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Wearable Technology for Infant Health Monitoring: A Survey

Saba Feroz Memon 1*, Mohsin Memon 1, Sania Bhatti 1

1
Department of Software Engineering, Mehran University of Engineering and Technology, Jamshoro, Pakistan.
*
sabaferoz01@gmail.com

Abstract: Continuous health monitoring for an infant is crucial for detecting and preventing a number of diseases. Recent
advancement in wearable technology has given rise to the development of wearable infant health monitoring systems
(WIHMS). These systems provide an edge over conventional infant health monitoring systems which are not only bulky and
uncomfortable for the infants but are also limited to the clinical settings. This paper reviews some state-of-the-art WIHMS,
mentions the advantages, limitations, and the challenges faced by such systems. This paper for the first time contributes an
appraisal of research prototypes and commercially available systems for WIHMS, which is the need of the day.

Since, as compared to adults, infants cannot articulate

1. Introduction
“A wearable is a combination of devices-typically a
belt or backpack PC, head-mounted display, wireless
communications hardware, and some input device, such as a
touchpad”. [1]. Wearable can either be worn externally on the
body as accessories and E-textiles or tattooed to the skin as
E-patches [2]. Wearable devices have undergone significant
development since the 1960s and are influencing people’s life
and work [3]. Such devices have gained immense popularity
over the years with a variety of applications including
healthcare and monitoring [4], mobile learning [5], fitness [6]
and industry [7].
Health Care monitoring is an essential application of
wearable technology. Over the years, a number of smart
health monitoring systems have been developed. Smart health
monitoring systems based on wearable technology can
replace the traditional ways of health monitoring and free
healthcare practitioners from the tedious tasks of self-
monitoring patients from time to time. Such systems can not
only be used to monitor the psychological and non-
psychological aspects of a patient in hospitals but can also be
used to monitor the vital signs such as Respiration rate
(Breathing Rate), Pulse Rate, Body Temperature, Blood
Pressure, Blood Oxygen Saturation (SPO2) etc. at their home
[8] and in some cases either trigger an alarm or send prompt
notifications to the health care professionals so that any
unwanted situation could be avoided. Such systems can be
quite helpful in overcoming the geographical barriers and
providing timely health care through telemedicine to people
who don’t have immediate access to the medical facility [9].
For example, Tewary, S. et al. [10] in their research have
described a cost-effective wearable heart rate monitoring
system that monitors ECG (Electrocardiogram), NIBP (Non-
Invasive Blood Pressure) and sudden fall signals and sends an
alert message to the healthcare provider in case of any
abnormality. In [11], the authors have designed a pH mapping
smart bandage with thread-based sensors for chronic wound
monitoring. In [12], the authors have designed a wrist-worn
wearable system that monitors the wearer’s cardiac activity
during sleep. The device can be used during sleep as well as
during daytime and measures heart rate parameters for up to
48hrs with 98% accuracy.
pain and uneasiness. Therefore, it is extremely important to
continuously monitor vital signs of infants specifically when
they are preterm or critically ill to prevent infant death [13].
In recent years, there has been significant development of
systems that employ wearable technology for continuous
health monitoring of infants. For instance, Chen, W. et al [14]
designed a system that can be incorporated into a smart
neonatal jacket for monitoring ECG of newborn infants. The
design employs wireless and smart textile technology for
monitoring and transmitting the ECG of the infants and
processes it to display the results on an embedded laptop. To
facilitate working parents to monitor their infants and protect
the infants from SIDS (Sudden Infant Death Syndrome), a
syndrome in which an infant within 12 months of age dies
during sleep without any known cause, authors in [15] have
designed a wearable pair of sock to continuously monitor
temperature and heartbeat of the infants. The system sends
the gathered information remotely to a mobile application
designed for the parents and notifies the parents in case of an
emergency. Similarly, Oshin, O. et al. in [16] have developed
a wearable infant monitoring system for preventing SIDS and
reducing the infant mortality rate. The system monitors the
temperature and heart rate of infants and displays the results
in an android application for parents and healthcare
professionals. Utilizing wearable systems for infant health
monitoring gives an edge over traditional health monitoring
approaches as it not only saves manpower but also captures
several vital parameters simultaneously. The data of the
monitoring can be utilized in detecting and preventing a
number of health conditions in the newborn such as SIDS.
Table 1 shows significant parameters that can be monitored
using WIHMS along with the associated health conditions
and the sensors that can be used for capturing them.
Although, numerous review papers [17-26] on
wearable technology for health monitoring, are available.
Most of them are generic and have focused on reviewing the
health monitoring systems designed for adults. As per our
knowledge, only three survey papers dedicated to WIHMS
have been published until now which include survey paper by
Chen, H. et al. [27] in which they have reviewed state-of-the-
art systems for monitoring body movements of infants,
review paper by Singh, P. et al. [28] in which they have

