Beyond an Infant Sleep Aid: Reclaiming infant carrying practices to support Indigenous infant and maternal health

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Infant carrying is emerging in the literature as a novel intervention to improve infant and maternal health outcomes. However, contemporary practices and the commercialization of infant carrying devices has largely stripped the practice of its cultural significance. The NIH and American Academy of Pediatrics has recognized that cradleboards, a tribally-specific infant carrier, is an acceptable sleep surface; we examine its cultural meaning beyond infant sleep benefits with the goal of revealing a clinical opportunity to enhance infant and maternal health in a culturally meaningful way. Individual interviews were conducted among urban Indigenous mothers living in AZ (N=16) to identify parenting traditions that help to promote maternal and infant health in the postpartum period. Among mothers who identified as Navajo or Diné, the use of a tribally-specific cradleboard was described as an important parenting tool. Four themes emerged from the data: attachment (e.g., “it gives…a sense of security because they are bundled up tight in blankets”), calming (“help when the kids were being fussy”), infants’ development (“to gain a posture and can hold their head high”), and tradition (“each part of the cradleboard has a meaning”). Social workers addressing the needs of Indigenous mothers in the postpartum period can benefit from organizational-level support and training on cultural humility, in an effort to promote the use of Indigenous cultural parenting tools and traditions, to ultimately support new mothers to reclaim their Indigenous cultural parenting practices. parenting babywearing southwest infant carrying mother-infant attachment Introduction The practice of infant carrying (that is, carrying an infant on the body using a carrier or cloth material) has historical and cultural relevance across many communities, including to American Indian and Native Alaska (AI/AN) people (Berecz et al., 2020, James et al., 2021). However, contemporary practices and the commercialization of infant carrying devices have largely stripped the practice of its cultural significance. Commercial baby carriers are marketed and sold under “travel gear” alongside strollers to highlight the advantages carriers offer to transport infants safely (see Rankin Williams & Turner, 2020a). Though this is one advantage of infant carrying, it is a missed opportunity for parents to use it as an effective parenting tool; particularly, to soothe their infant/put to sleep and to bond with their baby. In one experimental study, only mothers that were encouraged to use the carrier daily through an infant carrying intervention realized these benefits, compared to a control condition (Rankin Williams & Turner, 2020a). Infant carrying is emerging in the literature as a novel evidenced-based intervention, particularly to enhance maternal health (e.g., reducing risk for relapse among mothers with opioid use disorders, Rankin et al., 2024) and the mother-infant relationship (e.g., greater attachment security, increased maternal responsiveness and empowerment, Grisham et al., 2023). Experimental studies indicate that for younger mothers (Rankin Williams & Turner, 2020b) and for mothers from lower socioeconomic circumstances (Anisfeld, et al., 1990), infant carrying prospectively enhances a secure mother-infant attachment and decreases risk for an insecure or disorganized attachment. This is significant as infants’ attachment to their caregivers reflects an underlying schema for their understanding of relationships, including their expectations for how their emotional and physical needs will be met by others (Ainsworth, 1979). Infant carrying enhances bonding through sensitive and responsive caregiving. For example, one study found that mothers who engaged in infant carrying, compared to non-infant carrying mothers, interacted more contingently with their infants (Little et al., 2019), showing enhanced responsiveness to infant vocalizations and fewer maternal depressive symptoms at 6 weeks postpartum (Little et al., 2023). In a study of young mothers, mothers assigned to an infant carrying condition, compared to a control, spent more time in positive engagement with their infant during the Still Face Task, and less time in hostile or withdrawn engagement (Rankin Williams, 2020), demonstrating enhanced confidence and positive maternal behaviors, and less fearful and withdrawn behaviors, in response to their infants’ distress. Others have found greater frequency of infant carrying to increase sensitive responsiveness to infant crying (Firk & Großheinrich, 2024). Emerging longitudinal studies indicate a long-term effect on parenting; participation in an infant carrying intervention enhanced maternal mentalizing about their child’s inner states in the preschool years, thereby providing preliminary support for infant carrying as an intervention to support children’s social and cognitive development (Linde-Krieger & Rankin, 2025). Other direct benefits to infants include enhanced infant speech and language (e.g., transporting infants using a backpack style carrier compared to a stroller condition; Mireault et al., 2018), enhanced positive infant communication (Rankin, 2020), and decreased perceptions of infant pain (Rankin Williams et al., 2020). Infant carrying can support stress regulation (Rankin & Bigelow, 2025). Through maternal contact, infants enhance their developmental capacity to manage stress, as shown through reduced stress reactivity through the HPA-axis (cortisol reactivity and recovery) and parasympathetic control (cardiac vagal tone and the vagal brake, Feldman et al., 2010, 2014). In a sample of infants with Neonatal Opioid Withdrawal Syndrome, infant carrying was used as an intervention to facilitate symptoms of withdrawal. In a 30-minute infant carrying procedure, infants experienced less distress as evidenced by a reduced heart rate (a physiological parameter of neonatal pain) of 15 beats per minute (Rankin Williams et al., 2020). Further, infant carrying calms caregivers as well and influences parent-infant autonomic coregulation (Han et al., 2024). Despite the compelling emerging evidence for infant carrying to support positive parenting as well as infant and maternal health outcomes more broadly, AIAN mothers are often discouraged from its use due to the perpetuation of misinformation, subsequently resulting in both a loss of cultural traditions and of significant health benefits to mothers and infants during a critical period. In some AIAN communities, cradleboards are used for infant care and also hold deep cultural significance. A cradleboard secures an infant in place and is typically used to safely travel or work while their infant is on their back (though it can also be removed and placed against a tree or structure; Gadacz, 2020). The primary purpose is to protect and carry their infants, however, it also allows infants to quietly observe nature and learn daily routines, reflecting a value of patience and mindfulness. In addition to the varied styles, symbols, and decorations, they also hold traditional knowledge systems. Despite the forces of colonization that sought to erase Indigenous child rearing practices, the cradleboard remains representative of an effort to protect and promote cultural traditions beyond its practical function (Gadacz, 2020). The NIH and American Academy of Pediatrics has recognized that cradleboards are an acceptable sleep surface, yet they are also a parenting tool used in some AIAN communities that hold cultural meaning and extend infant sleep benefits. However, misunderstandings have resulted in prohibiting its use in childcare centers serving indigenous communities despite the recognition from the NIH and the American Academy of Pediatrics that a cradleboard is “a culturally appropriate infant sleep surface.” Recently, a cradleboard education program, which also included storytelling and oral traditions, was used as an intervention for AIAN people to address the social determinants of maternal and child health (James et al., 2021). Developed by community members in response to a community need, the program promoted healing in balance with components of the medicine wheel (emotional, physical, spiritual, and mental) to enhance positive health outcomes for mother and infant. In acknowledgement of no previously published literature addressing cradleboards and safe sleep education, James and colleagues advocate for consistent funding for AIAN people so that cradleboard class interventions can reduce negative AIAN maternal and infant health outcomes. The present study aimed to understand the practical and cultural meaning of infant carrying among a sample of Indigenous mothers living