Children’s Health Alliance of Wisconsin www.chawisconsin.org

This packet contains the materials and resources for Newborn Nests. The following documents are in

this packet:

o Newborn Nest one page overview

o Newborn Nest assembly instructions

o Newborn Nest tip sheet

o Newborn Nest frequently asked questions

o How to conduct pre and post tests for professionals working with families

o Newborn Nest follow-up checklist for families

If you have any questions contact Amanda Bagin at abagin@chw.org

Newborn Nest materials packet

Children’s Health Alliance of Wisconsin www.chawisconsin.org

Each week, at least one Wisconsin infant dies in an unsafe sleep environment. In

order to address this preventable tragedy, Children’s Hospital of Wisconsin has created a pilot project to distribute Newborn Nests (otherwise known as baby boxes).

Families engaged in home visiting services through Children’s Hospital of Wisconsin will be offered a Newborn Nest if they are pregnant and/or have an infant younger than 30 days old. The pilot will be evaluated to measure change in behavior, attitudes

of staff and families served and utilization of the Newborn Nest.

Why a Newborn Nest Alternatives to the traditional crib have been around for a very long time, such as a drawer or wash basket, and were

used to meet the needs of families. These alternatives allow for sleeping near their baby while keeping him/her

safe. Today, a common crib alternative is the Pack N Play; however space often remains an issue.

Although there is not any research in the United States on Newborn Nests, research from other countries is promising.

In 1937 Finland had an extremely high infant mortality rate of 65 deaths for every 1,000 births. The government passed the Maternity Grants Act to help decrease the high

rate. Originally for families in poverty, the grant provided every newborn infant with the basics so that he or she

would have the same start and chance at life as other infants in higher economic classes. The program now gives

every baby a box, no matter what economic class. The kit includes a box for the baby to sleep in along with other necessities such as clothes, diapers, etc. Once Finland’s babies started sleeping in boxes, their infant mortality

rates dropped to 3.38 deaths for every 1,000 births.

Highlights of a Newborn Nest Used for baby’s first few months of life, allowing baby to establish sleep

behavior by sharing a room but not a bed.

Lightweight and compact, making it easy to move around the house. Portable and can be taken to other places, such as grandma’s house or

childcare provider, to ensure baby always has a safe place to sleep.

Newborn Nests

Each Newborn Nest kit contains:

Unassembled box

Unassembled lid

Mattress

2 sheets (in plastic bag)

Sleep baby safe and snug book

Liability waiver

Pacifier

Clear plastic bag

Ribbon

Label

You will need to select a sleep sack from the supply in your office

Video on assembling Newborn Nest lid: https://vimeo.com/140472690

Video on assembling Newborn Nest box: https://vimeo.com/140472689

Newborn Nest assembly

Assembling the lid

Step 1. Open the lid completely

Step 2. Crease the long side where the tabs are. Make sure to put pressure on the

bottom so the fold is in the right place

Step 3. Repeat on other side

Step 4. Reopen both sides

Step 5. Put pressure on the bottom fold (closest to the main part of the box)

Step 6. Repeat on other side

Step 7. Lift up tabs and set in slot. Fold over and push in tabs

Step 8. Repeat on other side

Bottom fold

Step 9. Fold in long side. Make sure the long sides are holding the short sides in

Step 10. Repeat on other side

Step 11. Adhere Children’s Hospital of Wisconsin logo onto center of lid

Assembling the box

Step 1. Start with handles facing toward you and away from you

Step 2. Pull up side with handle and fold in short sides with tabs

Step 3. Fold over top part with handle carefully to ensure side is not bent

Step 4. Push in tabs and apply pressure to bottom of box to push in bottom seam

Step 5. Repeat on other side

Step 6. Fold short side along bottom fold (closest to main part of the box) and push

tabs in

Step 7. Repeat on other side

Step 8. Put sheet on mattress and place in assembled box

Step 9. Place liability waiver, book, pacifier and extra sheet in assembled box.

You will also need to select a sleep sack from your offices supply that is appropriate size

and fabric for your client

Step 10. Place in plastic bag and tie with ribbon

Note: Make sure to take plastic bag and ribbon with you

after setting Newborn Nest up for client

Newborn Nest tip sheet

Using your Newborn Nest safely

Place on the ground/floor. Do not place on a table, couch, or bed. The

Newborn Nest can be pushed off or fall off accidentally and hurt your baby.

