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Should We Talk to Parents About Suffocation Instead of SIDS?

December 5, 2022

Every year in the US, approximately 3,400 infants die suddenly and unexpectedly rom unexplained causes (including sudden infant death syndrome (SIDS) and ill-defined causes) and accidental suffocation or asphyxia. Pediatricians talk to families about safe sleep, but rates of adherence to safe sleep practices are much lower than we would like.

Most of our discussions about safe sleep mention SIDS risk reduction. But it has become increasingly clear in recent years that accidental deaths from suffocation or positional asphyxia are also important. Unfortunately, the last US case-control study on sudden unexpected infant deaths (SUID) ended in 1996.  

A team from the Centers for Disease Control and Prevention (CDC), led by Sharyn Parks, PhD, MPH utilized a creative strategy of combining two national databases to create a population-based case-control study; the cases (112 sleep-related suffocation cases and 300 unexplained infant death cases) came from the CDC’s SUID Case Registry, and the 1,648 age-matched controls were derived from the Pregnancy Risk Assessment Monitoring System. Their results appear in an article and an accompanying video abstract being early released this week in Pediatrics, entitled, “Risk Factors for Suffocation and Unexplained Causes of Infant Death” (10.1542/peds.2022-057771).

The authors were able to confirm that risk factors that have been reported in the past -  such as not sleeping on the back, use of soft bedding, sleeping on the same surface as another person or animal, and sleeping in a separate room from the mother/caregiver – continue to be important risk factors for both accidental suffocation and unexplained deaths, but the associations were stronger for accidental suffocation. Interestingly, not sleeping in an approved sleep surface (crib, bassinet, or portable crib) was associated with an increased risk of accidental suffocation but not unexplained death.

This is one of the first studies that has looked at room sharing separately from surface sharing (which is a more comprehensive term than “bed sharing” or “co-sleeping”). When the infant did not sleep in the same room as the parent, the risk of accidental suffocation and unexplained death was almost 19 times and 8 times higher, respectively! Surface sharing more than doubled the risk for both accidental suffocation and unexplained death. These results reinforce the importance of room sharing without bed sharing with one’s infant.

Interviews with parents have suggested that they are more likely to understand safe sleep recommendations as a strategy to prevent suffocation, because they can more easily visualize a suffocation event and how to prevent such an event.

These results support this strategy: If we talk specifically about ways to prevent accidental suffocation for their infant, perhaps counseling about room sharing without surface sharing, avoidance of soft bedding, and supine positioning will be more effective.

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