Baby Box Review: Unsanitary, Unsafe, Uncertified
Baby Box Review: Unsanitary, Unsafe, Uncertified. First published Jul 28, 2017. Last Updated: with statement from company.Should your baby sleep in a cardboard box? No. Cardboard boxes like the ones being given away by the Baby Box Company in cooperation with several states and/or charities are unsanitary, unsafe and uncertified. Do not use a cardboard box as a sleep space.
The Baby Box: Craze or Just Crazy?
Los Angeles-based Baby Box Company says their cardboard box is a safer place for a baby to sleep—and they’ve partnered with non-profits and hospitals to give away the boxes to new parents in New Jersey, Colorado and other states. Ohio is giving away 140,000 Baby Boxes. Texas, 400,000. Alabama, 60,000.
The pitch is simple: sign up with the for-profit Baby Box Company (forking over your email address, due date, whether you have other children and other personal info). After watching a couple of baby care videos and taking a six question survey about sleep safety, you are rewarded with a certificate for a free Baby Box, stuffed with goodies. You can either pick up the box at a local non-profit or have one shipped to you.
So what’s inside the box?
We picked up the Colorado version of the Baby Box recently for testing. Inside, there was a small pack of Pampers Swaddlers (and coupon), Pampers diaper wipes, a Halo Sleepsack, Lansinoh samples and educational materials—as well as a pitch for you to help promote the Baby Box on social media. Here’s a look at what’s inside:
The box also contains a one-inch foam mattress, which is is covered by a polyester protector and a cotton sheet.
“The main objective of this whole initiative is to teach our patients safe sleep practices with a newborn,” Robin Engleberg, program manager for the Denver Health Foundation, told the Denver Post. The Baby Box Co. is donating boxes to the Denver Health Foundation and the Rocky Mountain Children’s Health Foundation, which will help distribute them at about 45 clinics and health centers across the state, reported the Post. The company has run similar giveaways in other states and has affiliates in Canada and the UK.
Leaving aside the question of whether it is appropriate for government or charities to help a private company build a database of new parents for marketing purposes, let’s look at the Baby Box as a place for baby to sleep.
The Baby Box: Unsanitary
Curiously absent from the Baby Box we reviewed are any cleaning instructions. “Baby Boxes are as safe as a bassinet,” says the company in an online FAQ, adding the boxes are made of “durable cardboard.”
But this begs a question: how does one CLEAN cardboard?
After all, babies do all sorts of things in a bassinet or crib, including pee, poop and spit-up. Diaper blow-outs are real, folks.
The company says “our Baby Boxes have been extensively tested for water resistance, air flow, flammability, and durability as well as standard bassinet structural compliances.”
To test this theory, we poured a cup (eight ounces) of warm water on the Baby Box mattress in the box (what—you thought only the folks at Consumer Reports get to do experiments in white lab coats?).
After seven minutes, the results weren’t pretty:
The water pooled along the side of the mattress and soaked into the bottom and sides of the cardboard.
With a regular crib or bassinet, there is a plastic, wood or metal surface that can be cleaned, wiped down or disinfected. A porous material like cardboard can’t be cleaned.
Note how the water damage creeped up the sides of the box:
There was also damage on the exterior of the box, with the seams bowing out:
Bonus cleaning hazard: since the Baby Box doesn’t have a stand, anything it sits on will be become saturated with urine, spit-up or poop. When we tested a mere eight ounces of liquid poured into the Baby Box, the table underneath the test box was soon soaked. That means the carpet in a bedroom will need to be cleaned every time baby’s diaper leaks (or you will need to use a waterproof layer under the box).
So what happens at 2am when your baby’s Baby Box is saturated by a diaper blow out? Are you supposed to hit the local 24 hour Walmart and come up with another safe sleep space in the middle of the night?
We emailed the Baby Box Company to ask how parents could clean the cardboard box if it becomes soiled and didn’t get a reply by press time.
Another concern if you don’t have air conditioning: high humidity can cause the cardboard to become weak and damaged. Many of the neediest parents who are receiving boxes from non-profits may not have air conditioning in their homes or nurseries.
