Marqevia Johnson uses a Pack ‘N Play portable crib for her 2-month-old son, Cody, to sleep in, but often puts him down for naps in what is essentially a cardboard box.
She likes the box bed because it’s small and simple and easy to carry.
“I can keep it in my bedroom or take it downstairs when I’m cleaning and he is crying,” said the 23-year-old mom, who lives in East Baltimore and works for a child care center.
Johnson is part of a growing movement of mothers using baby box beds, a popular concept since the 1930s in Finland, but just starting to gain traction in the United States. While parents like Johnson like the simplicity of the beds, some public health officials say the boxes also offer safe sleeping spaces for babies and see them as a way to prevent infant deaths, particularly for families who can’t afford a traditional crib.
Sleep-related deaths are one of the main causes of infant mortality. Baltimore has seen a spike in such deaths with 12 so far this year, a number city officials call unacceptable. Babies get caught up in blankets in their crib or parents put their babies in bed with them and accidentally roll over and suffocate the child.
Safe sleep guidelines call for babies to sleep alone and on their backs in a crib free of blankets and pillows.
The baby box beds are fitted with a mattress that lies snugly against the sides of the box, so there are no spaces that babies can get caught in. A tight-fitting sheet covers the mattress. The walls of the box are high enough so that babies can’t roll out.
Some states, local health departments and hospitals around the country are giving the box to new moms at no charge to help promote safe sleep practices. Many of the programs require families to take a class on safe sleep practices.
Last January, New Jersey became the first state to start a program that gives every new mother a baby box bed. Alabama, Colorado, Ohio, Texas and Virginia now do the same. Temple University Hospital in Philadelphia gives the beds to every mother that delivers there. In Baltimore, the nonprofit Touching Young Lives offers the bed at no charge to parents, including Johnson.
“It is really simple, but it can help a baby sleep safely,” said Shantell Roberts, founder of Touching Young Lives. “It’s safe sleeping in its simplest form.”
The beds also have their critics who say there are no formal safety standards for the boxes and that there isn’t enough research to show if the boxes are safe or prevent sleep-related baby deaths.
The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome said in a position statement that “there is really no evidence for these boxes.”
The Baltimore City Health Department doesn’t endorse the boxes for these reasons and also says they are not durable and can easily get soggy and moldy. The city has a program in which Pack ‘N Play cribs are given to low-income parents, which they say are more proven than the baby box beds.
But the department is not totally opposed to the box beds, and Baltimore Health Commissioner Leana Wen said they could help parents in some instances.
“We believe that a box may be a good option in cases where the mother opts for a box given her housing situation or when there are no other options and a safe sleep space must be provided on the spot,” Wen said. “If Touching Young Lives can distribute free boxes in these instances, that is a reasonable complement to the portable crib system.”
Roberts started Touching Young Lives after her one-year-old daughter Tylour Marie suddenly died from bacterial pneumonia in 2011. She became an advocate for curbing infant mortality rates and believes baby box beds can help. She recently received an Open Society Institute-Baltimore community fellowship to help with her endeavor.
“I want to prevent other moms from suffering the loss of a child like I did,” she said.
Roberts said she has known of moms who have used dresser drawers, laundry baskets and even Amazon boxes as baby beds. While the Pack ‘N Play cribs are good for some households, she said they were too big and bulky for smaller homes and apartments.
Proponents of the box beds are starting to gather research on their effectiveness.
A recent Temple University study found that teaching mothers about safe sleep practices and then giving them the baby box reduces incidences of bed sharing, one of the leading causes of sleep-related baby deaths. The study found that bed-sharing dropped by 25 percent under the program at Temple University Hospital in Philadelphia and by 50 percent among exclusively breastfed babies, who are more likely to share a bed with mom.
Lead researcher Dr. Megan Heere, an assistant professor of clinical pediatrics at Temple’s Lewis Katz School of Medicine, said more research needs to be done to make more people comfortable with baby box beds. There is not enough research on the beds’ effectiveness on reducing sleep-related deaths, said Heere, who is also medical director of Temple University Hospital's Well Baby Nursery.
“More studies need to be done and I hope more people do them,” she said. “Practically, the bed just makes sense. It fits the criteria of a safe sleeping space.”
A designation by the Consumer Product Safety Commission, much like that assigned to cribs and bassinets, also would help, Heere said.
A Los Angeles-based firm, The Baby Box Co., partners with hospitals (including Temple), government agencies and nonprofits around the world to give free baby boxes to mothers. They must participate in an Internet seminar on safe sleeping practices to get the beds. The company distributes baby boxes in six states and plans to distribute in 22 additional states next year, including Maryland. The company also sells its version of the box online.
Even though the beds don’t have an official endorsement by the Consumer Product Safety Commission, The Baby Box Co. and others said they follow the agency’s safety guidelines for bassinets.
The Baby Box Co. also uses natural, organic products that don’t use flame retardants, formaldehyde, mercury, lead, heavy metals and other materials that have been found to be dangerous. The mattresses are firm foam pads which have been independently certified as non-toxic and safe.
Jennifer Clary, founder and CEO of The Baby Box Co., notes that parents have used such beds in Finland for decades.
“I think the baby box product has been tested extensively,” Clary said. “I think it is a safe sleep space parents can use for their infants.”
Roberts, who looked at Temple’s program when starting her own, said she hopes to increase the number of families she can give baby boxes.
Cherina Stevenson received a baby box bed from Roberts’ nonprofit to use with her granddaughter, who lives with her. She said she likes the portability of the box, but also that it keeps the baby safe.
“When the baby is napping we don’t have to take her all the way upstairs to a crib,” said Stevenson, a Baltimore health worker. ”It’s a go box. Go where you go.”