Baby Boxes: The Latest Effort in Reducing Sleep-Related Infant Deaths

The government of Finland, which has one of the world’s lowest infant mortality rates, has provided expecting mothers with cardboard boxes filled with baby supplies, which can also be used as baby beds. Now, American hospitals have taken notice of the successful trend that’s been around for decades and have begun distributing free baby boxes to parents in attempts to reduce the number of sleep-related infant deaths.

For mother Maisha Watson, she questioned the idea of using a baby box for her son.

“Why would I want to put my baby in a box?” she asked Marcia Virgil, a family support worker at the Southern New Jersey Perinatal Cooperative.

Although it’s a cardboard box, it’s considered a safe place for a baby to sleep. It comes with a firm mattress and snug sheet which follow American Academy of Pediatrics guidelines that protect against sleep-related deaths, such as sudden infant death syndrome.

Once Watson learned more about the baby box, the mother of 1-month-old Solomon has come to trust that her baby can sleep safely inside of it. In fact, Solomon has been sleeping in the baby box ever since he left the hospital.

After a bad car accident left her unable to go to work or attend school, Watson began living in a cramped motel room outside of Atlantic City, N.J. about a year ago. Due to living in such tight quarters, the baby box’s size and safe nature was a much more convenient option for her than a crib or bassinet.

The box Solomon rests in is just one of approximately 20,000 that New Jersey has distributed since January as part of the first program to provide a baby box to each newborn in the state. Since then, Ohio, Alabama and Texas have jumped on the “box wagon.”

Any new mother can receive a box as long as she watches videos focused on safe sleeping and passes a short quiz. A main goal is to educate mothers on proper sleeping habits for their children.

However, skeptics believe there is insufficient evidence that a cardboard box is an effective and safe sleeping space.

According to the American Academy of Pediatrics, “there is insufficient data on the role cardboard boxes play in reducing infant mortality.”

“I’ve been very surprised at how much enthusiasm there’s been for this and how people are just jumping on this bandwagon.” Dr. Rachel Moon, chairwoman of the American Academy of Pediatrics’ task force on SIDS, said. “They’re just assuming that since it worked in Finland that it’s going to be fine.”

Dr. Thomas Heygi, medical director of the SIDS Center of New Jersey believes there are many unanswered questions about the safety of the boxes. For example, could bacteria grow if the cardboard gets wet? Or do the boxes contain glues or emissions that could cause dermatitis or are unsafe to inhale?

“We’re very concerned as pediatricians in adopting interventions for babies without thoroughly testing them, because historically we’ve been burned,” Heygi said.

Dr. Kathie McCans, chair of the New Jersey Child Fatality and Near Fatality Review Board, which is using a $40,000 federal grant to partner with the California-based Baby Box Company for the state program, agrees that regulations and more testing needs to be done. However, she claims the educational component of the boxes outweighs the risks.

“My hope is that we will not have people making the errors of putting a baby in a sleep surface that has blankets and pillows and crib bumpers, that everyone will know that every baby needs to be put to sleep on their back each and every time,” she said.

McCans believes parents can take a lot of preventive measures against sleep-related infant deaths, and using a baby box as an incentive to spread awareness is a positive step in the right direction.

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