Program aims to promote safe sleep, healthy starts by putting babies in boxes

On March 10, Ohio became the first Midwestern state (and the second overall, behind New Jersey) to begin providing a safe place for newborns to sleep by offering “baby boxes” to all new parents.

Baby boxes are made of sturdy cardboard and filled with items including clothing, diapers, food, bathing supplies, medical and parenting information, children’s books and anything else the boxes’ providers care to add, along with a blanket and firm mattress. Once emptied, it’s a ready-to-go bed for newborns to use until they can roll over.

The idea originated in Finland in the late 1930s and was made universal in 1949. Boxes are provided to all expectant mothers, but to get one they must get a prenatal exam during the first four months of pregnancy. They’re credited with helping drop the infant mortality rate from 65 deaths per 1,000 births to 2.52.
New Jersey and Ohio offer them to parents-to-be, who must first complete an online education course at The program isn’t about the boxes per se, but about educating new and first-time parents, says Dr. Kathryn McCans, chair of New Jersey’s Child Fatality and Near Fatality Review Board, which identifies causes of deaths and near-deaths, their relations to governmental support systems, and ways to prevent them.
McCans says the idea to start a universal baby box program in New Jersey came from a member of the Review Board’s “Sudden Unexpected Infant Death” subcommittee who brought it to the full board’s attention, and “that story got people thinking.”
The program quickly became a public-private partnership of sorts: In November 2016, the Los Angeles-based Baby Box Co. told the board that with seed money, it could find funding to take universal baby box distribution statewide for 2017. The board then decided to tap $40,000 from a Safe Sleep grant it had gotten from the U.S. Centers for Disease Control and Prevention to get started.
“Ideally, every baby born in New Jersey this year [105,000 births, based on historic data] would get their own box,” McCans says. “If we see a downtick [in Sudden Unexplained Infant Death Syndrome fatalities], I’ll consider it a success.”
Jennifer Clary, CEO of the Baby Box Co., says more than 12,000 people in New Jersey have completed the online education course since the program launched there on Jan. 25. About 30 states, including some in the Midwest, have inquired about launching similar programs, she says. The company also runs a similar program in Canada, in all provinces except Manitoba and Saskatchewan.
The company works with local hospitals and health care providers to produce short informational videos for the website. Expectant or new parents log in and get a syllabus tailored to their location. Upon completing the program, parents get a certificate they can use to get a baby box at a designated pickup site or have it delivered directly to their home. (In New Jersey, so far, it’s about 50-50 between pickups and deliveries, Clary says.)
Part of the program’s success, she adds, is that Baby Box University is a platform designed to reach millennial parents who primarily use cell phones or tablets to get information; anyone can access it from any browser-equipped platform.
The Children’s Health Alliance of Wisconsin is taking a more targeted approach with a statewide pilot project launched in 2016 to put baby boxes (which they call “newborn nests”) in homes. Trained volunteers provide the educational component, and conduct home visits to help parents pick a location for the “nest,” and ensure sleep safety. Follow-up visits are paid two weeks and two months after nest placement for evaluation.
Although this approach is slower than a statewide, universal program, project coordinator Amanda Bagin says the alliance prefers doing things this way because the efficacy and safety of the boxes and education can be better understood as the program grows.
There’s not yet a lot of solid evidence about baby boxes in the United States, and “if we can evaluate the program as it goes, we can provide that evidence,” she adds.
Partly because the training had to be done first, only 25 to 30 nests have been distributed since the summer of 2016, Bagin says, adding that at least five local health departments are now getting the training for their own staffs so the program should grow faster through 2017.
In Alberta, the nexus of parental education and baby boxes is also the focus of a province-wide study led by Karen Benzies, a professor and associate dean of research for the Faculty of Nursing at the University of Calgary, examining how supporting first-time mothers can help children get off to a better start.
A total of 563 mothers who were about six months to 32 weeks along in their pregnancies, as well as their “mentors” (a friend or family member), were recruited from late October 2015 through 2016. Questionnaires were given at the start and after two months and six months.
The study concludes in June, with results to be announced at the end of July.
Stateline Midwest: March 20171.64 MB