To promote safe sleep, moms urged to think inside the box
Cardboard ‘cribs’ loaded with infant supplies part of program designed to prevent baby deaths
When 2-month-old Sherlyn goes to sleep at night, she is nestled in a small storage box on a table next to her mother’s bed. The box, lined with a firm, inch-thick mattress, has been the baby’s portable bassinet since the day she was born.
In the afternoons when her mother, Valeria, is working in the kitchen at their home in Santa Fe, Sherlyn naps soundly in the box on the table or another flat, sturdy surface close to her mother.
It may seem peculiar for a mother to keep a baby in a box, but the practice stems from a decades-old Finnish tradition that is gaining popularity around the world in an effort to prevent sleep-related infant deaths. Finland honors each new mother with newborn supplies in a gift box that doubles as a tiny, cardboard crib. The trend dates back to a 1930s initiative to promote prenatal and postnatal care for low-income women and to keep sleeping infants safe — particularly by encouraging parents not to share their bed with a baby.
The trend has been spreading in the past few years across the U.S. — which long has struggled with one of the highest infant mortality rates among developed nations. The movement recently made its way to New Mexico, where more than a dozen babies die each year while sleeping in a bed with an adult.
The state Children, Youth and Families Department and the Santa Fe nonprofit Many Mothers have launched a joint pilot project to provide 138 baby boxes to low-income families in Santa Fe, Rio Arriba and Los Alamos counties before the state fiscal year ends June 30.
The box, measuring approximately 27 inches by 17 inches by 11.5 inches deep, comes loaded with newborn necessities — diapers, wipes, baby wash, clothing, a swaddling blanket, toys and a book. The box also comes with a lid, but it should not be used when a baby is in the box.
One of the most important aspects of the box, state officials said, is that is serves as a conversation starter, a way to introduce safe sleeping practices to new parents and warn them about dangerous habits that too often lead to tragedy: an intoxicated parent rolling over on a baby sleeping in the same bed; a baby being smothered under heavy blankets or choking on a toy in a crib; an infant who dies from asphyxiation because she was sleeping on her stomach.
Experts have raised concerns in recent months about baby boxes, saying their popularity is commercially driven and that there is no evidence showing they prevent sudden infant death syndrome or accidental suffocation during sleep. And because the box can only serve as a crib for the first five or six months of a baby’s life, parents would need to find a safe alternative for an infant. That’s why, state officials said, the education component is key.
“This program has to be so much more than about the box,” Children, Youth and Families Secretary Monique Jacobson said. “… What we’re really trying to do is start a dialogue about safe sleep.”
Many Mothers, an organization that assists mothers with newborns, has a $33,000 contract with the child welfare agency to cover the costs of boxes and supplies from the Baby Box Co. of California, as well as education, outreach and an evaluation process to determine if the project has helped shape parents’ sleep practices.
The initiative follows the death in March of 3-month-old Jonathan
Valenzuela of Santa Fe, who police say was killed while sleeping in a motel room bed with his baby sitter and his sister.
The baby sitter, Rachel Smith, 25, faces charges of intentional child abuse resulting in death, possession of drug paraphernalia and obstructing an investigation. Police believe she used heroin and marijuana the night before the boy’s death, then rolled on top of him as they were sleeping, suffocating the child. She is being held without bond in the Santa Fe County jail until her trial.
Between 2012 and 2015, New Mexico Health Department data show, the state reviewed 96 sudden unexpected infant deaths, most of which occurred during sleep. Many were caused by accidental suffocation. More than half of the infants who died in those four years — 52 of them — had been sharing a bed with another person. In seven cases, the adult was impaired by alcohol, and in another seven cases, the adult had been using drugs.
Jacobson said she believes the baby box program could help prevent such deaths in a state that wrangles with substance abuse and addiction problems.
Valeria, who asked that her last name not be published, is one of about 25 mothers who are participating in the pilot program so far. She learned about it from staff at La Familia Medical Center while she was pregnant, she said, and she welcomed the little crib,
along with its contents and its message about safe sleep.
“I didn’t have something for the baby to sleep in,” she said in Spanish, through a translator. “So the box was my only resource.”
She placed dozy Sherlyn in the box, demonstrating its use as a crib. The baby drifted off to sleep as she lay on her back, as experts recommend. There were no blankets, pillows or toys in the box — items that pose choking and suffocation dangers for infants.
Many Mothers Executive Director Nancy Guthrie said each mother who accepts a box watches a video about safe sleep practices and receives home visits from one of the nonprofit’s program coordinators.
“As moms find out about the baby boxes, they’re coming to us,” Guthrie said.
If the pilot program is successful, Jacobson said, New Mexico could join the states of Alabama, Ohio and New Jersey in offering the boxes statewide.
According to a report in the Dallas Morning News, a private, statewide baby box initiative also was launched this month in Texas.
Data from the U.S. Centers for Disease Control and Prevention show there were about 23,000 infant deaths in the nation in 2015, including 3,700 sudden unexpected infant deaths. The U.S. infant mortality rate, about 5.8 deaths per every 1,000 live births, is slightly higher than New Mexico’s rate, at 5.1 deaths per 1,000 births, and more than twice that of Finland, which averages about 2.5 deaths per 1,000 births — among the lowest in the world. That nation partly credits its baby boxes.
Still, as the baby box movement has gained momentum, it also has faced some criticism in the U.S. and Canada. Critics see it as a profit-driven initiative pushed by baby box manufacturers and marketers — Baby Box Co. packages range from $70 to more than $200, according to its website — and say there’s a lack of scientific research to prove they are safer for sleeping babies than a traditional crib or bassinet.
Though, studies were launched earlier this year in both countries.
Dr. Lori Feldman-Winter, a member of the American Academy of Pediatrics’ Task Force on SIDS and a co-author of an academy report on safe sleep practices for infants, said the task force doesn’t believe there is enough evidence yet to determine whether baby boxes or similar sleeping devices are effective.
Finland’s infant death rate dramatically declined over the 20th century, she said, but so did the infant mortality rates
in most other industrialized nations, including the U.S. She cited improved nutrition, sanitation, vaccinations, antibiotics and other medical advancements as some of the reasons for the decline.
“There are potential hazards that are unique to baby boxes,” Feldman-Winter said in an email, “including handle strength, integrity of the box if it is subjected to humidity or dampness, flammability, and the potential that parents may place the lid on the box with the baby inside.
“Nevertheless,” she said, “for families unable or unwilling to use a crib or bassinet and who would otherwise bed-share, the box may be a safer option.”