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Table 1 Significant parameters to be monitored using WIHMS and associated health conditions
Parameter Description
ECG /EKG Measurement of the electrical
(Electrocardiography) activity of in an infant’s heart
Heart Rate Measurement of the number of
heartbeats per minute of an infant
SPO2 (blood oxygen Measurement of the percentage
saturation) of arterial haemoglobin that is
saturated with oxygen.
Respiratory rate Measurement of the number of
breaths per minute
Body Temperature Measurement of the average
temperature of an infant’s body
Hydration Measurement of water levels in
an infant’s body
Body Movements Detection of motion in an
infant’s body
discussed in detail the generic architecture of infant
monitoring systems for monitoring blood oxygen level and a
comprehensive survey paper by Zhu, Z. et al. [29] in which
they have reviewed some available WIHMS, and discussed
different methods, techniques, and applications of WIHMS.
Motivated by their work, in this paper we have gathered 22
state-of-the-art WIHMS designed between the years 2007-
2018 from different databases and websites such as IEEE
Xplore, Google Scholar, SpringerLink, ScienceDirect,
Amazon.com etc. and reviewed them. This is the first time
that a comprehensive study that includes both research
prototypes and commercially available systems designed for
infant health monitoring is presented.
Our paper bifurcates the research prototypes and
commercially available systems into single parameter and
multiple parameter WIHMS on the basis of the purpose of the
systems. Single parameter health monitoring system is
employed where only a single parameter needs to be
monitored for the identification of a health condition. For
instance, for health conditions like Apnea, Hypopnea,
Tachypnea only the breathing rate needs to be monitored. On
the other hand, a multiple parameter health monitoring
system is used where monitoring of several related health
parameters is required at the same time. For instance, for the
identification and prevention of SIDS often multiple
parameters such as heart rate, temperature and body
movements are monitored simultaneously.
In our study, we review different systems under each category
to determine the effectiveness of these systems and the
challenges faced by them. It has been observed that WIHMS
are very useful and can be beneficial for both paediatricians
and parents of the infants. However, they are still in their
preliminary stages and more research is needed to address the
challenges such as accuracy, communication network with
continuous connectivity, adequate battery duration, small size
and comfortableness, availability of a proper application
interface, flexibility and usability currently faced by WIHMS.
In section 2, we present the benefits of the study. In
section 3, we explain the generic architecture of infant health
monitoring system. In section 4, we describe state-of-the-art
WIHMS along with their advantages and limitations. In
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Sensors Health Condition
Ag/AgCl Electrodes, Textile Electrodes, Cardiovascular
Capacitive Electrodes diseases, Hypertension
Ag/AgCl Electrodes, Textile Electrodes, Tachycardia,
Capacitive Electrodes Bradycardia,
Reflectance sensors, optical sensors, pulse Hypoxia, Hypoxemia,
oximeter Hyperoxia
polyvinylidene fluoride (PVDF) film-based Apnea, Hypopnea,
sensor, girth sensor Tachypnea
Thermocouples, Thermostats, NTC (Negative Hypothermia,
temperature coefficient) Thermistors, RTD Hyperthermia,
(Resistance Temperature Detector),
Semiconductor based sensors
Gel electrodes Diarrhoea, Vomiting
Heatstroke
Accelerometer Spasticity, Flaccidity,
Range of motion, SIDS
section 5, we discuss the challenges faced while designing
WIHMS. Finally, we present the conclusion in the end.
2. Benefits of The Study:
In this research, we attempt to explain what exactly WIHMS
are and how they can be useful for health monitoring of
infants and can replace traditional methods of infant health
monitoring. We categorize WIHMS and under the
categorization scheme discuss a number of state-of-the-art
WIHMS along with their advantages and limitations. Finally,
we discuss the challenges faced by WIHMS. This study
provides six major benefits which are stated below:
1. This research provides a brief overview of WIHMS
which helps in understanding how such systems work and the
general architecture of such systems.
2. The study has gathered both commercial systems as
well as research prototype of WIHMS at one place, discusses
their technical specifications, technologies used and has
provided a detailed review that gives the insight of the current
status of WIHMS.
3. The research highlights the challenges faced by
WIHMS and the technologies being used in tackling those
challenges that would help researchers in selecting the best
approach while working on WIHMS.
4. The research describes the technologies that have
been explored so far in the design and developing of WIHMS
and can help researchers in selecting the latest tools and
technologies that have not been explored but are innovative
and can be useful for the development of WIHMS
5. The paper provides a clear view of WIHMS and how
this is an emerging field that can benefit a lot of people which
can motivate young researchers and students to choose
WIHMS as their research topic.
6. The study will help paediatricians / medical
researchers understand how WIHMS can replace
conventional infant health monitoring systems in the future
and provide non-invasive infant monitoring. This will help
reduce the gap between medical science and Information
Technology thereby opening doors of multiple opportunities
for WIHMS.
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3. Generic Architecture of WIHMS
A WIHMS contains different components with each
component having its own distinctive functionality. Fig 1
depicts the different components of WIHMS which are
explained below:
Fig.1. Generic Architecture of WIHMS
3.1 Bio-Sensors:
A WIHMS contains a number of biosensors for
sensing various bio-parameters such as temperature,
respiration rate etc. [26]. While traditional health monitoring
systems contain bulky and abrasive sensors which cause
discomfort to the infants, WIHMS replace those traditional
sensors with small and comfortable textile-integrated sensors
[30,31] mostly knitted with conductive yarn [32,33] which
can be comfortably worn by the infants as a part of their
clothing for long-term non-invasive monitoring.
3.2 Network Communication:
The parameters captured by the sensing element are
sent to the processor via wired or wireless communication.
Traditional monitoring devices use adhesive wires which can
be quite uncomfortable and painful for the infants, therefore,
nowadays wireless communication known as Wireless Body
Area Network is used for communication between the sensors
[34, 35] and transmitting the data from the sensors to the
processor for processing.
3.3 Processor:
The processor contains a number of components and
algorithms for extracting useful information from the signals
received from the sensors such as converting the analogue
signals to digital signals, removing noise from the signals,
amplifying the signals, filtering the data, comparing the date
with threshold values etc. [29]. The type of processor may
vary depending on the design of the system and the
parameters monitored. While some systems use a single
processor for performing all the tasks, others utilize a
processor along with different individual components for
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processing such as Analogue filter, ADC (Analogue-to-
digital converter) and other filters depending upon the design
of the system.
3.4 Alarm and Notification System
Since it is not possible for both parents and health care
providers to continuously monitor the vital signs of the
infants for detecting abnormalities. Therefore, an alarm and a
notification system are added. In case of variation of the
parameters from the threshold values (limit within which the
value of the monitored parameters can normally vary), the
processor either triggers an alarm via the alarm system or
sends a notification via notification system (e.g. SMS alert)
and sometimes uses both to notify the parents [36] or the
healthcare professionals.
3.5 Database System
A WIHMS contains a local or cloud-based database
that stores the threshold parameters that are fed into the
system during initial configuration as well as the data
captured by the sensors for processing. The data on the cloud-
based databases can be uploaded via WIFI or GPRS and can
be accessed anywhere.
3.6 GUI (Graphical User Interface)
The processor displays the processed data to the
parents or healthcare providers via a GUI which can be any
LED, Personal Computer, Laptop, Monitor or a customized
Smartphone application designed for the system. The
traditional monitors are usually connected via wires with the
other components. On the other hand, the new GUI interfaces
are connected through a wireless medium (Bluetooth,
Wireless) with other components of the system.
3.5 Power Supply :
A WIHMS requires an adequate power supply [24] to
continuously monitor the infant for long hours without
causing any disruption to long-term monitoring. To keep the
power supply continuous, several rechargeable and non-
rechargeable batteries along with certain new approaches
such as passive RFID tags [37] or pyroelectric transducers for
energy harvesting are being explored nowadays. [38]
The presented architecture is a generic one. Not all
WIHMS contain the same components. The structure and
components may vary depending on the design and approach
used for the specific system.
4 State-of-the-art WIHMS
WIHMS can be categorized into two categories i.e.
single parameter health monitoring systems and multiple
parameter health monitoring systems. In this section, we
discuss some research prototypes and some commercially
available WIHMS under both categories along with their
advantages and limitations. A summary of the review is
presented in Table 2, Table 3 and Table 4 (see Appendices).
4.1 Research Prototypes:
Over the years, several research prototypes of WIHMS have
been developed. Some of them have been reviewed below.
4.1.1. SingleParameter:SingleParameterhealthmonitoringisan
approach to health monitoring in which only the desired
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health parameter of the infant is monitored. Such systems can
be used to capture several individual parameters such as ECG,
Respiration, Blood Saturation, Temperature, Blood Pressure
etc. A variety of single parameter monitoring systems which
are used for Heart Rate, Hydration, Respiration, Blood
Oxygen Monitoring and Wetness Monitoring are presented in
this section.
4.1.1.1 HeartRate/ECGMonitoring:Heartrateisanextremely
important parameter for determining the cardiac health of
infants. It is crucial to monitor the heart rate of infants so that
health conditions such as tachycardia (increase in heart rate)
and bradycardia (decrease in heart rate) could be detected and
infant survival rate could be increased. Agezo, S. et al. [39]
designed a battery-less system based on RFID technology for
continuously monitoring the heart rate of the infants. The
system contained a onesie (jumpsuit) having two integrated
conductive fabric electrodes (TechnikTex P180+B) with
interconnects (electrode strips) to be positioned at the lower
parts of both sides of the musculus pectoralis major on the
front of the body of the infant for recording the ECG pulse.
The connectors on the onesie are connected to a detachable
RFID heart rate detection circuit which uses an on-off keying
modulation scheme to transmit heart rate data. An RFID
reader with the antenna has been used that powers the passive
RFID tags and captures the information from the tag. The
captured information is then fed into a processing unit
