The baby box craze in the United States is driven by the need to reduce the incidence of sudden infant death syndrome (SIDS). As you may know, the baby box is modeled on a box filled with bedding, diapers, and baby clothes that was first provided free to low-income pregnant women in Finland beginning in 1938. The box was large enough to be used as a baby’s bed. The goal was to attract expectant mothers to clinics for prenatal care in order to lower Finland’s then high rate of infant mortality. Beginning in 1949 the boxes were offered to all pregnant women in Finland and have been ever since. Over time, infant mortality (measured as the number of deaths during the first year of life) continued to drop, and now Finland has a very low rate of SIDS and infant mortality in general.
The reason for this seems, however, to be that country’s emphasis on and availability of good prenatal care, not to any effect of the baby boxes. A 2011 poll found that fewer than half the boxes given out were actually used as baby sleep spaces.
In the U.S., a company called “Baby Box” is giving a similar product for use as a bed to expectant parents in three states (New Jersey, Ohio and Alabama) to reduce SIDS. To qualify for a free box, which contains a mattress, diapers, wipes and a onesie, parents must take a video-based course about safe sleep on the Baby Box website. (The company also sells a range of baby boxes stuffed with various items at prices ranging from $70 to $225.)
Reducing SIDS is certainly a worthy goal, but we have no evidence – not a single published study – showing that sleeping in a baby box actually has any benefit. Experts have also questioned the safety of the baby box for sleeping, since there are no mandatory safety standards for them. Some pediatricians have additional concerns: whether the boxes, which are more confining than slatted cribs, hold a baby’s exhaled carbon dioxide differently; whether the cardboard bottoms heat up when placed on hot surfaces such as sun-drenched concrete or weaken if they get wet.
The baby box phenomenon would certainly be worthwhile if it raises awareness among new parents about the dangers of SIDS and the best ways to prevent these deaths. Sleep safety – always placing a baby on his or her back for sleep (including naps) – is important. So is not smoking during pregnancy, using a firm sleep surface (such as a mattress in a safety-approved crib, covered by a fitted sheet); having the baby share your room but not your bed; and keeping pillows and other soft objects out of your baby’s sleep area, as well as breastfeeding.
Andrew Weil, M.D