Message Content

Messages on Critical Issues

The Text4baby service includes over 250 messages with the most critical information that experts want pregnant women and moms with infants under one to know. The comprehensive set of messages address:

• Prenatal Care
• Safe sleep
• Immunization
• Breastfeeding (Breastfeeding Content Fact Sheet)
• Nutrition
• Oral Health
• Immunization
• Family Violence
• Physical Activity
• Safety
• Injury Prevention
• Mental Health
• Substance Abuse
• Developmental Milestones
• Labor & Delivery
• Car Seat Safety
• Exercise

Women who sign up at any point during pregnancy receive a “starter pack” with six messages containing critical information and encouragement to connect to care.

Message Development

The accuracy of Text4baby content is of utmost priority for the hundreds of partners who promote the service, including public health agencies working at the federal, state, county, and city levels. In addition to ensuring medical accuracy, ZERO TO THREE (ZTT) is committed to providing messages that are relevant, clear, understandable, and actionable by mothers of all literacy levels. Prior to the launch of the program, the National Healthy Mothers, Healthy Babies Coalition (HMHB), a founding partner, held informal discussion groups with pregnant women and new moms to gauge interest in Text4baby, determine topics of importance, and explore the relevance and comprehension of sample messages. Simultaneously, in collaboration with the Centers for Disease Control and Prevention (CDC), HMHB conducted a review of the literature and major medical guidelines to identify priority topics and critical content.

Message Input and Review

Dozens of federal agencies, national, state, and local organizations provided input into the content development (scroll down to see full list). HMHB considered all feedback received and collaborated with a number of public health authorities to determine next steps. Once developed, messages were again reviewed by experts from a range of key agencies and organizations (scroll down to see full list).


HMHB and ZTT would like to thank the many organizations who contributed to Text4baby and helped ensure that mothers nationwide are receiving accurate information critical to the health of their families. For more specific information about the development of the breastfeeding content, please click here.

Message Testing

Post-launch, HMHB worked with the Health Literacy Team at Emory University School of Medicine to perform one-on-one cognitive testing of a sample set of messages with the target audience. Findings from the groups and interviews helped to inform content development and revisions. HMHB also tested the Spanish Text4baby messages to ensure that messages have regional Spanish variation and that the content is consistent with norms and values of Spanish-speaking cultures.

Ongoing Revisions and Updates

ZTT most recently released revised versions of the pregnancy and infant messages in 2015 and intends to do a comprehensive review and revision annually. However, urgent changes to health recommendations are incorporated immediately.

Monthly Text4baby Alerts

Every month, all active users in Text4baby receive at least one "alert" message with breaking news related to maternal and child health, such as safety updates or policy changes.

Additionally, Text4baby sends emergency health messages, for example, during disease outbreaks. Since launch, we have sent out the following emergency messages:

  • Tylenol recall, May 2010
  • Pertussis outbreak CA (CDC), July 2010
  • Similac formula recall, September 2010
  • Sleep positioners warning (FDA), October 2010
  • New car safety seat guidelines (AAP), March 2011
  • Deadly hot cars (Safe Kids), July 2011
  • Benzocaine warning (FDA), August 2011
  • Window falls prevention (AAP & CDC), September 2011
  • Warning about crib bumpers (AAP & CDC), October 2011
  • Carbon monoxide poisoning (CT & MA) in response to power outages, November 2011
  • Warning about button batteries (Safe Kids), December 2011
  • CMS enrollment (CMS), February 2012
  • Medicine safety (CDC), March 2012
  • Pertussis - 7 states (CDC), April 2012


Sample Messages


  • Free t4b msg: Morning sickness may be caused by a change in your hormones. Try eating crackers or dry cereal. Eat small meals often. Don’t go without eating.
  • Free msg: Have you visited a Dr. or midwife (CNM/CM)? If not, make an appointment now. Call your health plan. Or 800-311-2229 to connect to low-cost care.
  • Free t4b msg: Your baby is growing a lot! Baby is now the size of a lime & can open its mouth & move its tiny hands.
  • Free msg: If you have any signs of preterm labor--cramps, belly tightening, low back pain, bleeding, or watery, pink/brown discharge--call your Dr. right away.
  • Free msg: A seat belt protects you & your baby. Shoulder belt goes between your breasts & lap strap goes under your belly (not on or above). Wear it every time.
  • Free t4b msg: Are you really in labor? Real labor won’t stop when you lie down or walk around. In real labor, the pains get worse & happen more often.
New Baby
  • Free msg: It's time for baby's 1-month Dr.'s visit. Your baby had blood tests right after she was born. At this visit, ask your Dr. for the results.
  • Free msg: Not sure if your car seat is installed right? Get it inspected. Department of Transportation can help. Call 888-327-4236 for locations near you.
  • Free msg: Your baby’s mouth needs cleaning now—even before the first tooth! Wipe your baby’s gums each day with a wet washcloth or use a soft baby toothbrush.
  • Free msg: Worried about keeping baby warm at night? Infant pajamas & infant sleep sacks are safe for baby to wear to sleep. But no loose blankets in the crib.
  • Free msg: Babies can get very sick from the flu. You & everyone who cares for your baby should get the flu shot during flu season. Call 800-232-4636 for info.
  • Free msg: Have you gone back to work? It can be tough. Take it one day at a time & know you’re not alone in this balancing act.


The organizations listed below have contributed feedback to the message content.

Federal Agencies

• U.S. Department of Health and Human Services:
• Centers for Medicare and Medicaid Services
• Centers for Disease Control and Prevention
• Health Resources and Services Administration, Maternal and Child Health Bureau
• HHS Office on Women’s Health
• National Institutes of Health
• U.S. Consumer Product Safety Commission
• U.S. Department of Agriculture, Food and Nutrition Service
• U.S. Department of Defense Military Health System
• U.S. Department of Transportation

National Organizations
• Alliance for Hispanic Health
• American Academy of Pediatrics
• American Academy of Pediatric Dentistry
• American College of Nurse-Midwives
• American Congress of Obstetricians and Gynecologists
• National Domestic Violence Hotline
• Postpartum Support International
• Text4baby Breastfeeding Council

The organizations listed below provided specific feedback on the Text4baby messages.*

• Arizona Dept of Health Services
• Association of Poison Control Centers
• Berkeley University
• California Dept of Social Services
• Carolina Breastfeeding Institute
• Fairview Hospital (Cleveland)
• First Candle
• Florida Dept of Health
• Georgia Dept of Community Health
• Healthy Fathering Collaborative
• Institute for Health and Recovery
• Just in Time Parenting
• Kansas Dept of Health & Environment
• Lamaze International
• Massachusetts Breastfeeding Coalition
• National Center for Hearing Assessment and Management
• National WIC Association
• Nevada Dept of Health
• New York State Dept of Health
• Ohio Dept of Health
• Oral Health Kansas
• Oregon Dept of Human Services
• Organization of Teratology Information Specialists
• Prevent Child Abuse Arizona
• Safe Kids USA
• The AOA Foundation
• UC University Center for Excellence in Developmental Disabilities

• The National Campaign to Prevent Teen & Unwanted Pregnancy
• Utah County WIC
• Virginia Dept of Health
• Washington State Dept of Health
• DC Breastfeeding Coalition
• West Virginia Hospital Association
• Wisconsin Childhood Lead Poisoning Prevention Program

*Please note. This is not a comprehensive list of organizations that submitted content feedback.