“From 2012 to 2014, CPSC received reports of 284 deaths among children younger than age five associated with, but not necessarily caused by, nursery products. In some cases, these deaths were a consequence of delayed development in arousal and cardiovascular control; when infants become compromised during sleep, they may be unable to arouse themselves to avoid a deadly event. However, many of these deaths occurred when infants were sleeping in unsafe situations.” ^[1]Pollack-Nelson, C., Wanna Nakamura, S., Nesteruk, H., Balci-Sinha, R., & Kish, C. (2018, September). Trends In Infant Sleep: What Do The Data Show? What Are Caregivers’ Behaviors?. … Reference List

But don’t be alarmed. As a society, we actually are doing quite well overall compared to before.

“In 2018, there were ten deaths classified as SIDS in Canada. A global decrease in the incidence of SIDS can be attributed to widespread “Back-to-Sleep” campaigns, which were aimed to promote placing babies in a supine position for sleeping.” ^[2]Statistics Canada. Table 13-10-0395-01 Leading causes of death, infants. 2020; https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039501. Accessed 2020 Sep 2. ^[3]Gilbert R, Salanti G, Harden M, See S. Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to … Reference List ^[4]Hauck FR, Tanabe KO. SIDS. Clin Evid. 2009;2009:0315.

I rarely do reviews and this is not a review post, but some thoughts that I have on it and a response to another post by some occupational therapists and physical therapists on the Snoo titled, “Five reasons not to purchase a Snoo: From a group of pediatric occupational and physical therapists”.

The target audience of this post is the general public including parents as well as pediatric practice therapists. First of all, I don’t have skin in the game. I am not paid to review this. I am not part of the Happiest Baby ambassador (affiliate referral) program. Full disclosure, although I may seem hypocritical, I am an Amazon Affiliate’s member so the keywords may trigger some ads for the Snoo itself, but this was not done intentionally. I actually discourage you from purchasing it through my link and getting it with a discount through other methods, e.g., military discount first.

I have nothing specifically against Harvey Karp and his approach. In fact, I used his “5 S’s” with my newborn with some relatively good success in calming and soothing my baby at times. Did it work all the time? Of course not. I am also not a Harvey Karp fanboy or anything so I will try to be as unbiased as possible.

Most of you are probably familiar with the Snoo Bassinet. My wife first told me about it and I immediately dismissed her about the idea of paying over $1000 for a bassinet that you use for approximately 6 months. Then the concept of it is kind of interesting if you were to describe it say, your grandma or someone who lived in the 1900s.

The Pitch

“Get this: so there’s this new bassinet on the market. It costs (whatever $1500 MSRP would have been at the time pre-inflation). It’s a robot that needs to be plugged into the wall for electricity. Oh and it needs to be on a flat surface. Basically, you straitjacket your baby on their back onto this device, even if they cry. The instructions say you absolutely need to make sure that your the zippers are zipped all the way up. Don’t put anything above their head or anything like mobiles. The device emits radio waves called “why-fy” to another handheld box called an “eye phone” in your hand. This needs to be on 24/7 to collect information on the baby’s sleep habits. Your Eye Phone is like a remote control for this robot. When the baby wakes up in the middle of the night and stirs, there are sensors that detect their movement. It automatically begins rock the baby back and forth. If the baby continues to make a fuss, the robot increases the intensity and rocks the baby more aggressively. If this does not work, it begins to play sound from a radio that sounds like this, “SSSSSSS!!!~” (whitenoise). No matter what in the beginning, let this robot try to put your baby back to sleep. And if you need to travel, bring this robot with you or rent another one. It’s called the Snoo.”

Wild. We live in a world surrounded by technology, for which I am grateful for. But just because it’s on the market does not mean it’s always safe, good for development, or cause for concern. So I decided to look into this further. I personally have not used it myself.

My primary concern is safety being that we are in the post-Fisher -Price Rock ‘n Play recall nightmare of 2019. 30 babies died because of it. This (the Snoo) does not seem to be as severe as the Rock ‘n Play in my opinion.

