虽然我已经在背戴基础系列文章中翻译了很多英文资料，说明了背戴宝贝的注意事项和好处，但还是经常收到一些客户的疑问，比如“新生儿可不可以竖背？是不是必须摇篮背？”这样的最基础的问题。
为了更好地集中回答一些基础性的问题，也为了结论更加权威，我特地进一步收集了科学研究和论文、书籍列出的观点。
在下面，我列出我的总概括，然后给出文献的摘要和出处。如果你不满意我的翻译，可以直接看英文（甚至可看全篇原文）。反之，如果嫌弃文章太长，可以只看我每一节开头的总结以及图片，想多看点的可以再看看我的每一段的翻译。
内容包括：
长时间平躺的风险？
为什么要抱孩子？
竖抱竖背安全吗？
为什么竖背？
总结和展望
长时间平躺的风险？
长时间躺着的的风险：
导致扁头综合征（头部某个部位长时间受压，重力会使得那个部位变得扁平。越小的宝宝头骨越软越容易扁平。）；
平躺时候伸直双腿，可能对于髋关节的发育不利；
婴儿自然弯曲的C型脊柱被迫伸直；
II-2级证据
美国儿科学会的研究显示，长时间躺在床上或推车上，重力会使得接触床面的身体部位变得扁平（扁头综合征），并减退肌肉张力。
Research backed by the American Academy of Pediatrics states that “with prolonged immobilization on a firm mattress or a flat bed (as in a stroller), the constant influence of gravity flattens the body surface against the mattress producing positional disorders and infants with decreased muscle tone”.
----Short, M. (1996). The Effects of Swaddling versus Standard Positioning in Very Low Birth Weight Infants.Neonatal Network. 15(4).from http://www.cebp.nl/vault_public/filesystem/?ID=2156
II-3级证据
很多家长喜欢让小婴儿在婴儿摇椅、安全座椅中长时间睡眠，因为在那里“他们睡得更好”。抬高的头部位置能够减轻胃食管返流，让宝宝睡得更香。在婴儿清醒状态下，可能继续躺着玩耍——很多宝宝会喜欢电动摇椅、秋千的摇晃，玩婴儿健身架，或者喜欢坐汽车去兜风。虽然这些工具能给家长减轻一些负担，但家长们必须警醒这些工具可能给孩子的头部造型带来的影响。
在出生后的头5个月之内，在婴儿摇椅或者婴儿汽车上长时间睡觉的婴儿，他们的头颅变形比平躺在床垫上的婴儿更加复杂。在这些设备中的活动自由度比在床上更少。在这种坚硬的，有坡度的表面上，婴儿的后脑勺会变得平且长，形成“长斜坡”，脑袋的后半部高度明显增加。
另外婴儿往往因为脖子缺乏力量，无法控制头部在有坡度的躺椅中居中放置，头部常常歪斜在一侧，靠在安全座椅的侧边，导致左右两侧的头颅被压平，形成“方形”脑袋。另外由于头部歪斜睡眠时候，肩膀挤压耳垂，耳骨也出现了畸形。
We are aware that because many infants are quite content in their car seats or swings, well-intending parents respond by leaving them there and orienting toys or other entertain-ment to accommodate. Battery-operated swings, although they provide some relief for the parent, are probably used in greater frequency and for longer periods than their old hand-crank predecessors.
In those infants who were reported to have slept in car seats or swings for long periods of time (often the first 3 to 5 months of life), the resulting deformity took on a very dis-tinctive look (Figures 1 to 3). In fact, in many of these cases, our clinicians were actually able to identify the infants who had slept in these devices before the parents disclosed this information. The cranial distortion results from the unique restrictions placed on infants while they are in these devices. The surface presented to the infant’s occiput is much more rigid and unyielding than a mattress and is often oriented at an angle to the back of the head. When the head rests against this hard, sloping surface for long periods, a brachycephalic configuration is most frequently the result. The occiput in this situation, however, is not just flattened uniformly, as in brachycephaly, but often can develop a superior-posterior slope and an associated increase in posterior head height.
Another feature frequently observed in these infants is a “squaring”or “cornering”of the back of the head. When placed in these devices as newborns, the infants have very malleable craniums and have not yet developed sufficient head and neck control to maintain their heads in midline against gravity. Subsequently, the head often comes to rest in a corner of the car seat or swing, where it is restricted along two planes. The resulting deformity is a squaring of the parietal-occipital region and compensatory growth on the contralateral side resulting in asymmetrical head height. This situation is further exacerbated by the presence of a torticollis, which again does not allow the infant to maintain its head in midline.
In conclusion, although “normal”use of infant car seats and swings should not be considered a significant risk factor for the development of deformational plagiocephaly, it is important to recognize that the potential does exist to deform the cranium with extended use of these devices. We have demonstrated several examples in which this has occurred. The resulting deformity can often be more complex than what is traditionally seen from plagio- cephaly resulting from sleeping supine on a mattress; in the last several years, we have observed a number of infants whose heads seem to have been deformed in this manner.
----Littlefield, T. R., 2003, Car seats, infant carriers, andswings: Their role in deformational plagiocephaly, J. Prosthetics &Orthotics, v. 15(3), p. 102-106.
以上三个婴儿照片均来自本篇论文。
III级证据
让婴儿躺着，会使得婴儿自然弯曲的C型脊柱被迫伸直。研究显示让婴儿的脊柱伸直并不是一个很好的生理学姿势，不但会给脊柱带来压力，而且对于婴儿髋关节的发育不利。
髋关节脱位示意图（重点看圆圈中内容）
上图来自国际髋关节学会网站
Laying your infant flat on his back stretches the c-curved spine into a straight line, against his natural shape. Research shows that keeping an infant’s spine straight is not a sound physiological position. In addition to stressing the baby’s spine it can also negatively influence the development of your baby’s hip joints.
