AP’s evidence-free story on ‘baby box’ giveaway suggests company had an inventive marketing success

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story does not quantify any of the benefits. It does not tell us how much risk of sudden infant death is decreased by the child sleeping in these particular boxes. In the excerpt below, a pediatrician is quoted saying the boxes “provide a clutter-free sleep space” and that has been shown to reduce accidental deaths. But just to clarify – it would seem you don’t have to use one of these boxes in order to provide a “clutter-free sleep space?” Can’t a family create a clutter free space in their own cardboard or an empty clutter-free crib?

The quoted pediatrician does not give us any research source for the proof of a benefit.

“The idea for baby boxes started in Finland in the 1930s, and is tied to a sharp drop in sudden infant deaths, according to Dr. Kathryn McCans, a pediatrician who chairs New Jersey’s Child Fatality and Near Fatality Review Board. The boxes provide a clutter-free sleep space that has been shown to reduce accidental and unexpected deaths, she said.”

Can’t parents provide a clutter-free sleep space for their infants on their own? Yes, but it doesn’t mean they will. The convenience and no cost of the box to the parents might be sufficient motivation to use it and the parents don’t need to do anything to make it safe — it already is. This in essence makes the right thing to do into the easy thing to do — a key tenet of patient safety. However, the concern that there simply are no numbers showing a benefit is a real one.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story has no foundation of evidence. We are not provided with any research studies, even from Finland, where the historic practice of baby boxes originated.

After a real effort to find them, we could find no studies other than the trend data from Finland, so the article would be hard-pressed to quote any. The story should have noted the lack of research.  This is an instance where a logic model is being used: the box mitigates some of the known causes of SUID and SUID rates go down. Therefore, the boxes are likely responsible.

But just because something sounds logical, doesn’t make it true. Parent education could be the key factor as noted above. Other causative factors for the decreased rate of SUID with the boxes could be the firm mattress and no bumper pads in the box. There is good evidence for both of these as important risk factors for SUID. 

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story tells readers that the Baby Box Co. is a “for-profit” company. But they don’t give us any details about the company’s relationship with the pediatrician, Kathryn McCans, who is the only physician quoted in the story.

Does Dr. McCans receive any funding or payment from The Baby Box Company? We can’t tell from the story. At the company’s own website, she is listed as one of “our experts” on this page.

She may have donated her time, but that isn’t made clear. At the very least, it should have been clarified that that McCans has a relationship with the company and is not totally independent.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

We think the headline and most of the story makes the boxes seem very important.

This is the only sentence that hints there are alternatives. “The boxes aren’t the only option for safe sleeping, of course, but health officials say they’re a useful part of a broader safe-sleep education program.” (Italics by reviewers.)

If the boxes are just part of a broader education, then perhaps it isn’t “ditching the crib” as the headline says that leads to safer infant sleep but parent training that advises a firm mattress, bumper-free cribs and absence of clutter that are keys to a safer sleeping environment.

Does the story establish the availability of the treatment/test/product/procedure?

Not Satisfactory

The boxes are given away, but parents have to “register” through babyboxuniversity.com.

They must “watch a handful of videos on sleep safety and pass a quiz. Parents can then take their digital or printed-out certificates to a participating hospital for their boxes. The boxes can also be sent in the mail, if a nearby hospital is not designated as a distribution center.”

We are left unsure whether any parent can get a box from the company without registering or can a parent watch the educational material without registering and giving away his or her identity?