The Inventor – Harvey Karp

Karp is a pediatrician and seems like a pretty good character from people who know him personally and he does care a lot about children, despite him being a businessman and probably making a lot of money from this invention. So I have respect for him and was not completely skeptical of this product, besides its price point. But this is understandable considering the technology that is built into this bassinet and for being the first of its kind on the market – it’s going to be expensive. The price will go down as other players come into the market and when the patent expires, etc.

Let’s take a look at the user manual’s safety information.

To preface, practically all baby products have some safety and warning information that sounds as series as what the Snoo describes:

Safety Information

From the owner’s manual:

FAILURE TO FOLLOW THESE WARNINGS AND INSTRUCTIONS COULD RESULT IN SERIOUS INJURY OR DEATH. READ ALL INSTRUCTIONS BEFORE ASSEMBLY AND USE OF THE PRODUCT. ADULT

ASSEMBLY REQUIRED. DO NOT USE THIS DEVICE IF IT IS DAMAGED OR BROKEN.

PREVENT FALL HAZARDS

• To help prevent falls, DO NOT USE this product if the infant can push up on hands and knees

or has reached 6 months of age, whichever comes ﬁrst.

• Maximum weight: 25 lbs. (11.3kg.)

PREVENT SUFFOCATION HAZARDS

• When using the SNOO Sack, ALWAYS have the zipper fully zipped and make sure the soft protective zipper hood is in place.

• Use only the mattress pad provided by Happiest Baby. NEVER add a pillow, comforter or another mattress for padding.

• NEVER place additional objects in SNOO Smart Sleeper, such as blankets, toys or other materials.

• ALWAYS ensure the mattress pad is positioned correctly. Do not create any pockets between the mattress pad and mesh sides.

• To reduce the risk of SIDS, pediatricians recommend healthy infants to be placed on their backs to sleep, unless otherwise advised by their physician.

• If a sheet is used with the mattress pad, use only the one provided by Happiest Baby, or an authorized Happiest Baby partner.

• NEVER use plastic bags or other plastic ﬁlm as a mattress cover.

• Discard all plastic packaging materials immediately after opening.

• SNOO is designed and is approved for use with only one baby at a time.

PREVENT STRANGULATION HAZARDS

• When using the SNOO Sack, ALWAYS have the zipper fully zipped and make sure the soft protective zipper hood is in place.

• ALWAYS keep SNOO on a ﬂat, even surface.

• NEVER place anything under the SNOO legs or mattress to elevate the baby’s head.

• Strings can cause strangulation. Do not place SNOO protective cloth bag or other items with a string in SNOO.

• Keep the power adapter cord out of reach of infants and children.

• DO NOT suspend strings or unapproved mobiles over SNOO or attach strings to toys.

• DO NOT place SNOO near a window or patio door where cord from blinds or drapes can strangle an infant.

Weight Limit and Parent ‘Snoo Anxiety’

25 pounds is a pretty generous weight limit for the device, but parents should be aware of it as their baby approaches this limit so that they can prepare and transition out of this device. On Reddit, there seems to be this phenomenon of parents having anxiety about transitioning out of this device and fear of the little one (LO) being dependent on it at which point, the parents will encounter sleep issues (and not be able to sleep – which is what parents purchased the device in the first place for).

American Academy of Pediatrics: Safe Sleep Recommendations

The AAP recommends parents follow the safe sleep recommendations every time they place their baby to sleep for naps or at nighttime:

Place your baby on her back to sleep, and monitor her to be sure she doesn’t roll over while swaddled.
Do not have any loose blankets in your baby’s crib. A loose blanket, including a swaddling blanket that comes unwrapped, could cover your baby’s face and increase the risk of suffocation.
Use caution when buying products that claim to reduce the risk of SIDS. Wedges, positioners, special mattresses and specialized sleep surfaces have not been shown to reduce the risk of SIDS, according to the AAP.
Your baby is safest in her own crib or bassinet, not in your bed.
Swaddling can increase the chance your baby will overheat, so avoid letting your baby get too hot. The baby could be too hot if you notice sweating, damp hair, flushed cheeks, heat rash, and rapid breathing.
Consider using a pacifier for naps and bedtime.
Place the crib in an area that is always smoke-free. ^[6]https://services.aap.org/en/patient-care/safe-sleep/

What the AAP recommends for swaddling:

“There was no evidence to recommend swaddling as a risk reduction strategy for SIDS”.