in an Urban region in the Southwest US. The findings uncover a clinical opportunity to enhance maternal and infant health outcomes for some AIAN people, particularly those who identified as Navajo or Diné, through understanding the use of a tribally specific cradleboard as a parenting tool. Method Participants Participants were asked to participate in a culturally grounded parenting practices study if they self-identified as a mother ( M = 2.19 children, SD = 1.56), as someone who is 18 years or older ( Mage = 36.69 years, SD = 12.12), and as a member of an indigenous community within the Southwest US (N = 16). This study was reviewed in accordance with ABOR 1-118 and approved by the Institutional Review Board (IRB) at BLINDED. Procedures Data recruitment, interviews, transcribing, and coding were all conducted by the 3 rd , 4 th , and 5 th authors of the study who are enrolled members of the Navajo Nation. Note that the interviewers selected pseudo names for each participant which are used in the reporting of direct quotes. The 5 th author conducted the first set of interviews in-person (n=8, 10 to 30 minutes) and subsequent transcription and qualitative coding of a series of open-ended questions regarding their experiences with parenting and core parenting beliefs and values. Included was “did you ever use a baby carrier to carry your baby?”.The use of cradleboards emerged as playing a role in their parenting values and practices (e.g., “The cradleboard is a life saver” Sheila, age 26, “Our ancestors knew what they were doing because it is the best thing to ever happen to us when we had our daughter for the first time, Tammy, age 35). Specifically, cradleboards were most often described in their utility for putting infants to sleep (e.g., “I would put my son in a cradleboard, it would be much easier for him to sleep through the night.” Alicia, age 24). Initial coding around the emergent themes was compiled into a handout by the 2 nd author that was used in a subsequent set of interviews (n=8) to triangulate the themes and to further our examination of the cultural meaning of cradleboards/infant carrying (see Appendix A). The 3 rd and 4 th author conducted the second set of interviews (4 each) by zoom (25 minutes to 3 hours) and one written response (500 words). Participants in the second phase were provided with the handout in advance and were told that they would be asked for their feedback on the initial themes. The 3 rd and 4 th authors transcribed the additional interviews verbatim and conducted thematic coding based on frequency, emotionality, and extensiveness in consultation with the 1 st author. Results Participant discussion around infant carrying was described in the context of using a cradleboard. A cradleboard is a traditional baby carrier used in Indigenous families from some Indigenous cultures (e.g., Hopi, Apache, Navajo) to carry, protect, and support infant sleep. Some mentioned trying Western style carriers, “but the babies didn’t seem to like it as much” (Shenika, age 45), others used both, and a few preferred a western style carrier over a cradleboard. For example, one mother used a cradleboard for her first baby, but used a baby carrier primarily for her second and third child “because it was more convenient when it came to packing and it did not take up much space” (Jennifer, age 40). Four participants (25%) did not use cradleboards: Two were not from a culture which used a cradleboard, one had to immediately return to work after her baby returned from the NICU, and one received a cautionary message from her father to avoid parenting Navajo children to be reserved. As Ava, age 39, explained, there was a fear of being raised “too Navajo” that would subject oneself to being taken advantage of: My [father] calls it “Being Navajo”. He’s like “Oh you’re going to be all Navajo now”…he was like, “I don't want my kids in the cradleboard. I don't want them to be, like, Navajo just sitting there. I don't want them, just to be like, not having an opinion about things….I want my kids to be vocal. I want my kids to be interactive. I want them to be in people's faces if that's what's necessary, and I don't want them to be taken advantage of! I don't want them just to sit there and just not act and not react or not have a response. Ava explained that she used a Western style baby carrier instead and that may be controversial to some: “I'm probably too new age, because, like, for me I preferred the baby being right here. Like, right here. Like, you know, on my chest, close to my heart. Like, I can feel the baby right here. And I remember my son, when he was an infant he would always, like, you know, when he wanted to eat he, like, get his little hand and push on me, and I'd be like, “Oh, it's time to eat!” you know? I just always just preferred the little device, where he was, like, right here on me, and we were like skin to skin almost and…it just felt natural and comforting to me even soothing, you know, that he’s there. I'm like, “My baby’s right here!” Half of the participants had tried a Western-style baby carrier, two did not like it and three reported only using it to transport them and would use the cradleboard to put the baby to sleep. While a practical parenting tool, the cradleboard also holds great significance within the Indigenous cultures that they are used in. Cradleboards were often handed down (“we used my cradleboard that my dad used for me when I was born”, Tammy, age 35) or were constructed for the baby to have their own (e.g., “I had a cradleboard made for my grandchildren as well”, Alice, age 64). As Shenika, age 45, explained, “for Navajos, you are supposed to use a cradleboard. There is a story behind the cradleboard”. Mia, age 30, described that there are specific stories “that go along with each part of the cradleboard, that has a meaning, or that’s put together and that’s put into use for baby”. Four themes around the use of cradleboards emerged: attachment, calming, infants’ development, and tradition. These themes were identified in the first round of interviews and triangulated in the second sound of interviews. Attachment The predominant theme that emerged was that cradleboards support attachment or bonding between parents and infants by fostering a sense of security. Parents described the infant’s experience of being securely tied to the cradleboard as providing the feeling of being back in the womb or being held safely in their parent or caregiver’s arms: “My mom had told me that when you put your child in the cradleboard it gives them a sense of security because they are bundled up tight in blankets, like they’re being held” (Jen, age 24). Winona explained, “the cradleboard reminds them of being inside the womb, like, you know, being inside your stomach”. In addition, the cradleboard also provides them with physical protection (e.g., a padded frame and a hood or head loop to protect from injury, provide shade, or support a quiet environment if a blanket is put over the top), which facilitates bonding and attachment through safety. Other participants also commented on the protection and safety that cradleboards offered, particularly while parents were occupied with other tasks. As Mia, age 30, shared: That helped a lot for me using a cradleboard, especially when I had to have some ‘me time’. Like if I want to do arts and crafts, if I want to work out, you know, in my home, anything that we do in my home, the cradleboard was there to use for my son to be safe in so that way I don't have to worry about dangers of like him rolling over or like, for him to have his face, you know, in the pillow or on the blanket, because that's what scares me a lot and especially cribs, um. You know, I've heard about babies who suffocate when they sleep or, you know, have large objects like a stuffed animal or pillows that was in the crib and then the baby would accidentally roll over and you know, suffocate and passed away from that. So, I've heard about stories of that, so knowing that my son, is not going to have that issue in his cradleboard, never come near that situation makes me feel happy about it, and know that he's protected and safe in his cradleboard. Calming Cradleboards were identified by most as their primary parenting tool, allowing an easy way to sooth their infant (e.g., “any time she would get fussy” Sheila, age 26, “it helped when my daughter would fight herself”, Jen, age 24). Most used them at night or when their children were napping in order to ensure a deeper and more restful sleep (“When they are wrapped in the board, they instantly fall asleep” Shenika, age 45). As Winona, age 37, explained: We would mainly [use the cradleboard] at nighttime because we wanted them to sleep at night longer, and we would-we tried to limit it during the day so they wouldn’t really fall into a deep sleep….When we