The Baby Box: Unsafe
The Baby Box Company points to a 75 year old baby box program in Finland as proof its boxes are safe and reduce Sudden Infant Death Syndrome. Yet this claim was recently blasted as false by New York City’s deputy director for child health, Dr. George Askew.
“(Baby boxes) are a fake panacea (emphasis added) for lowering infant mortality and a disservice to the communities that are affected by it most. Babies will outgrow them in two to four months, the peak age for suffocation deaths,” Dr. Askew wrote in a June 2017 letter to the editor of the New York Times:
The New York City Department of Health and Mental Hygiene has additional concerns apart from safety and lack of regulation regarding the cardboard boxes being offered to new parents at hospitals and elsewhere. From a health equity perspective, promoting cardboard boxes to low-income minority communities is not only a step back in time from dresser drawers; it is also a fake panacea for lowering infant mortality and a disservice to the communities that are affected by it most. Babies will outgrow them in two to four months, the peak age for suffocation deaths.
Promoting infant beds that don’t meet Consumer Product Safety Commission standards during this critical time is dangerous, especially when there are other safe sleep options that are commission-approved and can be used when the baby is more than four months old.
All babies deserve a safe place to sleep, and there are better options than a cardboard box.
LONG ISLAND CITY, QUEENS
Dr. Askew is deputy commissioner of the Division of Family and Child Health, Department of Health and Mental Hygiene. Ms. Ahmad-Baker is program initiatives director in the division’s Bureau of Maternal, Infant and Reproductive Health.
Lori Winkler agrees. As a registered nurse and the injury prevention coordinator for Cardinal Glennon Children’s Hospital in St. Louis, Winkler teaches safe sleep practices in East St. Louis, an area plagued by a higher than average infant mortality. St. Clair County, which includes East St. Louis, ranks among the top 30 counties in the U.S. for infant mortality (which includes Sudden Infant Death Syndrome cases).
Concerned about safety, Winkler doesn’t give away the Baby Box as part of her program. “These will only last until a baby is three or four months of age. That is the highest risk of dying from SIDS. They are outgrowing that cardboard box, then what is a parent to do?” Winkler said in a telephone interview with BabyBargains.com.
The problem: the Baby Box is only 27″ long. The average baby hits that between five and six months of age—that’s the peak concern time for Sudden Infant Death Syndrome. Larger babies could outgrow the Baby Box by three or four months by height. By contrast, Graco Pack N Plays and similar sleep solutions can be used for sleeping up to 30 lbs. and 35″ in height—that’s about three years of age.
Even the BBC, which kicked off the baby box craze in 2013 when it published an article on the Finnish baby boxes, recently questioned whether babies who sleep in cardboard boxes are safer. “The box alone doesn’t seem likely to matter,” said the BBC, which interviewed experts that pointed to Finland’s prenatal care and parent education as reasons for Finland’s low rate of infant mortality. “After all, there are countries with the same infant mortality rate as Finland, such as Iceland, Estonia and Japan, that do not have baby box schemes.”
Baby on the floor = major safety hazard. Our safety concern with the Baby Box has nothing to do with the debate about whether it lowers SIDS rates. The box does NOT have a stand and therefore it most likely will end up on the floor in a bedroom or living room.
As a result, a family pet will have direct access to baby—and sadly, there are recent cases (here and here) where this has ended in tragedy. Granted, in these cases babies were asleep in a laundry basket or infant car seat on the floor, but the access concern is the same. Even if a pet doesn’t bite a baby in a Baby Box, they could drop toys or other items inside the box with a sleeping baby, which would be a suffocation hazard.
A similar concern goes for siblings—a well-meaning brother or sister may see the Baby Box lid and decide to put it on the box or throw a blanket or toy on top of baby. . . while she is sleeping inside. Think about it—there is a reason why cribs and bassinets are generally elevated off the floor, folks.
Bottom line: babies don’t belong in cardboard boxes that are placed on the floor.
Knocking the box over. In an FAQ on Baby Box’s web site, the company claims the box can be used up to six months: “In first world countries a majority of parents report use of their Baby Box as a primary sleep space for their child until approximately 5-6 months of age.”