“To reduce the risk of Sudden Infant Death Syndrome, or SIDS, it’s important to place your baby to sleep on his back, every time you put him to sleep. This may be even more important if your baby is swaddled. Some studies have shown an increased risk of SIDS and accidental suffocation when babies are swaddled if they are placed on their stomach to sleep, or if they roll onto their stomach, says Rachel Moon, MD, FAAP, chair of the task force that authored the AAP’s safe sleep recommendations.”

“If babies are swaddled, they should be placed only on their back and monitored so they don’t accidentally roll over,” Dr. Moon says.

Rock ‘n Play Recall

The primary problem that the Rock ‘n Play had was that it left the LO at an incline for prolonged periods instead of on their backs (supine) as recommended by the American Academy of Pediatrics. The way the Snoo works does put babies on their backs, albeit swaddled and strapped to the bassinet.

It is a little concerning that the manual advises that parents “ALWAYS have the zipper fully zipped”. This is to probably prevent the baby from being choked or asphyxiated as the Snoo does its rocking motion. I don’t know about you, but this concerns me. They go on to concur with other good practices such as keeping objects out of the bassinet, especially plastic, and using the recommended mattress covers, and ensure they’re probably positioned to prevent asphyxiation and SIDS.

The next parts of the Snoo’s manual concern strangulation, with many warnings. This makes sense too and would apply to regular bassinets. A common culprit these days to be cautious of are phone charger cords. For example, we purchased 10′ long phone charger cords for convenience, but have to pay extra attention of how they run and where they are placed, especially around our crib.

So far, I would say the Snoo has additional hazards due to its moving and rocking design, but not at the “Rock ‘n Play alarming levels”. As long as parents read and follow the instruction manual, they should be fine. Hopefully, we don’t find out 10 years from now that many babies have died sleeping in this device.

Now I will do some commentary on the blog post on Carolina Kinder Development (CDK) by Tammy Hermann (who I am not sure is an occupational therapist, physical therapist, or just a staff member who manages the website, they were not listed in the About/Staff page).

Response to Reason #1 of CKD’s Post

“There is the potential for negative impact on bonding with your baby due to use of the Snoo.”

“At some point, the infant will stop crying. In our view, some infants stopped crying because they were lulled back sleep while other infants stopped crying because they learned, “I cried and no one came and so I gave up.” In both cases, the baby is back asleep, and it is impossible to know which baby has no ill-consequences and which does. In all cases, the baby remains in the horizontal position, their limbs do not move, they do not feel the warmth, get patted by or hear the voice of their parent. Their diaper isn’t checked and they are not given the opportunity to feed.”

I understand where CKD is coming from with this point but do not agree 100%. Many parents would probably disagree too and I am sure 99% of parents love their baby enough if they are to spend so much on this bassinet in the first place. I understand that parents just want to get a good night’s sleep or at least have their LO sleep a little bit longer. I doubt that parents are neglecting their LO and not nursing or changing their diapers. However, the Snoo could increase the chances that parents sleep through things like needed diaper changes.

I don’t think it is as extreme as CKD makes it sound because parents are not neglecting to bond with their baby all day, only at night when they want them to sleep. I see nothing wrong with scenario #2 where the baby learns that crying results in no attention from the parents. I think if this learned behavior occurs and is only unique to happening at night during bedtime, it is not a problem. It is not as extreme as those orphanage neglect situations because parents are giving love and providing care for their LO during waking hours.

