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Charity concerned at claims baby boxes reduce ‘cot death’

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A national charity that works to reduce the rates of sudden infant death syndrome (SIDS) has revealed concerns about the increasing popularity of “baby boxes”.

The boxes, which first gained popularity in Finland, are a range of products, usually made from cardboard with a mattress inside, intended for use as a baby’s sleeping place.

A number of health service trusts in England are trialing the distribution of the boxes to new parents and the Scottish government has announced the widespread adoption of the initiative.

But, in a policy statement published on Thursday, the Lullaby Trust said it wanted to highlight a number of issue to parents who were considering using a baby box as a sleeping place for their baby.

It said it was concerned about claims that the cardboard boxes were being promoted as a product parents could use to help reduce the risk of SIDS.

The charity acknowledged that, for some parents, who do not have an enclosed space for their baby to sleep such as a cot or moses basket, a box may be a better alternative than co-sleeping with a baby in hazardous circumstances, such as on a sofa.

However, based on the evidence currently available, the charity said it did not believe it was factually correct to directly link the use of a baby box with a reduction in infant mortality or SIDS.

In addition, the charity highlighted that it was not currently possible for baby boxes to fully comply with safety standards.

“We do have concerns about the baby boxes being marketed as products which will reduce infant mortality and SIDS”

Francine Bates

This was because current British and EU safety standards for nursery furniture only exist for traditional cots cribs and bassinets, it said, and there was no specific standard for the use of a cardboard box as a sleeping place for an infant.

The charity has also raised questions about the safety of the mattresses used in some of the baby boxes available on the market and advised parents to check that they met safety standards before purchasing or using a box given to them.

Mattresses for babies must comply with the British Standard 7177 and 1877 and the filling in the mattress needs to meet the standards of our UK fire regulations, it noted.

This should be clearly labelled on the mattress, said the charity, adding that the mattress should be firm, flat and waterproof, in line with safer sleep guidance on reducing the risk of SIDS.

The Lullaby Trust said it was aware that, in some areas, boxes were being distributed by health and social care professionals, to encourage parents to follow safer sleep guidelines to reduce SIDS risk.

It said it supported any initiative that raised awareness of SIDS and safer sleep but urged “all agencies” to ensure that boxes and mattresses supplied to parents complied as fully as possible with British and European Standards and our UK fire regulations.

The charity added that, based on current research and available evidence, it continued to recommend that a cot or moses basket was the safest place to sleep a baby.

However, it has published guidance for parents to help them use baby boxes as safely as possible.

Lullaby Trust

Charity concerned at claims baby boxes reduce ‘cot death’

Francine Bates

Francine Bates, chief executive of the Lullaby Trust, said: “We support all efforts to promote safer sleep for babies, however we do have concerns about the baby boxes being marketed as products which will reduce infant mortality and SIDS.

“We are not aware of any evidence, including in Finland, to support this claim,” she said. “It is also not possible for baby boxes to meet all current safety standards, as nursery furniture regulations only apply to traditional cots, cribs and bassinets, not boxes made from cardboard.

She added: “If parents choose to use the box to sleep their baby, we urge them to read and follow our advice, approved by our scientific and paediatric advisers.”

The Baby Box Company, which provides boxes for free to a number of NHS partners across England and Ireland, claimed the Lullaby Trust was misinformed.

Its chief executive Jennifer Clary said: “Nothing is as important to the Baby Box Co. as the safety of our customers.” 

“Baby Boxes have been used in Finland for 80 years. Since their introduction, Finland has seen a dramatic reduction in infant mortality rates,” she said.

“What the success of Finland’s positive results actually demonstrates is the significance of parenting education, engaging prenatal intervention and accessible community supports,” she said. “Every mother in Finland must visit a healthcare professional by her second trimester to receive a check-up and vital education before being eligible to claim the free baby box.”

She added: “Our programme is designed to pay homage to the Finnish model by providing safe-sleep baby boxes universally to expecting and new parents in communities where the local healthcare experts collaborate to develop and implement an education programme on Baby Box University.

“Our baby boxes meet or exceed all applicable safety regulations in the territories where our company operates. This includes full compliance with the EN/UK standard for cribs and cradles BS EN 1130,” said Ms Clary.

In addition, she said: “Our mattresses are made in the UK and comply with all UK government regulations. Our baby boxes meet the most up to date UK and EU cot mattress standards: BS 7177 2008 + A1:2011 and BS 1877 - 10:2011 + A1:2012.”

As recently reported by Nursing Times, US researchers have said the introduction of baby boxes and sleep education reduces risky bed-sharing between parents and babies in the first week of infancy.

They found that face-to-face education about safe infant sleep, combined with the distribution of a free cardboard baby box, reduced the rates of bed-sharing during babies’ first eight days of life.

Lullaby Trust guidance to parents who choose to use a baby box

  • Be aware that there is no direct evidence that the use of a baby box will reduce SIDS or lower infant mortality (despite use in some countries like Finland)
  • Be aware that some boxes may be of a higher quality than others
  • Be aware that there is no safety standard in existence anywhere in the world that specifically applies to a baby box as a sleeping place for a baby
  • Be aware that some manufacturers state that their boxes meet European Union 1130 standard for cots, cribs and bassinets. While some elements of a cardboard box may comply with this standard, for example, wood material, structure and smooth edges, remember that EU 1130 is a furniture standard for traditional cots, cribs and bassinets
  • Ensure that the mattress and mattress filling meets the British Standard 7177 and the 1988 UK fire regulations as amended. The mattress should also meet the British Standard 1877 and this should be clearly and permanently labelled on the mattress

The charity also said it “strongly advised” the following:

  • If you decide to use a box to sleep your baby, use for daytime naps only and sleep your baby in a cot or a moses basket next to your bed during the night
  • Do not lift or carry the box around your home if your baby is in it
  • Do not put the lid on the box if your baby is in it
  • Always keep the box clear as a sleeping space
  • Do not place additional bedding on top of the mattress to raise your baby up to a higher level
  • Ensure the box is placed on a solid surface and cannot topple over
  • Do not use the box if it gets wet or soiled
  • Do not put a box on an under heated floor
  • Ensure that any pets stay away from the box
  • Do not leave the baby in the box unattended or out of view
  • Do not use the box once your baby is able to roll
  • Ensure that you comply with any instructions relating to the maximum age and weight of the infant for which the box can be used
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Readers' comments (1)

  • What about a wooden drawer from a chest of drawers, which is what I slept in as an infant and, I believe, was common practice in the old days? (it saves the expense of both a crib and a cot). I've no idea what my mother used for a mattress, probably a couple of folded up towels. I survived the experience.

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