Keep at least two feet away from heaters. The Newborn Nest is made of

cardboard and can start on fire.

Keep pets away. Small pets may want to sleep with your baby. This is not safe.

Never put the lid on the Newborn Nest with baby inside. Your baby needs

air to breathe.

Do not carry the box with baby inside. Your baby can fall out.

Keep the Newborn Nest dry. If the Newborn Nest gets wet, throw it out and

ask for a new one.

Use the Newborn Nest until your baby grows too long for it. This may take

a few months. Then move baby to a crib or Pack N Play.

Only use the Newborn Nest with the mattress and sheets given.

Remember the ABCs of Safe Baby Sleep

Babies sleep safest ALONE, on their BACK, in a CRIB and in SMOKE-FREE air

Share the safe sleep message with everyone who cares for your baby

Use the Newborn Nest to keep baby close

Give baby plenty of tummy time while awake to support development and

bonding

Newborn Nest frequently asked

questions

Below are frequently asked questions and suggested answers.

1. Mom says, “I am not putting my baby in a box…”

You say, “I know this is a new concept and may seem odd to you. I want to share the

history of the Newborn Nest and why Children’s Hospital is encouraging our families to

utilize them. The Baby Box, which we call the Newborn Nest has been used in Finland

the past 80 years to keep babies safe. After implementing the program, Finland lost

many fewer babies from sleep-related death. The Newborn Nest allows you to keep

baby close, but in their own sleep space. What other worries do you have?”

2. Mom says, “We have pets in the home, I am worried….”

You say, “Pets are a wonderful part of families. It is recommended that you keep pets

away from any sleeping infant – no matter what the baby is sleeping in. This can be

accomplished by using a baby gate or closing a door to keep animals away from a

sleeping infant. You can put the lid on the Newborn Nest only when it is not in use.

What other questions do you have?”

3. Mom says, “I slept with all of my other children…”

You say, “Women whose babies died from an unsafe sleep space have said that they

‘didn't think it would happen to them’. Death in this way isn’t common but when it

happens, it is tragic to that family. Many women think that when they sleep, they won’t

roll over onto their baby. This is also what many women who lost their baby have said.

If we think about this a different way, many of us survived not wearing a seat belt as a

child. But based on what happened to thousands of other children we now have better

knowledge and ways to keep children safe in cars….like wearing seat belts. We have

found the same for putting babies to sleep. ”

4. Mom says, “How am I going to explain that my baby sleeps in a box…”

You say, “Some of your family might think it is weird for your baby to sleep in a box.

However, you can share with them that this program has helped keep babies alive in

Europe and we are bringing this here to help babies in the United States. Also, you can

share the videos that we watched.”

5. Mom says, “I don’t need a Newborn Nest because I have a…”

You say, “It is great that you have a safe sleep plan for baby while you are at home.

Where is baby going to sleep at daycare? When baby visits his father, does he have a

safe place to sleep? What about other family members? What about vacation?

6. Mom says, “It looks like a coffin…”

You say, “The Newborn Nest comes with a cover to keep the extra things from falling

out. Other than a box, many families will put babies in a dresser drawer, laundry basket

or wicker basket for the first couple months so they can keep them close, but also safe.

Think of this as a special small cozy place for your baby. A coffin has a cover and the

cover should never be used with your baby so they have air to breathe. This is an

important point to tell anyone you give the Newborn Nest for your baby.”

7. Mom says, “How long can I use the Newborn Nest for…”

You say, “The Newborn Nest is intended for the first few months until your baby grows

too long to be comfortable in the Newborn Nest. When your baby is too long, you

should move your baby to a crib or Pack N Play and we can help you find one if you

don’t already have one. We can continue to talk about how baby is developing and work

together to move your baby to his/her next sleep space.”

8. Mom says, “Can I carry my baby in the Newborn Nest…”

You say, “No. Even though the instructions say you can carry a baby until they are 15

pounds, I don’t recommend you carry the baby in the Newborn Nest at all. When you

carry a baby, they can move or shift their weight fast and it can be easy to drop them

by accident when they are in the box. It is easier to move the Newborn Nest and then

move your baby separately and safely. You also never know when you might trip or fall,

and it will be easier to see your way if you only have a baby and not the Box in your

way.