(Raspberry Pi 2 Model B) which processes it and sends it to
an android application via Bluetooth for displaying the results.
Additionally, a local alarm system is integrated with the
processing unit to notify the nearby people when there is a
signal loss or when the captured heartbeat deviates from the
given range (80-180 bpm).
It is a decent system that uses TechnikTex fabric
electrode which has a lower impedance as compared to foam
and other fabric electrodes tested in the study and shows an
accuracy of 98.8% as shown by the simulation results in
correlation with MediTrace foam electrode. Also, the RFID
tags are being charged by the RFID receiver due to which
long-term monitoring can be achieved by the system which is
another benefit of the research. However, the system doesn’t
provide any information regarding the range of the RFID tags
which depends on the type of tags used which is usually very
less. The system can face frequent disconnection if the infant
is taken out of range of the RFID tags and generate false
alarms. Also, to test the comfortability of the electrodes,
college students were selected by the authors who tested the
electrodes on their hand. The feedback given by the students
cannot be relied upon since an infant’s skin is very fragile and
sensitive as compared to an adult’s skin. Therefore, real-time
testing of the system on infants is needed to verify the
accuracy, range, and comfortability of the design.
Mahmud, M.S. et al. [40] designed a sensing system
attached to the infant’s diaper around the abdomen for
monitoring cardiovascular activities. The system contains
two capacitive electrodes (Plessy PS25255) based on EPIC
(Electric Potential Integrated coupling) for sensing ECG
without direct contact with the infant’s skin. The system also
contains an accelerometer and LMS (Least Mean Square)
filter to detect and remove the noise interference from the
sensed signal due to movement artefacts and improve SNR
(Signal to Noise ratio). Moreover, the system contains an
AFE (Analogue Front End) containing an amplifier,
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Butterworth, and notch filters for multistage amplifying and
filtering which is connected via BLE (Bluetooth Low Energy)
with a Simblee Iot (RFD77101) that processes and uploads
the data which can be viewed on a cell phone or a computer.
The entire system is designed in a way to consume less power
and uses a rechargeable Lithium-ion Battery which is charged
via USB charging circuit.
The overall system seems promising with compact
size and less power consumption. The system doesn’t require
direct interaction with an infant’s fragile skin and can be used
to detect different syndromes such as arrhythmia (irregular
heartbeat) or syncope (temporary loss of consciousness). The
battery can work for months without requiring to recharge as
claimed by the authors. The system was tested on two young
adults lying on their back and results were displayed on
PC/Laptop. It was observed that the system design was able
to overcome the high noise inferences and the results were
comparable with that of the commercially available EPIC and
AgCl (Silver Chloride) based devices. However, there are a
few limitations to the system. Such as the system contains a
number of components which despite being small in size can
cause discomfort to the infants who often roll over on their
back. Moreover, the system has been tested on adults only
and that too when they were lying on their back and testing
has not been performed for other positions such as lying on
their front and sides. Therefore, the system needs to be tested
on infants with different positions to determine the accuracy
and comfortableness of the system.
Ueno, A. et al. [41] designed an underwear based on
capacitive coupling (transferring AC signal from one part to
another part of the same or different circuit) for monitoring
Electrocardiography (ECG) through the dorsal surface of an
infant. The design contains a sheet of conductive fabric of
Nickel on Copper Plated Polyester as a conductive metal
electrode which interfaces with the skin through an
underwear fabric working as an insulator for capacitive
coupling when the infant is lying on a supine position (lying
on their back). The system further contains a pressure
relieving mattress, amplifier, notch filters, high pass and low
pass filters and inverting amplifier.
It is an innovative approach for monitoring ECG that
replaces the conventional electrodes that require direct
contact with the infant’s skin and can be harsh for them. The
system was tested on 6 infants aged between 43-136 days and
the results stored on a personal computer using Biopac MP-
150 data acquisition. The acquired results were compared
with the results obtained from a conventional ECG monitor.
The results were obtained in two situations when the infant
was sleeping and when the infant was awake to test the
accuracy of the system with motion artefacts. In the former
case, the comparison shows that the ECG waveforms were
synchronized with some variance in the ratio of P and T wave
to Q and R wave. However, in the latter case, it failed to detect
the ECG signal. Also, the system requires the infant to put
sufficient pressure by lying in a supine position which is
impossible to achieve all the time. Moreover, the system
doesn’t provide any information about network
communication and the battery being used for the system and
its duration which are two important aspects of WIHMs.
Therefore, in the current condition, the system cannot be used
accurately for monitoring ECG and requires more research
work.
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4.1.1.2 Hydration Monitoring:
“Dehydration is a major cause of morbidity and mortality in
infants and young children worldwide” [42]. Infants are at
more risk of dehydration specifically when they suffer from
vomiting or diarrhoea. Dehydration in infants can disrupt
homeostasis (tendency to maintain a stable internal
environment) at the cellular and even at system levels and
may lead to some serious health concerns. Therefore, it is
important to monitor the hydration level of infants. Talha
Agcayazi, T. et al. [43] designed a non-invasive wearable
system that makes it possible to monitor variations in
hydration levels of an infant out of the clinical settings using
BIA (Bio-Impedance Analysis). The design places two gel
electrodes, one electrode on the posterior calf and one on the
anterior thigh of the infant. Moreover, the system contains an
impedance converter chip (AD5933), an RFduino
(RFD22301), a coin cell battery enclosure to hold the battery
and uses Bluetooth Low Energy (BLE) communication for
displaying the results on a smartphone application.
The system presented above can be of great help for
full-time hydration monitoring of the infants who are
suffering from diarrhoea or vomiting and are prone to
dehydration. BIA used in the research is the only suitable
technique for real-time wearable monitoring and makes it
possible to monitor hydration out of the clinical environment.
However, there are a few of the limitations of the system. The
system doesn’t provide the value of total body water and is
only truly accurate when measuring changes in hydration,
relative to previously acquired data points. The evaluation of
the system has been performed on two young adults in which
just increase in hydration levels has been measured, a
decrease in hydration levels has not been evaluated which is
the sole purpose of the project. The gel-based electrodes are
abrasive and can be harsh for an infant’s skin for longer
durations [14]. Also, the position of the sensors (anterior
thigh and calf) can be quite uncomfortable for the infants.
Therefore, more work is needed in terms of selecting sensors,
position, and evaluation of the system.
4.1.1.3 Respiratory Monitoring:
Respiratory rate is defined as the number of breaths taken per
minute. It is crucial to monitor the respiratory rate of infants
in order to detect specific conditions such as sleep apnea
(suspension of breath rate during sleep for 10 seconds or more
during sleep) or hypopnea (reduction of breath) or tachypnea
(abnormally fast breathing) which can induce other medical
conditions like bradycardia or hypoxemia (oxygen deficiency
in blood) in infants [44]. Therefore, to monitor sleep apnea,
Mahbub, I. et al. [45] have designed a self-powered
respiratory monitoring system for preterm infants. The
system includes a non-intrusive polyvinylidene fluoride
(PVDF) film-based sensor and a CMOS (complementary
metal-oxide-semiconductor) integrated circuitry which can
be placed inside the nasal cannula or the breathing mask of
the patient. The PVDF sensor works as a pyroelectric and
transduces the heat generated during breathing to electric
charge. The PVDF sensor can also work as a piezoelectric
transducer and can convert the stress-energy (i.e. change in
the pressure of the airflow during breathing.) to electric
energy to supply the power to the system. The system also
contains a vibration device that is turned on when an apnea
event is detected to wake the patient up from sleep.
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The research provides a novel approach for respiratory
monitoring and has a number of benefits. Such as the system
utilizes energy harvesting techniques to be self-powered and
consumes less power. The sensor used is thin, flexible and
provides a quick response. The system is small and light in
weight and is able to fulfil its goal of detecting the respiratory
pattern with low cut off frequency and noise factors.
Moreover, the initial simulation of the system shows
promising results. However, the system is still in its initial
development stages. Although the authors have shown the
simulation results of different components of the system, they
have not evaluated the system on infants which is important
to identify the effectiveness and limitations of the system.
Therefore, it is recommended to perform real-time testing on
infants.
Another respiratory monitoring system based on RFID
technology has been designed by Mongan, W.M. et al in [46].
They have designed a bellyband (a girth sensor) for detecting
motion-based artefacts and contains passive RFID tags and
textile knitted antennas which are connected together through
conductive and non-conductive yarn wires. An RFID
Interrogator (4000 Wireless Tabletop Pulse Oximetry) is used
which is responsible for charging the passive RFID tags.
Instead of using any conventional biosensors, the authors use
the movements of the chest wall and abdomen for measuring
the breathing rate. Whenever the infant breathes, the
conductive the yarn wires attached to the bellyband oscillate
and the RSSI (Received Signal Strength Indicator) is used as
a time-series signal by RFID interrogator to monitor the
changes in breathing rate and other parameters.
It is a novel approach for breath rate monitoring with
a number of advantages. The evaluation was performed on an
infant mannequin by programming it four times for different
respiration rates i.e. 31, 15, 15, and 31 times per minute
respectively. The system was tested for detecting breath
cessation, the rate of breathing and ambient motion detection
and provided satisfactory results. The system can
successfully identify if the infant is breathing or not breathing,
detect apnea and hypopnea and sense movement. The textile
knitted antennas provide non-invasive real-time monitoring
for infants. Moreover, since passive RFID tags are being
charged by the RFID interrogator, therefore, long-term
monitoring can be achieved without the need for any external
battery. The only limitation of the system is that it requires a
large amount of processing including filtering, statistical
analysis, signal processing, and machine learning for
extracting the desirable results.
4.1.1.4 Blood Oxygen
Monitoring: Blood oxygen also called as blood oxygen
saturation or SPO2 can be defined as the percentage of arterial
