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

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...
Source: Maternal and Child Nutrition - Category: Nutrition Authors: Tags: COMMENTARY Source Type: research