A baby box is outfitted with a firm, foam mattress so that it can serve as a bassinet during the baby's first months, offering a safer alternative to co-sleeping. Picture: Washington Post

Washington - To prevent infant deaths, US lawmakers are considering a tool that has become synonymous with the record-low infant mortality rate in Finland - a cardboard box.

"Baby boxes" come packed with new baby supplies and are outfitted with a firm, foam mattress so they can double as a bassinet during the baby's first months, offering a safer alternative to co-sleeping.

First offered to Finnish mothers in the 1930s, the low-cost beds are now being embraced by politicians, philanthropists and hospital administrators across the United States as a way to prevent sleep-related deaths for infants.

A statement issued recently by the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome cited research on the outcomes related to baby boxes, even in Finland, where it's not clear whether the nation's low infant mortality is due to its baby boxes or broader system of prenatal care.

"There really is no evidence for these boxes," the statement says.

Other doctors are questioning whether it's safe to put newborn babies in a box to sleep. In the highly regulated marketplace for baby products, the boxes being mass distributed are not regulated by the U.S. Consumer Product Safety Commission, and doctors are questioning how air circulates in the box and what appropriate weight limits should be.

Jennifer Clary, co-founder and chief executive of The Baby Box Co., the for-profit company that is supplying the new statewide programs, said the boxes have undergone extensive safety testing and are the same boxes that have been used for decades in Finland.

No parent is given a box without learning about safe sleep habits and how to use the box safely, she said.

"Some people have an emotional problem with the concept of putting a child in a box," she said. "The reality is that it's every bit as safe."

Anjali Talwalkar, senior deputy director for community health administration at the D.C. Department of Health, said it's important to raise awareness about safe sleep, but she does not want to "distract" from the main drivers of infant mortality in the District. Significantly improving infant survival rates requires intervening earlier, she said, and improving the mother's health care and education before and during pregnancy.

Obesity, chronic illness and a history of trauma are all factors that could contribute to a high-risk pregnancy, Talwalkar said.

Still, unsafe sleep practices are considered a major risk factor among infant deaths that occur after the baby's first month. For young infants, co-sleeping with parents and sleeping on their stomachs or on soft beds puts them at risk for sudden infant death syndrome or accidental death by suffocation or strangulation.

The American Academy of Pediatrics recommends that babies be put to sleep on their backs in the same room as their parents but on a separate bed that has a firm mattress and is free of any loosefitting sheets or soft cushions.

The box was conceived - and still serves - as a kind of welcome kit from the government that would incentivize women to access the public health care services, said Sanna Kangasharju, a press counsellor at the Finnish Embassy in the District.

Expectant mothers can choose the box or a monetary award, currently the equivalent of about $180. To claim their prize, women first have to get a certificate from a health-care provider showing they have received prenatal care within the first four months of pregnancy, initiating a system of regular healthcare and counselling.