----Kirkilionis, E. (2002). Carrying an Infant: More than the Possibility of Child Transport. Kosel.
III级证据
在一天中多数时间躺着，不利于髋关节发育，还很可能导致扁头综合症、和低肌张力。
Not only is spending most of the day flat on your back bad for your hips but infants who lie frequently on their backs in a stroller may end up with plagiocephaly (deformed skulls, flattened on the back or side) and deformed bodies with poor muscle tone (Bonnet,1998).
----Bonnet, E.. (1998 ). In Points made during discussions regarding the carrying of Infants and small children, Published in Krankengymnastik 50 Jg (1998) No.8
III级证据
用推车推着宝贝在街区中散步几次，并不会会给宝贝的生理发育带来浩劫。但一个真实的数据是，在西方，3周到3个月大的婴儿，平均每天被抱着的时间只有2.5小时。
This does not mean that laying flat for a couple of walks around the block in a stroller is going to wreak havoc on your baby’s physical development. But the truth is that the average Western infant between three weeks and three months of age is carried a little more than two and a half hours a day.
----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.
III级证据
推车本身并不是坏东西，背戴宝宝和使用推车并不互斥。但婴儿在推车中最好能面朝家长，一旦他发出想要被抱的暗示，家长就能及时回应并满足。
Strollers are not “bad” per se. To go further, babywearing and strollers need not be mutually exclusive as long as an infant is content and his cues are responded to when he signals that he needs to be held (seated and facing his mother is preferable to encourage interactions and communication)
----Zeedyk, S.. (2008). What’s Life in a Baby Buggy Like? The Impact of Buggy Orientation on Parent-Infant Interaction and Infant Stress.
为什么要背孩子？
多抱多背孩子，好处多多：
婴儿可充满安全感，安静而警觉地认识世界；
更少的哭闹；
刺激前庭，增加空间安全感；
和母亲在一起时候免疫力增强；
有助于预防扁头综合征；
背着孩子可以实现肌肤相亲的袋鼠式照料，对于早产儿是一种安全健康的照料方式。可以让孩子温暖，稳定心率和呼吸，延长睡眠时间，延长安静警觉的时间，减少哭闹，增加体重增长，增加哺乳。
和婴儿的亲密接触不止是情感需求，它对于婴儿就像空气一样重要。
I级证据
传统早产儿的照料方式是母婴长时间分离，婴儿在恒温箱中照顾。最近的研究显示这样有负面影响。母婴肌肤接触的方式可作为一种替代，对于指标稳定的早产儿有已被证实的好处。论文开展了一个非盲的随机临床试验，34个低体重婴儿参与了试验。结论是采用肌肤相亲的袋鼠照顾法的新生儿，比起用恒温箱照顾的，临床指标更好更稳定。
袋鼠照料和恒温箱方式的利弊对比
点击图片可以查看大图
图片来自internewskenya.org/dataportal/data/59
AIM:Conventional care of prematurely born infants involves extended maternal-infant separation and incubator care. Recent research has shown that separation causes adverse effects. Maternal-infant skin-to-skin contact (SSC) provides an alternative habitat to the incubator, with proven benefits for stable prematures; this has not been established for unstable or newborn low-birthweight infants. SSC from birth was therefore compared to incubator care for infants between 1200 and 2199 g at birth.
CONCLUSION:Newborn care provided by skin-to-skin contact on the mother's chest results in better physiological outcomes and stability than the same care provided in closed servo-controlled incubators. The cardio-respiratory instability seen in separated infants in the first 6 h is consistent with mammalian 'protest-despair' biology, and with 'hyper-arousal and dissociation' response patterns described in human infants: newborns should not be separated from their mothers.
Bergman, N. J., Linley, L. L., & Fawcus, S. R., 2004, Randomized controlled trial of skin-to-skin contact from birth versus conventional incubator for physiological stabilization in 1200 g to 2199 g newborns., Acta Paediatrica, v. 93, p. 779-785. http://www.ncbi.nlm.nih.gov/pubmed/16373290
I级证据
婴儿的哭泣通常从0-6周逐渐增加，之后在4月龄以内逐渐减少。在这些哭泣中以夜啼居多。这些“正常”的哭泣，可以通过增加背或抱宝宝的次数减少，也就是说，除了喂奶，和响应宝宝的哭泣之外，还要尽可能多地抱宝宝。在一个随机对照的实验中，99对母婴被分成两组，一组增加背抱孩子，另一组控制背抱次数。在哭泣的巅峰——宝宝6星期大时，多被背和抱的那组孩子哭闹总体减少43%（其中夜间哭闹减少51%）。哭闹的减少与婴儿满足感的增加以及哺乳频率的增加有关。哺喂的时长和睡眠时间与背和抱孩子的时长没有相关性。
The crying pattern of normal infants in industrialized societies is characterized by an overall increase until 6 weeks of age followed by a decline until 4 months of age with a preponderance of evening crying. We hypothesized that this 'normal' crying could be reduced by supplemental carrying, that is, increased carrying throughout the day in addition to that which occurs during feeding and in response to crying. In a randomized controlled trial, 99 mother-infant pairs were assigned to an increased carrying or control group. At the time of peak crying (6 weeks of age), infants who received supplemental carrying cried and fussed 43% less (1.23 v 2.16 h/d) overall, and 51% less (0.63 v 1.28 hours) during the evening hours (4 PM to midnight). Similar but smaller decreases occurred at 4, 8, and 12 weeks of age. Decreased crying and fussing were associated with increased contentment and feeding frequency but no change in feeding duration or sleep. We conclude that supplemental carrying modifies 'normal' crying by reducing the duration and altering the typical pattern of crying and fussing in the first 3 months of life. The relative lack of carrying in our society may predispose to crying and colic in normal infants.