Most parents are probably well aware that babies have varying levels of crying. There is more ‘extreme’ crying in babies when they are really hungry or disturbed by a wet diaper. I think if at a certain point the Snoo does not calm the LO, parents definitely need to check on them and not ignore the crying. Babies need frequent nursing and they can soil themselves randomly. Overall, I am confident that the majority of parents fall on the loving end of the CKD’s concept of ‘spectrum of care’ of the extremes love vs. neglect. To me, it’s not a major concern because babies are not neglected all day, potentially only during naps and at night.

One change in parent habit and a question they probably will have is, do I put the LO down for naps in the Snoo or should I hold them or put them somewhere else? Personally, I would bond with my LO and take naps with them given the chance during the daytime because, why not? They’re so precious. It also teaches them that crying as a behavior does have rewards and does not always result in being ignored. This should alleviate the concern of CKD’s point #1.

Point #2

“The Snoo may increase the risk for head shape issues.”

They are referring to plagiocephaly. Most parents know about the concern for “flat head syndrome”. CKD reported (in their clinical experience) infants being more prone to plagiocephaly. I am a little confused about why think this is the case, as regular bassinets could cause the same issue. Perhaps its due to their concern for babies being left longer in the Snoo than alternatives or the babies being held in the supine position due to the restraint system, but you can say the same thing for babies that sleep well through the night on regular bassinets. They probably don’t move as much. They don’t really go into a long explanation for this point #2 like they did in #1, so I am not so convinced or concerned about this. As long as parents are providing time for the baby to be off their backs and nursing them, holding them, providing tummy time – it does not matter if another bassinet, the Snoo, or a fictitious $10,000 solution, babies need to be off their backs during the day. As long as parents are providing some boding and holding baby for naps and NOT always putting baby to rest in a Snoo this should alleviate CKD’s concerns for #2 for plagiocephaly.

Point #3

“The Snoo also limits a baby’s ability to move.”

This one I somewhat agree with. I am concerned that the baby is restrict in movement more than the sense of traditional swaddling. There is literally no opportunity for rolling while in a swaddle due to the restraint system.

Per CKD, “The Snoo markets that it impedes rolling and thus is safer from a SIDs perspective. This is in opposition to the American Academy of Pediatrics which recommends placing an infant on her back to sleep AND that when the infant independently repositions her or himself to their sides or tummy, it is safe and desirable to allow this.” ^[10]https://carolinakinderdevelopment.com/five-reasons-not-to-purchase-a-snoo-from-a-group-of-pediatric-occupational-and-physical-therapists/

I looked into the entire recommendation and I don’t think this statement by CKD is correct. Especially the “desirable” part. Just nitpicking here, I don’t think they did this intentionally, but I think they are misinterpreting the recommendation by the AAP. This is why it is important to verify your sources directly and never take stranger’s on the Internet to be correct, even if they “quote” the AAP and are occupational/physical therapy professionals.

The AAP actually quotes this (keeping in mind the primary goal of the AAP recommendation is SIDS, not child development, which is probably what CKD is concerned with):

“Although data to make specific recommendations as to when it is safe for infants to sleep in the prone or side position are lacking, studies establishing prone and side sleeping as risk factors for SIDS include infants up to 1 year of age. Therefore, the best evidence suggests that infants should continue to be placed supine until 1 year of age. Once an infant can roll from supine to prone and from prone to supine, the infant can be allowed to remain [NOT “desired” as stated by CKD] in the sleep position that he or she assumes.” ^[11]https://pediatrics.aappublications.org/content/138/5/e20162938

I highly recommend that you read the full AAP recommendation in footnote #11.

I don’t know where CKD got this statement from, but it is much different than AAP’s guideline. AAP is saying that if the baby can go from back to belly and vice versa, then it is okay for the baby to sleep in the position that they prefer. Nowhere does AAP say it’s desired to promote this. And even then, the research is still lacking as of 2016. But I get it, as OTs and PTs, they are concerned with baby development and milestones as well. I think CKD overexaggerates and misinterprets the point of the AAP recommendation for SIDS.

