Claudia M Gold M.D.

Child in Mind

The Baby Box Craze

Why it worked in Finland, and how we can insure it will work in the U.S.

Posted Aug 04, 2017

Aiming to model the Finland Baby Box program, New Jersey recently became the first state to distribute a free Baby Box, a sturdy, safe box to sleep in that is filled with newborn essentials, to all new families. Many other states have followed suit. The boxes are made by a private company The Baby Box Company; parents are required to take a 15-minute online course to receive it. 

 A recent article in the Washington Post describing plans for a new program to distribute the Baby Box cites 48 infant deaths in the DC area due to unsafe sleep practices.

Why are babies sleeping in unsafe places? Possibly parents were not told that babies should sleep on their backs. Unlikely—given the highly effective public health campaign initiated by the American Academy of Pediatrics in 1990 when evidence first came to light of the dramatic reduction in the incidence in Sudden Infant Death Syndrome when babies sleep on their back.  Advice about safe sleeping position is part of every well-child care visit during infancy.

Maybe the parents did not have access to a safe sleep space, a possibility in segments of our population struggling with extreme poverty.

A third and more likely explanation is that parents are overwhelmed, physically and emotionally stressed to the point where taking in information may be difficult and judgment may be lacking.

In Finland over 75 years ago, the implementation of the government sponsored program occurred in the context of other sweeping changes, including home visiting and nationalized healthcare. Mothers were required to attend a prenatal visit at 4 months gestation to receive the box. As other organizations, including the American Academy of Pediatrics, have highlighted, there is no evidence that the box itself decreases infant mortality. 

In my book The Silenced Child I offer context for the program:

For many countries, having a home visitor to support new parents in the early weeks and months is standard. In Finland, every new parent receives a “baby box” filled with clothes, diapers, and other assorted baby needs. When the box is empty, it often serves as the baby’s first bed. While the items themselves are useful, the meaning of this box is of greater significance. It says, “Our society places value on new parents and babies. 

To understand the possible benefit of the box, we need to ask, "What exactly is the nature of 'support' for new families?"  Certainly giving them things and instructing them on how to care for their baby are benign and possibly helpful interventions. But the latest research at the interface of developmental psychology and neuroscience tells us that by far the most important thing we can do for families is to insure that they feel connected. 

In his revolutionary book Baby and Child Care, Dr. Spock famously urged parents to trust themselves.  When parents feel chronically stressed and overwhelmed, access to their natural intuition may be severely inhibited. Linda Mayes, director of the Yale Child Study Center, in a recent presentation described the critical role of social connection in parent wellbeing and infant development. Recent research by neuroscientist Stephen Porges demonstrates the necessity of social connection to create a feeling of safety. When parents feel safe they can engage their natural intuition.

I recently led a training in the Newborn Behavioral Observations (NBO) System, a relationship-building tool for professionals who work with infants and parents. The NBO seeks to demonstrate to parents their natural ability to know their baby best. A delightful mother-daughter pair of doulas from Brazil was among those who attended. The daughter wisely observed that rather than instruction and advice, giving mothers confidence is the most important thing we can do. 

 A New York Times article describing recent research demonstrating the value of home visiting programs highlights this point:

“It gave me a lot of confidence,” said Ms. Arneson, 31, a hair stylist and a single mother in Kenosha, Wis. “I did not have my mom as a person who could do that for me, so my nurse was that person.”

Home visiting and the NBO are two relationship-building interventions that can serve to increase connection and promote confidence, not only for families identified as "at risk," a phrase that can be stigmatizing.  Interventions designed for all families normalize the challenges of the transition to parenthood

If we want to follow the lead of Finland, we need to implement these programs together with the Baby Box. While our Federal government may not currently be a source of support, state and local governments can take the lead in insuring that distribution of the Baby Box occurs together with programs that promote connection for new parents and infants. My local organization, Berkshire Baby Box, is taking the lead, working with local and state government to insure that connection and alleviation of social isolation are central are aspects of the program. Taking this broad scope from the start will help insure that the Baby Box will have a significant positive impact on the health and wellbeing of all new families. 

More Posts