would take our kids when they were sleeping in their cradleboard… they were really deep in sleep. We would take the whole cradleboard into Walmart too, and, um, put them in the cart. And then we would just push them around. They sleep through the whole thing. Infants’ development Parents viewed cradleboards as supporting their infants’ development. As Alicia, age 24, shared, “to gain a posture and can hold their head high”. Though they often received conflicting messages from their pediatricians. Alicia, age 24, shared she had been given the advice: “’if you do, put him in there [limit it to] three hours at a time’ and I was just like ‘uhhh okay I’m not going to listen to that’”. (P16). Alicia reflected on these and other institutional challenges, particularly as they may have impacted her mothers’ parenting practices, resulting in a shifted perspective. When I would put my son in a cradleboard it was much easier for him to sleep through the night… It was really weird because my mom didn’t want him to develop that kind of dependency on it, which was kind of frustrating…I don’t know why it was like that for her but maybe because I went daycare…they weren't comfortable using a cradleboard. And then it was when he started going to [blinded]…they didn’t really know how to use it and that’s when we kind of …slowly stopped using it because they preferred like a crib. But I saw a difference in his sleeping pattern. I think he really liked the feeling [of being in a cradleboard]. What a cradleboard does is it makes it like the womb because your swaddled and your warm like someone’s hugging you so that’s why they like it and they sleep well in it. But I definitely saw the difference and he liked his cradleboard a lot. Tradition Embedded in using a cradleboard was the ancestral connection across generations in a family. Winona, age 37, shares missing this connection by not having her cradleboard, “I feel like all our cultures were put into the cradleboard. I wish I had my cradleboard. I would have held it be like, ‘This is, you know, Father Sky. This is the Rainbow. This is Mother Earth. This is Lightning…I saw it more of…a storytelling teaching….more of like a protector’”. Included in the connection is the storytelling. Mia, age 30, explains, “there’s stories that go along with it, each part of the cradleboard has a meaning… that's put together and that’s put into use for baby”. Discussion This study explored infant carrying traditions as it relates to parenting to increase cultural awareness and to broadly support the health and wellness of infants and mothers who identify as Navajo or Diné, particularly in the postpartum period. It is important to note that while cradleboard use was common among participants and was highlighted as a meaningful parenting practice, not all mothers reported using them. However, those who did described the cradleboard as not only a practical tool for soothing and supporting infants’ development, but also as a practice in connection and cultural continuity. Their use promoted attachment, security, and emotion regulation. These findings underscore the cradleboard’s role in supporting infant wellbeing while simultaneously reinforcing intergenerational values and identity, emphasizing its enduring significance in both caregiving and cultural preservation. Understanding and integrating such Indigenous parenting practices into clinical social work offers an opportunity to enhance culturally responsive care and support Indigenous maternal and infant health. In the context of cultural disruption incurred by colonization on AIAN communities, cradleboards remain enduring symbols of Indigenous cultural resilience. Participants in this study described using cradleboards to promote restful sleep, to calm and soothe, and to ensure infants felt secure. These practices demand attuned caregiving that reflect patience and harmony in responding to infants’ needs. This is consistent with the findings of Diné researchers Kahn-John and Koithan ( 2015 ) on the Diné Hózhó wellness philosophy, in that patience, harmony, respect, and the honoring of relationships are among the values associated with Diné belief systems. Respect and relational honoring were evident in the intergenerational significance of cradleboards. Cradleboards were often passed down through families, or in some cases, made specifically for their grandchild. Some participants highlighted the role of stories and storytelling embedded in the structure of the cradleboard, suggesting it serves not just as a parenting tool but as a medium of ancestral teaching. In these ways, the cradleboard functions as a form of caregiving that aligns with cultural values, affirmed identity, and familial connection in the face of historical traumas. These insights underscore the importance of honoring Indigenous practices in clinical and community-based settings, such as in daycare centers. For infant and early childhood care centers and treatment interventions to effectively support AIAN families and communities, they are encouraged to be rooted in cultural values, guided by traditional knowledge, and grounded in cultural humility (Zoubak, 2020 ). While community-based cradleboard education programs have been successfully utilized to promote maternal and infant health among AIAN families (James et al., 2021 ), there remains a significant gap in published research exploring how these practices are experienced and valued by Indigenous mothers themselves. This study contributes important qualitative insights into the cultural meaning and caregiving functions of cradleboards for Navajo/Diné mothers. Drawing on cognitive behavioral therapy (CBT) and attachment theory, Mothers and Babies (MB) is an evidence-based intervention designed to address perinatal depression (Le et al., 2015 ; Muñoz et al., 2006 ). A study by Ward and colleagues ( 2022 ) explored cultural adaptations of MB for the Lakota community, incorporating tribe-specific language, spiritual elements, teachings, and values–offering a potential framework for adapting MB with other AIAN communities. In communities where cradleboards represent a meaningful caregiving practice, integrating its teachings into MB psychoeducation may function as a culturally grounded adaptation. For example, clinicians might draw on the caregiving principles reflected in cradleboard use–such as attachment security, calming and soothing practices, support for infant development, and intergenerational connection–to support maternal reflection and regulation within MB sessions. Supporting caregiver-infant bonding through culturally relevant activities, clinicians might also encourage mothers to engage in traditional cradleboard-related rituals and storytelling as part of their bonding practice, enhancing attunement while honoring culture. These principles resonate with MB’s focus on strengthening the caregiver-infant bond and managing stress through cognitive and behavioral strategies. Furthermore, incorporating stories and teachings associated with cradleboards may facilitate meaningful discussions on parenting identity and intergenerational connection that highlight culturally-grounded strengths and reinforce protective factors in perinatal mental health. Such adaptations reflect a broader effort to align evidence-based interventions with Indigenous knowledge systems, enhancing both clinical relevance and cultural integrity. This study’s focus on Navajo/Diné mothers living in the Southwest US provides rich, culturally specific insights but also limits the generalizability of findings across diverse AIAN populations. Cradleboard use and its associated meanings vary widely among tribes and individual families, underscoring the importance of avoiding generalizations. Additionally, as a qualitative study relying on participant self-report, findings reflect subjective experiences that may be shaped by individual, familial, and community contexts. Broader systemic factors–including colonial histories, childcare policies, and social determinants of health–inevitably influence parenting choices and practices, warranting further exploration. Future research would benefit from community-led, collaborative approaches that honor tribal sovereignty and cultural knowledge, examining cradleboard practices across diverse Indigenous communities. Longitudinal studies are needed to elucidate the impact of cradleboard use on caregiver-infant attachment, infant development, and maternal well-being over time. Advancing research and practice through partnerships with indigenous communities will be essential to developing culturally congruent interventions and policies that support maternal and infant health. Statements and Declarations Author Contribution L.R.: co-creation of original study design, supervision of work, writing.I.B.: literature reviews, writing.K.M.: data collection, coding and analysis, interpretation of findings/results.A. M.: data collection, coding and analysis.T.T.: co-creation of original study design, data collection. The authors do not have any financial or non-financial interests that are directly or indirectly related to the work submitted for publication. References Ainsworth, M. D. S. (1979). Attachment as related to mother-infant interaction. Advances in the Study of Behavior, 9(C), 1–51. 