Safest place for babies to sleep: A crib or a box?
Cribs for Kids, a national nonprofit based in Pittsburgh that provides infant safe sleep education, is offering a new portable bassinet/ crib to mothers.
And the organization says it is safer than the cardboard box — introduced in Finland 80 years ago — that is gaining popularity in the U.S.
Pediatricians agree that a safe sleep arrangement involves putting a baby on his or her back to sleep, on a firm surface in the same room but not in the same bed as the parents. It’s been proven to reduce the risk of sudden unexpected infant death.
Cribs for Kids, begun in 1998, has been providing a free Graco Pack ’n Play portable crib to any family in Allegheny County that can’t afford a crib. The new “Cribette” has all the same safety features of the Pack ’n Play, with the addition of a safe sleep message and tips printed on the mattress and rail pads. The message reads: “ABC Alone, on my Back, in a Crib.” It’s manufactured in Taiwan by Korbex International at a reduced cost, according to Heather Glaser, Cribs for Kids spokeswoman. A Cribette costs $49.99 if purchased individually.
Judith Bannon, executive director, said Cribs for Kids believes the safety and durability of the Cribette is far superior to other products, especially the cardboard box.
An infant breathing against the wall of a box might be in danger of suffocating, she said.
“The Cribette is basically a play yard, with all the safety features of the Graco unit. The sides are mesh, so if a baby rolls into the side of it,
the baby would still be able to breathe.” She added that the ABC message is a constant reminder to parents and caregivers.
“A cardboard box is not a long-term solution,” Ms. Bannon said. “Eventually someone has to give that family a Cribette or a crib.”
In Finland, a cardboard box used as a bed for newborns was credited as a positive part of that country’s low rate of infant deaths in a BBC News online article in June 2013. The Finnish practice started in the 1930s along with a promotion of prenatal care. To get the box full of mother-baby supplies (clothing, diapers and more), women have to come to a clinic early in their pregnancy.
Now some U.S. states’ health agencies and hospitals are sending new moms home with mattress, sheet and essential baby supplies enclosed in boxes, promoting it as a safe separate place for a baby to sleep.
Doctors and nurses at Temple University Hospital in Philadelphia in May 2016, for example, launched a safe-sleep program that sends a similar cardboard box home with every newborn, and includes safe-sleep education and help with finding needed family resources. Temple’s box is made by Baby Box Co., one of the first U.S.-based products inspired by the Finnish model. Online, the company sells the boxes (26¾ by 16¾ by 11½ inches) for $69.99, and they include mattress, bedding and educational materials.
Megan Heere, medical director of the hospital’s Well Baby Nursery, said there was concern about the city’s high rate of infant death, which was almost double the national rate. Research led by Dr. Heere and published earlier this year surveyed women within a week of giving birth at the Temple hospital asking about sleep behaviors, and they found that 6.3 percent of the babies were at least sometimes sleeping with the mother. Co-sleeping, with the baby in bed with the mother, greatly increases the risk of sleep-related deaths in babies under the age of 1.
The study recommended education that supports breast-feeding without bed-sharing and safe places for the infant to sleep.
“We decided to create a program to focus on safe sleep,” Dr. Heere said last week. The box is just part of the program.
“Trained safe-sleep nurses go to every baby room in the hospital,” she said. “The hallmark of our program is the education.”
In the future, she said, the online Baby Box University with its education component may become part of the hospital’s program. Baby Box Co. and its Baby Box University have programs affiliated with more than 200 hospitals and agencies in the United States, primarily in Alabama, California, Texas, Ohio and New Jersey.
“We can’t say the boxes themselves will reduce sleep-related deaths,” Dr. Heere said. “We’re hoping it cements the message.”
She said babies outgrow the boxes at about 2 to 3 months. “Our goal is the box is a bridge, that the baby sleeps in a safe environment until the baby can transition to a crib.”
Locally, the new Cribs for Kids Cribette is distributed through Allegheny County agencies and hospital birthing centers. The concept was announced at an infant safe sleep education conference in Pittsburgh in April, which was organized by Cribs for Kids, and shared research, program innovations and insights and promoted partnerships in safe sleep education.
Strides are being made. The U.S. death rate went from 26 in 1960 down to six in 2015, but it still has a higher rate than Scandinavia and much of Europe, according to the U.S. Centers for Disease Control and Prevention. A 2014 CDC report concluded that the higher infant mortality rate in the U.S. is due to a higher percentage of preterm births.
Elsewhere across the world, infant deaths (within the first year of a baby’s life) also have gone down dramatically since 1960, attributed to better prenatal care and improved intensive care for infants born prematurely or with medical complications.
The Cribette and the Pack ’n Play have two levels: The top level is for a baby weighing up to 15 pounds, and the bottom level is considered safe up to 30 pounds or 35 inches tall. Washable and resistant to fire, they also comply with standards of the U.S. Consumer Product Safety Commission, which does not yet regulate boxes but is developing voluntary standards for the baby box.
At the Pittsburgh safe sleep conference, Finnish researcher Anita Haataja (of Kela, the national Social Insurance Institution) said the socialized health care system in her country is the key to the reduction in infant deaths.
“There is free prenatal care; a mother gets a year off with pay — fathers get three months — so she can breast-feed her baby,” Dr. Haataja said. Exclusive breastfeeding is linked to a much lower risk of infant death.
As far as the box, Dr. Haataja said, “only 42 percent of women in Finland say they used the box [occasionally].”
The usefulness of a box is limited in many ways, said Ms. Bannon of Cribs for Kids. “In this day and age there are better products to put a baby to sleep in.”
On top of other advantages, she said, the Cribette comes with a carrying case with shoulder straps. The New York City Health Department distributes it and found mothers can take it home on the subway, she said:
“It can be taken anywhere.”