Reducing the risk of SIDS: Should babies sleep in cardboard boxes like in Finland?

Some Canadian provinces are beginning to adopt a baby box program similar to the one that's been in place in Finland for decades. Baby Box Co./Twitter

For the past 75 years, parents in Finland have been laying their babies to sleep in cardboard boxes. Since that time, researchers have noticed a trend: the country’s infant mortality rate has decreased significantly.

Is that just a coincidence, or is Finland on to something?

Researchers in Finland believe that these boxes — which are handed out to expectant mothers and used as cribs for the first few months of a baby’s life — may help reduce the risk of sudden infant death syndrome (SIDS).

The boxes are a gift from the government and come equipped with a small firm mattress, as well as other necessities for the baby like bathing products and baby wipes, the BBC reports.

READ MORE: SIDS: Parents are putting babies to sleep in unsafe positions, study says

According to Statistics Finland, the country’s infant mortality rate was around 65 per 1,000 births in 1935, three years before the boxes came into existence.

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The box was initially only available to low-income families until 1949. At that time, the infant mortality rate dropped to around 45 per 1,000 births.

But once the box was made available to all mothers across the country, the rate declined even further, and in 2015, the rate stood at 1.9 per 1,000 births, The World Bank reports.

Now Canada is catching on as some provinces and territories — like Nunavut, Ontario, New BrunswickNova Scotia and Newfoundland — are adopting the idea and rolling out their own programs.

Despite the Finland’s dramatically improved numbers, however, there still hasn’t been any scientific proof or studies to confirm the correlation between the baby boxes and the drop in infant deaths throughout the years.

“We don’t have any evidence-based or scientific studies that have looked at them in a scientific way, but their principals are certainly consistent with what’s in line with our safe sleep recommendations,” says Dr. Denis Leduc, associate professor of pediatrics at the McGill University Health Centre.

Nunavut was one of the first provinces to offer baby boxes in 2016, where the infant mortality rate is five times higher than the national average, according to Nunavut’s Department of Health.

(In 2013, Nunavut’s infant mortality rate was 18.2 per 1,000 deaths. The second-highest rate in Canada was Saskatchewan at 7.4 per 1,000 deaths. The national average was 4.9 per 1,000 deaths, Statistics Canada says.)

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“[Nunavut] had to do something about safe sleep practices and one of them was [specifically] addressing the unsafe environment of bed sharing and room sharing and being in very close proximity of other people, and the baby box answers that,” Leduc says. “And what we know is that the box promotes the decrease of bed sharing, which we know as a cause of SIDS.”

Leduc says another obvious benefit of having such a box is that it’s convenient and portable.

READ MORE: Calls for a ‘baby box’ program in Saskatchewan

But are there any risks?

Leduc says having a baby sleep in a box shouldn’t present any risks to the child as long as the mattress is firm and the box itself is empty. That means no toys, bumper pads, positioners, blankets or anything else that could smother the baby.

“A bed box offers a very good alternative to keep the baby near you but not in the bed with you,” he says. “But we cannot neglect all of the other things that are extremely important in SIDS. Apart from room sharing, no smoking, having nothing in the crib, parents shouldn’t be taking any medication ideally to impair their [ability to wake up], to breastfeed ideally and making sure immunization is up-to-date.”
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The Baby Box Co. is one of the companies currently rolling out the baby box program across Canada.

“Approximately 80 per cent of parents who receive a baby box use it as a primary safe sleep space for their infant, up to about six months of age,” CEO Jennifer Clary says in a statement about Ontario’s program. “A baby box program can have a real and measurable impact on both the health and well-being of Ontario infants, and the confidence of Ontario’s new parents.”

According to the company, the boxes — which are distributed annually through hospitals, community agencies and health care centres —  are compliant with Health Canada’s bassinet standards. The box itself comes with a firm mattress, waterproof cover and 100 per cent cotton fitted sheet.

They also come with essentials like diapers, wipes, brain-development activities, free meal-delivery vouchers, shampoo, a diaper tote bag and more.

However, only a limited number of boxes are currently given out. In Ontario, for example, only 145,000 boxes are distributed a year.


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