haemoglobin that is saturated with oxygen. It is another
crucial parameter that needs to be monitored specifically
when the infants are preterm or admitted at NICU. Chen, W.
et al. [47] presented the design of a non-invasive wearable
system for monitoring blood oxygen saturation of infants at
NICU. Two prototypes of the system were developed in
iterations. The design uses reflectance sensors based on NIRS
(Near Infrared Spectroscopy) techniques and employs
wireless medium for communication and power. The
designed system contains one sensing and one receiving
module. The sensing module which consists of a photodiode,
Red & Infrared light emitting diodes, (LEDs), an analogue
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processing circuitry, ADC (Analogue-to-Digital Converter),
an embedded microcontroller, and an RF (Radio Frequency)
transceiver is knitted into a textile and is small enough to be
integrated into a smart wearable platform (e.g.: smart
neonatal jacket). The receiving module contains a
microcontroller, an RF transceiver and a data cable to be
connected to the monitor that performs advanced processing.
Additionally, the system employs an Avant® 4000 Wireless
Tabletop Pulse Oximetry by Nonin for advanced processing
and wireless transmission.
The initial testing of the second prototype on an adult
and a premature infant showed promising results. The results
were accurate and closely synchronized with standard
systems. The sensors were tested in different locations to find
out the optimal positions and few positions were shortlisted
in the study. The testing showed that reflectance sensors can
be used at different positions for blood saturation monitoring
and are embedded into soft fabrics with minimal thickness to
ensure the comfortableness of the infant. Also, the design of
the system has passed the criteria for leakage current, hospital
hygiene, and allergic reactions. However, the system is in its
initial design phase. The authors need to cater to the issue of
false readings due to movement artefacts. Moreover, the
optimal position of the sensors is yet to be determined that
ensure comfort and accuracy. Therefore, more iterations of
the system are needed until the system matures.
4.1.1.5 Wetness Monitoring:
Babies spend approximately 7000 hours/ year in diapers and
change about 1500 diapers during the first year of their life.
This continuous use of diapers can cause skin rashes to the
babies due to prolonged exposure to wetness because of urine
and faeces. Therefore, authors in [48] have designed a smart
diaper that detects the wetness and informs the baby’s
attendant through call/SMS and audio alarm so that the diaper
can be timely changed and skin rashes can be prevented. The
system contains consisting of a wetness sensor (elongated
pair of spaced fine conductors) that detects the wetness, RF
transmission system that transmits the signal after detecting
the wetness and GSM alarm system that notifies the baby’s
attendant through alarm call/SMS and that sends the signal to
healthcare application so that it can trigger the alarm.
Additionally, the system contains an analogue switch, GSM
door sensor and a gateway technology such an Application
Programming Interface (API). The wetness detector system
uses small thin watch batteries for power.
The authors tested the five diapers with wet detectors by using
10 grams of flour dough with 40% water as faeces and
different volumes of water (from 1 to 5ml) as urine on the
inner surface of the diaper. The experiment showed that the
sensor successfully detected different levels of the moisture
and turned on the buzzer attached to the diaper for testing.
The battery used with the detectors have a good life and can
be used 100 times for continuous monitoring before they can
be changed. Also, the detector can be fabricated into smaller
chips to ensure the comfortability and safety of the babies.
However, the authors have only tested the detector unit not
the other components of the system stating that those have are
already tested units. The system with all the components
needs to be tested to ensure that the integrated system works
well and accurately detects moisture. Moreover, the testing
should be performed on babies to ensure that the system is
non-invasive and doesn’t cause discomfort to the babies.
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4.1.2. Multi-Parameter: While single parameter
monitoring can be very helpful when it is required to monitor
a single desired parameter, multi-parameter health
monitoring systems broaden the scope of infant health
monitoring and are used when we want to monitor multiple
health parameters of the infants through one single platform.
Here we present seven different examples of research
prototypes of multi-parameter WIHMS.
The first example has been described by Chen, W. et
al. in [49]. In their research, they have explained the design
of a smart jacket for monitoring vital signs of infants at
NICUs (Neonatal Intensive Care Units) developed in
iterations. The jacket is embedded with different textile
sensors (silver coated Medtex 130+B and the gold printed), a
reflectance pulse oximeter and a wearable negative
temperature coefficient (Mon-A-Therm 90045) sensor for
monitoring ECG, blood oxygen saturation, and body
temperature respectively. The jacket also consists of an open
structure fabric at the back and a hat with eye protection for
phototherapy. The sensors are connected together and knitted
into the jacket using conductive yarn wire which is coated in
silver nylon. The study uses 6 textile electrodes at different
positions to combat the movement artefacts for capturing
ECG. A number of tests were performed for comparing
several textile electrodes, testing the leakage exploring the
position for the sensors to be integrated into the jacket for the
accurate measurement of the parameters and to optimize the
functionality and comfort of the infants. Additionally, the
system contains a monitor (Solar 800M) to view the
parameters, which is connected to the sensors via copper
wires, wireless module, and conductive yarn wires.
The overall idea seems promising with a number of
pros. The initial testing was performed on two subjects
(neonates) for monitoring ECG, blood oxygen and body
temperature individually and showed positive results. The
design uses textile sensors and conductive yarn wires which
would cause the least discomfort to the neonates. Moreover,
the authors not only take care of the aesthetic requirement but
also try to comply with the critical requirements of leakage
current, hygiene, and allergic reaction. However, the design
is still in its testing phase. Though, the authors have tested the
components individually. They still need to integrate the
sensors and monitor all the three parameters together to
evaluate the behaviour and functionality of the system.
Therefore, a series of experiments need to be performed by
integrating the components together to ensure the comfort,
accuracy, and quality of the integrated system.
Similarly, Patil, S. et al. in [50] present the design of a
system that monitors body temperature, pulse rate, moisture
condition, movement of an infant. The system uses
temperature sensors (LM35) and an accelerometer
(ADXL335,) wrapped in cotton and placed inside the socks
to measure the temperature and motion of the infant. To
capture the pulse rate, optical sensor and IR transmitter pair
is clipped on one of the fingers of the infant. Moreover,
moisture condition (urine) can be detected by placing 2
copper electrodes below the cloth on which the infant is
sleeping. The system also contains a microcontroller
(PIC18F4520), an ADC (Analogue-to-digital converter) and
a sound detector. The parameters captured can not only be
viewed on an LCD screen but also trigger an alarm in case of
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abnormal measurements and can be communicated to the
parents by SMS using GSM module.
The prototype was tested on an infant and provided
satisfactory results. The obtained values were similar to the
ones obtained from standard monitoring devices. However,
there are some serious concerns regarding the design of the
system. The system size is considerably large with a number
of hard wires. The clips on the fingers of the infant can cause
discomfort to the infant. Therefore, the system fails to fulfil
the three basic requirements of the design of a WIHMS i.e.
aesthetic, comfortability and small size [51].
Another example of multiple parameter WIHMS has
been described by Ferreira, A.G. et al. in [52]. They have
presented the design of a chest belt called Smart Baby Watch
that continuously monitors infants during their sleep to
protect them from SIDS. The system comprises of a
Wearable IoT device, a Gateway, and an H Medical Interface
(customized interface) and monitors the vital parameters (i.e.
temperature, the heart and breathing rates and the body
position) important for SIDS identification. The wearable Iot
contains two textile electrodes, a 3D accelerometer
(LSM330DLC), an infrared thermopile sensor (TMP007) and
a battery with a power system to maximize its life. The system
can operate for continuous 8 hrs and send the information to
the gateway via ZigBee technology. The gateway analyses
the data received from the wearable Iot and in case of any
unexpected event triggers the alarm (sound and light) and
sends messages to the smartphone. Additionally, the gateway
sends the data to a cloud storage system that communicates
via ZigBee to the H medical interface and a mobile
application associated with the system.
The initial testing of the breathing and heart rate
sensor showed accurate results except in a few cases when the
baby was very active or changed his position due to which the
results were disrupted for a few seconds. The system’s
operational duration is satisfactory. Moreover, the
temperature system can monitor the temperate of the infant
without requiring any direct contact with the skin of the infant
which is an added benefit. However, the system is in its still
its initial design phases. The heart rate has only been tested
when the infant is lying on its back. Also, the breathing sensor
gives best results when the baby is lying on its back and gives
erroneous results in other positions. Moreover, the
temperature sensor presented in the study has not been
evaluated. Therefore, some alterations and testing of the
system are required to improve the system.
Similarly, Dhumal, S. et al. [53] designed a hand
glove that monitors temperature and heart rate of an infant.
The system contains a digital temperature sensor (DS18B20)
and heart rate sensors for monitoring temperature and heart
rate from wrist line and fingertip respectively. The sensors are
integrated with an amplifying unit and an Arduino Lilypad
(328 ATmega328P) and use BLE technology for transmitting
data to the middleware device (Raspberry Pi 3). The
middleware device processes the data and stores the data
locally as well as on a cloud-based storage. Currently, the
system uses a coin cell battery for power. However, in the
future, the authors have decided to use a rechargeable lithium
ion battery as a power source. Additionally, the authors have
developed a windows mobile application that displays the
current status, generates reports on the physical condition of
the infant and in case of emergencies sends alert notifications
to the users.
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The system provides a comfortable approach for vital
sign monitoring for infants. The system not only displays the
parameters to the user but also provides complete health
analysis of the infant so that apparent life-threatening events
(ALTE) could be avoided. However, the authors have
mentioned some risk factors that need to be taken care of such
as movement artefacts which could provide incorrect
readings, battery duration which enables long-term
monitoring, internet connectivity which is important for
