Preventable Infant Suffocation During Sleep: New Research

SIDS baby suffocation cribs blankets bedding wedging

How many safety issues can you spot in the above photo? One? Two? More?

There are two very obvious problems: the loose blanket under and around the infant, and the stuffed animal in the corner. These are called soft bedding, which is a big no-no for infant sleeping areas. Another possible issue is the lack of lightweight clothing for regulating your baby's body temperature effectively during the night.

There are a few good things to notice in the photo, too: The crib mattress appears to be nicely fitted in the crib, it does not appear to be a drop-side crib, and the infant is placed on his or her back for sleep.

But the issues with the blanket and stuffed animal are very serious because the leading cause of death among infants under 1 year of age is suffocation or strangulation while in bed, including both a parent's bed or their crib or bassinet.

New Research: Highly Preventable Risks

A recent study published in the journal Pediatrics demonstrates that an unexpectedly high percentage of these deaths (about 14% of them) are due to three highly preventable issues:

  1. Soft Bedding: About 69% of deaths involving suffocation or strangulation while in bed were attributed to soft bedding. This includes the mattress itself, any mattress pads or covers, and sheets and blankets.
  2. Overlay: About 19% of deaths involving suffocation or strangulation while in bed were attributed to overlay. Overlay is the technical term for a parent having accidentally suffocated a baby by laying partly or fully on top of them during sleep.
  3. Wedging: About 12% of deaths involving suffocation or strangulation while in bed were attributed to wedging. Wedging occurs when the baby gets trapped between a mattress and another object such as a wall or bed frame.

Lowering the Risks: Safe Sleep

Guidance about Soft Bedding: According to the APA, CDC, WHO, and several other pediatric, product safety, and medical organizations, you should never put anything in the crib with your baby. This includes stuffed animals, pillows, crib bumpers, or blankets.

If you think your baby will be cold, put on another layer of snug clothing. Do not use a mattress pad or padded mattress cover. Your baby will be perfectly comfortable on a firm crib mattress, and it's simply not worth the risk.

All of the best crib mattresses have at least one side that is super firm; this is by design, as it greatly reduces the risk of sudden infant death. Ideally, you would use a crib mattress that includes a perfectly-sized and breathable cover that zips on and off for easy cleaning - fortunately, many modern crib mattresses include this feature right out the box.

Guidance about Overlay: Co-sleeping with a child is very dangerous. Never sleep with your baby in your bed, and if you feel sleepy while breastfeeding, put your baby down in a safe place and get some rest. It doesn't matter what your bed is like, whether you are using blankets or pillows or anything else. It's simply too dangerous to justify.

If you would like to have the convenience and comfort of having your baby nearby while you're in bed, get a bassinet that scoots up next to the bed, like one of the many bedside bassinets in our annual list. Way too many babies die because a breastfeeding or bottle-feeding parent falls asleep during feeding and ends up accidentally suffocating their baby. 

Guidance about Wedging: The risk with wedging is often related to co-sleeping because your baby may end up wedged between a mattress and a head board, foot board, or a wall. This typically happens when the baby is in an adult bed, or otherwise not in their safe sleeping space (bassinet, crib). Wedging is extremely dangerous and another reason why you should never co-sleep with your baby. The best baby cribs and mattresses fit perfectly together like pieces of a puzzle, with no gaps larger than two fingers' width at the corners or edges.

Overall Conclusions for Parents

Increasing public awareness about the risks of unsafe sleep practices has lowered the rate of infant deaths related to SIDS (Sudden Infant Death Syndrome) and SUIDS (Sudden Unexpected Infant Death). This is because parents began to position their babies differently (the Back to Sleep campaign), remove soft bedding from their cribs, remove crib bumpers (bumper pads), and be more careful about setting up a safe sleep area. Hundreds of millions of dollars were invested in these campaigns, to raise awareness about safe sleep practices for newborns and infants.

But even as recently as 2015, research reports that about 22% of parents do not consistently place their baby on the back to sleep, over 60% of parents share beds with their baby, and about 40% have soft bedding in the baby's sleep area. This is especially the case for lower income families, parents with lower education levels, and younger parents.

Now that we've known about SIDS for decades, and are increasingly familiar with the techniques we need to use to reduce the risks, it's sometimes surprising that parents are still making the same old mistakes. Sometimes it's outside of their control, but often times the scenario that led to their baby's death was completely preventable.

The Centers for Disease Control details the 4 critical steps for safe infant sleep:

  1. Place your baby on his or her back for all sleep times, whether for naps or nighttime sleeping.
  2. Use a firm sleeping surface, such as a firm mattress in safety-approved bassinet or crib.
  3. Never include soft bedding such as pillows, blankets, bumper pads, or soft toys in your baby's sleep area.
  4. It is OK to share the room with your baby, but never OK to share the bed with your baby.

If you're ever uncertain about your baby's sleep situation, take a picture or video and send it to your pediatrician to get personalized advice. Be sure to double-check any advice you're given by friends or family, because it might be old and outdated.

References

Lambert, A. B. E., Parks, S. E., Cottengim, C., Faulkner, M., Hauck, F. R., Shapiro-Mendoza, C. K. (2019). Sleep-related infant suffocation deaths attributable to soft bedding, overlay, and wedging. Pediatrics, 143, e20183408, doi: https://doi.org/10.1542/peds.2018-3408

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