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 Development, 61(5), 1617–1627. Berecz, B., Cyrille, M., Casselbrant, U., Oleksak, S., & Norholt, H. (2020). Carrying human infants–An evolutionary heritage. 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Supplementary Files AppendixACradelboardThemes.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 07 Apr, 2026 Reviews received at journal 12 Nov, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers agreed at journal 13 Oct, 2025 Reviewers invited by journal 19 Aug, 2025 Editor assigned by journal 01 Aug, 2025 Submission checks completed at journal 01 Aug, 2025 First submitted to journal 31 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7264319","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":502671644,"identity":"1c72d95a-4e8e-4623-82a9-31b4363515db","order_by":0,"name":"Lela Rankin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACPgbmBjBDgpmB8QFELAG/FjYGRrgWZgMStQDZEsRpYW9s/MC4xy5Psp33WMWPP4cZ+NlzDPBr4TnYLMHwLLlYmpkv7WZv22EGyZ43BLRIJDZIMBxgTpzHzGN2g7fhMIPBDUK2yD9s/sFwoB6spfAP0GH2BLVIMLYBbTmcOBuohZmHDWiLBEG/JLZZJBw4njizmcdYWrYtnUfizLMCvFr42Q8fvvHhQHXijPNnDD+++WMtx9+evAGvFjBIQGLzEFY+CkbBKBgFo4AgAAAQg0AcVEOucAAAAABJRU5ErkJggg==","orcid":"","institution":"Arizona State University","correspondingAuthor":true,"prefix":"","firstName":"Lela","middleName":"","lastName":"Rankin","suffix":""},{"id":502671645,"identity":"99eef68a-2d9a-4580-81db-cd655dd960e4","order_by":1,"name":"Isabel Ball","email":"","orcid":"","institution":"Ellie Mental Health","correspondingAuthor":false,"prefix":"","firstName":"Isabel","middleName":"","lastName":"Ball","suffix":""},{"id":502671646,"identity":"c2c03643-cc9d-4aaa-8118-2d591173f38b","order_by":2,"name":"Kaitlin Mcdonnell","email":"","orcid":"","institution":"Arizona State University","correspondingAuthor":false,"prefix":"","firstName":"Kaitlin","middleName":"","lastName":"Mcdonnell","suffix":""},{"id":502671647,"identity":"f48f4732-8c82-42ae-bf28-4b7510785f4c","order_by":3,"name":"Arlynna Mitchell","email":"","orcid":"","institution":"University of Arizona","correspondingAuthor":false,"prefix":"","firstName":"Arlynna","middleName":"","lastName":"Mitchell","suffix":""},{"id":502671648,"identity":"b70f695c-3049-4712-a2b7-bf81e5264a06","order_by":4,"name":"Tianna Tso","email":"","orcid":"","institution":"University of Arizona","correspondingAuthor":false,"prefix":"","firstName":"Tianna","middleName":"","lastName":"Tso","suffix":""}],"badges":[],"createdAt":"2025-07-31 16:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7264319/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7264319/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90093545,"identity":"bd73ead4-1e9d-4c88-bbe2-517c6ff91a09","added_by":"auto","created_at":"2025-08-28 11:41:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":323152,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7264319/v1/a9d1cb83-07b6-404a-a95d-920da77d0cd9.pdf"},{"id":90092564,"identity":"52bfb017-423c-47ec-a18e-caa77c42c25a","added_by":"auto","created_at":"2025-08-28 11:33:53","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":25791,"visible":true,"origin":"","legend":"","description":"","filename":"AppendixACradelboardThemes.docx","url":"https://assets-eu.researchsquare.com/files/rs-7264319/v1/28748028ec53babb9c1ee183.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Beyond an Infant Sleep Aid: Reclaiming infant carrying practices to support Indigenous infant and maternal health","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe practice of infant carrying (that is, carrying an infant on the body using a carrier or cloth material) has historical and cultural relevance across many communities, including to\u0026nbsp;American Indian and Native Alaska (AI/AN) people (Berecz et al., 2020, James et al., 2021).\u0026nbsp;However, contemporary practices and the commercialization of infant carrying devices have largely stripped the practice of its cultural significance. Commercial baby carriers are marketed and sold under “travel gear” alongside strollers to highlight the advantages carriers offer to transport infants safely (see Rankin Williams \u0026amp; Turner, 2020a). Though this is one advantage of infant carrying, it is a missed opportunity for parents to use it as an effective parenting tool; particularly, to soothe their infant/put to sleep and to bond with their baby. In one experimental study, only mothers that were encouraged to use the carrier daily through an infant carrying intervention realized these benefits, compared to a control condition (Rankin Williams \u0026amp; Turner, 2020a).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInfant carrying is emerging in the literature as a novel evidenced-based intervention, particularly to enhance maternal health (e.g., reducing risk for relapse among mothers with opioid use disorders, Rankin et al., 2024) and the mother-infant relationship (e.g., greater attachment security, increased maternal responsiveness and empowerment, Grisham et al., 2023). Experimental studies indicate that for younger mothers (Rankin Williams \u0026amp; Turner, 2020b) and for mothers from lower socioeconomic circumstances (Anisfeld, et al., 1990), infant carrying prospectively enhances a secure mother-infant attachment and decreases risk for an insecure or disorganized attachment. This is significant as infants’ attachment to their caregivers reflects an underlying schema for their understanding of relationships, including their expectations for how their emotional and physical needs will be met by others (Ainsworth, 1979).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInfant carrying enhances bonding through sensitive and responsive caregiving. For example, one study found that mothers who engaged in infant carrying, compared to non-infant carrying mothers, interacted more contingently with their infants (Little et al., 2019), showing enhanced responsiveness to infant vocalizations and fewer maternal depressive symptoms at 6 weeks postpartum (Little et al., 2023). In a study of young mothers, mothers assigned to an infant carrying condition, compared to a control, spent more time in positive engagement with their infant during the Still Face Task, and less time in hostile or withdrawn engagement (Rankin Williams, 2020), demonstrating enhanced confidence and positive maternal behaviors, and less fearful and withdrawn behaviors, in response to their infants’ distress. Others have found greater frequency of infant carrying to increase sensitive responsiveness to infant crying (Firk \u0026amp; Großheinrich, 2024). Emerging longitudinal studies indicate a long-term effect on parenting; participation in an infant carrying intervention enhanced maternal mentalizing about their child’s inner states in the preschool years, thereby providing preliminary support for infant carrying as an intervention to support children’s social and cognitive development (Linde-Krieger \u0026amp; Rankin, 2025).\u0026nbsp;Other direct benefits to infants include enhanced infant speech and language (e.g., transporting infants using a backpack style carrier compared to a stroller condition; Mireault et al., 2018), enhanced positive infant communication (Rankin, 2020), and decreased perceptions of infant pain (Rankin Williams et al., 2020).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInfant carrying can support stress regulation (Rankin \u0026amp; Bigelow, 2025). Through\u0026nbsp;maternal contact, infants enhance their developmental capacity to manage stress, as shown through reduced stress reactivity through the HPA-axis (cortisol reactivity and recovery) and parasympathetic control (cardiac vagal tone and the vagal brake, Feldman et al., 2010, 2014). In a sample of infants with Neonatal Opioid Withdrawal Syndrome, infant carrying was used as an intervention to facilitate symptoms of withdrawal. In a 30-minute infant carrying procedure, infants experienced less distress as evidenced by a reduced heart rate (a physiological parameter of neonatal pain) of 15 beats per minute (Rankin Williams et al., 2020). Further, infant carrying calms caregivers as well and influences parent-infant autonomic coregulation (Han et al., 2024).