Philadelphia hospital giving out 'baby boxes' to promote safe newborn sleep

When Brianna Devero brought her newborn son home for the first time on May 3, she’d spent two days in the hospital, was exhausted, and didn’t have his pack ’n play set up because he was two weeks early.

But as the first recipient of a baby box from Temple University Hospital (TUH)’s newborn safety program, what she did have was clothing, diapers, and educational materials— all packed in a cardboard box with a fitted mattress. The box, a functioning bassinet, is Steven Anthony Tonzelli Jr.’s home until he outgrows it.

“[After] coming home and nothing being put together because he came early, this was nice and easy to place him in there when I needed to relax,” Devero, 21, of Philadelphia, told “I was discharged at 8 p.m., and nobody feels like putting anything together late at night after being in the hospital.”

While a cardboard box for a newborn may sound unusual, it’s been a tradition in Finland since the 1930s. The Finnish government offers new mothers a baby box or $150. Most first-time mothers opt for one, and it’s widely accepted as a rite of passage.

“The reason we like it so much is because it’s a very safe place for a baby to sleep,” Dr. Megan Heere, an assistant professor of pediatrics at the Lewis Katz School of Medicine at Temple University, told “During that time, parents hopefully can establish a safe sleep environment for Baby.”

The baby boxes, which are manufactured by The Baby Box Co., have been independently tested for safety by the Consumer Product Safety Commission, and they can be used until the baby is about 5 to 6 months old, or weighs 15 pounds.

For the team at TUH, the box is a potential solution for the city’s high infant mortality rate. For every 1,000 live births in Philadelphia, 11.2 infants die— that’s almost twice as much as the national rate. In north Philadelphia, the area served by TUH, the rate is even higher, Heere said. To address the issue, TUH launched the Sleep Awareness Family Education at Temple, or SAFE-T, program in January 2015.

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Through Temple research and known data, the team became aware of a “huge issue with infant sleeping practices and environment, as reported by parents and, sadly, death reports of our city,” said Heere, who is also the medical director of the Well Baby Nursery at TUH. An infant’s SIDS risk peaks when they’re between 1 and 4 months old, she said, adding that 90 percent of cases occur before six months.

Any sudden and unexpected  death of an infant, whether explained or unexplained, is medically considered a sudden unexpected infant death (SUID). Sudden infant death syndrome (SIDS) is the leading cause of SUID, followed by unknown causes, and accidental suffocation and strangulation in bed, according to the Centers for Disease Control and Prevention (CDC). Every year in the United States, there are about 3,500 cases of sudden unexpected infant death (SUID).

In 2011, the American Academy of Pediatrics expanded its recommendation on SIDS prevention to include safe infant sleeping environment.  Babies should sleep alone, on their backs, in their own cribs with just a mattress— no blankets, bumpers, or stuffed animals. Heere noted that the recommendation is abbreviated as ABC, standing for alone, back, crib.

“Our infants and our parents have an issue with this, so we decided to give out the baby box to see if intervention would change [sleeping habits],” Heere said.

The baby boxes are the third part of the SAFE-T program. The first phase ran from January 2015 through October 2015, at which time 1,200 new moms received standard-practice sleep education. During phase two, which started in February, mothers received more extensive safe sleep education and given materials about safe sleep. This third phase, which will last about one year, includes the extensive safe sleep education, the baby boxes, and access to a website with newborn education videos. Through each phase, TUH followed up by phone survey.

Using the phone survey data, the Temple team can assess whether rates of co-sleeping change, and if there is a risk reduction for SIDS.

Temple projects it will give 3,000 baby boxes to new mothers; about 250 moms give birth at the hospital each month. Heere noted that the medical team is aiming to obtain additional funding to extend the program but are fully funded for one year.

The resources packed in the boxes, which are manufactured by The Baby Box Co., include an immunization record to stress the importance of vaccines and pamphlets on breastfeeding, community resources, smoking cessation, organizations that offer free cribs and other baby gear, teen parenting classes, and organizations that help teen parents obtain work and life skills.

“Knowing our patients live in a high-risk area, we include information on the domestic violence hotline for Philadelphia,” Heere said. The city fire department has partnered with the program and offers free installation of smoke detectors.

The box also has a cardboard baby book from the Charlie’s Kids Foundation to encourage reading to babies, help foster parent-child bonding and double as a safe-sleep reminder to parents.

When TUH was fundraising for the program, they received $5,000 in 48 hours, the fastest crowd-funded project in the hospital’s history. Not only did they get donations, but they also got volunteers, including 30 medical students and doctors from other departments who joined in packing the boxes.

“We’re just really excited about the program, not only for what it can do for our community— and our goal is to reduce infant mortality— but also from the community support it’s gotten,” Heere said.

For Devero and her fiancé, Steven Anthony Tonzelli, the box allows them to keep the boy nearby wherever they are in the house and has made parenthood less stressful.

“It’s very good they’ve started doing this because a lot of people won’t admit they don’t have everything ready. It’s OK to be afraid to be a new mom,” she said. “It’s a good starting spot for him. When he’s older, it’ll always be a memory we have.”