----Hunziker, U. A., & Barr, R. G., 1986, Increased carrying reduces infant crying: A randomized controlled trial., Pediatrics, v. 77(5), p. 641-648.http://www.ncbi.nlm.nih.gov/pubmed?term=Increased%20carrying%20reduces%20infant%20crying
其它相关文献：
II-2级证据
5、Barr, R., et al., 1991, Crying in !Kung San infants: a test of the cultural specificity hypothesis., Dev. Med. Child Neurol., v. 33, p. 601-610.http://www.ncbi.nlm.nih.gov/pubmed?term=Crying%20in%20!Kung%20San%20infants
II-1级证据
采用袋鼠照顾法的新生儿的睡眠时间，比没有采用袋鼠照顾法的婴儿明显增加。在袋鼠照顾期间，新生儿情绪更好，呼吸和心率更稳定，血氧饱和度也保持稳定。
There was a significant increase in sleep time for the neonates during K Care as compared to when they were not receiving K Care. The neonates exhibited less agitation, apnea, and bradycardia episodes and maintained stable oxygen saturation during K Care.
----Messmer, P. R., Rodriguez, S., Adams, J., Gentry, J. W., Washburn, K., Zabaleta, I., & Abreu, S., 1997, Effect of Kangaroo care on sleep time for neonates., Pediatr. Nurs., v. 23(4), p. 408-414. http://www.ncbi.nlm.nih.gov/pubmed?term=9282055
II-2级证据
从出生头一个月就开始背着，每天至少背一个小时的宝宝，到2个月和五个月大的时候，仍旧吃母乳的概率比没有被背着的孩子更高。
This study investigated whether the use of baby carriers with term infants during the first month of life is associated with increased breastfeeding rates. It found that infants carried for at least one hour per day during the first month of life breastfed more frequently at two and five months than those who were not carried.
----Use of baby carriers to increase breastfeeding duration among term infants: the effects of an educational intervention in Italy, A Pisacane, P Continisio, C Filosa, V Tagliamonte, G I Continisio 2012
III级证据
背着宝贝能够锻炼脖子和核心肌肉的力量。当孩子头部还未稳定时，在背巾中可以尝试短暂的控制头部，比如转个方向看世界，当疲劳的时候就可以把头靠在妈妈的胸口。父母也可以很方便的帮助孩子变换头部朝向。
背着宝贝有助于预防和矫正扁头综合征，原理是避免头部某个部位长时间受压。矫正头型的原理是多多变换姿势，避免长时间受压，尤其是应该最小化在推车摇椅等平躺器具当中的时间。虽然很多儿科医生建议通过每天半小时的tummy time来帮助矫正头型，但是很多新生儿并不太喜欢趴着，且每天能够趴着的时间也很有限。手抱孩子容易疲劳，背着孩子能够很大程度上延长头骨不受压力的时间，帮助矫正头型。
抱新生儿的六种姿势，注意对头部和背部的支撑
图片来自WikiHow，How to hold a baby
When you wear your baby, he is working neck and core stability. Another benefit that babywearing can provide is repositioning the baby’s head. When you are wearing your child in a carrier on your front, most babies will try and practice holding their heads steady for short periods to look at the world around them. They may rest one check or the other against your chest as their neck muscles begin to tire out. This has the added benefit of the parent being able to reposition the baby’s head from one side to the other, thus gently stretching his neck muscles, which is a recommended treatment for torticollis (asymmetrical tightening of the neck muscles). What the baby is not doing is resting any pressure on the back of the head.
Another of the recommendations from the literature on the prevention of plagiocephaly is that infants should spend as little time as possible in positioning devices like swings, bouncers and car seats (when not riding in the car) which put pressure on the back of the skull. Once again, wearing the infant prevents putting pressure on the infant’s developing skull. In general, the use of cranial molding orthotics (helmets) is only indicated when repositioning and/or physical therapy has not produced desired results.
In many cases, babywearing can achieve the goals of repositioning (keeping pressure off the flattened area of the infants head) in a manner that is not just tolerable, but enjoyable for all parties involved.
----Talking Heads: An Occupational Therapist’s Perspective on Positional Plagiocephaly and Babywearing, Sara Kift 2015
III级证据
对于早产儿，肌肤相亲的袋鼠式照料在西欧广泛流行，早产儿只穿着纸尿裤，拥抱在母亲获母亲怀中，肌肤贴着肌肤。西欧和美国的研究数据显示了这种方式的安全性和有效性。通过这种方式，婴儿足够暖和，并且有更规则的心率、呼吸，更深的睡眠和安静的警觉，更少的哭闹，没有增加感染的风险，更好的体重增长。并且有助于更多的乳汁分泌和更长久的哺乳。父母和婴儿紧密相连，更加自信能照顾好他们。
Skin-to-skin ('kangaroo') care for preterm infants is becoming widespread in Western Europe. During this care the mother holds her diaper-clad premature infant against her skin beneath her clothing and allows self-regulatory access to breast-feeding. Fathers hold their infants skin-to-skin also. Research projects in Western Europe and the United States provide data that support the safety and effectiveness of this method. Infants held skin-to-skin are warm enough and have regular heart rate and respirations, more deep sleep and alert inactivity, less crying, no increase in infections, greater weight gain, and earlier discharge. Lactation is more productive and of greater duration. Parents become attached to their infants and feel confident about caring for them. This research is summarized and annotated in a table, along with descriptive reports and videotapes. These data can be used by health care professionals to make informed decisions about offering kangaroo care opportunities to selected parents and their preterm infants.