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDespite the compelling emerging evidence for infant carrying to support positive parenting as well as infant and maternal health outcomes more broadly, AIAN mothers are often discouraged from its use due to the perpetuation of misinformation, subsequently resulting in both a loss of cultural traditions and of significant health benefits to mothers and infants during a critical period. In some AIAN communities, cradleboards are used for infant care and also hold deep cultural significance. A cradleboard secures an infant in place and is typically used to safely travel or work while their infant is on their back (though it can also be removed and placed against a tree or structure; Gadacz, 2020). The primary purpose is to protect and carry their infants, however, it also allows infants to quietly observe nature and learn daily routines, reflecting a value of patience and mindfulness. In addition to the varied styles, symbols, and decorations, they also hold traditional knowledge systems. Despite the forces of colonization that sought to erase Indigenous child rearing practices, the cradleboard remains representative of an effort to protect and promote cultural traditions beyond its practical function (Gadacz, 2020). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe NIH and American Academy of Pediatrics has recognized that cradleboards are an acceptable sleep surface, yet they are also a parenting tool used in some AIAN communities that hold cultural meaning and extend infant sleep benefits. However, misunderstandings have resulted in prohibiting its use in childcare centers serving indigenous communities despite the recognition from the NIH and the American Academy of Pediatrics that a cradleboard is “a culturally appropriate infant sleep surface.”\u0026nbsp;Recently, a cradleboard education program, which also included storytelling and oral traditions, was used as an intervention for AIAN people to address the social determinants of maternal and child health (James et al., 2021). Developed by community members in response to a community need, the program promoted healing in balance with components of the medicine wheel (emotional, physical, spiritual, and mental) to enhance positive health outcomes for mother and infant. In acknowledgement of no previously published literature addressing cradleboards and safe sleep education, James and colleagues advocate for consistent funding for AIAN people so that cradleboard class interventions can reduce negative AIAN maternal and infant health outcomes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe present study aimed to understand the practical and cultural meaning of infant carrying among a sample of Indigenous mothers living in an Urban region in the Southwest US. The findings uncover a clinical opportunity to enhance maternal and infant health outcomes for some AIAN people, particularly those who identified as Navajo or Diné, through understanding the use of a tribally specific cradleboard as a parenting tool.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e\u003cem\u003eParticipants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were asked to participate in a culturally grounded parenting practices study if they self-identified as a mother (\u003cem\u003eM\u0026nbsp;\u003c/em\u003e= 2.19 children, \u003cem\u003eSD =\u0026nbsp;\u003c/em\u003e1.56), as someone who is 18 years or older (\u003cem\u003eMage\u0026nbsp;\u003c/em\u003e= 36.69 years,\u003cem\u003e\u0026nbsp;SD =\u0026nbsp;\u003c/em\u003e12.12), and as a member of an indigenous community within the Southwest US (N = 16). This study was reviewed\u0026nbsp;in accordance with ABOR 1-118 and approved\u0026nbsp;by the Institutional Review Board (IRB) at BLINDED.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProcedures\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eData recruitment, interviews, transcribing, and coding were all conducted by the 3\u003csup\u003erd\u003c/sup\u003e, 4\u003csup\u003eth\u003c/sup\u003e, and 5\u003csup\u003eth\u003c/sup\u003e authors of the study who are enrolled members of the Navajo Nation. Note that the interviewers selected pseudo names for each participant which are used in the reporting of direct quotes. The 5\u003csup\u003eth\u003c/sup\u003e author conducted the first set of interviews in-person (n=8, 10 to 30 minutes) and subsequent transcription and qualitative coding of a series of open-ended questions regarding their experiences with parenting and core parenting beliefs and values. Included was “did you ever use a baby carrier to carry your baby?”.The use of cradleboards emerged as playing a role in their parenting values and practices (e.g., “The cradleboard is a life saver” Sheila, age 26, \u0026nbsp;“Our ancestors knew what they were doing because it is the best thing to ever happen to us when we had our daughter for the first time, Tammy, age 35). Specifically, cradleboards were most often described in their utility for putting infants to sleep (e.g., “I would put my son in a cradleboard, it would be much easier for him to sleep through the night.” Alicia, age 24).\u003c/p\u003e\n\u003cp\u003eInitial coding around the emergent themes was compiled into a handout by the 2\u003csup\u003end\u003c/sup\u003e author that was used in a\u0026nbsp;subsequent set of interviews (n=8) to triangulate the themes and to further our examination of the cultural meaning of cradleboards/infant carrying (see Appendix A). The 3\u003csup\u003erd\u003c/sup\u003e and 4\u003csup\u003eth\u003c/sup\u003e author conducted the second set of interviews (4 each) by zoom (25 minutes to 3 hours) and one written response (500 words). Participants in the second phase were provided with the handout in advance and were told that they would be asked for their feedback on the initial themes. The 3\u003csup\u003erd\u003c/sup\u003e and 4\u003csup\u003eth\u003c/sup\u003e authors transcribed the additional interviews verbatim and conducted thematic coding based on frequency, emotionality, and extensiveness in consultation with the 1\u003csup\u003est\u003c/sup\u003e author.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eParticipant discussion around infant carrying was described in the context of using a cradleboard. A \u003cem\u003ecradleboard\u003c/em\u003e is a traditional baby carrier used in Indigenous families from some Indigenous cultures (e.g., Hopi, Apache, Navajo) to carry, protect, and support infant sleep. Some mentioned trying Western style carriers, \u0026ldquo;but the babies didn\u0026rsquo;t seem to like it as much\u0026rdquo; (Shenika, age 45), others used both, and a few preferred a western style carrier over a cradleboard. For example, one mother used a cradleboard for her first baby, but used a baby carrier primarily for her second and third child \u0026ldquo;because it was more convenient when it came to packing and it did not take up much space\u0026rdquo; (Jennifer, age 40).\u003c/p\u003e\u003cp\u003eFour participants (25%) did not use cradleboards: Two were not from a culture which used a cradleboard, one had to immediately return to work after her baby returned from the NICU, and one received a cautionary message from her father to avoid parenting Navajo children to be reserved. As Ava, age 39, explained, there was a fear of being raised \u0026ldquo;too Navajo\u0026rdquo; that would subject oneself to being taken advantage of:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eMy [father] calls it \u0026ldquo;Being Navajo\u0026rdquo;. He\u0026rsquo;s like \u0026ldquo;Oh you\u0026rsquo;re going to be all Navajo now\u0026rdquo;\u0026hellip;he was like, \u0026ldquo;I don't want my kids in the cradleboard. I don't want them to be, like, Navajo just sitting there. I don't want them, just to be like, not having an opinion about things\u0026hellip;.I want my kids to be vocal. I want my kids to be interactive. I want them to be in people's faces if that's what's necessary, and I don't want them to be taken advantage of! I don't want them just to sit there and just not act and not react or not have a response.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAva explained that she used a Western style baby carrier instead and that may be controversial to some: \u0026ldquo;I'm probably too new age, because, like, for me I preferred the baby being right here. Like, right here. Like, you know, on my chest, close to my heart. Like, I can feel the baby right here. And I remember my son, when he was an infant he would always, like, you know, when he wanted to eat he, like, get his little hand and push on me, and I'd be like, \u0026ldquo;Oh, it's time to eat!\u0026rdquo; you know? I just always just preferred the little device, where he was, like, right here on me, and we were like skin to skin almost and\u0026hellip;it just felt natural and comforting to me even soothing, you know, that he\u0026rsquo;s there. I'm like, \u0026ldquo;My baby\u0026rsquo;s right here!\u0026rdquo;\u003c/p\u003e\u003cp\u003eHalf of the participants had tried a Western-style baby carrier, two did not like it and three reported only using it to transport them and would use the cradleboard to put the baby to sleep.\u003c/p\u003e\u003cp\u003eWhile a practical parenting tool, the cradleboard also holds great significance within the Indigenous cultures that they are used in. Cradleboards were often handed down (\u0026ldquo;we used my cradleboard that my dad used for me when I was born\u0026rdquo;, Tammy, age 35) or were constructed for the baby to have their own (e.g., \u0026ldquo;I had a cradleboard made for my grandchildren as well\u0026rdquo;, Alice, age 64). As Shenika, age 45, explained, \u0026ldquo;for Navajos, you are supposed to use a cradleboard. There is a story behind the cradleboard\u0026rdquo;. Mia, age 30, described that there are specific stories \u0026ldquo;that go along with each part of the cradleboard, that has a meaning, or that\u0026rsquo;s put together and that\u0026rsquo;s put into use for baby\u0026rdquo;.\u003c/p\u003e\u003cp\u003eFour themes around the use of cradleboards emerged: attachment, calming, infants\u0026rsquo; development, and tradition. These themes were identified in the first round of interviews and triangulated in the second sound of interviews.\u003c/p\u003e\u003cp\u003e\u003cem\u003eAttachment\u003c/em\u003e\u003c/p\u003e\u003cp\u003e The predominant theme that emerged was that cradleboards support attachment or bonding between parents and infants by fostering a sense of security. Parents described the infant\u0026rsquo;s experience of being securely tied to the cradleboard as providing the feeling of being back in the womb or being held safely in their parent or caregiver\u0026rsquo;s arms: \u0026ldquo;My mom had told me that when you put your child in the cradleboard it gives them a sense of security because they are bundled up tight in blankets, like they\u0026rsquo;re being held\u0026rdquo; (Jen, age 24). Winona explained, \u0026ldquo;the cradleboard reminds them of being inside the womb, like, you know, being inside your stomach\u0026rdquo;. In addition, the cradleboard also provides them with physical protection (e.g., a padded frame and a hood or head loop to protect from injury, provide shade, or support a quiet environment if a blanket is put over the top), which facilitates bonding and attachment through safety.\u003c/p\u003e\u003cp\u003e Other participants also commented on the protection and safety that cradleboards offered, particularly while parents were occupied with other tasks. As Mia, age 30, shared:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThat helped a lot for me using a cradleboard, especially when I had to have some \u0026lsquo;me time\u0026rsquo;. Like if I want to do arts and crafts, if I want to work out, you know, in my home, anything that we do in my home, the cradleboard was there to use for my son to be safe in so that way I don't have to worry about dangers of like him rolling over or like, for him to have his face, you know, in the pillow or on the blanket, because that's what scares me a lot and especially cribs, um. You know, I've heard about babies who suffocate when they sleep or, you know, have large objects like a stuffed animal or pillows that was in the crib and then the baby would accidentally roll over and you know, suffocate and passed away from that. So, I've heard about stories of that, so knowing that my son, is not going to have that issue in his cradleboard, never come near that situation makes me feel happy about it, and know that he's protected and safe in his cradleboard.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eCalming\u003c/em\u003e\u003c/p\u003e\u003cp\u003eCradleboards were identified by most as their primary parenting tool, allowing an easy way to sooth their infant (e.g., \u0026ldquo;any time she would get fussy\u0026rdquo; Sheila, age 26, \u0026ldquo;it helped when my daughter would fight herself\u0026rdquo;, Jen, age 24). Most used them at night or when their children were napping in order to ensure a deeper and more restful sleep (\u0026ldquo;When they are wrapped in the board, they instantly fall asleep\u0026rdquo; Shenika, age 45). As Winona, age 37, explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe would mainly [use the cradleboard] at nighttime because we wanted them to sleep at night longer, and we would-we tried to limit it during the day so they wouldn\u0026rsquo;t really fall into a deep sleep\u0026hellip;.When we would take our kids when they were sleeping in their cradleboard\u0026hellip; they were really deep in sleep. We would take the whole cradleboard into Walmart too, and, um, put them in the cart. And then we would just push them around. They sleep through the whole thing.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eInfants\u0026rsquo; development\u003c/em\u003e\u003c/p\u003e\u003cp\u003e Parents viewed cradleboards as supporting their infants\u0026rsquo; development. As Alicia, age 24, shared, \u0026ldquo;to gain a posture and can hold their head high\u0026rdquo;. Though they often received conflicting messages from their pediatricians. Alicia, age 24, shared she had been given the advice: \u0026ldquo;\u0026rsquo;if you do, put him in there [limit it to] three hours at a time\u0026rsquo; and I was just like \u0026lsquo;uhhh okay I\u0026rsquo;m not going to listen to that\u0026rsquo;\u0026rdquo;. (P16). Alicia reflected on these and other institutional challenges, particularly as they may have impacted her mothers\u0026rsquo; parenting practices, resulting in a shifted perspective.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhen I would put my son in a cradleboard it was much easier for him to sleep through the night\u0026hellip; It was really weird because my mom didn\u0026rsquo;t want him to develop that kind of dependency on it, which was kind of frustrating\u0026hellip;I don\u0026rsquo;t know why it was like that for her but maybe because I went daycare\u0026hellip;they weren't comfortable using a cradleboard. And then it was when he started going to [blinded]\u0026hellip;they didn\u0026rsquo;t really know how to use it and that\u0026rsquo;s when we kind of \u0026hellip;slowly stopped using it because they preferred like a crib. But I saw a difference in his sleeping pattern. I think he really liked the feeling [of being in a cradleboard]. What a cradleboard does is it makes it like the womb because your swaddled and your warm like someone\u0026rsquo;s hugging you so that\u0026rsquo;s why they like it and they sleep well in it. But I definitely saw the difference and he liked his cradleboard a lot.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eTradition\u003c/em\u003e\u003c/p\u003e\u003cp\u003eEmbedded in using a cradleboard was the ancestral connection across generations in a family. Winona, age 37, shares missing this connection by not having her cradleboard, \u0026ldquo;I feel like all our cultures were put into the cradleboard. I wish I had my cradleboard. I would have held it be like, \u0026lsquo;This is, you know, Father Sky. This is the Rainbow. This is Mother Earth. This is Lightning\u0026hellip;I saw it more of\u0026hellip;a storytelling teaching\u0026hellip;.more of like a protector\u0026rsquo;\u0026rdquo;. Included in the connection is the storytelling. Mia, age 30, explains, \u0026ldquo;there\u0026rsquo;s stories that go along with it, each part of the cradleboard has a meaning\u0026hellip; that's put together and that\u0026rsquo;s put into use for baby\u0026rdquo;.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored infant carrying traditions as it relates to parenting to increase cultural awareness and to broadly support the health and wellness of infants and mothers who identify as Navajo or Din\u0026eacute;, particularly in the postpartum period. It is important to note that while cradleboard use was common among participants and was highlighted as a meaningful parenting practice, not all mothers reported using them. However, those who did described the cradleboard as not only a practical tool for soothing and supporting infants\u0026rsquo; development, but also as a practice in connection and cultural continuity. Their use promoted attachment, security, and emotion regulation. These findings underscore the cradleboard\u0026rsquo;s role in supporting infant wellbeing while simultaneously reinforcing intergenerational values and identity, emphasizing its enduring significance in both caregiving and cultural preservation. Understanding and integrating such Indigenous parenting practices into clinical social work offers an opportunity to enhance culturally responsive care and support Indigenous maternal and infant health.\u003c/p\u003e\u003cp\u003eIn the context of cultural disruption incurred by colonization on AIAN communities, cradleboards remain enduring symbols of Indigenous cultural resilience. Participants in this study described using cradleboards to promote restful sleep, to calm and soothe, and to ensure infants felt secure. These practices demand attuned caregiving that reflect patience and harmony in responding to infants\u0026rsquo; needs. This is consistent with the findings of Din\u0026eacute; researchers Kahn-John and Koithan (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2015\u003c/span\u003e) on the Din\u0026eacute; H\u0026oacute;zh\u0026oacute; wellness philosophy, in that patience, harmony, respect, and the honoring of relationships are among the values associated with Din\u0026eacute; belief systems. Respect and relational honoring were evident in the intergenerational significance of cradleboards. Cradleboards were often passed down through families, or in some cases, made specifically for their grandchild. Some participants highlighted the role of stories and storytelling embedded in the structure of the cradleboard, suggesting it serves not just as a parenting tool but as a medium of ancestral teaching. In these ways, the cradleboard functions as a form of caregiving that aligns with cultural values, affirmed identity, and familial connection in the face of historical traumas.\u003c/p\u003e\u003cp\u003eThese insights underscore the importance of honoring Indigenous practices in clinical and community-based settings, such as in daycare centers. For infant and early childhood care centers and treatment interventions to effectively support AIAN families and communities, they are encouraged to be rooted in cultural values, guided by traditional knowledge, and grounded in cultural humility (Zoubak, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). While community-based cradleboard education programs have been successfully utilized to promote maternal and infant health among AIAN families (James et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2021\u003c/span\u003e), there remains a significant gap in published research exploring how these practices are experienced and valued by Indigenous mothers themselves. This study contributes important qualitative insights into the cultural meaning and caregiving functions of cradleboards for Navajo/Din\u0026eacute; mothers.\u003c/p\u003e\u003cp\u003eDrawing on cognitive behavioral therapy (CBT) and attachment theory, Mothers and Babies (MB) is an evidence-based intervention designed to address perinatal depression (Le et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2015\u003c/span\u003e; Mu\u0026ntilde;oz et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2006\u003c/span\u003e). A study by Ward and colleagues (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) explored cultural adaptations of MB for the Lakota community, incorporating tribe-specific language, spiritual elements, teachings, and values\u0026ndash;offering a potential framework for adapting MB with other AIAN communities. In communities where cradleboards represent a meaningful caregiving practice, integrating its teachings into MB psychoeducation may function as a culturally grounded adaptation. For example, clinicians might draw on the caregiving principles reflected in cradleboard use\u0026ndash;such as attachment security, calming and soothing practices, support for infant development, and intergenerational connection\u0026ndash;to support maternal reflection and regulation within MB sessions. Supporting caregiver-infant bonding through culturally relevant activities, clinicians might also encourage mothers to engage in traditional cradleboard-related rituals and storytelling as part of their bonding practice, enhancing attunement while honoring culture. These principles resonate with MB\u0026rsquo;s focus on strengthening the caregiver-infant bond and managing stress through cognitive and behavioral strategies. Furthermore, incorporating stories and teachings associated with cradleboards may facilitate meaningful discussions on parenting identity and intergenerational connection that highlight culturally-grounded strengths and reinforce protective factors in perinatal mental health. Such adaptations reflect a broader effort to align evidence-based interventions with Indigenous knowledge systems, enhancing both clinical relevance and cultural integrity.\u003c/p\u003e\u003cp\u003eThis study\u0026rsquo;s focus on Navajo/Din\u0026eacute; mothers living in the Southwest US provides rich, culturally specific insights but also limits the generalizability of findings across diverse AIAN populations. Cradleboard use and its associated meanings vary widely among tribes and individual families, underscoring the importance of avoiding generalizations. Additionally, as a qualitative study relying on participant self-report, findings reflect subjective experiences that may be shaped by individual, familial, and community contexts. Broader systemic factors\u0026ndash;including colonial histories, childcare policies, and social determinants of health\u0026ndash;inevitably influence parenting choices and practices, warranting further exploration. Future research would benefit from community-led, collaborative approaches that honor tribal sovereignty and cultural knowledge, examining cradleboard practices across diverse Indigenous communities. Longitudinal studies are needed to elucidate the impact of cradleboard use on caregiver-infant attachment, infant development, and maternal well-being over time. Advancing research and practice through partnerships with indigenous communities will be essential to developing culturally congruent interventions and policies that support maternal and infant health.\u003c/p\u003e"},{"header":"Statements and Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eL.R.: co-creation of original study design, supervision of work, writing.I.B.: literature reviews, writing.K.M.: data collection, coding and analysis, interpretation of findings/results.A. M.: data collection, coding and analysis.T.T.: co-creation of original study design, data collection.\u003c/p\u003e\n\u003cp\u003eThe authors do not have any financial or non-financial interests that are directly or indirectly related to the work submitted for publication.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eAinsworth, M. D. S. (1979). Attachment as related to mother-infant interaction. Advances in the Study of Behavior, 9(C), 1\u0026ndash;51.\u003c/li\u003e\n \u003cli\u003eAnisfeld, E., Casper, V., Nozyce, M., \u0026amp; Cunningham, N. (1990). Does infant carrying promote attachment? An experimental study of the effects of increased physical contact on the development of attachment. Child Development, 61(5), 1617\u0026ndash;1627.\u003c/li\u003e\n \u003cli\u003eBerecz, B., Cyrille, M., Casselbrant, U., Oleksak, S., \u0026amp; Norholt, H. (2020). Carrying human infants\u0026ndash;An evolutionary heritage. \u003cem\u003eInfant Behavior and Development\u003c/em\u003e, \u003cem\u003e60\u003c/em\u003e, 101460.\u003c/li\u003e\n \u003cli\u003eKahn-John, M., \u0026amp; Koithan, M. (2015). Living in health, harmony, and beauty: The Din\u0026eacute; (Navajo) H\u0026oacute;zh\u0026oacute; wellness philosophy. \u003cem\u003eGlobal Advances in Health and Medicine, 4\u003c/em\u003e(3), 24\u0026ndash;30. https://doi.org/10.7453/gahmj.2015.044\u003c/li\u003e\n \u003cli\u003eFeldman R, Singer M, Zagoory O. (2010). Touch attenuates infants\u0026apos; physiological reactivity to stress. \u003cem\u003eDevelopmental Science, 13\u003c/em\u003e(2), 271-278. doi: 10.1111/j.1467-7687.2009.00890.x. PMID: 20136923.\u003c/li\u003e\n \u003cli\u003eFeldman, R., Rosenthal, Z., \u0026amp; Eidelman, A. I. (2014). Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. \u003cem\u003eBiological psychiatry\u003c/em\u003e, \u003cem\u003e75\u003c/em\u003e(1), 56-64.\u003c/li\u003e\n \u003cli\u003eFirk, C., \u0026amp; Gro\u0026szlig;heinrich, N. (2024). Infant carrying: Associations with parental reflective functioning, parental bonding and parental responses to infant crying. \u003cem\u003eInfant Mental Health Journal\u003c/em\u003e, \u003cem\u003e45\u003c/em\u003e(3), 263-275.\u003c/li\u003e\n \u003cli\u003eGadacz, R. R. (2020). Cradleboard. In\u003cem\u003e\u0026nbsp;The Canadian Encyclopedia.\u0026nbsp;\u003c/em\u003eRetrieved from https://www.thecanadianencyclopedia.ca/en/article/cradle-board\u003c/li\u003e\n \u003cli\u003eGrisham, L. M., Rankin, L., Maurer, J. A., Gephart, S. M., \u0026amp; Bell, A. F. (2023). Scoping review of biological and behavioral effects of babywearing on mothers and infants. \u003cem\u003eJournal of Obstetric, Gynecologic \u0026amp; Neonatal Nursing\u003c/em\u003e, \u003cem\u003e52\u003c/em\u003e(3), 191-201.