Baby in a Box? Free Cardboard Bassinets Encourage Safe Sleeping

Jernica Quiñones, a mother of five, was the first parent in New Jersey to get her free baby box — a portable, low-tech bassinet made of laminated cardboard. But first, she had to take an online course about safe sleeping practices, which experts say can sharply reduce the chances of sudden infant death syndrome.

“Basically, you want to have the baby on the mattress, and that’s it,” she said after watching a 20-minute series of videos.

The message may not be new. But health officials say it is critical to keeping babies safe. To reduce infant mortality, parents must put babies to sleep on their backs on a firm mattress in either a bassinet or a crib — with no pillow, blanket, stuffed animal or bumpers.

Now, New Jersey has become the first state to adopt a broad program to reduce infant deaths by aiming to distribute as many as 105,000 of the so-called baby boxes — the expected number of births in the state this year. Baby boxes, which have a snug-fitting mattress, have been handed out to new parents for decades in Finland, which has one of the lowest infant mortality rates in the world, and less than half that of the United States.

“It’s really not about the box; it’s about the education,” said Dr. Kathie McCans, a pediatric emergency physician at Cooper University Hospital and chairwoman of the state’s Child Fatality and Near Fatality Review Board.

“Honestly, people like free things,” she added. “The box is the incentive for the education. And the box comes with Pampers, baby wipes, a onesie, breast-feeding pads and other goodies.”

In 2014, the most recent year for which statistics were available, 57 of New Jersey’s 61 cases of sudden unexpected infant death, or 93 percent, involved an unsafe sleep circumstance, Dr. McCans said. The risks included the presence of a blanket, which poses a strangulation or suffocation hazard; parents who sleep next to their babies, creating the potential of rolling onto them; and instances of entrapment in which an infant becomes wedged between couch cushions or between an ill-fitting crib mattress and a crib frame.

“I understand that that’s a small sample size, but that’s still a lot of babies who died,” Dr. McCans said. “Relative to other states, New Jersey has good statistics for sudden, unexplained infant death. And that’s great, but if we are still losing 50 babies a year — or even one — and there is something we can do to increase the knowledge base, to me that just makes sense.”

Nationwide, New Jersey has the lowest rate of sudden unexpected infant death, or SUID, an umbrella category that encompasses the more familiar sudden infant death syndrome, or SIDS, as well as accidental suffocation or strangulation and unknown causes. Federal data captures three-year segments, and from 2011 to 2013, New Jersey’s SUID rate of 0.5 per 1,000 live births was tied with California for the lowest. The national rate for this period was 0.87 per 1,000 live births.

Last spring, Temple University Hospital in Philadelphia began its own baby box program. Camden, a postindustrial city confronting high crime, unemployment and poverty, is across the Delaware River from Philadelphia, so Dr. McCans and her colleagues quickly learned about Temple’s initiative.

It turned out that the Baby Box Company, in Los Angeles, was behind the program. The company has worked with hospitals and governments in more than a dozen states, as well as in Canada and England. Though the company is for-profit, it receives support from foundations so the costs to governments can be kept to a minimum.

New Jersey’s Child Fatality and Near Fatality Review Board already had a safe-sleep program, using about $40,000 each year from the federal Centers for Disease Control and Prevention. The state will use that financing for the new program, but the Baby Box Company has pledged to come up with the rest of the money needed to provide free baby boxes statewide.

Company officials declined to say what the projected costs were for the state, citing proprietary information.

Companies like Pampers and Lansinoh, which sells breast-feeding products, supply the items inside the box.

The Baby Box Company was started in 2013 by Jennifer Clary and a friend who was pregnant after Ms. Clary read about Finland’s success with its baby boxes. They decided to devise an education program, called Baby Box University, that centers on a series of videos, which cover sleep safety, but also breast-feeding and the proper use of car seats, among other things. After watching the videos, expectant mothers or new parents take a short quiz and then print out a certificate of completion.

In New Jersey, parents can opt to have the baby box shipped to their home for free, or can pick it up at distribution sites like hospitals or social service agencies — and eventually public libraries.

The distribution network in New Jersey is still being developed. Cooper University Hospital was the first such site, starting its program in January.

“The plan is to have at least several distribution sites in every county,” Dr. McCans said.

In the first two weeks of the program, more than 12,000 people took the online course, according to the Baby Box Company.

The Centers for Disease Control and Prevention said it did not endorse any products, including the baby box. Still, a spokeswoman for the agency, Nikki Mayes, said parents should take sufficient steps to help reduce the risks of sudden infant death.

Nationwide, about 3,700 infants died suddenly and unexpectedly in 2015, according to the agency. Such deaths have fallen significantly since the 1990s, when the American Academy of Pediatrics released safe-sleep recommendations, including urging parents to put infants to bed on their backs. Sudden infant death syndrome rates declined from 130.3 deaths per 100,000 live births in 1990 to 38.7 in 2014.

While many new parents already have proper gear for their newborns, New Jersey officials say everyone can benefit from the baby box program. The boxes are a useful supplement to a bassinet or crib and can be easily transported for an overnight stay in a hotel or with grandparents.

Ms. Quiñones, 33, said she had already owned a bassinet for her 3-month-old son, Bless’n, but kept it upstairs. Before she picked up the baby box, which is now in the living room, she had to run upstairs to check on him.

“It came in handy for me,” she said.

Dr. McCans said many new parents laid a sleeping infant on a couch during the day, when family life revolves around the kitchen and living room. Couch cushions, like crib bumpers, can lead to poor air flow around a baby’s mouth.

“Ten or 15 years ago, we may not have recognized that couches were particularly dangerous,” she said. “Even if a baby turns partially, the face might not clear. If there is a gap, the baby can get wedged.”

While putting babies in cardboard boxes might strike some as too downscale, especially in an era of $1,000-and-up cribs, Dr. McCans thinks the boxes might appeal to millennials who value minimalism.

“There are a lot of people who are trying to simplify their lives,” she said. “If millennials see that this is cool and renewable and nontoxic, and if it catches their attention so they get the education in a format that is acceptable to them, then I don’t see any harm. We’re trying to target everybody.”



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