In regards to other positions, the AAP prefers the baby to be actually awake, e.g, for tummy time:

“Although there are no data to make specific recommendations as to how often and how long it should be undertaken, the task force concurs with the AAP Committee on Practice and Ambulatory Medicine and Section on Neurologic Surgery that “a certain amount of prone positioning, or ‘tummy time,’ while the infant is awake and being observed is recommended to help prevent the development of flattening of the occiput and to facilitate development of the upper shoulder girdle strength necessary for timely attainment of certain motor milestones.” ^[12]https://pediatrics.aappublications.org/content/138/5/e20162938

Also, every baby is different. My LO hates being on his back unless he is nursing. His preferred sleeping position now at 7 months is on his belly, and we allow him to do this because he knows how to control his airway by tilting his head to the side and/or rolling. When his airway is blocked, we observe him finding ways to re-open it. So your baby could hate being on their back, but tough luck with the Snoo – they can’t move at all.

Personally, I think swaddling works, but the LO should have some degrees of freedom for movement in the bassinet, and the Snoo ‘overswaddles’ and does not allow this in the way it is intended to be used. If you were to be black and white and follow AAP’s guidelines, they are actually not proponents (which is the idea behind the Snoo) of swaddling:

There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS. –American academy of pediatrics^[13]https://pediatrics.aappublications.org/content/138/5/e20162938

Will this slow down your baby’s development? I don’t know. Probably not significantly if you promote other positions such as tummy time (under AAP’s guidelines mentioned above) or holding them in different positions and engaging their sensory systems. More research needs to be done, specifically with the Snoo regarding its effects on a baby’s development. For example, do babies who use the Snoo compared to babies who do not show differences in development such as reaching their milestones or gross motor skills? This would be a good study to conduct. I think that as long as during awake time, LO has opportunities to explore their world with gross motor activities, they should be okay – which is in line with what AAP recommends. (I am not a doctor and this is not scientific, just a prediction so don’t take my word for it without further research.)

So I somewhat agree with point #3, but it’s overexaggerated in my opinion. Babies should be okay.

Point #4

It is a very expensive.

I covered this already, but cost should not be a factor when it comes to safety and your baby’s development – at least in consideration for its potential benefits. That’s the thing with technology. It should not exclude parents from being ‘beta testers’ of this device. This type of technology will one day be cost-effective to the average parent who wants to purchase the Snoo. So I actually disagree with CKD’s point about the price and its potential benefits. Personally, I would never buy one, but I would be willing to rent or try one to see how my baby responds. I am not knocking or judging on parents who purchase or rent the Snoo. I think if it works for their LO, that’s awesome. It might one day be the future of bassinets, we don’t know yet.

And that’s the thing with science and research when we are in the middle of it, we don’t know. Then comes 10 years in the future, we may change our recommendations based on the latest research. And that’s to be expected because humans change their behaviors and technology changes our lives. For example, our grandmothers did not grow up with the iPhone.

Point #5

The marketing promotes strict adherence to their protocol, including bringing or renting a Snoo when out of town.

This brings me to the point of feasibility and compliance. In research, it refers to how compliant participants are with a protocol or intervention. In reading the subreddit on the Snoo, you’ll actually discover that most parents don’t follow this strict protocol and introduce a lot of variation in behaviors that deviate from this. They actually follow the recommendations that I made earlier: Parents use other devices for naps or nap with their baby, don’t bring it with them when they travel and use alternatives, and do other smart things in general. Overall, this is reassuring to me.

If the Snoo allows parents to get a few more hours of sleep at night, no matter if they follow the recommended protocol or not, it should not matter. The point of getting this device is to (1) be safe for the baby and (2) allow parents to get some more sleep. For me, it does not interfere too much the baby’s development. Will it piss them off in though? Yes. They can’t move.

