Abstract
Between 2016 and 2019, two different infant sleeping-box interventions were implemented in England: (1) shallow polypropylene baby boxes were distributed via a feasibility study to families with Sudden Infant Death Syndrome (SIDS) risk factors; and (2) a commercial–health system partnership scheme distributed cardboard baby boxes to new mothers in particular locations. We conducted parent evaluations of both interventions at the time of implementation. The views of 79 parents receiving polypropylene boxes and 77 parents receiving cardboard boxes were captured using online questionnaires and telephone interviews. Participants provided feedback on education received about using the box, their perception of the box design and materials, their experiences of using the box they received, and whether they would recommend it to others. Parents appreciated that both boxes provided a portable space to place their baby near them anywhere in the home, discouraging other riskier practices. The polypropylene box was rated more favourably regarding transparency, hygiene, and portability outside the home. A minority of parents found the idea of putting their baby in any box unappealing; however, younger mothers and smokers particularly appreciated the ability to safely co-sleep with their babies using the shallower box. Overall, the versatility of the polypropylene box scheme was more positively evaluated than the cardboard baby box scheme, which, stripped of its social value as part of a larger welfare provision, had minimal value for parents that received it.
Highlights
Accepted: 28 October 2021Prevention advice for Sudden Unexpected Infant Death (SUDI) encourages parents to ensure their baby sleeps in a safe space for every sleep
We aim to summarise the costs and benefits of these devices, better understand what makes such interventions acceptable/unacceptable to their intended recipients and consider whether one box is preferable as a baby sleep space over the other
English health professionals implemented the cardboard box schemes in good faith with the intention of using the boxes to engage families with pre and postnatal services, the National Health Service (NHS)-commercial partnership was not sustainable nor effective in providing benefit to most parents and lacked the social value provided by the Finnish baby box programme [21]
Summary
Prevention advice for Sudden Unexpected Infant Death (SUDI) encourages parents to ensure their baby sleeps in a safe space for every sleep. Varies according to international (and sometimes regional) guidance, but most authorities emphasise placing babies supine on a flat surface that is clear of loose bedding and other suffocation or overheating hazards [1]. This guidance is offered under the assumption that all parents will have suitable safe places available for infant sleep, the lived realities of parenting can sometimes make compliance with idealised guidance unlikely or impossible [2,3,4,5,6]. In recognising that babies may sometimes be placed to sleep on unsuitable surfaces, or in hazardous contexts, novel interventions have been devised to provide parents with a safe (or safer) space in which their baby can sleep [7,8,9,10]. Small shallow polypropylene boxes (originally underbed storage boxes) fitted with mattresses and bedding were distributed to displaced
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