The coroner said there appeared to be “no advice that breastfeeding hands-free a young baby is unsafe due to the risk of suffocation”.

Ms Brown called for industry standards promoting the safe use of slings.

“There appeared to be no helpful visual images of ‘safe’ versus ‘unsafe’ sling/carrier postures,” she said, adding that “the NHS available literature provides no guidance or advice”.

“In my opinion action should be taken to prevent future deaths,” she said.

Copies of the coroner’s report, published on Saturday, were sent to a baby carrier manufacturer and a baby sling manufacturer, as well as the NHS and the Department of Health and Social Care.

A spokesperson for The Lullaby Trust, a charity providing advice on safer sleep for babies, said: “The safest baby carrier to use will keep the infant firmly in an upright position where a parent can always see their baby’s face, and ensure their airways are free.”

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