Sudden unexpected infant death and safe sleeping environment

The AAP expanded its recommendations for preventing sleep-related deaths in 2011.The new recommendations include supine sleeping, room sharing without bed sharing, using a firm sleep surface, avoiding soft bedding, reducing exposure to tobacco smoke, and breast feeding.  In 2014, there was not a single sleep-related death in Minnesota in which the infant was found in a safe sleeping environment as defined by the AAP. More specifically, every case involved either soft bedding or a shared sleep surface…

Physicians and other health care providers who come in contact with parents of infants and expectant parents have an opportunity to discuss safe sleep practices and the reasons for them. Our review of medical records from SUID cases suggests that parents often receive a clear message about placing infants to sleep on their backs but less clear messages about the dangers of bed sharing and soft bedding. Several parents mentioned that they knew a bed was not safe for infants, so they placed pillows around the infant to prevent them from falling off. Parents of one infant who died suddenly and unexpectedly after being placed on his stomach told death scene investigators that they thought they were following their provider’s recommendation for “tummy time.”

In addition to increasing and targeting education about safe sleeping practices, policy changes could help prevent SUIDs. The large disparities in SUID rates by race is a notable finding. The number of American Indians and Asians in our study was small. However, the magnitude of the disparities between the rates of SUID for these groups and others are consistent with what we have measured in the past. A limitation of this study is that data were only available for the mother’s race. Including the father’s race may have affected the SUID rates by race. The Advancing Health Equity in Minnesota Report to the Legislature identifies health disparities, such as those that affect infants of color, and recommends changes that address institutional discrimination and social determinants of health. Smoking during pregnancy has been consistently identified as a risk factor for sudden infant death, and policies that support preventing tobacco use and smoking cessation are important to preventing SUIDs.

Conclusion

 All infant deaths are tragic, especially those that could have been prevented. Many factors affect a baby’s risk of SUID including social determinants of health, a caregiver’s understanding of safe sleep practices and ability to consistently provide a safe sleep environment, and exposure to tobacco. Public health, law enforcement, health care practitioners and other community members all have roles to play in addressing these issues and helping parents make Minnesota a safer place for babies.

http://www.mnmed.org/MMA/media/Minnesota-Medicine-Magazine/Clinical-THYDEN-160708.pdf