uploading data, testing of sensors and secure transmission of
data. Also, the authors have not provided any testing results
which are important to judge the functionality and
effectiveness of the research and also to asses to what extent
the system can be affected by the risk factors.
The fifth example of multiple parameter WIHMS
described by Mongan, W.M. et al. in [54] is the design of a
wearable Bellyband based on RFID technology. The system
contains two passive RFID based sensors for sensing heart
rate and breathing rate of infants. The heart rate is monitored
by the system by monitoring the time between the ECG spikes
(R waves) received from the RFID tags. To monitor the
breath rate, an approach similar to the one presented in [46]
is used. Abdominal wall movement is used by RSSI for
sensing breathing rate data. The circuit is connected through
conductive yarn wires and uses wireless communication
method for communication with the RFID receiver.
The device was evaluated on a programmable infant
mannequin which monitored heart rate, ECG and breathing
rate of the infant. To monitor ECG, two electrodes were
attached to both arms of the infants. The parameters obtained
by the testing were closely synchronized with the actual
parameters and the system was able to identify Apparent Life-
Threatening events such as apnea and bradycardia. However,
there are a few limitations to the system. Such as the presence
of two different RFID tags collision could occur and may
result in inaccurate data to be captured due to which the
authors have discussed the possibilities of using a single
RFID tag for both sensors. Moreover, the system only works
correctly within the range of 100 cm from the RFID antenna.
Thirdly, the system requires a lot of processing to obtain the
desired results.
Piccini, L. et al. [32] designed a non-invasive chest
belt called “BioBelt” with integrated sensors and transducers
for monitoring temperature, breathing rate, heart rate, body
movements, and SPO2 of an infant. The system contains a
Belt unit and an electronic unit. The belt unit which uses the
conductive yarn for creating electrodes contains linear
MEMS (Micro-Electro-Mechanical Systems) accelerometer
for sensing respiratory activity through thoracic movements,
textile extensometer for measuring chest dilations, NTC
(Negative Temperature Co-efficient) Thermistor
(B57550G550) for monitoring temperature and portable
Radical7 pulse oximeter for sensing Heart rate and SPO2.
Apart from the belt part, the system contains an electronic
unit with an analogue front end, a 32-bit CPU based on ARM
architecture for processing the data and a Bluetooth
transmission module (PAN1540) that can be used to transmit
the sensed data to a monitor or a computer. The system also
provides a GUI “assembly browser” to the doctors through
which they can view and compare the parameters obtained by
various monitoring devices.
It is an overall promising system with a number of
advantages. The bio belt is made of soft cotton and lycra
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(fabric known for its elasticity) fabric to ensure
comfortableness and can be fitted according to the infant’s
size. The system, if successful can be used for non-invasive
monitoring and replace the bulky systems that are currently
used in NICU. The system was tested on 4 children aged
between 2-12 months and results were obtained. However,
the paper has not provided any details about the battery being
used and its duration. Also, the results presented are
preliminary. Proper testing has not been conducted and the
results have not been compared with other commercial
devices to ensure accuracy. Therefore, proper testing of the
system is required.
Rao, H. et al. [55] designed an abdomen belt for
monitoring the body temperature of an infant. The system
operates on a CR2032 coin cell battery and contains an NTC
thermistor (MF51E) with an aluminium cap for sensing the
temperature, microcontroller for processing the sensed data,
and a BLE for transmitting the temperature data wirelessly to
either a Raspberry Pi or a Google Nexus Smartphone which
are used as gateway devices and stores data online in a
database. The system also contains an analogue front end, a
12-bit CC2540 ADC (Analogue-to-Digital Converter), status
LEDs, inverted F-antenna and RF balun filter. While initially
the device was dedicated to measuring body temperature.
Another iteration of the device was designed with the aim to
reduce the size which was a considerable issue with the first
iteration. The iteration replaced the inverted F-antenna with a
chip antenna and added an inertial sensor along with op-amp
(operational amplifier) so that the breathing rate of the infant
could also be monitored.
The initial iteration of the system was tested by
measuring the temperature of a glass beaker filled with water
by heating it water up to 40°C and allowing it to cool to room
temperature. The testing continued for 10 hours with 2 mins
interval between temperature recordings. The results were
satisfactory as compared with the temperature readings
obtained by a digital thermometer with errors being within
the range of 1°C. The belt is soft and washable and comes in
different sizes. The high precision thermometer used in the
system has a quick response time and accurately detect body
temperature that can be useful in detecting hypothermia
(extremely low body temperature) and hyperthermia
(extremely high body temperature) events. The system is
designed in a way to consume less battery and the battery can
operate approximately for a year. However, though the
authors claim to have designed the second iteration to resolve
the size issue, no information has been provided regarding
whether the new design has resolved the issue. The
transmission range after the replacement of F-antenna has not
been tested and detected that whether the replacement works
well. Also, the second iteration along with the newly added
inertial sensor has not been tested. Therefore, it is required to
test the second iteration of the system.
4.2. Commercial Systems
There are many commercially available WIHMS that
are aiding parents in keeping a track of the vital signs of their
infants and providing a sigh of relief to them. Some of them
have been discussed below with their advantages and
limitations as reported by the users.
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4.2.1. Singe Parameter: This section presents a
review of commercially available single parameter WIHMS
some of which are depicted in Figure 2.
4.2.1.1 TemperatureMonitoring:Temperatureisanimportant
parameter that should be monitored continuously specifically
if the infant is suffering from fever. To make temperature
monitoring comfortable and non-invasive, TempTraq [56] a
non-invasive thermometer patch has been developed that can
be attached under the arm of a sick baby for real-time
temperature monitoring. The patch shown in fig.2 (a) has
three versions which use non-rechargeable carbon-zinc
batteries for continuous monitoring for up to 24, 48 and 72
hours. While the initial version (24 hours) of the batch was
directly connected with the associated smartphone
application (iOS and Android) via Bluetooth Low Energy
(BLE) technology. The latest versions use Bluetooth
technology for sending the temperature readings every 10
seconds to a Bluetooth gateway that stores the data to an
associated cloud service (TEMPTRAQ Connect) which can
be viewed by the parents from anywhere via an associated
mobile application. The application can be used by the
parents to analyse the temperature of multiple children at the
same time. TempTraq is an FDA approved medical device
that can also be integrated with clinical monitoring stations
so that the data could be analysed by healthcare professionals.
Additionally, the parents can add notes in the application and
forward the readings to the child’s paediatrician. Not just this
but the application also alerts the parents when the
temperature readings bypass the alert temperature level.
Reviews of the commercially available TempTraq
versions (24 and 48 hours) show that parents of the infants
are happy with the idea since it provides continuous
temperature monitoring and is quite comfortable for their
infants. They don’t have to disturb their baby for taking
temperature readings and it saves them from the trouble of
manually checking the temperature of their infants from time
to time when they are ill. However, they are not happy with
the price of the patch which is 13-19$ per patch which can be
used only once. Moreover, a number of people have
complained that the 24-hour patch shows inaccurate
temperature results. While some people claim that the
variation is by 2 degrees. Others argue that the variation is by
5-10 degrees. Also, some people claim that the application
frequently goes out of range even when the phone is within
40 feet (as per requirement). A few have complained about
the patch causing bumps to their infant’s skin too. All in all,
we could say that although the design and the idea are really
impressive. However, some improvements are needed to
ensure temperature readings and range accuracy of the patch.
[57].
Another smart device for temperature monitoring is
Pacif-i [58] shown in fig.2(b), a smart pacifier with an
integrated temperature sensor and non-rechargeable CR2032
coin cell battery that can be used to monitor the infant’s
temperature readings without troubling them. Pacif-i uses
BLE that has a range of 65 feet/ 20 meters for transmitting the
temperature readings to an associated smartphone application
(iOS and Android). The application helps you track the
baby’s temperature and medications over time with the help
of timestamped logs. Additionally, the application also allows
you to set alarms for reminding the parents about tracking the
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infant’s temperature and giving medications to them. It also
helps you in locating the pacifier if it is lost somewhere.
Pacif-i is an innovative device for temperature and
shows an accuracy of 0.1°C/ 4°F as claimed by the Blue
Maestro Company that developed it [59]. It is BPA
(bisphenol) free and complies with health and safety
standards for a pacifier. We couldn’t find many reviews about
this product to comment on the accuracy except one blog post
[60] in which a mom claimed that it is a useful tool and can
be very handy sometimes but she also mentioned that shows
a bit temperature error which needs to be calibrated properly
and said that it can be little too heavy for an infant. However,
we are unable to mention more limitations of this product.
4.2.1.2 Breathing Monitoring:
We mentioned earlier how monitoring the breathing rate is
important for sleep apnea, tachypnea, and hypopnea. A
commercially available monitor called has Snuza [61] shown
in fig.2(c) has been designed that uses movement sensor to
and turns on an audible alarm if there is no movement after
15, 18 or 20 seconds. Snuza Hero and HeroMD vibrate after
15 seconds of no breathing movements in an attempt to rouse
the infant and turn on the audible alarm only if there is no
movement for another five seconds or after three rousing
vibrations.
We read different reviews about Snuza which reveal
that it has been preferred and recommended by a lot of parents.
The parents of the infants who used it reported that it is a
lifesaver monitor for them and has given them a piece of mind.
It has saved them from the hassle of waking up at nights to
check their baby. The device can be clipped on easily and is
a really very good device for infants suffering from apnea.
However, there were a few negative comments as well. Some
people complained that the size of the sensor is too big for an
infant, and the sensor falls off easily. Some people said that
Snuza is good only until the infant grows up and becomes
active as it generates false alarms due to movement artefacts.
Some people also complained of some lights present on the