----Anderson, G.C., 1991, Current knowledge about skin-to-skin (kangaroo) care for pre-term infants, J. Perinatol., v. 11(3), p. 216-226.http://www.ncbi.nlm.nih.gov/pubmed/1919818
III级证据
抱着，轻轻摇晃或摇摆可以刺激婴儿的前庭，使得他们的空间安全感更好。多数婴儿，一天大多数时间都离开母亲在各种摇椅推车中度过，会使得他们长大后容易头晕（因为前庭刺激不充分），并且容易缺乏空间中的安全感（比如恐高，害怕坐飞机等）。
Carrying, rocking and swaying stimulate an infants’ vestibular apparatus and helps them to feel secure in space. Most babies today spend most of their day apart from their mothers in a container or in a stroller leaving them prone to vertigo, and a feeling of physical insecurity in space in general. Interestingly enough, the fear of flying and the fear of heights which plagues many of today’s adults can often be traced back to not being carried as an infant. Carried babies feel secure and are less apt to develop space related phobias.
----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.
III级证据
和母亲分开的时候，婴儿的免疫力下降。它的身体产生的白细胞减少。当母亲重新和他相聚，他的免疫力又重新增强。
Upon being separated from his mother, a baby’s immune system weakens. His body literally stops producing as many leukocytes. But when mother rejoins him, he strengthens again (Montagu, 1986).
----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.
其它相关文献：
III级证据
Durand, R., Hodges, S., LaRock, S., Lund, L., Schmid, S. Swick, D., et al., 1997, The effect of skin-to-skin breast-feeding in the immediate recovery period on newborn thermoregulation and blood glucose values., Neonatal Intensive Care, v. 10, p. 23-29.
III级证据
当远古我们还是猎手和植物采集者的时候，婴儿总是由母亲抱着。虽然文明在变化，但是婴儿与母亲近距离接触的需求没有改变。婴儿需要母亲的亲密拥抱，以感到安全，他们的生理发育，心理发育，大脑发育都有赖于此。和婴儿的亲密接触不止是情感需求，它对于婴儿就像空气一样重要。
“Virtually all of our biochemistry and physiology are fine-tuned for the conditions of life that existed when we were hunters and gatherers, in which babies were held by their mothers,” McKenna writes. Our culture may be changing, but our evolutionary need for touch remains the same. Babies’ brains have evolved to expect closeness and proximity-to be held-for their safety, their psychological growth, physical growth, mental growth, to aid and stabilize their physiological processes and keep their immune systems strong” (Field, 69-74). “Touch is not an emotional fringe benefit. It’s as necessary as the air we breathe” (Heller, 5)
----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.
其它相关文献：
II-1级证据 Anisfeld, E., Casper, V., Nozyce, M., & Cunningham, N., 1990, Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment., Child Dev., v. 61(5), p. 1617-27. http://www.ncbi.nlm.nih.gov/pubmed/2245751
II-3级证据 Christensson, K., Cabrera, T., Christensson, E., Uvnäs–Moberg, K., Winberg, J., 1995, Separation distress call in the human neonate in the absence of maternal body contact., Acta Paediatr., v. 84(5), p. 468-73. http://www.ncbi.nlm.nih.gov/pubmed?term=7633137
II-1级证据 Christensson, K., Siles, C., Moreno, L., Belaustequi, A., de la Fuente, P., Lagercrantz, H., Puyol, P., & Winberg, J., 1992, [Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot]., Jordemodern. v. 105(11), p. 397-9. http://www.ncbi.nlm.nih.gov/pubmed/1464561
III级证据
我们的身体就像一个感官聚宝盆，那些微笑的温暖、芬芳的气味和开怀大笑的震颤，伴着爱抚的触摸，将整个感官世界呈现在我们怀抱的婴儿面前，触手可及。婴儿通过和我们的肌肤接触获得触觉刺激，通过它的小手小脚和我们身体之间的压力感而获得本体感。当我们哺乳时候，她获得了触觉、味觉和嗅觉的刺激，并通过我们身体的移动获得前庭刺激（当竖背哺乳时候，宝宝努力平衡头部位置以吃到奶，也可锻炼前庭）。当婴儿四处观察时获得视觉刺激，当我们温柔耳语时候获得听觉刺激，当我们变换背戴姿势时候获得肌肉运动的刺激。反之当我们把婴儿放置在各种容器中的时候（比如推车、床），尤其是当我们看不见婴儿的脸的时候，这些丰富的感官滋养都不再有。
“Our body is a sensual cornucopia where smiles, aromas and laughter mingle amid undulating caresses that put the entire sensory world at our baby’s fingertips. Our baby gets tactile or cutaneous stimulation from our skin touching hers and proprioception from the pressure of her limbs flexed into our body. She gets tactile, olfactory, and gustatory stimulation if we nurse, of our milk, and vestibular stimulation from the gentle stimulation of our movements and, when held upright, from her efforts to right her head and maintain her balance. She gets visual stimulation when she looks all around her, auditory impulses as we whisper endearments, and kinesthetic stimulation as we change her to the other side… when we put our babies in a container, and especially if out of sight all of this sensory nourishment is lost.” (Heller,112)
----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.
