There has been a recent trend of cardboard baby boxes for infants that are supposed to promote their sleeping. Some have claimed these boxes to be safer than traditional cots, cradles and bassinets. Now researchers from Universities of Bristol and Durham have warned that these recommendations are not founded on research and evidence and it is safer to use traditional cots for putting babies to sleep.
The new recommendation has been published in the latest issue of the journal British Medical Journal. Professor Peter Blair at the University of Bristol and colleagues wrote in a letter to the BMJ stating, “the cardboard baby box should not be promoted as a safe sleeping space, but as only a temporary substitute if nothing else is available.” They urge researchers to conduct high quality studies for better understanding of “how families use the cardboard baby box and its safety implications.”
In Finland for example these cardboard boxes have been given to all expectant mothers since the 1930s with a mattress that fits into the bottom of the box. The idea originated there. The officials there claim that these boxes have brought down cot deaths or Sudden Infant Death Syndrome (SIDS). Since then these boxes are also being given out to pregnant mothers in parts of UK and other places as well.
Blair and his fellow researchers including Francine Bates, chief executive of the safe sleep charity the Lullaby Trust, state however that there is no evidence that these boxes can cut down SIDS because even without the boxes, Sweden and Denmark have also seen a decline in cot deaths.
One of their major arguments is the fact that cots with their rails, bassinets and Moses baskets with their low walls can not only allow air to flow easily but also allow the parents to see their babies sleeping.
The cardboard boxes on the other hand have opaque side walls that do not allow carers to see the baby easily unless they are directly overhead. These baby boxes are also flammable, the authors write and also when placed on the floors they can be easily accessible to pets and young brothers and sisters.
When placed on floors, these boxes can also let in low level droughts, they write. When placed higher up these boxes are susceptible to falls and when wet or dirty they may become susceptible to breakage and result in fatal injuries.
Another important problem with these boxes is the limited size and babies older than three months cannot be placed in them.
Most cases of SIDS occur before six months of age in the babies. These boxes cannot be used in the parent’s bed and thus bed-sharing is not allowed just like any of the other forms of sleeping arrangements for infants such as cots or bassinets.
The authors write, “We support any initiative that raises awareness of SIDS, including appropriate SIDS risk reduction advice distributed with cardboard baby boxes. But this advice can be undermined if the messages given are incorrect or mixed with non-evidence based messages about the intervention itself.”
They conclude, “Population-wide initiatives should have to meet high standards of safety and efficacy and should be subject to rigorous evaluation before implementation, because the potential to cause inadvertent and unintended harm is much greater than for those that target a selected population.”