The Royal College of Midwives (RCM) has recommended the universal provision of cardboard baby boxes handed out to parents with newborns, but the endorsement has been criticised by a leading cot death charity.
The Lullaby Trust warned the boxes might not be safe after the RCM said they should be distributed across the UK. Scotland already gives them to all new parents and some hospital trusts in England and Wales have started pilot projects.
The RCM says the boxes, which contain essential items such as clothing, bedding and books, give a baby its own defined sleeping space, reducing the risk of them sharing a sofa or bed with a parent. Co-sleeping is believed to be a risk factor for sudden infant death syndrome (SIDS), better known as cot death.
Gill Walton, the RCM’s chief executive, said: “A baby box is a positive gift which signals that every baby is important and welcomed. Providing them will help many families whatever their background, and provide a more equal start to life for the baby.
“The Scottish baby box contains a number of very useful baby items that can support the health and wellbeing of new babies including an electronic thermometer, a baby-carrying sling, a bath thermometer and a range of clothing.
“Most importantly, by enabling parents to give their babies a safe sleeping space, baby boxes may reduce unsafe co-sleeping or babies sleeping in an inappropriate place such as a sofa.”
However, the Lullaby Trust said that while a baby box was better than sleeping on a sofa with a parent, the boxes did not conform to British safety standards because none had been drawn up for the boxes.
“There is still no evidence directly linking the use of a baby box with a reduction in infant mortality or SIDS,” said Francine Bates, the charity’s chief executive. “Given current pressures on public health budgets, we question whether the call to introduce the scheme across the country is the best use of resources to reduce infant deaths.”
Dr Mary Ross-Davie, the director of RCM Scotland who is leading for the college on the issue, said its support was focused on what the scheme does for health inequalities and not just on the boxes as somewhere for babies to sleep.
“It’s the message they give to families about how their babies are valued and providing parents with some very valuable materials and kits at what can be a time of financial pressure,” she said.
The ear thermometer would help parents know whether their baby needed to see a GP, for instance, and there are books to read to the baby and clothing that would last until they were six months old.
The real risks for cot death are a baby put to sleep on its front rather than back, sharing a bed or sofa with an adult who had been drinking, and sleeping on a soft surface where the baby could get trapped in bedclothes.
There is growing evidence from studies that the risks were lower when a family gave the baby a place of its own to sleep, whether a Moses basket, bassinet or a box. “A baby box could offer a reduction in those known risks. We are very clear that more research is needed,” Ross-Davie said.
However, Bates said the British Standards Institution had recently started working on safety standards for the boxes, because of concerns about the possible hazards of using them for infant sleep that were voiced by the trust and others when they were introduced in Scotland. “We would strongly advise awaiting for the publication of this standard before any decision is taken to commission manufacturers to provide boxes to give to new families.”
Part of the Lullaby Trust’s advice to parents says: “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).”
Following the decision to use the boxes in Scotland, the Finnish welfare and benefits agency, which has given out the boxes in Finland, said “empirical data on the effect of the maternity package on infant mortality does not exist”.