The company adds: “Our recommendation is for babies to cease using their Baby Box as a primary sleep space once they can pull themselves up independently. A baby who can roll, however, is perfectly safe inside his or her Baby Box, and the box will not tip over as long as it is on a sturdy surface.”
Here’s our concern: a baby typically learns to roll over by four months (some babies as soon as two months). A cardboard box can tip over when weight is applied to the side. That’s why we think a bassinet or crib is a safer bet.
In an emailed statement to BabyBargains.com, Baby Box Company CEO Jennifer Clary said these concerns about the Baby Box were unfounded. “Speculative claims about potential misuse scenarios are not grounds for condemning a product; all infant products have the capacity to be misused in the absence of education to parents, and education is at the very center of our program,” Clary said.
Our lawyers told us to say this
Most ominously, Baby Box requires parents to agree to a liability waiver if they use the Baby Box:
If you receive or purchase a baby box sleeping solution from either Baby Box Co or a Distributor, the following terms apply: YOU AGREE THAT YOUR USE OF THE BABY BOX SLEEPING SOLUTION IS ENTIRELY AT YOUR OWN RISK. TO THE EXTENT ALLOWED BY APPLICABLE LAW, BABY BOX CO HAS NO RESPONSIBILITY OR LIABILITY WHATSOEVER FOR ANY DAMAGES YOU MAY SUFFER AS A RESULT OF YOUR USE OF THE BABY BOX SLEEPING SOLUTION . . .
That is unprecedented, in our opinion. When you purchase a Pack N Play, Graco doesn’t require you to sign a liability waiver. Ditto for any crib maker like Stork Craft. In the 25 years we’ve been writing about juvenile products like bassinets and cribs, we’ve never seen a manufacturer of a sleep space that requires you to sign away legal liability for using it with your baby. It’s a baby bassinet, not sky diving, for heaven’s sake.
The Baby Box: Uncertified
Non-profit organizations that have given away the Baby Box have stated that it is a “certified safe” space for babies to sleep.
“The baby box is not just a cardboard box,” explained Luanne Williams, executive director of Rocky Mountain Children’s Health Foundation to a newspaper in Parker, CO. “It has gone through a lot of testing to be rated as a bassinet.”
The Consumer Product Safety Commission has no safety standards for cardboard boxes as bassinets. Zero. Zip. Even Baby Box Company admits this on their web site: “Baby Boxes are not technically considered bassinets in the United States.”
There is no standard today for baby boxes as their own category, which is why we proactively tested ourselves against the bassinet standard. There is an effort underway to create a standard for baby boxes as a category, and when that gets set we will certify ourselves against the standard as well.
Translation: you just have to take the company’s word that they safety tested the Baby Box.
In a statement to BabyBargains.com, Baby Box Company CEO Jennifer Clary said the only difference between the Baby Box and a bassinet is the latter has legs. “Our product has been proactively tested to the existing bassinet standard and the only distinction between our units and bassinets is that there are no legs on a Baby Box. We meet every other aspect of the existing CPSC standard which means that there are no grounds for frequent claims of ventilation issues, flammability issues, etc.”
So they are safe, right? Unfortunately, the American Academy of Pediatrics doesn’t see it that way.
Dr. Rachel Moon, chairwoman of the American Academy of Pediatrics’ task force on Sudden Infant Death Syndrome, was interviewed in this New York Times in an article on the subject in May 2017. “The rapid pace at which the box programs have been adopted by states and hospitals worries some experts, who say the boxes have not yet been proven to be a safe infant sleep environment or an effective tool in reducing infant mortality,” said the New York Times.
“I’ve been very surprised at how much enthusiasm there’s been for this and how people are just jumping on this bandwagon,” said Dr. Rachel Moon, chairwoman of the American Academy of Pediatrics’ task force on Sudden Infant Death Syndrome. “They’re just assuming that since it worked in Finland that it’s going to be fine.”
Ann Marie Burkle, acting chairwoman of the Consumer Product Safety Commission pointed out in the same article that other nursery products are highly regulated, and urged caution on whether baby boxes should be considered a safe sleep space.