a) TempTraq [56] c) Snuza [61]

b) Pacif-i [58]

Fig.2 Commercially Available Single Parameter Health Monitoring Systems

monitor abdominal movements (breathing movements) of the
infants and alerts the parents if there is weak movement or
there are less than eight movements per minute. It is basically
a clip in sensor that can be attached to the baby’s diaper either
at the front or the back side. Snuza breathing monitor (Fig.2c)
has three versions Snuza Go, Sunuza HeroSE and Snuza
HeroMD that use a non-rechargeable CR2/CR14250 battery
and are able to detect even the slightest abdominal
movements. While Snuza Go monitors breathing movements
sensors that disturb the baby during their sleep. [62].
4.2.2. MultipleParameter:Herewepresentfivedifferentexamples
of commercially available multiple parameter WIHMS which
are depicted in figure 3.
The first example is Owlet smart sock 2 [63] shown in
fig.3(a) which is a wearable sock that uses pulse oximetry for
monitoring heart rate and oxygen level of infants. The sock
comes in 3 different sizes and can be used for infants who are
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either aged between 0-18 months or weight between 6-25lbs.
The information captured by the sensors is communicated via
BLE to a wireless base station that uses different lights and
sounds to notify the users of various conditions such as
abnormality in parameters, adjustment of the sock,
connection issues etc. The system uses a coin cell
rechargeable battery for power and contains two smartphone
applications i.e. one free app for viewing the parameters and
one paid connected care app for both Android and iOS
platforms that display the detailed analysis of the condition of
the infant.
We read reviews of different people on Owlet smart
sock 2. A number of people stated that it has been very
beneficial for them and has given them peace of mind. It
shows accurate readings and generates timely alarms which
help them assure the safety of their children and keep an eye
on SIDS symptoms. Moreover, since it comes in three sizes,
it can easily fit their infants up to 1 year of age. However,
some people claim that it is too overpriced for the services it
provides. Also, some users have also reported that the sock
frequently disconnects from the base station and generates
false alarms which irritate them. Therefore, the company
should consider lowering the cost of the sock along with
improving the connectivity issue. [64]
Designed by Rest Devices, Mimo Smart Baby monitor
[65] shown in fig.3(b) is a smart onesie that contains a
customized turtle sensor with rechargeable Lithium-ion
batteries to monitor breathing rate, skin temperature, sleep
pattern and body position of the infants aged within aged
between 0 and 12 months. The captured parameters along
with audio recording are sent via BLE to a base station
a) Owlet Smart b) Mimo Smart
Sock 2 [63] Baby [65]
d) Sprotuling Baby
Monitor [71]
Fig.3. Commercially Available Multiple Parameter Health Monitoring Systems
(Lilypad) that processes and stores the information on the
cloud server and sends it to an associated smartphone
application (iOS and Android) so that the parents could
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analyse it. The application also alerts the parents when there
is no movement or parameters become abnormally low or
high.
The parents of the infants who used it were happy to
use it and claimed that it is better than the other monitoring
devices that they have used. The onesie material is soft and
comfortable for the infants. However, a good number of
people complained that it is difficult to set up and they could
never set it up for use. Also, though the suit comes in three
different sizes still the sizes are too small to fit the infants of
that particular age. Moreover, the turtle sensor can irritate the
skin and can be uncomfortable for the infants when they roll
over on their tummy. Therefore, efforts should be done to
make it more comfortable and user-friendly. [66]
Another example of commercial multiple parameter
WIHMS is the MonBaby Breathing & Movement Smart
Baby Monitor [67] shown in fig.3(e) which is a wearable
sensor that can be clipped onto the baby’s onesie or pyjama
for monitoring breathing rate and body movements of the
baby. It uses a Non-rechargeable coin cell lithium battery and
BLE technology for sending the captured information to a
connected smartphone application (iOS and Android). The
application then displays the information about breathing and
body position (i.e. whether the baby is lying on his back or
stomach), fall detection and alerts the parents when needed.
It is an extremely useful non-intrusive sensor as
reported by the parents and can be clipped on any clothing
without having the need to wear particular clothes. The
application provides the option to choose the parameters they
would like to monitor and the alerts the parents would like to
receive. However, almost all parents (even those who gave a
c) Sense-U Smart
Swaddle [69]
e) MonBaby [67]
5-star rating to the sensor) complained about the Bluetooth
range which is extremely low. While some people said that it
works within the same room. Others argue that the range is
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not even 3 meters and gave a hard time to them even after
using MonBridge (an additional application provided by the
vendors for improving the range). Some people even said that
they had to use an extra phone and an audio monitor near the
baby to cope with the problem. A few people also reported
having faced false alarm and battery duration issue. [68].
Sense U Smart-Swaddle Blanket [69] shown in fig.3(c)
is a wearable swaddle for monitoring multiple health
parameters of infants up to 6 months of age. Wrapped around
the baby, it uses non-rechargeable lithium-ion batteries and
can detect the baby’s breathing movements, temperature
variations, and body position. It sends the captured
information via BLE to the smartphone application (iOS and
Android) associated with the sensor. The application displays
the information to the parents and alerts them when the
breathing rate is too slow, too fast or stopped for more than
15 seconds. It also notifies the user when the temperature is
too hot or cold or the baby has rolled over and is lying on his
stomach to avoid any unusual circumstances.
Sense U is the winner of 2018 IF design awards and is
recommended by parents for monitoring of SIDs. It is a light
weighted and comfortable swaddle that makes the monitoring
easy. However, some people have reported that they received
frequent false alarms and also are not satisfied with the
battery duration. [70]
The last example of commercially available multiple
parameter health monitoring system is Sproutling Baby
monitor [71] shown in fig.3(d), which is an ankle band for
monitoring a number of parameters including heart rate,
temperature, sleep pattern, body position, environment
conditions (room temperature, humidity, sound and noise
levels) around the infant, infant’s mood etc. The device
contains a wireless base station that serves as a charging
station, a night light and a sound device. The captured
parameters are sent to an associated smartphone application
(iOS and Android) that alerts them via app notifications or
base station lights in case of abnormalities in the captured
parameters. Additionally, the application also collects data
over time and predicts the sleeping patterns of the infants to
inform the parents.
We read some review about the Sproutling baby
monitor. The parents of the infants say that it is a soft and
comfortable band which is easy to set up. The associated
application is easy to use and works well. However, some
parents complained about the inaccuracy of the device and
claimed that it provides false results. Moreover, it is more of
a sleep monitoring device than a health monitoring device and
is too pricey for that ($249) [72].
5. Discussion and Challenges
In this research, we discussed different WIHMS for
infants. Each of the systems presented in this study has its
own set of advantages as well as limitations. Constant efforts
have been done to create a trade-off between different
parameters such as accuracy, communications network,
battery duration, GUI/Application Interface, size and
comfortableness and flexibility and reusability. In this section,
we will discuss the major challenges faced in the research and
development of WIHMS and which approaches have so far
been proved to be the best for those challenges.
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5.1 Accuracy:
The sole purpose of WIHMS is to replace traditional
infant health monitoring systems. However, while designing
these alternative systems, the most important factor that
should be kept in mind is the accuracy of the results [27]. The
obtained results from the designed systems should be
consistent with the traditional ones. Otherwise, the systems
won’t be preferred and relied on or used by the parents and
healthcare professionals of the infants. The commercial
systems that we discussed in this study have been used by the
parents for monitoring vital parameters of their infants. While
the majority of the people have given satisfactory reviews,
there are reviews in which people have mentioned that the
readings provided by the systems were inaccurate and
frequent false alarms had been faced by them. As far as the
research prototypes are concerned, many of them have been
tested on infants and showed accurate results with few
exceptions such as movement artefacts, range issues etc.
However, some of the systems mentioned above have not
been thoroughly tested, only some aspects of those systems
have been tested which cannot be completely relied upon.
Overall, we can say that WIHMS have become quite
successful in achieving accuracy but still, they have not
reached enough maturity in terms of accuracy to replace
conventional infant health monitoring systems and more
work and testing is required to match the accuracy standards
of traditional infant health monitoring systems.
5.2 Communications Network
One important requirement of WIHMS is the constant need
to transmit the information from the sensors to the processor
so that the data could be processed and displayed to the user.
Due to the uncomfortableness associated with wired
transmission methods, wireless medium is now being used
for these transmissions [29]. Two main things under
consideration for wireless transmission are power
consumption and range. To ensure continuous and long-term
infant health monitoring, a wireless device with low power
consumption and higher transmission range should be
employed. Majority of the commercial devices used in our
research use BLE for wireless communication whereas the
research prototypes use diff devices such as passive RFID
tags, Zigbee technology and BLE which is a low power
version of the classic Bluetooth. It has been observed that all
the three employed technologies consume less power but
Table 5 Different wireless communication networks and
their specifications
Wireless Range (Approx.) Power
Medium Consumption (Max)
Zigbee - Up to 300+ meters 30mW
(line of sight)
- Up to 75-100 meters
indoor
Passive RFID - 3 feet (low and high -
frequency)
- 15-20 feet (ultra-high
frequency)
BLE (4.0) - Up to 100 meters 1mW - 100 mW
BLE (5.0) - Up to 400 meters 1mW - 100 mW
- Up to 1000 meters
(outdoors)
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Bluetooth Low Energy technology has been preferred
because it consumes less power than all the other three
technologies as shown in Table 5.
However, as far as the range of the devices is concerned,
Passive RFID tags have the shortest range followed by
Zigbee and BLE 4.0. BLE 5.0 provides the highest
transmission range which makes BLE 5.0 the ideal device
for WIHMS. However, despite good range users with BLE
device also faced connectivity issues and frequent
disconnection was experienced [56]. Therefore, it is
necessary to employ techniques to have the maximum
possible range whenever needed so that the health data can
be transmitted with connectivity issues. The normal
transmission range of Ultra High Frequency (UHF) passive
RFID tags is up to 15 feet. However, few UHF passive
RFID tags designers have been successful in increasing its
range up to 300 feet [73]. Similarly, we can increase the
transmission range of Zigbee technology by dividing the
longer distance into smaller ones and using multiple hop
communication [74]. Similarly, range of BLE can be
increased by employing a wireless base station that is placed
within the range of the infant as in [63, 65, 71] which then
transfers the information to a cloud-based database or a
smartphone through WIFI/GPRS which caters the range
issue of the BLE.
5.3 Battery Duration
Another important requirement of the WIHMS is that the
batteries attached to the sensors should have a longer duration
so that uninterrupted monitoring of the infants could be
performed [29]. In this study, various approaches have been
discussed as shown in Table 6 such as passive RFID tags
being charged by the RFID receiver, Energy harvesting
techniques (Pyroelectric and piezoelectric transducers),
Wireless charging by WIFI module, external rechargeable,
and non-rechargeable batteries such as Lithium-ion batteries,
Carbon-zinc batteries, coin cell batteries. While external
batteries have been preferred by the commercial systems,
parents have often complained about the non-rechargeable
batteries that the batteries don’t last long and worn out earlier
than the mentioned time and they have shown their
dissatisfaction with those batteries. This problem can be
solved by the approaches used in the research prototypes in
which the batteries are usually charged by the RFID receiver
or the Wireless module so infants can be monitored
uninterrupted for longer durations. Energy harvesting
techniques is another good approach that can provide
continuous charging and should be explored.
Table 6 Different power options used for WIHMS
Name Description
Lithium Battery/ Non-rechargeable batteries that use
Lithium Metal lithium metal as the anode.
Battery
Lithium-ion / Li- Rechargeable lithium batteries that use
ion battery lithium compound as an electrode
Carbon Zinc Non-rechargeable dry cell batteries that
Battery use zinc at the anode.
Coin Cell/ Button These are button-shaped non-chargeable
Cell/ Watch as rechargeable batteries made up of
Battery either Lithium, Silver Oxide or Alkaline.
Wireless Module Instead of using an external battery, a
wireless module is placed along with the
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processing unit that wirelessly charges the
battery
Passive RFID RFID tags that don’t require any external
battery and are charged by the RFID
receiver
Pyroelectric It is the property of a material to generate
electricity when it is either cooled or
heated. The generated electricity is used
to power the system.
Piezoelectric It is the property of a material to generate
as a result of mechanical stress applied to
it which is then used to power the system.
5.4 Size and Comfortableness
The most important requirement of WIHMS is that the size
of the monitors should be small and they should be
comfortable for the infants. An infant health monitoring
system can be rejected by the parents if it fails to provide the
desired comfort to their infants. Therefore, special attention
needs to be paid to ensure the small size and comfortableness
[27]. We discussed a number of approaches in the study that
attempted to cater the comfortability requirement such as
employing textile sensors, using smart clothing such as onesie,
socks, bellyband or clip-able sensors for monitoring which
have proved to have met the size and comfortability
requirement. However, in some cases, the size and
comfortability issues have been raised such as sensors being
too big or harsh for infant’s skin which need to be resolved to
make health monitoring comfortable and improve the trust of
the parents in smart WIHMS.
5.5 GUI/ Application Interface
Another challenge for the developers/researchers of WIHMS
is to provide a proper Application Interface to the
parents/healthcare professionals where they can not only
view the monitored parameters but also can see a detailed
health analysis report to get an insight of the patient’s
condition and treat them accordingly. While some research
approaches still use traditional monitors, the majority of the
systems employ a smartphone application to show the data
along with a detailed health analysis of the infant. Some
smartphone applications also provide the option to
share/email the details with health care professionals enabling
telemonitoring of the infants. Some systems also provide the
option to connect the mobile device with a centralized
monitoring device so that better monitoring could be
achieved. Overall, we can say that this challenge has been
effectively addressed by the majority of the WIHMS.
5.6 Flexibility and Reusability:
WIHMS are currently in their preliminary design phases and
a considerable amount of research is currently being
conducted to tackle the challenges currently faced by them.
Also, despite going for low-cost options, still a considerable
amount of money and time is being spent on its design.
Therefore, one important challenge in this case that must be
considered is flexibility and reusability. The system and its
components should be designed in such a way that they are
flexible enough to reap the advantages of reusability. Doing
so would not only reduce the cost and time being spent on
altering the system but also we can reuse its components for
other similar systems.
6. Conclusion:
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Wearable technology has paved the way for the design
and development of health monitoring systems for infants.
Such systems contain a number of components which include
biosensors, communication network, power supply,
processor etc. The research discussed different WIHMS
categorized as a single parameter, multiple parameter
WIHMS. These systems enable long-term monitoring of
infants in and out of the clinical settings and help in the early
detection of ALTE (Apparent Life-Threatening Events). Such
systems not only provide comfort to the infants but also
provide satisfaction to the parents that their children are being
monitored safely. Although WIHMS have undergone
significant development and provide multiple benefits, there
are also some limitations to the systems. Most systems are
still in the design, development and testing phase and even
the commercially available systems are struggling to create a
trade-off between size, comfortableness, accuracy and
adequate power supply. Therefore, we can conclude that
although smart WIHMS are being developed rapidly, they
still need some more research and time until they mature and
gain the trust of parents as well health care professionals so
that conventional infant health monitoring could be replaced
by them.
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 8. Appendices:

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Table 2(a) Research Prototypes of Single Parameter WIHMS
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Author Parameter Sensors Communication Power Processor Alarm/ Advantages Limitations Wearable
Network Supply Notification/GUI type
Agezo, S. Heart Rate TechnikTex Wireless Passive Raspberry Local alarm - Simulation - Lacks Onesie
et al. [39] fabric (RFID), RFID tags Pi 2 Model shows 98.8% information (jumpsuit)
electrode Bluetooth charged by B accuracy. regarding the
the RFID - Long term range of RFID
receiver monitoring - Needs to be
achievable tested on
due to infants for
continuous accuracy and
charging of comfortability
passive RFID
tags
Mahmud, ECG EPIC BLE rechargeable Simblee Iot Computer/Laptop - Compact size - Can cause Diaper
M.S. et Capacitive Lithium ion and less discomfort to
al. [40] electrodes, Battery power the infant
accelerometer consumption - Tested is only
- Doesn’t performed in
require direct supine position
interaction - Not tested on
with infant infants
skin
- Long battery
duration
- Provides
good results
Ueno, A. ECG Capacitive - - Multiple Computer - Novel - Shows some underwear
et al. [41] Electrodes components approach variance in the
- Replaces ratio of P- and
conventional T wave to Q
harsh and R wave.
electrodes - Failed to detect
- Synchronized ECG when the
waveforms infant was
when the awake
infant was - Doesn’t
sleeping provide any
information
about network
communication
and battery
duration
Agcayazi, Hydration Gel BLE Coin cell RFduino Smartphone - Makes long - Doesn’t anterior
T. et al. electrodes battery (RFD22301) application term measure total thigh and
[43] hydration body water posterior
monitoring - Uses abrasive calf
possible out gel electrodes
of the clinical - Only increase
environment in hydration
- Increase in level is tested
hydration - Uncomfortable
levels is position of the
accurately sensors
measured