III级证据
让新生儿离开妈妈，自己躺着，是对于孩子的误解。新生儿渴盼被紧紧拥抱并随着母亲轻轻摇晃，通过和母亲连续的触觉接触和温暖的身体支持，随着妈妈一起逐渐认识更广阔的空间。
“To remove the newborn baby from his mother and place it on its back or on its front on a flat surface, often uncovered is to fail to understand the newborn’s great need for enfoldment, to be supported rocked and covered from all sides, and that the infant may only gradually be introduced to the world of more open spaces. From the supporting, continuous, tangible presence of his mother the infant will gradually come to move some distance toward the outside world”.
----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.
竖背竖抱安全吗？
正确的竖背是安全的。
正确的竖背，给予孩子的全身均匀而良好的支撑，能够非常好地贴合孩子当前阶段的自然生理造型。正确的竖背并没有强迫新生儿竖脖子或独坐，因为有足够的外界支撑，婴儿的脊柱从造型到受力情况都是符合阶段发展规律的。
不同月龄的宝宝在背巾中的透视图
可以竖背多久？理论上正确的竖背多久都不会损伤脊柱（但是需要留意孩子的意愿，如果他不想再被背着也要及时响应，建议每次最多2小时左右就换个造型，或者可以手抱一会，或者就把孩子放下来）
什么是正确的竖背？各个月龄段孩子造型如图，具体安全守则请看背戴宝贝（baby wearing)基础系列——Safety（安全要点），具体工具如何使用才能正确还需要背戴指导。
I级证据
通过多达14个随机对照实验得出结论。证实了使用袋鼠照顾、用手臂抱和用背巾正确背，对于早产儿和足月新生儿，都是安全的。
对于早产儿可以缩短住院时间，减少发病率，更高的纯母乳率和更长的哺乳延续时间，更好的体重增长，父母更自信。对于足月新生儿，好处包括更好的生理状态和运动协调性，更好的温度适应性，更好的镇痛效果（比如肠绞痛）。软结构的背戴工具，使得母亲更容易响应孩子被抱的需求，并且更安全地抱着孩子。因为这些好处，应该鼓励母婴肌肤接触，手臂抱以及安全的背戴孩子。
In sum, safety has been adequately demonstrated for all types of holding (kangaroo care, in-arms and in a sling). There is strong evidence to support the use of kangaroo care for preterm babies with benefits that include shortened hospital stay, decreased morbidity, higher exclusive breastfeeding rates/longer breastfeeding duration, increased weight gain, improved state regulation, and improved maternal sense of competence. Evidence-based benefits of KC for term babies include improved state organization and motor system modulation; improved extrauterine temperature adaptation; and an analgesic effect. No serious deleterious effects were reported. Simple holding, without the skin-to-skin contact, was found to reduce crying, and the provisions of soft carriers led to mothers who were more responsive to their babies and to babies who were more securely attached. Given the many benefits of physical contact between mother and baby, it appears reasonable to encourage this essential practice of holding – promoting skin-to-skin contact, inarms holding, and holding in a soft baby carrier, as a matter of course in the care of new babies (both premature and term) and their parents.
----HOLD ME CLOSE: ENCOURAGING ESSENTIAL MOTHER/BABY PHYSICAL CONTACT,Excerpt from Blois, Maria Blois, MD,“Birth: Care of Infant and Mother: Time Sensitive Issues.” Best Practices in the Behavioral Management of Health from Preconception to Adolescence, edited by William Gordon and Jodie Trafton. Los Altos: Institute for Disease Management. 2007-8. pp. 108-132
I级证据
上图为双胞胎早产儿，图片来自英文维基kangoroo care词条
一项在医院中进行的公开的随机对照试验。1084名体重小于2kg的婴儿被追踪，其中有746名被分为两组，382名采用袋鼠式照顾法，其余364名采用传统恒温箱的照顾方式。382名袋鼠妈妈照顾式的宝宝，每天24小时以竖抱的姿势，肌肤贴肌肤在母亲胸前，并用一块布料妥当固定住婴儿。其余364名婴儿待在恒温箱中直到达到出院条件。两组婴儿之后都被跟踪直到12个月的矫正月龄，其中有90%的测试婴儿在12个月时候可被用于评估。报告数据包括死亡率，感染报告，早产儿出院后的再次住院情况，以及生长情况和哺喂方式。
结果：两组婴儿的生长指标基本一致。恒温箱组婴儿的尿路感染频率更高，袋鼠妈妈照顾法一组的婴儿达标出院后，重新住院的时间更少。
结论：袋鼠式照料法对于临床指标稳定的低体重新生儿是安全的。
BACKGROUND:
In 1978, kangaroo mother care (KMC) was proposed as a caring alternative for low birth weight (LBW) infants. We are reporting here early outcomes of a randomized, controlled trial comparing KMC to traditional care.
An open randomized, controlled trial was conducted in a large tertiary care hospital. All newborn infants </=2000 g, surviving the neonatal period and being eligible for a minimal care unit, were included. A total of 1084 newborns </=2000 g were followed, and 746 were randomized-382 to KMC and 364 to traditional care. KMC infants were discharged after randomization, regardless of weight or gestational age. Infants spent 24 hours per day in an upright position, in skin-to-skin contact, and attached to the mother's chest. After randomization, control infants remained at the minimal care unit until meeting usual discharge criteria. Both groups are being followed up to 12 months of corrected age; 679 (90%) were available for evaluation when they reached term (40 to 41 weeks of postconceptional age). The present paper reports early outcomes (when reaching term) including mortality, infectious episodes, hospital stay after eligibility, and growth and feeding patterns.
Both study groups were similar regarding all baseline variables but weight at eligibility. The risk of dying was similar in both groups (relative risk = 0.59, 95% confidence interval 0.22-1. 6). There were no differences in growth indices. Nosocomial infections were more frequent in control infants. Hospital stay after eligibility was shorter in KMC, primarily for infants </=1800 g.