Ms. Buerkle said there are a number of unknowns about the boxes. “What is the box made of? How durable is it? If you use it through three different children does it deteriorate?” she said.
The National Institutes for Health chimes in that government regulators don’t have the authority to pre-test Baby Boxes to see if they are safe:
“Cardboard boxes for babies are currently not subject to any Consumer Product Safety Commission (CPSC) mandatory safety standards. These products do not meet CPSC’s definition of a bassinet, crib, or handheld carrier. It is important to note that CPSC does not have the authority to pre-approve or pre-test products for safety before they are sold.”
Translation: we don’t know. Maybe safe. Maybe not. We’ll get back to you.
Dr. Moon points out that New Jersey is rushing to give out the boxes, even though there is “no research that will be happening as these boxes are given out. That is a real shame.” She concludes: “The AAP Task Force on SIDS does not believe that there is yet enough evidence to say anything about the potential benefit or dangers of … baby boxes.”
Our opinion: when a state gives away a product and says you can use it for your baby to sleep in, that is an obvious endorsement that carries weight with parents. Add in local non-profits and hospitals that are touting baby boxes and it’s no wonder that folks think they are safe. To us, however, it is obvious states and non-profits have rushed to give out the free boxes before considering whether they are sanitary, safe or certified as bassinets . . . all to benefit a private company that is amassing a database of new parents and handing out samples to benefit consumer giants like Procter & Gamble.
Finland! Look at Finland!
The Baby Box company repeatedly points to Finland as proof their Baby Box is safe:
For more than 80 years, Finland’s expectant mothers have been given a Baby Box by the state that serves as a starter kit for their new baby. It contains clothes and other newborn necessities, and the Baby Box itself–which is lined with a mattress–is used as the child’s first bed. The Baby Box program has helped Finland achieve one of the world’s lowest infant mortality rates.
But here’s an inconvenient fact: the vast majority of babies in Finland today don’t sleep in cardboard boxes! “A 2011 poll showed less than half of box recipients (in Finland) — 42% — used it as an infant sleep space,” reported USA Today in March 2017.
And there is much debate about whether Finland’s lower infant mortality rate has anything to do with cardboard boxes as bassinets and perhaps more to do with modern antibiotics, immunization and prenatal care. As the BBC pointed out, Iceland, Japan and Luxembourg have the same or lower rates of infant mortality . . . and none of these countries have babies sleeping in cardboard boxes.
Bottom line: we do not recommend Baby Boxes or other cardboard bassinets. They are unsanitary, unsafe and uncertified. If you want to get a box for the free swag, we suggest not using your real name, email or contact info to avoid being targeted for marketing purposes.
What do you think? Add your comments below. Baby Box Review: Unsanitary, Unsafe, Uncertified.
After this article and an additional blog post about the Baby Box appeared on our site, we received a response from the Baby Box Company. Quotes from the statement are above; the entire response is below:
“From The Baby Box Co. co-founder & CEO Jennifer Clary:
- Baby Boxes are only safe when they are used properly, just as any other infant sleep space is only effective when used properly. This is why we emphasize education, including information on proper product use.
- We did not commission or influence the Temple University study, which is the only published US Baby Box study to date. Therefore, the comment that “all of the studies being done are sponsored by the industry” is unfounded and can be easily confirmed by a call to Dr. Megan Heere (who lead the stud).
- An objective comparison of product safety incidents is readily available to the CPSC, to Dr. Hoffman and to the public.
- Baby Boxes have been handed out in Finland for 80 years. Even if a minority of parents actually use them as a sleep space, etc. there is still no way that a government body would hand out an inherently dangerous product for all new citizens over eight decades.
- Finally, our product has been proactively tested to the existing bassinet standard and the only distinction between our units and bassinets is that there are no legs on a Baby Box. We meet every other aspect of the existing CPSC standard which means that there are no grounds for frequent claims of ventilation issues, flammability issues, etc.
- Speculative claims about potential misuse scenarios are not grounds for condemning a product; all infant products have the capacity to be misused in the absence of education to parents, and education is at the very center of our program. “
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