide some slack which can hinder the adequate support as well as being less comfortable.
Knee to knee: do you know that there are tendons behind the knees that help protect baby’s blood flow?
Hands up: babies love putting their hands in their mouths and on their faces
Tilted pelvis: this helps bring the weight baring part onto their tail bone and also with the support of their spine (and also neck)
Feet free to move: need I say more?

Carer comfort and safety:

Relaxed shoulders: can you smooth fabric? can you bring the pressure away from your neck towards the outside of your shoulders?
Knot placement: play around with how you tie your sling, you may find some places mor comfortable than others.
Material smooth: the more you can spread the fabric, the more it spreads the weight of your child
Comfortable footwear: carrying babies can be demanding to your body. You also want to ensure you can control how you move into the space
Centre of gravity: the closer baby is to you, the closer your collective centre of gravity is, so play around with height of carrying to ensure a comfortable carry.

Following some feedback, we are tweaking and adding new visuals to support the ABS of carrying safely. Here are the ones currently available: