Full text of DOI:10.1002/oti.104

Occupational Therapy International, 7(1), 1–20, 2000 © Whurr Publishers Ltd
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Living with lifting: Mothers’
perceptions of lifting and back
strain in childcare
SUSAN D. GRIFFIN School of Occupation and Leisure Sciences, University
of Sydney
VIKKI J. PRICE School of Occupation and Leisure Sciences, University of
Sydney
ABSTRACT: The methods a mother selects to physically care for her young
children may subject her to back strain or injury depending on the methods she
selects. Little is known about what motivates mothers to select particular child-
care methods and equipment. The aim of this qualitative study was to explore
the choices mothers of young children make in this area and their experiences
using the methods they select. Nine mothers completed a brief questionnaire and
participated in a semi-structured interview. Analysis of the data revealed a num-
ber of motivating factors that were considered before making a final decision on
what method to use. Rarely were issues related to posture and back care consid-
ered. Primarily, mothers chose methods based on what was best for the child,
without consideration of their own needs. Consideration of the effect of a
method on their back was given only when they experienced back strain. Further
research is required to investigate the best methods for lifting and handling young
children while providing maximum protection for the mothers’ backs.
Key words: lifting, childcare, back strain, mothers.
Introduction
As a child is dependent on its mother for all of its basic needs, a mother’s role
will include tasks such as dressing and changing, feeding, bathing, transport-
ing and providing activities to entertain the child. While mothers carry out
their everyday routines they are at risk of injuring their backs as they lift chil-
dren on and off various surfaces such as highchairs and change tables. The
lifting demands associated with this role change as the child ages. The risk of

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injury to the back increases with increasing frequency, repetition and duration
of lifting (King Lee et al., 1988; National Occupational Health and Safety
Commission, 1990).
Unspecified back injury accounts for 7.3% of long-term injuries reported
by women (Australian Bureau of Statistics, 1994). Statistics do not show
whether these injuries have occurred at work or at home, or whether lifting
children has contributed to these injuries. Back pain is the most frequently
reported complaint of childcare centre staff (Grant et al., 1995) and 49% of
back injuries reported in one study were associated with lifting a child (Brown
and Gerberich, 1993). Most childcare-related injuries occur to the lower back
(Whitebook et al., 1989, cited in King et al., 1996).
Three studies that examined the lifting and handling practices of childcare
workers found that they were not using correct lifting and handling tech-
niques (Owen, 1994; Grant et al., 1995; King et al., 1996). Recommendations
arising from the studies included the provision of information and skills on
correct lifting techniques as well as ergonomic solutions such as adjusting the
height of work surfaces such as change tables. Mundt and colleagues (1993)
recommended that education about correct lifting techniques should be
extended beyond the workplace and into the home.
The stooped position involves lifting a load from the floor with straight
knees and a bent back. The soft non-muscular tissue of the back that supports
the load during this type of lift is often strained. As the weight and size of the
load increases, as with a child getting older, the natural tendency is to bend
over from the waist, in order to lower the loading momentum at the lumbar
spine (Wilmarth and Herekar, 1991). Twisting, bending and holding the load
away from the body can also cause strain on the back as the weaker muscles of
the back are being used instead of the stronger muscles of the thighs (Nordin
and Frankel, 1989; Workcover Authority of NSW, 1995; Phillips et al., 1996).
The heavier the load and the further away from the body it is held, the more
force there is on the discs and the more opportunity there is to damage them
(Owen, 1994). The risk of sustaining a back injury also increases by two to
three times when a person is twisting while lifting (Frymoyer, 1991).
Using the correct lifting technique is difficult when lifting children, as
they may be heavy and are possibly in constant motion. This often results in
having to lift children in positions that are biomechanically stressful, such as
with feet and bodies placed in awkward positions or lifting children from the
side, causing a twisting motion (Brown and Gerberich, 1993; Owen, 1994).
Children are not compact packages, are unpredictable in their behaviour dur-
ing the lift and are often lifted from the floor level and in confined workspaces
where correct posture is difficult (Owen, 1994). Maintaining abnormal pos-
tures and positions over a long period of time has been identified widely as
contributing to lower back pain (Phillips et al., 1996). ‘As posture would seem

Lifting and back strain in childcare for mothers
3
to be an important factor in the development of long term backache, there
should be greater efforts to make mothers more aware of their posture’ (Russell
et al., 1993: 1302). Ergonomic considerations such as the height of work sur-
faces (Carson, 1994), workplace design (Workcover Authority of NSW, 1995)
and design of equipment (Brown and Gerberich, 1993) can decrease the expe-
rience of back pain for mothers.
Clearly, the methods a mother selects to physically care for her young chil-
dren and the equipment she uses while doing these tasks have the potential to
affect her level of low-back pain or injury. To date, there seems to be no
research that investigates the methods mothers select to perform childcare
tasks, how they make these choices and the extent to which they are knowl-
edgeable about techniques which protect them from back injury. The aims of
this study were to discover the lifting and handling practices mothers use
when performing childcare tasks; how they selected these methods; and their
experiences using these methods. By determining what motivates mothers to
do childcare tasks in particular ways, healthcare workers will be better able to
design effective intervention strategies to assist mothers to select methods
which put minimum strain on their backs but still meet their needs and con-
cerns. This may lead to a decrease in the experience of back pain and injury
for mothers of young children and those working in the childcare industry.
Mothers included in this study were those with a child between birth and
three years of age. This age group of children is perceived to place the greatest
demands for physical care on mothers (King et al., 1996) and require the most
lifting and handling.
Methods
Participants
Ten semi-structured in-depth interviews were conducted between April and
September 1997. Participants were accessed from personal contacts of the
researcher and subsequent snowballing (Minichiello et al., 1995). Each mother
had at least one child between birth (0) and three (3) years of age. Figure 1
gives a brief description of the nine families who participated as part of this
study (using pseudonyms). The mothers had no history of back pain prior to
the birth of their first child. All participants were the primary carer for the
child. This study considered a select group of tasks that involve lifting and
handling of the child by the mother. The mothers in this study, through an ini-
tial questionnaire, selected the tasks that were focused on. None of the moth-
ers had professional expertise in areas that would be likely to increase their
knowledge of lifting and handling techniques (for example, physiotherapist).

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FIGURE 1: The families
Kirsty, Peter, Jane and Charlie
Kirsty is the mother of two young children, Jane (3) and Charlie (1 ⁄ ).
1
2
Kirsty and Peter currently live in a large town in rural NSW. Kirsty is a full-
time mother, but does occasional night packing at a local supermarket. She
prefers to do this so she does not have to worry about babysitters. Kirsty’s
husband Peter is a full-time labourer who works long hours and does shift
work. This means Kirsty often does most of the childcare herself.
Louise, Robert and Helen
Louise and Robert live in a small town in rural NSW. Robert works on the
family farm and thus works long hours every day. This leaves Louise to per-
form most of the childcare for Helen (2). Although Louise is occasionally
involved in part-time family day care, at the time of the interview she
wasn’t working.
Janet, Ron and Stephanie
Janet is a qualified accountant who is currently working part time. Her hus-
band Ron works full time (usually shift work) as an attendant carer.
Although he looks after Sarah (2) on his days off, Janet is still doing the
majority of care giving. Janet and her family live in rural NSW.
Lisa, Allan and Mark
Lisa has one child, Mark (1), and is currently working from home. This
allows her to be the primary care giver while her husband works full time.
Lisa and Allen live in Western Sydney, close to family and friends.
Julie, Anthony, Reece and Andrea
Anthony works as a mechanic for a large company in rural NSW. This job
provides the financial security that allows Julie to stay at home with their
1
children, Reece (3 ⁄
2
) and Andrea (11 months).
Lesley, Scott, Kylie and Wayne
Lesley and Scott also live in rural NSW. Scott owns and runs his own busi-
ness which means he is away from home for long hours each day. This
1
leaves Lesley to care for the children, Kylie (2 ⁄
2
) and Wayne (5 months),
which she is currently doing full time. She occasionally works the odd day
at the local courthouse when needed.
Alison, Gary, Jenny and Natalie
Alison has recently moved to a large country town in NSW. Her husband
Gary works full time as a labourer while Alison works a few nights a week

Lifting and back strain in childcare for mothers
5
as a waitress. This allows them greater financial security without having to
pay for childcare. Alison therefore is the primary carer for her children,
Jenny (3) and Natalie (2).
Michaela, Matt, Sally, Jason and Beth
Michaela has not worked since having her children, Sally (10), Jason (3)
and Beth (2), as she prefers to stay at home with the children. Her husband
Matt works at the local newspaper and often does shift work, which also
does not allow her to work without childcare. Michaela and her family live
in rural NSW.
Belinda, Mitchell and Natasha
Belinda and Mitchell live in Sydney’s inner west district. Belinda is a phar-
macist but is currently not working, preferring to stay home with Natasha
(16 months) while her husband works. Belinda and Mitchell share much of
Natasha’s care, although Belinda still does most of it as she is at home the
majority of the time.
Data collection
Participants were initially contacted by phone. If interested in participating,
they were mailed an information package containing a cover letter confirming
a date and time for an interview, an information sheet for participants, a con-
sent form, and the preliminary questionnaire. The questionnaire was designed
to focus the interviews on the tasks the mothers thought involved them in the
most lifting and handling of their child. The questionnaire was pilot tested
with the mother of a young child not participating in the study before mailing
it to mothers in the study (Bailey, 1991; Polgar and Thomas, 1995).
The information gained from the questionnaires was used as the basis for
the in-depth interview with each mother. The semi-structured interviews
focused on three broad areas for the tasks discussed: (1) What method was
used and why?; (2) What experiences had they had using these techniques?;
(
3) What methods of lifting and handling did they use and why? Semi-
structured interviewing allowed the content and the process of the inter-
view to focus on the issues that were central to the research and permitted
flexibility to explore issues that were pertinent to the participant from their
perspective (Minichiello et al., 1995). All interviews were tape-recorded
and transcribed with the mother’s prior knowledge and consent. The study
was granted approval from the Human Ethics Committee of the University
of Sydney.
Theoretical sampling was used in conjunction with snowballing. Each
interview was taped, transcribed, coded and then analysed before the next
interview was conducted. This enabled data to be collected, coded and

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Griffin and Price
analysed concurrently so that decisions could be made on what further data
needed to be collected from the informants in order to develop emerging
themes. This gave direction to the research and emerging themes (Strauss and
Corbin, 1990; Minichiello et al., 1995). Figure 2 shows the tasks discussed
during the interviews and examples of questions and probes asked for each
task and in relation to lifting.
FIGURE 2: Interview aeas and questions
●
Bathing – shower, bath and baby bath; Dressing – change table, floor,
bed, etc.
●
●
●
Playing – indoor/outdoor; Sleeping – cot, bassinet, bed, etc.
Feeding – highchair, rocker; Shopping – pram, stroller, trolley
Getting in/out of car – car seat, capsule, positioning of seats
Types of questions asked for each task:
●
●
●
●
●
What method do you use for __________ ?
Can you describe how you do this?
Why did you choose that method?
Why have you decided to do it this way? Have you tried other methods?
What was it about the previous method that you used that you didn’t
like?
●
●
What do you think your main priority was when buying equipment?
Did you get advice on what to look for from family and friends?
Questions on lifting included:
●
●
●
●
●
●
How do you lift your children?
Why do you lift this way? Have you tried other ways?
Do you know the correct way to lift?
Where did you learn this?
What is it about the child that means you don’t lift properly?
Why do you lift boxes correctly and not children? What is the differ-
ence between them that causes you to lift differently?
Do you lift differently depending on what activity you are doing?
Were you ever given any advice on how to lift your children at the hos-
pital or clinic?
●
●
●
Have you ever had any trouble with your back?
Immediately on completing the interview, field notes were written not-
ing any additional information that may not have been on tape and non-
verbal cues that were noted during the interview. This also included
information about the family such as ages of children and names of family
members. Interviews were then transcribed verbatim and personal and

Lifting and back strain in childcare for mothers
7
analytical files written as soon as possible after each interview and before
the next one.
The validity of the interviews was ensured in several ways. First, emerging
themes that were brought up in interviews were then tested through inclusion
in subsequent interviews. Second, to ensure data triangulation, secondary data
such as field notes and journals were used. Third, all interviews were tran-
scribed verbatim to ensure the researcher did not misinterpret what was said
by the mother. The researcher had chances to observe the mother performing
some of the tasks discussed and view some of the equipment used. This
ensured that what the informant was saying in the interview was what they
were actually doing. Key issues that arose during the interview were also
noted to assist the researcher in remembering issues that needed further
explanation or investigation.
Data analysis
Data were coded using two techniques, open and axial coding (Strauss and
Corbin, 1990). Initially, unrestricted (open) coding of interviews occurred.
This allowed the identification and development of concepts in terms of their
properties and dimensions. The researcher was then able to group similar
events and incidents to form themes (Strauss, 1987; Strauss and Corbin,
1
990). These themes were explored and developed to identify similarities and
differences between them. Each interview was analysed individually and then
compared with the other interviews, literature and field notes, so that com-
mon or consistent themes emerging could be noted. Axial coding consists of
analysis of the individual categories. Possible relationships between the cate-
gories devised in open coding are noted in relation to their properties and
dimensions (Strauss, 1987; Strauss and Corbin, 1990). Patterns, exceptions
and more dimensions are looked for and noted. Strauss and Corbin (1990)
suggest that this stage looks at working towards the development of a core
category or central phenomenon around which all themes can be related.
Results
In this study data analysis was refined until the researcher had two major cate-
gories. These were choosing childcare methods and living with lifting. Choos-
ing childcare methods includes those factors that influence how a mother
does the childcare tasks, and living with lifting is about how mothers actually
lift their children and why.
Choosing
Choosing childcare methods is a process that involves mothers considering
certain factors before making the final decision on what method to choose.

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Griffin and Price
For the mothers in this study, the comfort and safety of the child was central
to the decision on what methods to use. The process of choosing is outlined in
Figure 3.
FIGURE 3: Factors affecting mothers’ choice of childcare method
Child-centred focus
Contextual factors
influencing choice
Number of children
Time constraints
Awareness of options
Energy conservation
Duration of task
Decision-influencing
factors
Cost
Duration of equipment
Experience and advice
Age and weight of child
Space
Frequency of task
Height and weight of
equipment
Choosing
Conscious choice of method or
used by default
All mothers put their own needs after those of the child. For example, the
position of the car seat had little to do with the amount of effort it took the
mothers to get their child in and out of the car. Rather, the decision was about
the safest place for the child.
For the five mothers who used a baby capsule in the car, the decision on
whether to lift the baby out, or the baby and the capsule, was based on
whether the child was asleep. Although the mothers found the capsules heavy
and awkward to lift in and out of the car they would still prefer to do this if it
meant keeping the baby asleep. ‘I only ever got the capsule out when she was
asleep. The rest of the time I just lifted her out because it was heaps easier’
(Louise).
In prenatal classes, the focus is on the child and care of the child. The
advice mothers were given on lifting and carrying focused on pregnancy to
ensure no harm would come to the baby. Mothers were given information
concerning how to bathe, dress and care for the child from the child’s perspec-
tive — that is, how to hold the baby so that the baby would not be dropped or
injured. After the baby was born little information was given to the mothers
on their own care in relation to lifting and carrying the child, but once again
focused on the child.

Lifting and back strain in childcare for mothers
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Contextual factors influencing choice
There was little difference in the way choices were made between those
mothers who only had one child and those who had more than one child.
Mothers preferred ways that saved them time and effort and caused them the
least amount of worry. The methods chosen were not, however, always those
that were ‘best’ for the mother’s back, just those that were time saving. Rea-
sons given for choosing to use incorrect lifting techniques rather than correct
lifting techniques were ‘time’, ‘laziness’, ‘I did not think about what I was
doing’ or ‘it was just a habit’. All the mothers commented that lifting was an
unconscious activity thought about only when they have back pain or an
ache. For mothers who had more than one child, time was of greater impor-
tance, because of the increased workload. These mothers would use time-
saving techniques that involved doing tasks with both children at the same
time, such as bathing.
Another area where time was important for the mothers was when the
child was crying or upset. At such times the mothers preferred to get to the
child as quickly as possible and would often do so to the detriment of their
back, using poor lifting techniques.
Few of the mothers interviewed were aware that some equipment, such as
cots, highchairs and prams, is now height-adjustable. Those mothers who did
know about them found they were often too expensive to be included in the
choice process.
Those mothers who put more thought into what they were buying before
they purchased the equipment or chose a particular method, and who tried
out the equipment, were the ones who were happier in the end. Mothers who
had little input into the choice process, for example when equipment was
given to them as a gift, tended to be less satisfied. Trying out equipment and
putting more thought into the choice process occurred more often when a
particular method was being replaced. At this stage the mothers were more
aware of other options available, thus allowing them to improve on those fac-
tors they were not happy with.
Being able to conserve energy throughout the day was a factor in the
mother’s choice of lifting and carrying techniques. The methods chosen were
ones that took the least amount of time and conserved the most energy, such
as bathing children together. Playing games that involve lifting the children
on to swings or pushing bikes, as well as rough and tumble, were also seen as
physically straining. These activities were found to take considerable energy if
done for extended periods. One of the mothers prevented a lot of bending and
lifting while playing outside with her child by sitting.
Being tired affected the way mothers lifted. Although the mothers admit-
ted to using incorrect lifting techniques most of the time, they also said that
when they were tired, especially at the end of the day, they really did not care
how they lifted.

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Often the length of time the tasks took to perform was a factor in how
much it affected the back, with the longer time having a worse effect on the
mother’s back. Mothers would therefore limit the amount of time spent per-
forming these activities, either by doing them for a certain length of time or
stopping when they felt a twinge in their back. Other tasks, such as putting
children into a highchair, could be completed comparatively quickly so were
not seen as such a strain.
To counteract back strain, mothers would try choosing methods that
decreased the amount of lifting and bending. For example, mothers would
adopt a position such as kneeling or sitting beside the bath that allowed them
to tend to their children but also limited the strain placed on their back.
The frequency of the task and the amount of back strain it caused for each
mother were entirely individual, with some mothers finding lifting more frequent-
ly when the child was younger harder than lifting a heavier, older child less often.
For other mothers it was the reverse. Belinda said that at a young age the child is a
dead weight and cannot support itself, and therefore she had to do all the work.
Those who found it more difficult with older children developed tech-
niques that would allow them to decrease the amount they were lifting and
carrying. Children would be dressed on the floor, and/or the mother would get
down to the child to comfort him/her instead of lifting the child up. In addi-
tion, older children became more independent, so that they were less likely to
want to be picked up and carried, and the mothers encouraged this.
Toilet training was one task when frequency was really noticed. The number
of times the mothers had to assist their child on to and off the toilet each day was
considerable, and this became quite physically demanding. By comparison, lifting
the child into and out of the highchair was not a problem because it was some-
thing that was done only a couple of times a day and did not take long to com-
plete. Getting the child in and out of the car was not commented on very often
because it was also a task that was not performed as frequently as other tasks, for
some of the mothers. Picking up toys was an area where frequent bending was
causing back strain for some mothers. They attempted to minimize this by get-
ting children to help or by picking up groups of toys less frequently.
Decision-influencing factors
Cost figured in the choice process for all mothers, regardless of their financial
situation. All mothers, without exception, felt it was too expensive when set-
ting up the nursery to buy everything new. Those items that were more often
than not purchased new were car seats and baby capsules because the mother
felt it was not safe to buy secondhand. Items borrowed or bought secondhand
were often purchased from people the mothers knew.
Space was considered along with cost. Items they could ‘do without’, such
as a change table, were passed over for the more essential items such as cot
and cupboards if the bedroom was small.

Lifting and back strain in childcare for mothers
11
When looking at secondhand equipment and after ensuring it was appro-
priate for the child, quality was most important to ensure it would last for the
required period. All mothers interviewed chose to use secondhand cots due to
the expense involved in buying these new. How safe and sturdy it was was a
major consideration. What cots looked like was of secondary importance as
long as they were presentable. On the other hand, most of the prams and car
seats were bought new and what they looked like was more important to the
mothers.
The length of time a piece of equipment would be used for also affected
the decision of whether to buy new or secondhand. Equipment that was used
for shorter periods, such as bassinets and change tables, were more likely to be
borrowed or secondhand, and were less likely to be replaced if not suitable.
Cheap pieces of equipment such as baby baths were often bought new.
Equipment that was used more frequently was more likely to be replaced if
they were not suitable. For example, prams were more likely to be replaced
than change tables because they were used for longer periods.
When deciding what method or equipment to use, advice from other peo-
ple such as friends and family was not a high priority. Occasionally, a mother
would see a friend use a method she liked, ask her about it and then decide to
use that method. Usually this did not occur until after their first child was
born and they were themselves deciding what were the best methods to use.
One of the most useful informal social networks talked about by two moth-
ers was a parenting group or playgroup. This involved getting together once a
week and while the children played the mothers could talk and share stories
or ask advice if something was troubling them. Because the mothers all had
children at similar stages, advice was current and relevant for them.
Advice on correct methods from health professionals was given higher
regard than the advice of friends and family. When questioned on whether
they were given any advice on what were good methods to use, either pre- or
postnatal, the general response was that advice was given. However, it was
not adopted unless the mother had a particular interest in the advice given.
When the mothers asked for advice from health professionals, their advice
was more likely to be used. The advice that was given and asked for was more
likely to be about the welfare of the baby than that of the mother. For exam-
ple, when a nurse in the hospital gave Michaela advice on how to bathe her
baby, what was a good posture for Michaela to adopt or a good height to be
bathing the baby at was not discussed.
Although three of the mothers received information about correct lifting
after giving birth, they found that they did not really take much of it in. Gen-
erally, they felt in the first week after the birth that they were overwhelmed
with information coming from many different sources. It was not until they
had passed this initial stage that they were more open to information. Howev-
er, this was again subject to what they were interested in hearing. Thus, the
timing of when to give mothers advice on correct methods to use is critical.

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Mothers seemed to want to find out information for themselves and relied
on their own experience and knowledge rather than on that of others. The
mothers interviewed found that once they had gained some experience with
particular methods they were better able to judge what was a good method for
them. Methods would often be changed as the child aged and outgrew a par-
ticular method. For example, moving from a change table to the floor
occurred as the child aged and became too heavy to lift up. One mother, Ali-
son, reported bathing with her children when they were very young and need-
ed support because this placed less strain on her back than leaning over the
bath. Once her children were old enough to sit unaided in the bath she
reverted to sitting beside the bath. For many of the mothers, bathing did not
become a problem until they moved from a baby bath to a proper bath. Other
tasks where the type of demand on the mother was age specific included dress-
ing, toilet training, playing and lifting children into and out of cots. For some
of these tasks, namely dressing and lifting in and out of the cot, the demands
eased as the child became older and more independent. For other tasks such as
playing and toilet training the demands intensified as the child aged because
of increasing demands for bending and lifting.
Along with their own experience, mothers read parenting magazines to get
ideas on what were the safest and ‘best’ methods to use. The Choice magazine
articles seemed to be the ones that most of the mothers relied on, along with
articles in parenting-specific magazines such as Parenthood. Reading magazines
and getting ideas from them was preferred to getting advice from others.
With secondhand equipment, aesthetics was important only to the extent
that the equipment was presentable and in good condition. However, for new
equipment, aesthetics was much more important. Mothers were often attracted
to what the new item looked like before anything else. With items such as prams
and strollers that were more likely to be on show, aesthetics was important.
The weight of a piece of equipment was considered only when buying
prams. Mothers wanted a pram that was light so that lifting it into and out of
the car and pushing it was not a problem. The height of equipment was not a
focus in the choice of method for most mothers. Only one mother set out
purposefully to buy a pram that had adjustable handles. The other mothers
did find that it became an issue after they started using a particular method.
For example, mothers found that they chose bassinets based on availability
and cost but found once they started using them that they were a good
height.
When settling on a particular childcare method it seemed that the choice
was either made specifically for its correct lifting or ergonomic features (by a
minority of mothers) or chosen for other reasons and later found to be
ergonomically or posturally correct. This occurred in the choice of equipment,
specific methods and positioning of equipment. Regardless of whether meth-
ods were chosen consciously or used by default, the process of choosing meth-
ods was the same. Occasionally, decision-influencing factors would need to be

