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SIDS linked to unsafe sleep practices – US analysis

More than three-quarters of sudden infant deaths (SIDS) involved multiple unsafe sleep practices, including co-sleeping, a recent analysis suggested, with the researchers saying soft bedding was common among all of the infants who died – and most of them were under three-months-old.

The study, which was published in the journal Paediatrics, looked at 7 595 sudden infant death cases in a US Centres for Disease Control and Prevention registry between 2011 and 2020.

The statistics revealed that 59.5% of the babies who died suddenly were sharing a sleep surface at the time of death, while 75.9% were in an adult bed. Though some demographic factors such as sex and length of gestation were not clinically significant, the researchers found that the babies sharing a sleep surface were more likely to be black and publicly insured than those who didn’t share sleep surfaces.

They said 76% of the cases involved multiple unsafe practices.

The Washington Post reports that the analysis mirrors known risk factors for sudden infant death. Current recommendations direct parents and other caretakers to provide infants with firm, flat, level sleep surfaces that contain nothing but a fitted sheet.

Though room sharing reduces the risk of sudden infant death, CDC officials discourage parents from sharing a sleep surface with their child.

Exposure to cigarette smoke during pregnancy was more common among infants who shared surfaces when they died. Though most infants were supervised by an adult when they died, the supervisor was more likely to be impaired by drug and alcohol use among those who shared a sleeping surface.

The available data could be incomplete or biased because it relies on witness reports taken in what can be a “chaotic scene”, the researchers note. Because caregivers didn’t report their reasons for sharing a sleep surface or engaging in unsafe sleep practices, it could be difficult to help families follow the current recommendations, the study adds.

Overall, the researchers write, “Surface sharing in the absence of other unsafe sleep factors was rare.”

“These are known risk factors for SUID (Sudden Unexpected Infant Death),” said Fern Hauck, a physician at UVA Health and the University of Virginia School of Medicine and co-author of the paper.

The high number of “hazardous sleep practices” that were reported, “tells us that we need to do a better job of working with families to increase acceptance of the recommendations to create safer sleep spaces for their infants”.

Study details

Characteristics of sudden unexpected infant deaths on shared and non-shared sleep surfaces

Alexa Erck Lambert, Carrie Shapiro-Mendoza, Sharyn Parks, Carri Cottengim, Meghan Faulkner, Fern Hauck.

Published in Paediatrics on 20 February 2024

Describe characteristics of sudden unexpected infant deaths (SUID) occurring on shared or non-shared sleep surfaces.

We examined SUID among residents of 23 US jurisdictions who died during 2011 to 2020. We calculated frequencies and percentages of demographic, sleep environment, and other characteristics by sleep surface sharing status and reported differences of at least 5% between surface sharing and non-sharing infants.

Of 7 595 SUID cases, 59.5% were sleep surface sharing when they died. Compared with non-sharing infants, sharing infants were more often aged 0 to 3 months, non-Hispanic black, publicly insured, found supine, found in an adult bed or chair/couch, had a higher number of unsafe sleep factors present, were exposed to maternal cigarette smoking prenatally, were supervised by a parent at the time of death, or had a supervisor who was impaired by drugs or alcohol at the time of death. At least 76% of all SUID had multiple unsafe sleep factors present. Among surface-sharing SUID, most were sharing with adults only (68.2%), in an adult bed (75.9%), and with 1 other person (51.6%). Surface sharing was more common among multiples than singletons.

Among SUID, surface sharing and non-sharing infants varied by age at death, race and ethnicity, insurance type, presence of unsafe sleep factors, prenatal smoke exposure, and supervisor impairment. Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counselling for every family at every encounter.


Paediatrics article – Characteristics of Sudden Unexpected Infant Deaths on Shared and Non-shared Sleep Surfaces (Open access)


The Washington Post article – Most sudden infant deaths involved unsafe sleep habits, study finds (Restricted access)


See more from MedicalBrief archives:


Genetic link finding in SIDS – Danish study


Co-sleeping with your infant unsafe – American Academy of Paediatrics


Siblings of SIDS infants at 10-fold risk of same death










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