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Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution

Bartick, Melissa; Tomori, Cecília; Ball, Helen L.

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Authors

Melissa Bartick

Cecília Tomori



Abstract

Concerns about bedsharing as a risk for sudden infant death syndrome and other forms of sleep-associated infant death have gained prominence as a public health issue. Cardboard “baby boxes” are increasingly promoted to prevent infant death through separate sleep, despite no proof of efficacy. However, baby boxes disrupt “breastsleeping” (breastfeeding with co-sleeping) and may undermine breastfeeding. Recommendations enforcing separate sleep are based on 20th century Euro-American social norms for solitary infant sleep and scheduled feedings via bottles of cow's milk-based formula, in contrast to breastsleeping, an evolutionary adaptation facilitating the survival of mammalian infants for millennia. Interventions that aim to prevent bedsharing, such as the cardboard baby box, fail to consider the implications of evolutionary biology or of ethnocentrism in sleep guidance. Moreover, the focus on bedsharing neglects more potent risks such as smoking, drugs, alcohol, formula feeding, and poverty. Distribution of baby boxes may divert resources and attention away from addressing these other risk factors and lead to a false sense of security wherein we overlook that sudden unexplained infant deaths also occur in solitary sleep environments. Recognizing breastsleeping as the evolutionary and cross-cultural norm entails re-evaluating our research and policy priorities, such as providing greater structural support for families, supporting breastfeeding and safe co-sleeping, investigating ways to safely minimize separation for formula-fed infants, and mitigating the potential harms of mother–infant separation when breastsleeping is disrupted. Resources would be better spent addressing such questions rather than on a feel-good solution such as the baby box.

Citation

Bartick, M., Tomori, C., & Ball, H. L. (2018). Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Maternal and Child Nutrition, 14(2), Article e12544. https://doi.org/10.1111/mcn.12544

Journal Article Type Article
Acceptance Date Sep 18, 2017
Online Publication Date Oct 18, 2017
Publication Date Apr 1, 2018
Deposit Date Oct 25, 2017
Publicly Available Date Oct 18, 2018
Journal Maternal and Child Nutrition
Print ISSN 1740-8695
Electronic ISSN 1740-8709
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 14
Issue 2
Article Number e12544
DOI https://doi.org/10.1111/mcn.12544

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Copyright Statement
This is the accepted version of the following article: Bartick M., Tomori C., Ball H.L. (2017) Babies in boxes and the missing links on safe sleep: Human evolution and cultural revolution. Maternal & Child Nutrition, which has been published in final form at https://doi.org/10.1111/mcn.12544. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.







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