Intended for healthcare professionals

Letters Cardboard baby boxes

Concerns about the promotion of a cardboard baby box as a place for infants to sleep

BMJ 2018; 363 doi: (Published 17 October 2018) Cite this as: BMJ 2018;363:k4243
  1. Peter S Blair, professor of epidemiology and statistics1,
  2. Anna Pease, senior research associate1,
  3. Francine Bates, chief executive2,
  4. Helen Ball, professor of anthropology3,
  5. John M D Thompson, associate professor, epidemiologist, and statistician4,
  6. Fern R Hauck, professor of public health sciences5,
  7. Rachel Moon, professor of paediatrics5,
  8. Betty McEntire, CEO and executive director6,
  9. Anat Shatz, chief executive7,
  10. Marta Cohen, consultant paediatric pathologist8,
  11. Trina C Salm Ward, assistant professor of social work9,
  12. Peter Fleming, professor of infant health and developmental physiology1
  1. 1Bristol Medical School, University of Bristol, St Michael’s Hospital, Bristol BS2 8EG, UK
  2. 2Lullaby Trust, London, UK
  3. 3Durham University, Durham, UK
  4. 4University of Auckland, Auckland, New Zealand
  5. 5University of Virginia, Charlottesville, VA, USA
  6. 6American SIDS Institute, Naples, FL, USA
  7. 7Israeli Foundation for the Study and Prevention of Sudden Infant Death, Jerusalem, Israel
  8. 8Sheffield Children’s Hospital NHS Trust, Sheffield, UK
  9. 9University of Wisconsin, Milwaukee, WI, USA
  1. p.s.blair{at}

The successful reduction in cot deaths (sudden infant death syndrome or SIDS) in England and Wales from nearly 1600 deaths in 1988 to less than 200 in 2015 stems from evidence based research.1 Results from case-control studies internationally form the basis for infant sleep recommendations. We are, therefore, concerned that cardboard boxes are being promoted for infant sleep, as a safe alternative to the more traditional cots, bassinets, or Moses baskets, without any observational evidence in place.23 The cardboard baby box is based on a Finnish tradition of giving pregnant women a box full of free infant care items—including a mattress that fits into the bottom of the box as a makeshift infant sleeping environment—as an incentive to enter prenatal care early. It was one component of a drive towards reducing health inequalities, recognising the privations of the Finnish population after the second world war. Any government or charity that is willing to provide a box full of free unbranded infant care items should be applauded, but we have three concerns: the scarcity of observational evidence that the cardboard baby box can be used safely (and no evidence that it reduces SIDS), the lack of safety standard regulations in place, …

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