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- Peter S Blair, professor of epidemiology and statistics1
- Anna Pease, Senior Research Associate1
- Francine Bates, General manager2
- Helen Ball, professor of anthropology3
- John M D Thompson, associate professor, epidemiologist and statistician4
- Fern R Hauck, professor of public health sciences5
- Rachel Moon, professor of pediatrics5
- Betty McEntire, CEO and Executive Director6
- Anat Shatz, General manager7
- Marta Cohen, pediatric pathologist consultant8
- Trina C Salm Ward, assistant professor of social work9
- Peter Fleming, Professor of Child Health and Developmental Physiology1
- 1Bristol Medical School, Bristol University, St Michael's Hospital, Bristol BS2 8EG, United Kingdom
2Lullaby Trust, London, United Kingdom
3University of Durham, Durham, United Kingdom
4University of Auckland, Auckland, New Zealand
5University of Virginia, Charlottesville, VA, USA
6American SIDS Institute, Naples, FL, USA
7Israeli Foundation for the Study and Prevention of Sudden Infant Death, Jerusalem, Israel
8NHS Trust, Sheffield Children's Hospital, Sheffield, United Kingdom
9University of Wisconsin, Milwaukee, WI, USA
- p.s.blair {at} bris.ac.uk
The successful reduction in the number of infant deaths (Sudden Infant Death Syndrome or SIDS) in England and Wales, from nearly 1600 deaths in 1988 to less than 200 in 2015, stems from research based on evidence.1 The results of international case-control studies form the basis of recommendations for infant sleep. We are therefore concerned that cardboard boxes are promoted for the baby's sleep, as a safe alternative to more traditional beds, basins or Moses baskets, with no evidence of observation in place. . The baby cardboard box is based on a Finnish tradition. to give pregnant women a box of free items for infant care – including a mattress that can be inserted at the back of the box as an improvised sleeping environment – to encourage children to seek antenatal care at a early stage. It was one of the components of the fight against inequalities in health, recognizing the deprivation of the Finnish population after the Second World War. Any government or charity willing to provide a box filled with free and unbranded items for kids should be applauded, but we have three concerns: the scarcity of evidence of observation indicating that the baby box in cardboard can be used safely (and no evidence that it reduces the SIDS), the lack of standard safety regulations and the fact that the promotion of the baby cardboard box can undermine the safety messages current.
Lack of evidence of observation
The use of the cardboard baby box in Finland since the 1930s and the relatively low rate of SIDS in this country do not prove that boxes reduce SIDS. Rates in neighboring countries, such as Sweden and Denmark, are also low 4, although they do not traditionally provide boxes. The few case-control studies conducted in Finland567 do not mention the box and largely attribute the lower mortality rates to "a relatively high standard of living, a good level of education of mothers, primary health care services". well organized for mothers and children, and rapid progress in health. obstetric and neonatal care are also available and regionalized. "6 There is little published data on the frequency of use of these boxes for infant sleep in Finland and whether this is largely limited to daytime naps.
SIDS deaths usually occur unobserved. We therefore encourage parents to sleep at night in the same room as infants and to stay in the same room for at least the first six months of the day.8 Above, cribs (with their bars and raised surface) ) and Moses baskets or baskets (with the low sides) allow parents to easily see the babies and can also facilitate the circulation of air, while the cardboard box (with its more opaque sides) does not not allow. Caregivers can only see the baby as they look directly at the box.
Any future observational study on the safety of baby cartons should be monitored so that the results can be compared to usual practices and sufficiently fed with a sufficient number to quantify adverse events.
Security regulations
The cardboard baby box has other potential problems. Some of the boxes have lids, are potentially flammable (especially if they are not laminated) and, if placed on a floor, are exposed to drafts, pets and younger siblings. If placed at a height the box can fall off and can be a tempting sleeping space for pets. There is no data on the durability of the box (especially if it becomes wet or dirty). In terms of size, the majority of babies outgrow the age of the cardboard box at the age of 3 months, whereas most bassinets and cradles can be used up to about 5 months .9 Current UK and European safety standards for crib furniture only exist for traditional beds. cradles and bassinets; There is currently no specific standard for the use of a cardboard box as a sleeping place for a baby, although this is under review.10 The mattresses must be in accordance with British Standard 7177 and 1877 and the padding must comply with UK fire regulations; it must be clearly labeled.
Other evidence-based interventions
The baby cardboard box should not be confused with wahakura (Maori woven linen basket) or pepi-pod a (low-sided and ventilated plastic box), both of which are designed to be placed in the crib. parents to give children their own separate sleeping space. These devices are currently under study in New Zealand to avoid potentially dangerous bed sharing situations (when parents smoke or drink alcohol); The first results are extremely encouraging.1112131415 However, the baby cardboard box is not intended for use in the parents' bed and therefore is not a better alternative to bed sharing than the cradle, cradle or the Moses basket.
Post-perinatal mortality in New Zealand decreased by 30% between 2009 and 201516, but we do not know if this was due to the use of the wahakura or pepi-pod, to the specific advice provided with it. intervention or acute sense of awareness of infant safety. We support any SIDS awareness initiative, including appropriate risk-reduction advice for SIDS distributed with baby cardboard boxes. But these tips may be compromised if the messages given are incorrect or mixed with non-evidence-based messages about the intervention itself. Parents can not join the educational component if the driving force of the baby carton is not a public health initiative but a commercial marketing strategy, the motives of which may include entering data into profiling or direct marketing purposes.
conclusions
The dramatic fall in SIDS rates is the result of observational studies. Initiatives aimed at the entire population should meet high standards of safety and efficiency and should be subject to rigorous evaluation before their implementation, as the potential to cause unintentional and unintentional damage is much greater than for those targeting a given population. Without evidence to support, the baby cardboard box should not be presented as a comparable alternative to Moses' beds, basins or baskets, but as a temporary substitute if nothing else will not. is available – if the device complies with recognized safety standards. We encourage rigorous, controlled studies to better understand how families use the baby cardboard box and its safety implications.
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