Lifting and back strain in childcare for mothers
13
considered before the child if finances were limited. However, a cheaper
method would be chosen only if the child would be safe and secure.
Living with lifting
Lifting tended to be an activity that was given little thought by the mothers
interviewed in this study. They found that they did not think about what they
were doing unless they had an ache or pain that made them aware of their
lifting technique:
So you just do it whichever way you think of at the time, you just grab her and do it,
whichever way was the quickest. If you had back trouble, like if you actually ended up
having something wrong with your back, it would make you more conscious and you’d
probably think about it more often. But while you get away with doing the silly things
every now and then, you don’t think about the consequences (Janet).
The lifting method chosen was consistent for all the tasks the mothers
completed each day. None of the mothers felt they lifted differently for differ-
ent tasks. Stoop lifting, the method they chose, was chosen because it was
what seemed to come naturally for all the mothers.
The six mothers who had worked in jobs that required lifting and carrying
used correct lifting techniques at work but not at home. They found lifting
inanimate objects was different to lifting children and did not think to use
correct techniques at home. Those mothers who did not learn lifting tech-
niques at work learned them through other avenues such as school or health
campaigns. The three mothers who did occasionally use correct techniques
were prompted to only after developing back strain.
Mothers also reported not feeling the same need to get down under a child
as they did for lifting tasks at work. Children are usually not low so the moth-
er could lift them under the arms. They felt that this did not encourage the
same use of correct lifting procedures as the lifting needs at work. The moth-
ers also did not class their children as heavy compared with shopping bags.
The mothers felt therefore that they did not need to use correct lifting tech-
niques despite the strain that poor lifting would be placing on their backs:
I just pick her up under the arms, I don’t bend my knees, I suppose I should but she’s
not very heavy, she’s only about 12 or 13 kilos. Perhaps a little bit more, and yeah I just
lift her up and put her straight in front of me and that’s it... I don’t really think to bend
my knees because by the time you think to bend them you’ve already lifted her, before
you even think about it. I mean if she was a big box or something you’d bend your
knees (Louise).
The mothers were not transferring what they were learning in one task to
other areas of their routine. For example, when a mother used a bench to
bathe the child and found it to be a good height, she was not then transfer-
ring this information to other tasks such as dressing. The same occurred with

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playing. Mothers would stop pushing a child on a bike or swing when their
back started to ache, but did not necessarily stop performing other household
or childcare tasks because of back strain.
The mothers would justify using an incorrect lifting technique by saying
that they did not use it very often or that the task takes only a short amount
of time. What they were not realizing is that all the small tasks that they were
performing incorrectly may eventually lead to an injury by gradually building
up until finally some small or large incident caused major back strain. Coming
into contact with someone else with a back strain also did not mean the
mother would lift and carry properly to prevent an injury of her own.
All three mothers who tried to use correct lifting techniques noted that it
was hard to accomplish correct lifting. Unless they were concentrating when
performing each lift, they would revert to their old habits of poor lifting.
Mothers also felt that it was not always possible to use correct techniques
when lifting children. Examples are lifting a child out of a car seat or a cot,
when it is not possible to squat lift. Also squat lifting involves using the larger
muscles of the thighs and the mothers found this more work and greater effort
than just bending down to pick up the child. Using squat lifting was seen as
an added strain on their resources, instead of a way to conserve energy.
Although mothers were not aware of what they were doing to their backs,
they did seem to adopt or change methods to ones that put less strain on their
backs and made it easier for them to complete childcare tasks. This seemed to
be a technique to prevent back injury and ultimately minimize the effect on
the mothering role.
Alison summed up how methods were chosen. She said she did not know
whether her methods were the right methods, but they were the right ones for
her as they make the job easy and had not caused her any type of back injury.
The methods came about by learning from mistakes previously made or from
finding that something hurts and not using that method again. As yet, none of
the mothers has had any major disruptions to their mothering role as result of
back strain. Those mothers who have had back strain have developed methods
that allow them to continue to perform the tasks demanded of their role with-
out further injuring their backs. It is possible that by changing methods at an
early stage of discomfort they may actually be preventing a more serious injury.
Two of the three mothers who indicated that they have had back problems
since having children have more than one child. In general, the mothers with
more than one child did seem to get more frequent back strain or aches with
the increase in physical demands.
Back strain after having children seemed to be something the mothers
expected to happen. They would put up with the pain, explaining that it was
just something that came with having children and there was little that could
be done about it. Lesley said that she would not even go to the doctor because
she felt there was nothing he could really do for her and it was just something
she had to put up with.

Lifting and back strain in childcare for mothers
15
Discussion
The daily tasks listed on the questionnaire by mothers in this study were con-
sistent with those listed by Brown et al. (1994), Christiansen (1991) and
Dyck (1992). Tasks included feeding and hygiene needs, play and housework.
Specific tasks listed were consistent with the tasks identified by childcare
workers such as changing nappies, dressing and lifting in and out of highchairs
and cots (Owen, 1994; Grant et al., 1995; King et al., 1996).
The childcare workers in the King et al. (1996) and Owen (1994) studies
identified the same tasks as the mothers of this study, namely lifting in and
out of cots and on and off change tables, as involving a lot of lifting and carry-
ing. For mothers in this study bathing was the most common task listed which
is not done by childcare workers generally.
Literature suggests that the focus of childcare is on the child, not the care-
giver (King et al., 1996). Childcare centres were designed to respond to the
needs of the child, without considering what needs the childcare worker may
have (Grant et al., 1995; Markon and LeBeau, 1994, cited in King et al.,
1
996). Childcare methods for mothers are similarly undertaken, emphasizing
those features that are beneficial for the child, often without thought for the
mother’s own needs.
Calder (1994) observed that caregivers may be knowledgeable about
health issues for their children, but do not then relate that information to the
promotion of their own health. The mothers in this study were well aware of
what methods were appropriate for the child’s health and safety and put this
before anything else, including their own health needs. Because most child-
care is performed by mothers (Kane, 1993) it is important for them to become
aware of their own needs and to act on them. Looking at their own needs was
seen to be selfish by the mothers in this study. Attanucci (1988) describes
this: ‘the good mother responds to the child’s needs and demands in the
child’s terms and is, thereby, rendered selfless. The bad mother takes into con-
sideration her own needs and is, thereby, perceived as selfish’ (1988: 203).
Inadequate work heights, incorrect lifting techniques and frequent sitting
on the floor were specific problems noted by King et al. (1996) in the lifting
practices of childcare workers, and by mothers in this study. Literature sug-
gests that the physical setting is usually designed for the needs of the child,
not the carer (King et al., 1996) and was similarly seen in this study.
The mothers’ focus on the child’s needs is understandable. However, the
mother needs to be aware that if a major injury were to occur to her back, her
mothering role would be affected. She may then not be able to successfully
tend to all of the child’s needs, as she may want to. Thus caring for her back is
essential to her and her child’s well-being.
The use of time-saving techniques by mothers in this study is consistent
with the literature (Kane, 1993), especially for mothers with more than one
child. These mothers experienced more frequent back strain or aches than did

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mothers with one child. This was due to the increase in physical demands
brought on by the increase in workload, as seen by Frymoyer (1991). High fre-
quency and repetition of tasks, such as lifting children and bending and pick-
ing up toys, was a major issue for the mothers in this study. This high
frequency and repetition of tasks has been reported in the literature as a factor
that increases the risk of back injury (King Lee et al., 1988; National Occupa-
tional Health and Safety Commission, 1990). To minimize this, the mothers
developed techniques that involved less bending, which helped to relieve the
repetitive cycle of compression on the spine (NSW Department of Education,
1
983) and lowered the risk of injury.
With advice from family and friends not a high priority for the mothers in
this study it seems that they were not greatly influenced by ‘cultural scripts’
Willard, 1988). In this study advice from others was listened to only if the
(
mother asked for it and wanted to know something. This was where informal
social networks were used by the mothers (Okagaki and Divecha, 1993) to get
information from a number of friends before deciding what they would do
themselves. The informal sharing of information and ideas during groups such
as playgroups enables mothers to check what they are doing with their chil-
dren against cultural scripts and common practice of society (Willard, 1988).
Groups such as this should be encouraged so that mothers can learn from the
wealth of experience that other mothers have without feeling that they are
being told what to do. When mothers received advice from health profession-
als, this was given greater weight by mothers in this study than advice from
family and friends. This may have been because of the professionals’ special-
ized knowledge and perceived experience with a large number of mothers.
Mothers in this study made decisions for themselves based on their own
past and present experience, as did those in the study by Attanucci (1988).
This became an important tool in the choice of what method to use.
Although the mother began to use a method based on cultural scripts or what
she had seen someone else do, it was her own experience that enabled her to
tell whether this method was going to work for her.
This is consistent with the third script presented by Willard (1988), where
methods will be created based on the mother’s individual situation. The first
and second cultural scripts mentioned by Willard (1988), although not direct-
ly discussed by the mothers, could be seen through their actions. The first
script of being a selfless wife and mother can be seen in the mother’s desire to
always put the child’s needs before her own needs. The second cultural script,
the superwoman role, can be seen in those women who combine mothering
with the work role and try to ‘do it all’ (Willard, 1988: 229).
Mothers in this study did not see the workplace as a valuable resource, as
has been reported by Willard (1988). This applied not only to advice but also
to lifting and handling skills learned in the workplace, which were not being
used in the home for lifting and carrying children. Parenting literature was,
however, widely used by the mothers to determine what were the ‘better’