9. Mom says, “What about using the Newborn Nest in the car or bus…”

You say, “The Newborn Nest cannot keep babies safe in a car and should not be used

as a car seat. If you need a car seat, we can work together to find one.”

10. Mom says, “Can I put the Newborn Nest in bed between my partner and

me…”

You say, “The safest place for your baby is alone, on his/her back, in a separate sleep

environment, like a Newborn Nest and in smoke free air. Many mothers want to be as

close as possible to their baby. Women may be tempted to put the Newborn Nest on

the bed. However, a bed isn’t a firm, flat surface like the floor or ground. This means

the Newborn Nest can be pushed during sleep, can tip over, or can fall off the bed. Can

I show you what I am talking about?

If mom says yes, place doll (or baby – baby is best, because their center of gravity is

more realistic than a doll) inside of Newborn Nest and take to bedroom. Demonstrate

how sitting or rolling next to the Newborn Nest can result in the baby moving around in

the Newborn Nest.

Print the following items:

1. Print the sign in sheet and pre and post-tests for each attendee.

2. Have each attendee legibly sign in with their agency and email address.

Attendees will be contacted with a follow-up survey link approximately 1-2

months following your training date with this information.

3. After your introduction to the course, pass out the pre-test. Instruct everyone to

put their middle initial and the last four digits of their phone number on the ID

line of their test. This is an anonymous way to match the pre and post-tests after

the training.

4. Remind attendees that it is ok if they do not know the answer and that their

results will remain anonymous. Collect all pre-tests before conducting the

training.

5. Conduct the training.

6. At the end of the training, pass out the post-test and have attendees put the

same letter and number variation on the ID line at the top of their test. Remind

them again that their test will remain anonymous. Be sure to collect all post-

tests before the attendees leave.

7. Remind the attendees that they will receive a follow-up survey link one to two

months after the training. Reiterate the importance of their response to the

survey so that we can continue to improve our trainings and resources.

8. Scan and email the sign in sheet, pre-tests and post-tests to Abby Collier

ajcollier@chw.org, or to mail 957.

How to conduct pre and post tests for

Sleep Baby Safe trainings

Newborn Nest follow-up checklist for families

Home visiting site

Eau Claire Janesville Madison (KinderReady)

Marathon (Start Right) Merrill Milwaukee

Racine Rhinelander Wausau

Client name Follow-up type

2 weeks

2 months

Section 1 Observations: Do not ask the client these questions, instead observe the sleep environment

Where in the home is the Newborn Nest placed during the day? (mark all that apply)

Living room Bedroom Kitchen Sibling's bedroom

Dining room Basement Outside Other

When baby is inside the Newborn Nest, on what surface is the Newborn Nest placed? (mark all that apply)

Floor Table or other raised, flat surface

On a couch, sofa or recliner On a bed

Other

What items are in the Newborn Nest? (mark all that apply)

Mattress with fitted sheet Extra fitted sheet

Blanket(s) Toy(s)

Book(s) Pillow(s)

Clothes Baby care items (e.g., diapers, wipes, etc)

Other

Is there another safe sleep environment in the home? (select only one)

Yes, non-portable crib

Yes, Pack N Play

No

Other

If answered yes in the previous question, what items are in the other sleep environment (mark all that apply)

Mattress with fitted sheet Extra sheet

Blanket(s) Toy(s)

Book(s) Pillow(s)

Clothes Baby care items (e.g., diapers, wipes, etc)

Other

Section 2 Open dialogue with the family: Ask the client the following questions to engage in discussion about safe sleep

Tell me all the places you and baby normally go on a typical day? (mark all that apply)

Day care Relative's house

Shopping Doctor's office

WIC Friend's house

Recreation activity (e.g., park)

Other

Tell me all the places your baby sleeps on a typical day? (mark all that apply)

Newborn Nest Non-portable crib Pack N Play Car seat

Swing Bouncy seat Adult bed Couch

Floor

Other

Tell me how you've been using the Newborn Nest? (mark all that apply)

Naps Nighttime sleep Visiting friends/relatives

Storage for baby items

Other

If baby is using the Newborn Nest, ask mom what she likes the most and least.

Return completed forms to your leader who will send them to Children's Health Alliance of Wisconsin at mail stop 957 or email ajcollier@chw.org