Baby in a Box

Countries like Finland are ditching the crib and bassinet in favor of simple corrugated cardboard box. What do local doctors think about the idea?

By Deborah Jeanne Sergeant

Parents anticipating the birth of their first child usually shop extensively for the perfect bassinet or crib in the right color to match the nursery.

In Finland, it could be a corrugated cardboard box — not because they necessarily can’t afford a crib. It’s believed boxes are the cause behind the reduction in the nation’s formerly high rate of infant mortality.

Could a box instead of a crib make a difference?

In the 1930s, Finland introduced the program in which income-qualifying parents received a box containing baby essentials. Pre-natal care was required to obtain the box. Eventually, the income requirement was dropped and the program continues to this day.

The rates of infant mortality dropped, coinciding with the program; however, there’s no magic in sleeping in a box.

Sleeping near mom is helpful, though in the US, sleeping in the same room as mom at the hospital is a fairly new concept that has proven beneficial.

“Moms and babies sleep better in close proximity,” said Libby DiPiano, a registered nurse who is a board certified lactation consultant at Millard Fillmore Suburban Hospital. “When the baby is taken away, they’re in a stress mode.”

A generation or two ago, separating moms from babies at the hospital was commonplace. Today most healthy babies remain in a crib next to mom’s bed.

“They started the program to get these moms into prenatal care,” said physician Jayasree Nair, assistant professor of pediatrics, University at Buffalo, and attending neonatologist at John R. Oishei Children’s Hospital. “Their premise was if we offer this, we’ll establish contact with a prenatal clinic before they got this box. Numerous studies show that prenatal care helps infant mortality rates go down.”

A host of life-saving vaccines, increased prevalence of breastfeeding, and improved maternal nutrition, and education have all helped decrease mortality rates.

Nair said that the maternity leave in Europe increased, with many offering almost a year of leave.

“The box isn’t the solution, though it’s a nice thing to hand things out,” Nair said. “The value of the education, of prenatal care and safety, is what’s important.”

A safe sleeping environment and safe sleep practices are vital for infant health. Laying babies on their backs to sleep has demonstrated a 50 percent reduction in sudden infant death syndrome (SIDS) since introduced 30 years ago. This indicated that a baby’s sleep position has something to do with SIDS. Babies lack the strength to easily move their heads from obstructions, but that’s only one factor in SIDS.

“Don’t have soft things in the crib,” Nair said. “Just a firm mattress and fitted sheets are all you need. Avoid stuffed animals, crib bumpers, wedges for positioning and any suffocation risks.”

Nair pointed out a lack of safety standards and research on baby boxes. Would parents know when to transfer to a bigger sleeping space? Could parents ensure an older sibling wouldn’t place a cover over the box which would decrease the baby’s oxygen supply?

There’s also the chance that the baby would face the solid side of the box and inhale less oxygen than optimal.

The crib itself should either be purchased new from a store (and thus up to current safety standards) or carefully examined for adherence to safety standards, including non-lead based paint, fixed sides, the proper distance between rails and other considerations. The mattress should not gap from the bed’s sides.

“If it’s more than five years old, get it checked out to make sure it meets safety standards,” Nair said.

The American Academy of Pediatrics promotes the ABC acronym to explain how babies should sleep:

• A : alone, not in bed with a parent or caregiver, but in the same room.

• B: on their backs, not facing down. Sleeping on the stomach can close off their airway.

• C : in a safety-approved crib containing nothing but a firm mattress and fitted sheet. Avoid placing crib bumpers, stuffed animals, sleep positioning devices, pillows, blankets or anything else in the crib.

Additionally, parents should keep the room smoke-free, a comfortable temperature and use a sleep sack style pajama to keep the baby warm, not blankets.