These results show that KMC is a safe approach to the care of clinically stable LBW infants. Our findings provide the necessary scientific support to a method that is already incorporated in the care of LBW infants at many hospitals around the world and at different levels of care.
----Charpak, N., Ruiz-Pelaez, J. G., Figueroa, Z., & Charpak, Y., 1997, Kangaroo mother versus traditional care for newborn infants </=2000 grams: A randomized, controlled trial., Pediatrics, v. 100(4), p. 682-688. http://www.ncbi.nlm.nih.gov/pubmed/9310525
II-1级证据
新生儿喜欢保持一种自然蜷缩的造型，他的膝盖会自然收起到他的胸部下方。
Newborns are almost impossible to stretch out unless wrapped or swaddled. When you place an infant flat on his back, his thighs will usually be pulled up towards his chest.
----Schon, R. (2007). Natural Parenting-Back to Basics in Infant Care. 5(1), 102-183. from Evolutionary Psychology from http://www.epjournal.net/filestore/ep05102183.pdf
II-2级证据
给予婴儿腿部背部良好支持，符合生理学的竖背工具，就像妈妈的手臂自然拥抱宝宝的造型一样，并不会损害孩子的脊柱和腿部。
Upright baby carriers that support the legs, carrying a baby as a mother would naturally would in arms, does not compromise a baby’s spine or hips.
----Kirkilionis, E. (2002). Carrying an Infant: More than the Possibility of Child Transport. Kosel.
II-2级证据
当一个孩子，在合适的背戴工具中，竖立地，面对面地，以合理的造型包裹在家长身上，布料给予均匀的牢固的包裹，以保证小宝宝既不会陷入布料中（导致脊柱过度弯曲），也不会阻碍呼吸。这样有背巾的支持，孩子可以以大宝宝的视角来竖立地观察世界，并安全地尝试控制自己的头部。
“a child .. placed upright in a suitable baby carrier or embraced firmly and properly in a wrap, supported and upright against the body of the parents, firmly embraced by the fabric, which ensures that even the smallest little one will not sink into himself ending in an over-curvature of the spine, staying out of the danger zone of the little head being forced into a position that will compromise the breathing. The upright supported posture allows even very small babies moving patterns that are usually not seen until two to three month later. Free from the chore of controlling and holding his little head while trying to stabilize against gravity, an infant secured in a wrap for example can hold and turn his own head early on.”
----Dr. Evelin Kirkilionis, Deutsch Hebammenzeitschrift 7/2010
III级证据
腹部贴腹部拥抱宝宝，可以减少婴儿的腹部暴露于外界，有利于婴儿的体温调节，减少能量消耗，更好消化食物。另外还能够保护他们的感觉器官和重要身体器官。
Infants use less oxygen which conserves energy and waste less calories. They digest their food better. It is also the best position for thermoregulation because of reduced stomach exposure. Also, we have more efficient temperature regulating cells and more fat on the back side of our bodies as well. When we hold our infants stomach- to- stomach we are protecting all the receptor and vital organs (Montagu, 1986).
----Montagu, A. (1986). Touching: The Human Significance of the Skin. Harper Paperbacks.
III级证据
母亲用手臂，支撑婴儿的身体和大腿，使得它膝盖上收，身体微倾斜。符合生理学的背戴工具，就像妈妈的手臂自然拥抱宝宝的造型一样，给予婴儿腿部背部良好支持。
A mother using either her arms or a simple piece of cloth, supports her baby’s legs in a flexed (with the knees bent) abducted (away from midline) position supporting the hip and the spine. Instead of fabric at the crotch which contributes no leg support, or swaddling the legs which is too restrictive, ergonomic carriers put the baby in the position that supports the legs just as a mother’s arms would. The flexed abducted position is what infants are hard-wired to assume when picked up.
----Schon, R. (2007). Natural Parenting-Back to Basics in Infant Care. 5(1), 102-183. from Evolutionary Psychology from http://www.epjournal.net/filestore/ep05102183.pdf
更多关于Kangoroo Care的研究论文：
I级证据 Ferber, S.G., Makhoul, I.R., 2004, Skin contact (kangaroo care) shortly after birth on the neurobehavioral responses of the term newborn: a randomized, controlled trial., Pediatrics, v. 113(4), p. 858-65. http://www.ncbi.nlm.nih.gov/pubmed?term=15060238
II-3级证据 Meyer, K., & Anderson, G. C., 1999, Using kangaroo care in a clinical setting with fullterm infants having breastfeeding difficulties., Am. J. Matern. Child Nurs., v. 24, p. 190-192. http://www.ncbi.nlm.nih.gov/pubmed/10405558
II-2级证据 Moore ER, Anderson GC, Bergman N., 2007, Early skin-to-skin contact for mothers and their healthy newborn infants., Cochrane Database of Syst. Rev., v. 3, Art. No.: CD003519. http://www.ncbi.nlm.nih.gov/pubmed/17636727
II-2级证据 Durand, R., Hodges, S., LaRock, S., Lund, L., Schmid, S., Swick, D., Yates, T., & Perez, A., 1997, The effect of skin-to-skin breastfeeding in the immediate recovery period on newborn thermoregulation and blood glucose values., Neonatal Intensive Care, v. 10, p. 23-29.
