Virginia is becoming the latest state to borrow an age-old Finnish approach to countering the troubling trend of infants dying in unsafe sleeping environments.

The state’s Department of Social Services, along with Children’s Hospital of Richmond at Virginia Commonwealth University, on Wednesday plans to announce a new program to provide every new parent over the next year with an online-tutorial about safe sleep habits and a “baby box” that comes packed with new baby supplies and fitted with a firm mattress so it can double as a bassinet during an infant’s first months.

The boxes are being supplied by The Baby Box Co, a California-based for-profit company that is already distributing boxes to new and expectant parents in five other states. Washington DC is considering legislation to adopt a similar program.

Carl Ayers, director of family services for the Department of Social Services, said baby boxes, which have been provided to expectant parents in Finland since the 1930’s, are far from new technology.

“These are gussied up cardboard boxes,” he said. “But we feel like the baby boxes, in conjunction with safe sleep message for parents, are what families need to protect their young children.”

Baby boxes are being embraced by a growing number of policy makers and hospital administrators, interested in the low-cost approach to promoting safe sleep. Typically, the company provides the boxes for free, based on a business model that some parents will return to them as customers and purchase baby supplies from their web site.

In January, New Jersey became the first state to launch a universal program providing every new mother with a baby box along with training about safe sleep habits. Since then, statewide programs have been launched in Alabama, Ohio, Texas and Colorado.

In some states, the programs are government-led. In others, they are being organized by hospital systems or community agencies, while government agencies debate about the potential risks and benefits of adopting a program that has little research base.

“We’re certainly interested in seeing what the research shows, but there is not enough evidence at this time for Texas to distribute or endorse baby boxes,” said Chris Van Deusen, spokesman for the Texas Department of State Health Services.

As enthusiasm grows for baby boxes in the United States – The Baby Box Co. is poised to distribute more than a million boxes next year – many in the medical community are questioning the safety of the boxes, which are not regulated by the U.S. Consumer Product Safety Commission, and questioning their effectiveness at reducing infant mortality rates.

The American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome recently issued a public statement citing a death of research on the outcomes related to baby boxes, even in Finland, where boxes have historically been given out as an incentive to access prenatal care early in pregnancy, and it’s not clear whether the nation’s low infant mortality rate is due to its baby boxes or broader system of care for new families.

“Finland has universal health care, a robust visiting nurse system for families who just had a baby, and extended maternity and paternity leave. All of these we know impact positively on infant mortality rates,” said Rachel Moon, a University of Virginia pediatrician and chair of the task force.

“The U.S. has none of that,” she said.

The state, working with Virginia Commonwealth University, plans to study the effectiveness of the program – examining how well new parents understand and practice safe sleep guidelines after receiving a baby box, and how their behavior changes if they receive face-to-face safe sleep education, on-line education, or receive a home visit from a medical expert.

Sleep-related deaths are by far the leading cause of unnatural infant deaths in Virginia – 80 percent of the nearly 100 infant deaths in 2013 – according to a preliminary analysis of a new child death surveillance system that the state is developing, according to the state’s Office of the Chief Medical Examiner.

A 2017 report of 130 child deaths that were investigated for potential abuse or neglect in fiscal year 2016 documented more than 70 deaths that were related to unsafe sleeping environments. The report described cases where infants were found unresponsive on air mattresses or wedged into couch cushions or, more often, simply lying next to their parents in bed.

The baby box program in Virginia is part of a larger campaign to promote safe sleep for infants that was developed by a team of officials in Virginia that received a grant to develop solutions to reduce the number of child fatalities in the state.

Nationally, about 3,500 infants die each year from sleep-related causes. For young infants, co-sleeping with parents and sleeping on their stomachs or on soft beds puts them at risk for sudden infant death syndrome or accidental death by suffocation or strangulation.

The American Academy of Pediatrics recommends that babies be put to sleep on their backs in the same room as their parents but on a separate bed that has a firm mattress and is free of any loose-fitting sheets or soft cushions.

Jennifer Clary, co-founder and chief executive of The Baby Box Co. ,said the boxes have undergone extensive safety testing. She emphasized that the boxes themselves are not key to reducing infant deaths, but they are a vehicle for educating a wide swath off new parents about safe sleep practices.

“Parent education does reduces infant deaths. There is copious research to support that,” she said.

The company’s Baby Box University developed a 20-minute online tutorial, comprised of short videos with local health care providers and experts, talking about safe sleep and maternal health issues. Minute-long video segments include such topics as “What is the difference between baby blues and postpartum depression?” and “How can parents support healthy brain development?” as well as “How do I safely use the box?” Parents must pass a short quiz before they can receive their box.

Alexis Simms, 24, of Richmond, took an online tutorial through Baby Box University and received a baby box through a community-based program several months ago.

She already had a bassinet and a crib at home but the box came in handy, she said, when she was hospitalized shortly after her daughter was born for stress-related health issues. Her relatives cared for her newborn while she was in the hospital and used the box as a portable crib.

The training was helpful too. She knew that babies should be put to sleep on their backs, but she did not know they could suffocate on light blankets or soft toys. She said she went home and removed all the stuffed animals and the quilted bumper that she had already used to decorate her baby’s crib.

Back at home with her baby, she said she is very conscious about keeping her now 2-month old daughter safe when she falls asleep. “I try to put her in the bassinet as much as possible,” she said.