What Parents Need to Know About Using Baby Boxes

In an effort to curb SIDS, several states offer free cardboard baby boxes that double as cribs. But are these baby boxes really safe?
The Baby Box Company/Facebook

Several states currently offer Finnish baby boxes to new and expectant parents, touting them as safe alternatives to Moses baskets, cribs, and bassinets. The cardboard boxes have long been used by parents in Finland, which has the lowest infant mortality rate of any country in the world (the U.S. ranks 26th on that list). Proponents of the boxes believe they help reduce the risk of sudden infant death syndrome (SIDS). But according to a professor in Britain, parents should think twice before letting their child sleep in one.

Professor Peter Blair at the University of Bristol recently told the BMJ that "the cardboard baby box should not be promoted as a safe sleeping space, but as only a temporary substitute if nothing else is available.” His statement is based on the lack of supporting evidence regarding the safety of the boxes.

Baby boxes are essentially non-toxic, sustainable cardboard cribs that include a firm mattress and fitted sheet. Back in January 2017, New Jersey became the first state to gve free baby boxes to new parents, in effort to prevent SIDS (In Finland, where these baby boxes are widely used, the infant mortality rate is just 1.3 deaths per 1,000 births. By contrast, in the U.S. the infant mortality rate is 6.1 deaths per 1,000 births, according to the CDC.)

Several other states, including Ohio and California, have followed New Jersey’s path, and began offering baby boxes as well. The boxes are being supplied by a company called The Baby Box Company, which provides education materials for parents about safe sleep. To obtain a box, parents must first watch a short informational program and fill out a survey.

Professor Blair and his colleagues claim that baby boxes don't actually reduce the risk of SIDS, and they’re also safety hazards. Unlike cribs and bassinets, baby boxes don’t allow parents to easily see their child. The boxes also limit air flow, and where a box is placed carries certain dangers. For instance, if the box is placed on the floor, an adult could trip over the box and fall on top of the baby, or a pet could reach in. If placed on a table, dresser, or couch, the box could tip over and injure the baby.

In the past, nonprofit organization CJ First Candle, which is devoted to eliminating SIDS and Sudden Unexpected Infant Death (SUID), also cautioned parents that certain guidelines should be followed in order to make baby boxes a truly safe sleeping environment for babies. First and foremost, the baby box should contain only a firm mattress with fitted sheet, and it should be absent of any other padding, bedding, or stuffed animals.They also stress that parents should be diligent about where they place the box.

And here’s something else to consider: According to the American Academy of Pediatrics (AAP), Finland has never studied the baby box specifically, so there's no way to know for sure if the boxes are responsible for the country's low infant mortality rate. Rachel Y. Moon, M.D., division head of general pediatrics at University of Virginia School of Medicine and a member of the AAP Task Force on SIDS, told Parents.com the differences between the U.S. and Finland are an "important context within which to consider the role of the baby box." Namely, Finland offers a broad system of social support and benefits for its people, like maternity leave and healthcare. So we aren't exactly comparing apples to apples.

If you do decide to use a baby box, it's imperative to follow these safety tips, provided by baby box company Finnbinn:

  • Keep it firm. It's very important that the surface a baby sleeps on is firm and not overly plush, which could lead to suffocation (Finnbins and Baby Boxes include a padded insert).
  • Bring baby into the bedroom (but not the bed!). Baby boxes should be placed next to the parents' bed on the floor, keeping the baby in the same room as parents.
  • Out with the bumpers. Do not place a bumper or extra padding of any kind inside your baby box.
  • Read up. Educate yourself about safe sleeping guidelines (both Finnbinns and Baby Boxes come with educational materials for parents on this topic).

Also, be sure to check out the AAP's safe sleep guidelines.

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