Putting Babies In Boxes To Prevent Infant Deaths Catching On In NY

By James T. Mulder
Syracuse Media Group, N.Y.

WWR Article Summary (tl;dr) Many infant deaths occur when babies are accidentally suffocated by adults sleeping in the same bed. Advocates see cardboard baby boxes as an inexpensive way to reach large numbers of expectant parents and educate them about the potentially deadly consequences of sharing beds with babies. The box, which functions like a bassinet, is big enough for most infants until they are 5 or 6 months old.


Putting babies to sleep in cardboard boxes, a new strategy to prevent infant deaths, is catching on across New York state and may soon arrive in Syracuse.

Crouse Hospital, which delivers more babies than any other hospital in Central New York, plans to begin distributing cardboard baby boxes lined with mattresses later this year to all new parents regardless of income.

To get a box, parents will have to complete an online course about the danger of sleeping with their newborns or putting them in other unsafe sleep situations.

Many infant deaths occur when babies are accidentally suffocated by adults sleeping in the same bed. The number of babies killed in unsafe sleep accidents is rising in Onondaga County and statewide.

The baby boxes are growing in popularity nationwide. New Jersey, Ohio and Alabama recently began giving the boxes, made by The Baby Box Co. of California, to families of newborns. The boxes were pioneered in the 1930s in Finland, which has one of the world’s lowest infant mortality rates.

The baby box boom is generating lots of enthusiasm and some skepticism. Advocates see them as an inexpensive way to reach large numbers of expectant parents and educate them about the potentially deadly consequences of sharing beds with babies and other dangerous sleep practices. Critics say there’s not enough research to know if the boxes are safe or effective.

In New York, a hospital in Gloversville and a health clinic in Westchester County began giving out baby boxes earlier this year.

A bill recently introduced in Albany would make the state Health Department start a pilot program to distribute baby boxes in parts of New York with high infant mortality rates.

Crouse will either participate in the proposed state pilot program or launch a program of its own. The hospital has talked to the Baby Box Co. about possibly rolling out the program here in September, according to Joan Dadey, Crouse’s director of women and infants services.

She said Crouse doctors who care for ill and premature newborns are passionate about the baby box program.

“We see babies go home who are smothered, put in makeshift sleep environments and die,” Dadey said. “For us it gets personal.”

St. Joseph’s and Upstate Community hospitals have no plans to get on the baby box bandwagon.

After declining, infant deaths increasing again

Safe sleep public health campaigns have helped reduce infant mortality, but the rate is still too high, child health advocates say.

The federal government recommends babies be put to sleep alone on their backs in a crib with a firm mattress covered by a fitted sheet. Cribs should be free of blankets, bumpers, pillows and soft toys.

There were 3,700 sudden unexpected infant deaths in the U.S. in 2015. The death rate fell significantly between 1990 and 2014, but has been creeping up since then, according to the federal Centers for Disease Control and Prevention.

The annual number of sleep-related deaths in New York increased from 83 in 2011 to 103 in 2014, the most recent data available from the state health department.

Six infant deaths in Onondaga County last year were blamed on unsafe sleep environments. That’s up from three unsafe sleep deaths in 2015 and two in 2014, according to the Onondaga County Child Fatality Review Team.

New Jersey expects to give away more than 100,000 boxes

The Baby Box Co. is a for-profit company that receives support from foundations and government agencies to keep costs at a minimum. In New Jersey, for example, a $40,000 federal grant is helping pay for the baby box giveaway. The state expects to distribute more than 100,000 boxes this year. The company also sells boxes directly to consumers on its website at prices starting at $69.99.

Baby boxes are made of laminated cardboard and measure 26 3/4 by 16 3/4 by 11 1/2 inches. They come with a waterproof firm foam pad and a fitted cotton sheet.

The box, which functions like a bassinet, is big enough for most infants until they are 5 or 6 months old, according to the Baby Box Co.

Most parents use the box as a safe spot for their baby to sleep at night, the company says. Other parents use the boxes as a place where the baby can nap during the day in the kitchen, living room or elsewhere in the house.

The company recommends the box be placed on the floor next to the parents’ bed, not in the parents’ bed.

The boxes come filled with complimentary diapers, wipes, breastfeeding supplies and other free baby swag.

The gifts are appreciated by new moms at Nathan Littauer Hospital in Gloversville, which began passing out the boxes in February, according to Dr. Peter Dowling, an obstetrician-gynecologist who championed the idea at the hospital.

“We were trying to think of a way to help our new mothers,” Dowling said. “We have patients here who are poor and I don’t think some of them even know what a baby shower is.”

The number of infant deaths in Finland has plummeted since the country began passing out baby boxes to pregnant women in the 1930s. The country’s infant mortality rate, one of the lowest in the world, is often attributed to the use of baby boxes.

But the American Academy of Pediatrics task force on Sudden Infant Death Syndrome says there is no evidence to support the notion that baby boxes reduce infant deaths.

Dr. Rachel Moon, a member of the AAP task force, said in a statement Finland has never studied the effect of the baby box on infant mortality. She said many countries have seen similar dramatic declines in infant mortality because of improved nutrition, immunizations, intensive care nurseries and other factors.

“It appears the enthusiasm and excitement (about baby boxes) has outpaced the knowledge we have,” she said.

As interest grows in baby boxes, so have questions about their safety.

“What happens if they get wet or people use them on the floor in a home where there is a dog or other pets?” said Elizabeth Crockett, executive director of REACH CNY, a Syracuse health agency.

Her agency participates in the national Cribs for Kids program, which educates parents about safe sleep and gives portable “Pack ‘n Play” cribs to families who cannot afford to buy regular cribs.

The agency gave out 114 portable cribs in Onondaga and Oswego counties last year. The number it gives away is limited by the amount of money it can raise to buy the cribs, which cost about $55 each.

Onondaga County families on full public assistance who have newborns get extra money to buy cribs, she said.

“But there are still many low-income families not on public assistance who need help,” she said.

Company says education, not boxes alone, can prevent infant deaths

Jennifer Cleary, CEO of Baby Box. Co., said baby boxes are as safe as bassinets and have been extensively tested for water resistance, air flow, flammability and durability. She said the safe sleep education for parents that comes with the boxes — not the boxes alone — can reduce infant deaths.

The company requires parents to complete a short online course, take a quiz and receive a certificate of completion before getting a box.

Dadey of Crouse Hospital said baby boxes complement the Cribs for Kids and similar programs.

“It’s another way to provide a safe sleep environment,” she said. “It’s not going to be just one initiative that brings the mortality rate down.”

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