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Thinking outside the box: Finnish baby boxes could save infant lives

Finnish "baby boxes" have inspired a similar program in Texas and New Jersey. The boxes offer a safe sleeping spot for babies.
/ Source: TODAY Contributor

Finland has found an unusual solution to a leading cause of infant death — baby boxes. Now the state of New Jersey and hospitals across the United States are adopting Finland's example.

Since 1949, the Finnish government has offered every new mother a box including a mattress, fitted sheet, blanket, sleeping sack, snowsuit, mittens, booties, hooded suits, overalls, socks, knitted hat, balaclava face mask, rompers, leggings, onesies, bath towels, nail scissors, hairbrush, toothbrush, cloth diapers, picture books, bra pads, and even condoms.

IMAGE: Adrian Delgado in a baby box
Baby Adrian Delgado, who was born at 32 weeks gestation and is two weeks old in this photo, tries out the baby box in San Antonio, Texas. Children's Hospital of San Antonio

The best part — the box itself serves as an infant bed until the baby reaches eight or nine months old, when the risk of unexpected death lessens. The Finnish baby box helped the nation drastically reduce its infant mortality rate from 65 per 1,000 when the program started to 2.5 per 1,000 today, one of the world's lowest infant mortality rates. The current U.S. infant mortality rate is 5.8 per 1,000 births.

The state of New Jersey announced that it will give free baby boxes to new parents as long as they complete a short parenting education course online. The Baby Box Co. expects to distribute 105,000 baby boxes in New Jersey this year.

In San Antonio, Texas, a pilot program in 2016 also distributed baby boxes to new parents, in an effort to reduce SIDS (Sudden Infant Death Syndrome).

“Safe sleep is actually quite simple. That’s what is so freaking frustrating,” said neonatologist Dr. Sanjuanita Garza-Cox, chief of staff of Children's Hospital of San Antonio. “I think it only takes one [success] for other people to follow, especially if we have the ability to document the change.”

IMAGE: Nurse Kelli Brimagner with a baby box
Nurse Kelli Brimagner, an educator at the neonatal intensive care unit at the Children's Hospital of San Antonio, displays a baby box. Children's Hospital of San Antonio

“The reason the box works really well (is) you are getting a good air flow,” Garza-Cox said. The firm mattress also helps, offering exactly the texture needed to prevent suffocation.

Garza-Cox said that while hospitals try to educate new parents about safe sleep, it just doesn’t seem like it’s working.

“It is very frustrating,” said Garza-Cox. “We are trying to figure out how to help the community.”

While Garza-Cox knew the boxes could help reduce deaths from unsafe sleeping conditions, the Bexar County Unexpected Infant Death Coalition struggled to find funding for the boxes.

At the same time, John Chance, past president of San Antonio's North Central Rotary Club, found an article about the Finnish baby boxes. Himself a new grandfather, Chance thought local moms might appreciate the box. But after learning of the extent of baby deaths in the area, he was really sold.

IMAGE: John Chance with baby box
John Chance poses with one of baby boxes that the North Central Rotary Club donated to the pilot program in San Antonio.Courtesy John Chance

“I saw the statistics from Finland and saw how [the boxes] reduced the infant mortality rates,” he said. “We can be giving them a welcome to motherhood package, [which] is in the safe sleep baby box.”

Chance convinced the club to purchase 100 baby boxes to start a pilot program at the University Health System. The boxes include almost everything that the Finnish boxes do, minus the snow gear — this is Texas, after all. If the pilot goes well, he hopes the club and other organizations will donate enough boxes for the entire city.

“We are trying to save lives. You can’t imagine the tragedy of the newborn baby who turns up dead because they are suffocated,” Chance said.

Unsure how to make baby's sleep as safe as possible? Garza-Cox provides these tips:

  • Each baby should sleep in its own environment, whether that's a crib, bassinet, playpen or box

  • Baby should sleep on a firm mattress with a fitted sheet

  • Use only one blanket, wrapped tightly under the shoulders, or a baby sack

  • Make sure the sleep area is free of soft items, including stuffed animals, bumper pads, or pillows

  • Babies should be put to sleep on their backs

  • Babies need to sleep in a smoke-free environment

  • Breastfeeding reduces risk of sudden unexpected infant death

  • After a month, pacifier use reduces baby’s risk.

Editor's note: This story was first published on January 26, 2016, and was updated on January 27, 2017.