II-1级证据 Tessier R., Cristo, M., Velez, S., Giron, M., Ruiz-Palaez, J. G., Charpak, Y., et al., 1998, Kangaroo mother care and the bonding hypothesis., Pediatrics, v. 102(2), e17.http://www.ncbi.nlm.nih.gov/pubmed/9685462
II-2级证据 Wahlberg, V., Affonso, D., & Persson, B., 1992, A retrospective comparative study using the kangaroo method as a complement to standard incubator care., European J. Public Health, v. 2(1), p. 34-37. http://eurpub.oxfordjournals.org/content/2/1/34.abstract
II-2级证据 Pelaez-Nogueras, M., Field, T. M., Hossain, Z., & Pickens, J., 1996, Depressed mothers’ touching increases infants’ positive affect and attention in still-face interactions.,Child Dev., v. 67, p. 1780-1792. http://www.ncbi.nlm.nih.gov/pubmed?term=8890507
II-1级证据 Kangaroo Care (Skin Contact) Reduces Crying Response to Pain in Preterm Neonates: Pilot Results, R Kostandy R, Pain Management Nursing, 9(2) 2008
为什么竖背？
竖背有哪些好处？
有利于婴儿警觉而安静的观察世界；
缓解婴儿胃食管返流症状，一定程度上预防中耳炎；
贴合孩子的自然生理造型，可能有利于髋关节发育；
多竖背能减少头部某个区域长时间受压，预防扁头综合征。（前面章节已有论据）
和家长腹部贴腹部有利于体温调节；（前面章节已有论据）
II-2级证据
竖背可缓解婴儿的胃食管返流症状，并预防中耳炎。
Wearing your baby upright can actually be a preventative measure against ear infections and can help ease the symptoms of GERD.
----Schon, R. (2007). Natural Parenting-Back to Basics in Infant Care. 5(1), 102-183. from Evolutionary Psychology from http://www.epjournal.net/filestore/ep05102183.pdf
其它相关文献：
Douglas, P. S., 2005, Excessive crying and gastro-oesophageal reflux disease in infants: Misalignment of biology and culture., Med. Hypotheses, v. 64(5), p. 887-98.http://www.ncbi.nlm.nih.gov/pubmed/15780481
II-2级证据
对于习惯后背孩子的非洲人口，进行髋关节情况的调查，认为髋关节发育不良的超低发病率主要是由于他们后背孩子的习俗。并且认为双腿并拢的背法会增加髋关节发育不良的风险。但论点仍旧需要对于非洲以外地区人口的大量临床试验的进一步证实。
BACKGROUND: Developmental dysplasia of the hip (DDH) is rarely encountered in the native sub-Saharan African population. We present a retrospective review of the incidence of symptomatic DDH in Malawi and a systematic review of the role of back-carrying as a potential influence of prevalence in this population group.
METHODS: We retrospectively reviewed the diagnosis and management of all infants seen at the Beit CURE International Hospital, Malawi and its mobile clinics, from November 2002 to September 2012. In addition, methodical review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist and algorithm was performed.
RESULTS: A total of 40,683 children aged less than 16 years were managed at our institute over a 10-year period, of which 9842 children underwent surgery. No infant presented with, or underwent surgical intervention, for symptomatic DDH.
CONCLUSIONS: The majority of mothers in Malawi back-carry their infants during the first 2 to 24 months of life, in a position that is similar to that of the Pavlik harness. We believe this to be the prime reason for the low incidence of DDH in the country. In addition, there is established evidence indicating that swaddling, the opposite position to back-carrying, causes an increase in the incidence of DDH. There is a need for the establishment of a large clinical trial into back-carrying and prevention of DDH in non-African population groups.
----Back-carrying Infants to Prevent Developmental Hip Dysplasia and its Sequelae: Is a New Public Health Initiative Needed?，S Graham, J Manara, L Chokotho, W Harrison Journal of Pediatric Orthopedics 35 (1) 2015
II-3级证据
有大量的流行病学证据显示，将婴儿髋关节紧紧内收包裹的背戴工具，对髋关节发育会带来不利影响。
相比于双腿并拢的横背更推荐竖背
图片指示了相关性而并非因果性
图片来自国际髋关节学会网站
There is abundant epidemiological evidence for the negative effects on hip development of wrapping, swaddling or carrying susceptible babies with hips tightly adducted and extended, as well as confirmatory animal studies.
----Increase in late diagnosed developmental dysplasia of the hip in South Australia: risk factors, proposed solutions，K Studer, N Williams, G Antoniou, C Gibson, H Scott, W Scheil, B Foster, P Cundy MJA 204 (6) 4 April 2016
III级证据
婴儿竖抱姿势时间越长，他们越警觉和安静。即使是大部分时间都在睡觉的新生儿，一旦被抱起并靠在我们的肩膀上，就会停止哭泣并活跃起来。不过如果是在婴儿椅中呈竖直状态，婴儿并不会像在家长的怀抱中竖抱那样警觉。对于还不会独坐的婴儿，竖抱能让他们有机会学习到更多。
In her book The Vital Touch, Dr Sharon Heller states,
“The more time that babies spend vertical, the more time that they are alert and calm. Even newborns that spend most of their time sleeping, stop crying and perk up when picked up and placed on our shoulder. Interestingly, how alert a newborn is relates to where he is. Upright in an infant seat, he is less alert than when upright in arms… Vertical positioning as optimal in infants makes perfect sense. Think of how much time our infants spend horizontal- flat on their back in a crib or a buggy. Might this affect their alertness? There’s a good chance… Researchers found that infants too young to sit independently learn more when placed in a vertical position.”(Heller, 94)
----Heller, S. (1997). The Vital Touch: How Intimate Contact With Your Baby Leads To Happier, Healthier Development. Holt Paperbacks.