Lifting and back strain in childcare for mothers
17
methods to use. Advice in these magazines tended to be about what was best
from the child’s perspective and not that of the mothers.
As children aged, the mothers reported less physical handling of their
child being required. So, when children are younger, mothers are performing a
lot of lifting and handling and need to care for their backs to prevent injury
from occurring. However, this study indicates that mothers tended to use
stoop lifting which seemed a natural choice for them. Childcare workers
(King et al., 1996) also favoured this technique. Mothers in this study put lit-
tle thought into how they would lift, doing what was quickest and easiest.
This is also consistent with other literature (Owen, 1994; King et al., 1996).
Although childcare has been classified as light work (National Occupa-
tional Health and Safety Commission, 1990; Grant et al., 1995), the repeated
use of poor techniques over many incidences of lifting and carrying exposes
mothers to the potential of cumulative stress as a cause of back injury
(Leonard, 1990). Mothers in this study gave no evidence that they used any
of the safe lifting and handling techniques suggested in the literature (NSW
Department of Education, 1983; Nordin and Frankel, 1989; Workcover
Authority of NSW, 1995; Phillips et al., 1996). This may be because the prin-
ciples suggested are for inanimate objects (NSW Department of Education,
1
983; Delitto et al., 1987; Sullivan, 1989) and are hard to apply to a moving
child. Little information is available about lifting moving objects such as chil-
dren. Mothers may not know what the ‘best’ method is when the principles of
good back care when lifting cannot all be applied to the childcare situation.
Mundt et al. (1993) suggested extending the education of lifting techniques
beyond the workplace and into the home. There is no evidence in the litera-
ture that this has been done.
Literature also suggests that little research has focused on ergonomics in
childcare (King et al., 1996). Choosing equipment for ergonomic reasons was
not a priority for mothers in this study. Most childcare equipment is designed
for the ‘average’ mother, and equipment that is adjustable is generally at the
more expensive end of the range. Literature suggests that with correct work-
place design, in this case each mother’s home, repetitive bending, stooping
and twisting can be minimized (Carson, 1994; Workcover Authority of NSW,
1
995).
Breen et al. (1994) reported that a dull ache across the lower back was the
most common complaint reported shortly after birth. This was also the case
with the mothers interviewed. However, for the mothers in this study the
backache was not just initially after the birth but continued off and on until
the time of the interviews (5.5 months to 3.5 years). This may indicate that
back pain in these mothers is linked to factors other than the birth process or
anaesthesia (MacArthur et al., 1990; Breen et al., 1994), such as the continu-
ous lifting and carrying of children while using incorrect techniques.

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Conclusion and recommendations
When choosing a childcare method the mothers in this study took into con-
sideration a wide range of motivating factors. Contextual factors involved
consideration of the number of children the mother had, her time constraints,
her awareness of options available, ways to conserve energy and the duration
and frequency of the task. Decision-influencing factors mainly revolved
around the purchase of equipment and included cost, duration of time the
equipment would be used, what experience and advice was offered by others,
aesthetics, the age and weight of the child, space available and the ergonomic
dimensions of the equipment. Most methods were chosen for the safety of the
child rather than because they met the mother’s needs.
Often mothers would give little or no thought to the way they were lifting
and carrying their children. Previously learned methods of correct lifting and
handling were generally not transferred and applied in the home situation to
lifting and carrying children. Stoop lifting was the method most often used.
Such a technique repeated often during the day as a mother cares for her child
exposes her to increased risk of back injury.
Research is needed to determine the best methods for lifting and handling
children in the variety of childcare tasks that mothers perform every day. Spe-
cific techniques for the variety of tasks can then be recommended to mothers,
with a view to decreasing the incidence of back pain. Mothers need to be
assisted to apply these to their own unique situation and context. This infor-
mation needs to be provided at a time when mothers are ready to receive it
and make use of the information. Immediately following the birth of their
baby does not seem to be an optimum time, as mothers feel overwhelmed with
their new role and the amount of information they need to absorb. It might be
better to provide this information through mothers’ groups and other commu-
nity settings when mothers are more ready to listen. The information provid-
ed needs to take into consideration the contextual factors that influence
mothers’ decision-making about childcare methods. Information about mak-
ing ergonomically sound choices when purchasing equipment needs to reach
mothers before the birth of their first child, which is when they tend to be
making these choices. This study indicates that parenting magazines may be a
good place to provide this information.
Further research is also required to determine the extent of back pain expe-
rienced by mothers. The nature of the tasks mothers perform each day over a
number of years as they care for their children indicates that they are likely to
be subject to back pain. However, no research has determined the extent of
the problem in this area. Curricula for health professionals such as occupa-
tional therapists and physiotherapists need to include information about the
mothering role, the risk of injury the role exposes mothers to and suitable
intervention strategies aimed at both prevention and treatment.

Lifting and back strain in childcare for mothers
19
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