- Associated Press - Monday, May 15, 2017

DALLAS (AP) - A few weeks ago, Dallas resident Rachel Salinas decided to ditch the $175 bassinet she had purchased for her newborn son’s nursery. Instead, Mason sleeps in an inexpensive, flower-patterned cardboard box, right beside her bed.

The Dallas Morning News (http://bit.ly/2q6IM9K ) reports it may sound like an unusual sleeping arrangement to many parents, but a startup created by two North Texas natives aims to get hundreds of thousands of babies across the United States sleeping this way before the end of the year.

The “baby boxes” are intended to educate new parents about safe sleep practices and reduce the risk of sudden infant death, which sometimes occurs when babies get accidentally suffocated by soft bedding or entrapped in crib railings.

The Los Angeles-based Baby Box Co. recently announced partnerships with several Texas institutions, including Dallas Regional Medical Center in Mesquite and Dallas Medical Center in Farmers Branch.

New and expectant parents who take a free online course focused on safe sleep, including videos and quizzes created by pediatricians and other local experts, can get a certificate to pick up a free baby box at one of dozens of distribution centers in the state.

“The product in and of itself is not magical; it’s like any other crib or bassinet that has been objectively reviewed,” said Baby Box Co. CEO Jennifer Clary, a Dallas native.

“This is a comprehensive education and community initiative,” she said. “And the box is the first point of contact for the parents.”

Salinas, 30, said before she learned about the boxes, she would sometimes allow her baby to sleep beside her in the bed, a practice experts do not recommend. Now she prefers the box.

“You can move it anywhere. It’s lightweight, portable and goes easily to grandma’s house,” she said at an recent event.

Texas is the fourth state to announce such an initiative, following launches in New Jersey, Ohio and Alabama earlier this year.

Clary and co-founder Michelle Vick have been best friends since childhood. Both attended the Hockaday School in Dallas.

Sudden infant death syndrome, or SIDS, was the leading cause of mortality in Texas infants older than 28 days in 2014, according to the Department of State Health Services. The deaths were more prevalent among black and teen moms.

There were about 3,700 sudden unexpected infant deaths in the United States in 2015, according to the Centers for Disease Control and Prevention. Of those, about 900 were due to accidental suffocation and strangulation in bed.

There has been a national campaign to encourage safe sleeping. Guidelines say parents should always place babies on their backs to sleep and use a firm sleep surface covered by a fitted sheet. They should never share the bed with a baby or keep loose bedding in the baby’s sleep area.

The goal of the baby box program is to encourage mothers to seek regular prenatal care and encourage new parents to have discussions about safety with their health care providers.

Still, there are things consumers should know before they obtain a box.

The American Academy of Pediatrics’ official position on the boxes notes that “there is insufficient data” on the role the product plays in reducing infant mortality. The AAP is a national organization of more than 64,000 pediatricians that makes recommendations and policy statements and issues clinical reports related to pediatric health.

Cardboard boxes for babies are currently not subject to any mandatory safety standards and do not meet the federal definition of a crib or bassinet, according to the U.S. Consumer Product Safety Commission.

The Baby Box Co. founders say the emphasis is on education, not just a box.

Still, their distribution in the absence of safety standards is a concern for Marisa Abbe, manager of the injury prevention program at Children’s Health in Dallas.

Products like cribs and bassinets have undergone rigorous testing. The boxes have not. And it can take years for statistics about reported injuries to catch up when a new trend becomes popular in health care.

“What I like about the boxes is that they seem to help parents sleep in the same room with their child,” Abbe said. “But we would always advise that parents put their child to sleep in an approved space that has been shown to be safe.”

The CPSC wants manufacturers to work with child safety experts, standards development organizations and others to create voluntary standards for the emerging industry.

The Baby Box Co. says its product has a proven track record.

“Their safety has been tested in the sense that we have a substantial number of units in circulation and no infant injuries or fatalities in our product to date,” Clary said.

Around 100,000 have been distributed in participating states. The goal is to send out 400,000 in Texas alone by year’s end.

The concept of the baby box began in Finland around the 1930s to address a high infant mortality rate. Every new mother would get the baby’s first bed, a box full of essential items, given as part of a maternity package from the Finnish government.

But in order to receive one, each new mom had to get a medical exam during the first four months of pregnancy, according to a BBC report on the initiative. The effort worked. Finland has one of the lowest infant mortality rates in the world, about 2.52 for every 1,000 births.

However, data has never been collected on the role the cardboard boxes played in the success, and some say that correlation does not mean causality. Better access to prenatal care and a concerted national focus on the problem probably played a large role.

“It wasn’t just the box that led to reductions in infant mortality. It was just a contributor,” said Dr. Dyann Daley, a pediatric anesthesiologist in Fort Worth who is working with the Baby Box Co.’s research department to create a study to track the success of efforts in Texas.

Part of that includes educating health professionals. While researching infant mortality rates, Daley looked into whether staff in birthing hospitals across North Texas regularly told patients about breastfeeding and safe infant sleep practices.

“We learned that they were not. This is a problem,” she said. Her research also found that not all parents, especially those in low-income communities, have access to a safe infant sleep surface.

The Baby Box Co. was founded in 2013. The boxes being distributed in Texas are made out of durable cardboard. They have a mattress certified for infant sleep, a waterproof mattress cover and fitted sheets.

The effort is part of a public-private partnership. The box comes filled with goods such as diapers, baby wipes and nursing pads, donated by corporate manufacturers. The pattern of the box includes the bluebonnet, Texas’ state flower, and was designed by a South Texas nonprofit.

Local pediatric experts and hospitals volunteered to create an online syllabus for families.

The Baby Box Co., a for-profit entity that also sells products on its website like onesies and breast pads, typically sells the boxes for about $70 each.

Private donations and proceeds from the direct-to-consumer site allow them to provide thousands of boxes for free to those who take the online course.

“We see a strong return on our investment in communities,” said Clary, noting that people tend to return to the website for other products. “And we also believe we’re doing the right thing for public health.”

The private information of those who sign up is not shared with private partners or health providers for marketing purposes, although people can opt in for those things, she said.

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Information from: The Dallas Morning News, http://www.dallasnews.com

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