Intended for healthcare professionals


Cardboard baby boxes should not be promoted as safe to sleep in, warn experts

BMJ 2018; 363 doi: (Published 17 October 2018) Cite this as: BMJ 2018;363:k4311
  1. Jacqui Wise
  1. London, UK

A group of leading cot death experts have warned that cardboard baby boxes should not be promoted as a safe alternative to a cot, bassinet, or Moses basket.1

The cardboard baby box is based on a Finnish tradition of giving pregnant women a box of free infant care items, including a mattress that fits into the bottom of the box to make a makeshift bed. In Scotland, cardboard baby boxes have been given to all new babies since 2017 and some NHS trusts in England have introduced pilot or full schemes over the past two years. Wales and Northern Ireland do not have any baby box schemes.

In August this year the Royal College of Midwives released a statement supporting the introduction of universal baby box schemes in the UK.2 It said that providing baby boxes so the baby has their own sleep space is likely to reduce the risks associated with unsafe cosleeping. Risk factors associated with sudden infant death syndrome (SIDS) include sharing a sleeping surface with a parent who smokes or has been drinking alcohol, or sleeping on soft surfaces such as a sofa.

Writing in The BMJ, Peter Blair, professor of epidemiology and statistics at Bristol Medical School, and 11 other international experts say there is a lack of evidence that the cardboard baby box can be used safely and no evidence that it reduces deaths from SIDS.1 They point out that the relatively low SIDS rate in Finland is not evidence that boxes reduce SIDS; rates in Sweden and Denmark are equally low, despite them not traditionally providing boxes.

They write that there are other potential safety problems with the box. Cots, bassinets, and Moses baskets allow infants to be easily seen by parents and their bars or raised sides may also facilitate air flow. It is more difficult for a carer to see a baby in a cardboard box because of its higher opaque sides which also restrict air flow.

In addition, some boxes come with lids, are potentially flammable, and if placed on the floor are subject to draughts, domestic pets, and young siblings. There is no data on the durability of the box, especially if it becomes wet or dirty. They say it should only be promoted as a temporary substitute if nothing else is available and if it meets accepted safety standards.


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