Baby Boxes for Safe Infant Sleep?
Donna Walls, RN, BSN. ICCE, IBCLC, ANLC
In the 1930’s the idea of using “baby boxes” for infant sleep was introduced in Finland with the idea of reducing SIDS (sudden infant death syndrome). These baby boxes were given to new parents, often filled with infant supplies, as they left the hospital. The boxes were used as “next to the bed cribs” or as a safe sleep surface in the parental bed. Finland began its baby box program 80 years ago, when nearly one out of every 10 children in the country died before age 1. Now, the country has one of the world’s lowest infant mortality rates.
In New Zealand, after the 2011 Christchurch earthquake the pepi-pod and the wahakura, which are small traditional infant cribs woven from flax, and can be used for infant sleep in or near the parental bed were re-introduced. The use of both the wahakura and pepi-pods demonstrated a reduction in the rates of SIDS.
Researchers in May of 2017 from Temple University concluded “face-to-face postpartum education about safe infant sleep, combined with the distribution of a baby box, a cardboard bassinet, reduced the rates of bed-sharing during babies’ first 8 days of life.” The research team also found that:
- Face-to-face sleep education and providing a baby box with a firm mattress and fitted sheet reduced the rate of bed-sharing by 25% in the first eight days of life.
- For exclusively breastfed infants, a population at increased risk of bed-sharing, bed-sharing was reduced by 50%.
- Of the mothers who received the baby box, a majority said they used the box as a sleeping place for their infants.
- Of the mothers who received the baby box, 12% said they used the box as the primary or usual sleeping space for their infants.
- Of the mothers who exclusively breastfed and also used the box as a sleeping space, 59% said the box made breastfeeding easier.
According to the American Academy of Pediatrics:
There are no Consumer Protection Safety Commission safety standards for in-bed sleepers. The task force cannot make a recommendation for or against the use of either bedside sleepers or in-bed sleepers, because there have been no studies examining the association between these products and SIDS or unintentional injury and death, including suffocation. Studies of in-bed sleepers are currently underway, but results are not yet available. Parents and caregivers should adhere to the manufacturer’s guidelines regarding maximum weight of infants who use these products. In addition, with the use of any of these products, other AAP guidelines for safe sleep including supine positioning and avoidance of soft objects and loose bedding, should be followed.
There have also been some concerns raised in regard to the safety of these infant sleep boxes. These concerns focus on the flammability of the cardboard box and the durability if the box becomes damp or soiled. Considerations include questions as to instructions being given on safe placement of the boxes, eg not to place boxes on an elevated surface that might tip over, could family pets have access to the box or assuring there are no loose blanket or pillows in the box? Also, there has been very little research on the use of these boxes, their potential safety concerns or limitations for use. As of now the Consumer Product Safety Commission does not have standards for baby boxes. American Society for Testing and Materials, which develops standards for manufacturing and safety, is considering safety rules for baby boxes which may be adopted by the federal safety commission, but is not yet available.
Baby boxes for infant sleep have been introduced in the United States with many states including New Jersey, Ohio and Alabama offering free boxes after watching an online video about SIDS and safe sleep and taking a short quiz. They can pick up a box at a local distribution center or have it mailed to them. New Jersey plans to distribute 105,000 boxes; Ohio, 140,000; Alabama, 60,000 in the near future with plans for expanding to Minnesota, Philadelphia, San Francisco, San Antonio, TX, and parts of Canada. These boxes come with a firm foam mattress and tight-fitting sheet; and also includes breastfeeding accessories, a onesie, diapers and wipes. In 2006 a feeding bottle was removed to encourage breastfeeding.
In keeping with the ICEA mission to provide “freedom of choice through knowledge of alternatives” we can offer information based on the current research and common practices on the use of infant sleep boxes. Along with safe sleep guidelines, this information can help expectant and new parents make an informed decision regarding safe sleep and the use of these infant sleep boxes.
Moon, R. et al. Safe Infant Sleep Interventions: What is the Evidence for Successful
Behavior Change? Curr Pediatr Rev. 2016 Feb; 12(1): 67–75. Published online 2016 Feb. doi: [10.2174/1573396311666151026110148
Temple University Health System. “Baby boxes, sleep education reduced bed-sharing in first week of infancy.” ScienceDaily. ScienceDaily, 22 May 2017. <www.sciencedaily.com/releases/2017/05/170522080746.htm>.
Bartick, M., Ball, H. Babies in boxes and missing links on safe sleep: Human evolution and cultural revolution. September, 2017 https://www.researchgate.net/publication/320495119_Babies_in_boxes_and_the_missing_links_on_safe_sleep_Human_evolution_and_cultural_revolution
Fleming, P. et al. Concerns about the promotion of a cardboard baby as a place for infants to sleep. October, 2017. BMJ; 363 doi: https://doi.org/10.1136/bmj.k4311 (cite this as: BMJ 2018;363:k4311
Baby in a Box? Free Cardboard Bassinets Encourage Safe Sleeping – The New York Times. https://www.nytimes.com/2017/02/12/nyregion/new-jersey-parents-cardboard-bassinets.html?
The International Childbirth Education Association (ICEA) is a professional organization that supports educators and health care professionals who believe in freedom to make decisions based on knowledge of alternatives in family-centered maternity and newborn care.