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Table 2(b) Research Prototypes of Single Parameter WIHMS

Author Parameter SensorsCommunication Power Processor Alarm/ Advantages Limitations Wearable

Network Supply Notification/GUI type
Mahbub, Respiration polyvinylidene - Energy CMOS Vibration - Novel - Presents Nasal
I. et al. rate fluoride harvesting integrated approach only Cannula/
[45] (PVDF) film- techniques circuitry - Self- simulation Breathing
based sensor (Pyroelectric powered results Mask
and system - Real time
piezoelectric - Small testing on
transducers) system with infants is
thin and required
flexible
sensors
- Low cut-off
frequency
and noise
factors
Mongan, Respiration RFID based Wireless (RFID) Passive - - - Textile Large Belly
W.M. et rate Bellyband RFID tags knitted amount of band
al. [46] (girth) Sensor charged by antennas processing
the RFID provide including
receiver non- filtering,
invasive signal
real time processing,
monitoring statistical
- Testing analysis, and
provides machine
satisfactory learning is
results required for
- Long term extracting
monitoring the desirable
achievable results.
due to
RFID tags
Chen, Blood Reflectance Wireless Wireless Different Display Monitor - Provides - Requires Smart
W. et al. Oxygen sensors module processing accurate more neonatal
[47] Saturation provides components results iterations to jacket
(SPO2) power - reflectance cater false
sensors can readings
be used at due to
different movement
positions artefacts
for blood - optimal
saturation location for
monitoring the
- Design is reflectance
comfortable sensors
and meets needs to be
the criteria determined
of leakage
current,
hospital
hygiene
and allergic
reactions.
Simik Wetness Wetness Wireless (RF Watch Different - call/SMS/ alarm - Accurately - All - Diaper
M.Y.E Monitoring sensor transmission) battery components detects components
et al. (conductors) different of the
[48] levels of system
wetness have not
been tested
- Needs to be
tested on
infants.
- - - -

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 Network SupplyNotification/ Type
GUI
Patil, body temperature Wires - LCD, Alarm, - obtained - Bulky system Socks.
Auto-generated PDFS.P. by
et ReView
temperature, sensors,
This article has been accepted for publication in a future issueSMS results
of this journal, wereIET
but has Circuits,
withfully
not been a Devices
Finger& Systems
edited.
al. [50] pulse rate, accelerometer, similar to the number of clips
Content may change prior to final publication in an issue of the journal. To cite the paper please use the doi provided on the Digital Library page.
moisture optical ones hard wires
condition sensor-IR obtained - Fails to meet
and transmitter from aesthetic,
movement pair and standard comfortability
copper monitoring and size
electrodes devices requirements

Ferreira, temperature, textile Wireless External Alarm, SMS, - Provides - Heart rate has Chest belt
A.G. et the heart electrodes, a (ZigBee) battery mobile accurate only been
al. [52] and 3D application results with tested in one
breathing accelerometer, few position
rates and the and infrared exceptions - Breathing
body thermopile - Satisfactory sensor
moisture sensor battery provides
operational inaccurate
timing results in
- Temperature some
can be situations
measured - Moisture
without condition has
direct not been
contact with tested.
the skin
Dhumal, heart rate, digital BLE Coin cell Mobile - Provides Hand
S. et al. temperature temperature battery Application complete - Certain risk glove
[53] sensor, (Windows) health factors such
heart rate analysis and as movement
sensor generates artefacts
reports battery
- Notifies for duration,
potential sensor testing,
life- internet
threatening connectivity
events data security
are associated
- Doesn’t
provide
testing results
Vora, Heart Rate, RFID based Wireless (RFID) Passive Computer - Long term - Multiple Bellyband
S.A. et Breathing heart rate and RFID tags monitoring RFID tags
al. [54] Rate breath rate charged by achievable result in
sensors the RFID due to RFID collision and
receiver tags inaccurate
information
sometimes
- Limited RFID
range
- Large amount
of processing
is required to
extract the
desirable
result
Luca, P. temperature, Linear Bluetooth - Assembly - Soft and - Only Chest belt
et al. breathing accelerometer, browser GUI comfortable preliminary
[32] rate, heart textile belt that fits testing results
rate, body extensometer infants easily are presented
movements, NTC - Can be used - Proper testing
and SPO2. Thermistor for non- needs to be
and pulse invasive performed
oximeter monitoring and compared
with
commercial
systems
- No
information
regarding
battery is
given
Rao, H. Temperature NTC BLE Non- - - Provides - Large in size Abdomen
et al. and thermistor, rechargeable satisfactory - New iteration belt
[55] Breathing inertial sensor CR2032 temperature has not been
Movement Coin cell results with tested
battery quick
response
time
- Belt is soft
and
washable
and comes in
different
sizes
19
- Can be used
for detecting
hypothermia
and
hyperthermia
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 Table 4 Commercially Available WIHMS

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Parameter accepted
Sensors for publication
Communicat in a future
Power journal, but hasIET
issue of thisAdvantages
Alarm/ not Circuits,
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Wearable& Systems
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Limitations
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ionof the journal.
SupplyTo cite the paper please use the doi provided on the Digital
Notificati typeLibrary page.
Network on/GUI
TempTraq [56] Temperature Temperatu BLE Non- Smart - Continuous - Over prized Stick on
re sensor rechargea Phone temperature - Provides patch
ble Applicati monitoring inaccurate
Carbon on - Comfortable readings
zinc patch - Out of range
batteries issue
- Caused bump to
few infants
Pacif-I [58] Temperature Temperatu BLE Non- Smart - shows an - Can be a bit Pacifier
re sensor rechargea Phone accuracy of heavy for
ble Applicati 0.1°C/ 4°F infants
CR2032 on - BPA (bisphenol) - Results need to
coin cell free and complies be calibrated
battery with health and properly
safety standards
for a pacifier.
Snuza [61] Breath rate Movement - non- Vibration - Easy to clip on - Large size Clip on
Sensor rechargea , Alarm - Good for apnea - Sensor falls off sensor
ble patients easily
CR2/CR1 - False alarms due
4250 to movement
battery artefacts
- Light irritates
the infants
Owlet Smart Breathing rate Pulse BLE Rechargea Lights - Provides accurate - Over prized Sock
Sock 2 [63] and heart rate oximeter ble coin and readings and - Frequent
sensor cell Alarms, timely alerts disconnection
battery Smart - Available in 3 and false alarms
Phone sizes
Applicati
on
Mimo Smart breathing rate, Customize BLE Rechargea Smart - Available in 3 - Difficult to set Kimoso
Baby [65] skin d turtle ble Phone different sizes up (Onesie)
temperature, sensor Lithium Applicati - Comfortable and - Didn’t work for
sleep pattern, ion battery on soft onesie some people
body position - Turtle sensor
and audio can be
uncomfortable
sometimes
MonBaby [67] breathing rate Different BLE Non- Smart - Non-intrusive - Extremely poor Clip on
and body sensors rechargea Phone - Can be clipped range sensor
movements ble coin Applicati on any clothing - False alarms
cell on - Customizable - Small battery
lithium alerts life
battery
Sense-U Smart Breathing Different BLE Non- Smart - 2018 IF design - False alarms Swaddle
Swaddle Blanket movements, Sensors rechargea Phone awards winner - Small battery
[68] temperature ble Applicati - Lightweight and life
variations and Lithium on comfortable
body position. ion battery - Good for SIDs
prevention
Sproutling Baby heart rate, Different BLE Rechargea Smart - Soft and - Shows Ankle
Monitor [71] temperature, Sensors ble phone comfortable inaccurate Band
sleep pattern, battery applicatio - Easy to set up results
body position, n, Lights and use - Too pricey
environment - Works well for - Only works as a
conditions some people sleep monitoring
(room
temperature,
humidity,
sound and
noise levels)
around the
infant,
infant’s mood
etc

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