Which brings me to the point of biases, assumptions, and difficulty of researching this topic and this device. Would your LO have been fine without the Snoo in the first place? You would never know, unless you had a time machine. And that’s the challenge. Parents may also think it works, but they may introduce other behaviors or interventions that may have actually helped the baby sleep instead of the Snoo working its magic, e.g, room temperature change, blackout curtains. I read one post on Reddit where a family did all the sleep hygiene interventions AND used the Snoo. Maybe they didn’t need the Snoo in the first place, but they were raving about it. See what I mean? There are many biases that most people (including people who give it positive reviews) are not aware of. So as a general consumer, you have to be critical, do your research, and question stranger’s or even your friend’s approach and what they claim – unless they are sleep scientists and sleep researchers by trade.

One point they did not mention is…

About the Potential Honesty of Reviews

Screenshot of the Snoo affiliate program. Source: https://www.happiestbaby.com/pages/affiliates

A word on “reviewers” and the honesty of strangers on the Internet. The Snoo does have a referral program that provides a commission to “influencers” that pitch the product. So you should be skeptical of how honest the reviews that you read on the Internet are, especially if they post a link to the product or really mention it a lot in their social media or blog. I am not saying all reviews are dishonest, but the majority of them probably are overhyped.

Conclusion

So, the million-dollar question: should YOU get the Snoo?

You probably guessed my response: it depends.

CKD takes a pretty anti-Snoo approach. I am a little more middle-of-the-road.

I am not completely anti-Snoo or pro-Snoo.

It also depends on how much you want to follow the AAP’s guidelines. If you want to follow it strictly, the Snoo actually contradicts the AAP’s guidelines because the Snoo swaddles, when the AAP says the data is inconclusive on swaddling for SIDS. Again, I think swaddling has its place and is actually helpful.

As an occupational therapist, I will say that it depends on your situation, background, needs, priorities, and goals. That is what the CKD article should have at least mentioned.

It’s like getting a Ferarri vs. a Ford. Would I like a Ferrari?

Yes. Can I afford one? No.

My Snoo Recommendation

I say, get it if:

You can afford to purchase it or rent it. They have a military discount.
You will carefully read AND follow the safety guidelines.
You will carefully monitor your LO at night and provide needed care such as nursing and diaper changes.
You are cognizant and look out for plagiocephaly.
You provide opportunities for other positions such as tummy time or side positions while nursing.
You stop using the device when contraindicated.

Don’t get it if the opposite of any or most of the points just mentioned apply to you or your anticipated situation.

Happy sleeping all you parents!

References [+]

References
↑1	Pollack-Nelson, C., Wanna Nakamura, S., Nesteruk, H., Balci-Sinha, R., & Kish, C. (2018, September). Trends In Infant Sleep: What Do The Data Show? What Are Caregivers’ Behaviors?. In Proceedings of the Human Factors and Ergonomics Society Annual Meeting (Vol. 62, No. 1, pp. 247-250). Sage CA: Los Angeles, CA: SAGE Publications.
↑2	Statistics Canada. Table 13-10-0395-01 Leading causes of death, infants. 2020; https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039501. Accessed 2020 Sep 2.
↑3	Gilbert R, Salanti G, Harden M, See S. Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002. Int J Epidemiol. 2005;34(4):874–887.
↑4	Hauck FR, Tanabe KO. SIDS. Clin Evid. 2009;2009:0315.
↑5	https://www.manualslib.com/manual/1320388/Happiest-Baby-Snoo.html?page=18#manual
↑6	https://services.aap.org/en/patient-care/safe-sleep/
↑7	Subramonian, A., & Featherstone, R. (2020). Interventions for the Prevention of Sudden Infant Death Syndrome and Sudden Unexplained Death in Infancy: A Review of Guidelines.
↑8	https://services.aap.org/en/patient-care/safe-sleep/
↑9, ↑10	https://carolinakinderdevelopment.com/five-reasons-not-to-purchase-a-snoo-from-a-group-of-pediatric-occupational-and-physical-therapists/
↑11, ↑13	https://pediatrics.aappublications.org/content/138/5/e20162938
↑12	https://pediatrics.aappublications.org/content/138/5/e20162938