\u003c/li\u003e\n \u003cli\u003eJames, R., Hesketh, M. A., Benally, T. R., Johnson, S. S., Tanner, L. R., \u0026amp; Means, S. V. (2021). Assessing Social Determinants of Health in a Prenatal and Perinatal Cultural Intervention for American Indians and Alaska Natives. \u003cem\u003eInternational Journal of Environmental Research and Public Health\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(21), 11079. https://doi.org/10.3390/ijerph182111079\u003c/li\u003e\n \u003cli\u003eLe, H.-N., Perry, D. F., Mendelson, T., Tandon, S. D., \u0026amp; Mu\u0026ntilde;oz, R. F. (2015). Preventing perinatal depression in high risk women: Moving the Mothers and Babies Course from clinical trials to community implementation. \u003cem\u003eMaternal and Child Health Journal, 19\u003c/em\u003e(9), 2102\u0026ndash;2110.\u0026nbsp;https://doi.org/10.1007/s10995-015-1729-7\u003c/li\u003e\n \u003cli\u003eLinde-Krieger, L. B. \u0026amp; Rankin, L. (2025). Infant carrying to enhance parental reflective functioning in early childhood: A model of direct and indirect pathways in a sample of adolescent mothers, \u003cem\u003eAttachment \u0026amp; Human Development\u003c/em\u003e, doi.org/10.1080/14616734.2025.2480066\u003c/li\u003e\n \u003cli\u003eLittle, E. E., Bain, L., \u0026amp; Hahn-Holbrook, J. (2023). Randomized controlled trial to prevent\u0026nbsp;\u003c/li\u003e\n \u003cli\u003epostpartum depressive symptomatology: An infant carrier intervention.\u003c/li\u003e\n \u003cli\u003e\u003cem\u003e\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Journal of Affective Disorders, 340\u003c/em\u003e, 871-876.\u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eLittle, E. E., Legare, C. H., \u0026amp; Carver, L. J. (2019). Culture, carrying, and communication: Beliefs and behavior associated with babywearing. \u003cem\u003eInfant Behavior and Development,\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003e57\u003c/em\u003e:101320. doi: 10.1016/j.infbeh.2019.04.002.\u003c/li\u003e\n \u003cli\u003eMireault, G. C., Rainville, B. S., \u0026amp; Laughlin, B. (2018). Push or carry? Pragmatic opportunities for language development in strollers vs. backpacks. \u003cem\u003eInfancy, 23\u003c/em\u003e(4), 616\u0026ndash;624.\u0026nbsp;\u003ca href=\"https://doi.org/10.1111/infa.12238\"\u003ehttps://doi.org/10.1111/infa.12238\u003c/a\u003e\u003c/li\u003e\n \u003cli\u003eMu\u0026ntilde;oz, R. F., Le, H.-N., Ippen, C. G., Diaz, M. A., Urizar Jr., G. G., Soto, J., Mendelson, T., Delucchi, K., \u0026amp; Lieberman, A. F. (2006). Prevention of postpartum depression in low-income women: Development of the Mam\u0026aacute;s y Beb\u0026eacute;s/Mothers and Babies course. \u003cem\u003eArchives of Women\u0026apos;s Mental Health, 9\u003c/em\u003e(6), 273\u0026ndash;279. https://doi.org/10.1016/j.cbpra.2006.04.021\u003c/li\u003e\n \u003cli\u003eRankin Williams, L. (2020). The impact of infant carrying on adolescent mother\u0026ndash;infant interactions during the still-face task. \u003cem\u003eInfant and Child Development, 29\u003c/em\u003e(3), Article e2169. https://doi.org/10.1002/icd.2169\u003c/li\u003e\n \u003cli\u003eRankin, L., Grisham, L. M., Mendoza, N., \u0026amp; Allen, A. (2024). Babywearing reduces urges to use substances in the postpartum period among mothers with OUDs. \u003cem\u003eSubstance use \u0026amp; misuse\u003c/em\u003e, \u003cem\u003e59\u003c/em\u003e(8), 1150-1156.\u003c/li\u003e\n \u003cli\u003eRankin Williams, L., Gebler-Wolfe, M., Grisham, L. M., \u0026amp; Bader, M. Y. (2020). \u0026ldquo;Babywearing\u0026rdquo; in the NICU: An intervention for infants with neonatal abstinence syndrome. \u003cem\u003eAdvances in Neonatal Care, 20\u003c/em\u003e(6), 440\u0026ndash;449. https://doi.org/10.1097/anc.0000000000000788.\u003c/li\u003e\n \u003cli\u003eRankin Williams, L. \u0026amp; Turner, P. R. (2020b). Infant carrying as a tool to promote secure attachments in young mothers: Comparing intervention and control infants during the still-face paradigm. \u003cem\u003eInfant Behavior and Development, 58, 101413.\u003c/em\u003e\u003c/li\u003e\n \u003cli\u003eWard, E. A., Iron Cloud-Two Dogs, E., Gier, E. E., Littlefield, L., \u0026amp; Tandon, S. D. (2022). Cultural adaptation of the Mothers and Babies intervention for use in tribal communities. \u003cem\u003eFrontiers in Psychiatry\u003c/em\u003e, \u003cem\u003e13\u003c/em\u003e, 807432. https://doi.org/10.3389/fpsyt.2022.807432\u003c/li\u003e\n \u003cli\u003eZoubak, E. (2020). Infant and early childhood mental health in American Indian and Alaska Native communities: Considerations for early childhood partners and funders. \u003cem\u003eZERO TO THREE Journal, 40\u003c/em\u003e(5), 66\u0026ndash;72. https://www.zerotothree.org/wp-content/uploads/2020/05/40-5-Zoubak.pdf\u003cem\u003e\u003c/em\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"clinical-social-work-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"csow","sideBox":"Learn more about [Clinical Social Work Journal](http://link.springer.com/journal/10615)","snPcode":"10615","submissionUrl":"https://submission.springernature.com/new-submission/10615/3","title":"Clinical Social Work Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"parenting, babywearing, southwest, infant carrying, mother-infant attachment","lastPublishedDoi":"10.21203/rs.3.rs-7264319/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7264319/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe practice of infant carrying (carrying an infant on the body using a carrier or cloth material) has historical and cultural relevance across many communities, including to American Indian and Native Alaska (AI/AN) people. Infant carrying is emerging in the literature as a novel intervention to improve infant and maternal health outcomes. However, contemporary practices and the commercialization of infant carrying devices has largely stripped the practice of its cultural significance. The NIH and American Academy of Pediatrics has recognized that cradleboards, a tribally-specific infant carrier, is an acceptable sleep surface; we examine its cultural meaning beyond infant sleep benefits with the goal of revealing a clinical opportunity to enhance infant and maternal health in a culturally meaningful way. Individual interviews were conducted among urban Indigenous mothers living in AZ (N=16) to identify parenting traditions that help to promote maternal and infant health in the postpartum period. Among mothers who identified as Navajo or Diné, the use of a tribally-specific cradleboard was described as an important parenting tool. Four themes emerged from the data: \u003cem\u003eattachment\u003c/em\u003e(e.g., “it gives…a sense of security because they are bundled up tight in blankets”), \u003cem\u003ecalming\u003c/em\u003e (“help when the kids were being fussy”), \u003cem\u003einfants’ development\u003c/em\u003e (“to gain a posture and can hold their head high”), and \u003cem\u003etradition\u003c/em\u003e(“each part of the cradleboard has a meaning”). Social workers addressing the needs of Indigenous mothers in the postpartum period can benefit from organizational-level support and training on cultural humility, in an effort to promote the use of Indigenous cultural parenting tools and traditions, to ultimately support new mothers to reclaim their Indigenous cultural parenting practices.\u003c/p\u003e","manuscriptTitle":"Beyond an Infant Sleep Aid: Reclaiming infant carrying practices to support Indigenous infant and maternal health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-28 11:33:49","doi":"10.21203/rs.3.rs-7264319/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-07T15:40:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-12T22:13:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"112537856302422622830450276640858059269","date":"2025-10-22T15:08:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"74389064810533805793729002676357750772","date":"2025-10-13T07:34:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-19T15:49:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-01T14:23:03+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-01T07:43:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Clinical Social Work Journal","date":"2025-07-31T16:28:55+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"clinical-social-work-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"csow","sideBox":"Learn more about [Clinical Social Work Journal](http://link.springer.com/journal/10615)","snPcode":"10615","submissionUrl":"https://submission.springernature.com/new-submission/10615/3","title":"Clinical Social Work Journal","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"23cd5bc7-a8f1-422b-899d-d569b29182fe","owner":[],"postedDate":"August 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-08-28T11:33:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-28 11:33:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7264319","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7264319","identity":"rs-7264319","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}