III级证据
在90年代，由于医学上的保守，许多家长在婴儿出生的头几周都是横抱孩子。但如今在德国，横抱已经不再普遍。如今在德国大多数家长都在孩子一出生就开始竖背。这个变化也要感谢Mrs.Kirkilionis博士关于婴儿背带工具的不懈研究，他的研究得到了骨科、儿科医生、理疗师的认可。竖背有利于髋关节的健康发育。
Due to medical reservations in the nineties parents felt bound to carry their babies in the first weeks of their life in a horizontal position. Today in Germany this isn’t common any more. It is common to carry babies in an upright position even when parents start wearing newborns directly after birth. The beginning of this change of heart was the research results presented in the thesis of Mrs.Kirkilionis and her untiring work in cooperation with involved midwives andother committed babywearers. By her publications, lectures and further educations she was also able step by step to convince orthopaedists,paediatricians, and physiotherapists. She presented solid and convincing arguments. To carry babies upright means also that they are sitting in the wrap in a spread squatting leg position. Her measurements demonstrated clearly thatthe babies’ legs in this position are ideally oriented to their hip joints.Stretched legs on the other hand create a non central pressure on the femurhead on the acetabulum, which can flatten out more and more. Proper babywearing supports the healthy development of the hip joint and prevents hip dysplasia.The position of the baby’s legs meets exactly the data given in the respective medical literature in case of hip dysplasia.
总结和展望
在总结之前，我们必须了解，因为背戴宝宝的领域，还未被很多科学杂志所重视，所以发表相关论文的概率并不高（不是热门话题），间接地使得很多研究学者或者机构不倾向于做相关研究。虽然背戴宝贝很多潜在的好处似乎显而易见，但很少研究者去进行相关的随机对照试验以进一步证实。
除了相关科学研究之外，国际背戴产业联盟（Baby Carrier Industry Alliance, BCIA）的行业峰会和研究，一些发达国家的背巾背带相关行业标准，和行业共识也非常重要，因为虽然科学论文是前沿，但是产业化的标准更是将可重复大量验证的科学事实应用于实际。目前BCIA官网，以及许多国际老牌大牌的背巾网站如Didymos，已经取消在网站上示范摇篮背（虽然一些半倾斜宝宝面部清晰可见的背法还是可以用，但大家的共识是更推荐竖背）。宝宝头部沦陷在布料中的摇篮背已经导致多起婴儿死亡事故并且已经被召回（如下图）。
另外说到背巾质量，如果大家查阅BCIA官网认证的背巾品牌名单（https://babycarrierindustryalliance.org/about-us/member-directory/），就会发现国产的品牌没有一家上榜，究竟差距在哪里，大家可以进一步看我的公众号了解相关知识，后面也还会更新。
根据著名国际背戴组织网站2015年8月发布的《Babywearing Research – Part 2: Relevant Research》文章中对于目前背戴宝宝相关的科研成果的总结，以及本文前面所列的相关文献的结论，总结如下：（https://babywearinginternational.org/2015/08/03/babywearing-research-part-2-relevant-research/）
关于头型：
背戴宝宝有助于避免头部某个区域长时间受压，进而有助于预防扁头综合征。
需要进一步数据支持：
背戴工具应用于如斜颈和扁头综合征的预防和治疗，会有多大的好处？
关于髋关节，以下论点已经被充分的证实：
婴儿的髋关节健康很重要；
不是所有的婴儿都生来就有有健康的髋关节；
髋关节体检（必要时拍片）很重要；
需要进一步数据支持：
背戴工具的种类和背戴姿势对于髋关节的有利或不利影响；
“欠佳的背戴姿势”有哪些，对于髋关节健康的影响有哪些？
背戴宝宝怎样才能有效的被用于髋关节发育不良的干预治疗？最佳的实践指南如何？
关于母子联系和袋鼠育儿，已经被充分的证实的：
背戴宝宝有利于母子的身心联系；
背戴孩子能够有效减少婴儿的哭泣；
袋鼠育儿法，是可测量、可重复验证的成功婴儿照料方式。
需要进一步数据支持：
背戴工具如何帮助与孩子在身心联结上有困难的照料者（比如养父母）？
背戴工具支持实现袋鼠育儿法的系统性指南如何？尤其是对于早产儿？
关于背戴姿势和背戴安全：
新生儿正确地竖背，是安全的；
背戴姿势能保证呼吸畅通不被遮挡非常重要；
必须保证始终可以看到孩子的脸；
在背戴之前必须检查背戴工具是否有损坏；
需要进一步数据支持：
肚子贴肚子的竖背，在多大的程度上，更有利于保证呼吸通畅？
摇篮背有多大的不安全性？
竖背的好处包括核心肌肉的发育，胃食管返流的控制等。
科学总是在进步的，期待未来能有更多相关的研究指导我们更好的应用和享受背戴工具。
最后，也是非常重要的是，正如美国消费产品安全委员会CPSC所认可的（Consumer Product Safety Commission），在使用背戴工具的时候，“教育”非常重要。也就是说，必须有可靠的人，告诉你很多正确使用的相关知识。关于背巾使用的安全要点，我已经总结在公众号之前的文章中，以后还会有更多的升级和更新。当然对于某个具体的产品来说，正确的一对一的使用指导也是非常重要的，哪怕简单如背带也不是随便拿来就能用得对。
在我的淘宝店铺“背戴之爱”购买国际BCIA联盟认证品牌的背巾背带，就可以获得一对一的使用指导。在元宵节结束之前（2018.3.2 24点），转发此文到朋友圈并截图，新客户均可获得在店铺首次购买背巾背带的20元减免，减免有效期为元宵节结束后5天内（2018.3.7,24点）。算是给大家的元宵小礼物。
当然最重要的是别忘了关注我的公众号。
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