Unsafe Sleep Habits Are Involved in Most Sudden Infant Deaths

The vast majority of sudden infant deaths in the United States involve unsafe sleep habits, according to a new study.

Between 2011 and 2020, more than three-quarters of sudden unexpected infant deaths involved multiple unsafe sleep factors, including co-sleeping.

That’s according to a recent study published in Pediatrics, which examined 7,595 cases of sudden infant deaths among residents of 23 U.S. jurisdictions. Of these cases, 59.5% were sleep surface sharing when they died, and most were younger than three months-old.


Sleep surface sharing, or co-sleeping, refers to when an adult and infant sleep together on the same surface, such as a bed, couch, or chair. It’s highly discouraged by experts and considered to be quite dangerous, putting an infant at a higher risk for injury, sudden infant death, and situations like an adult accidentally rolling over them.

According to the study, 75.9% of infants were in an adult bed when they died.

The researchers found that infants who died while sleep surface sharing were more often aged 0 to 3 months, non-Hispanic Black, publicly insured, lying 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.

“Most SUID, regardless of sleep location, had multiple unsafe sleep factors present, demonstrating the need for comprehensive safe sleep counseling for every family at every encounter,” the authors wrote.

Safe sleeping for newborns

According to the U.S. Department of Health and Services, a safe sleep environment for a baby is firm (returns to its original shape quickly if pressed on), flat (like a table, not a hammock), level (not at an angle or incline), and covered only with a fitted sheet.

That’s because research has shown that babies who sleep on soft surfaces or with items are at higher risk of sleep-related death including sudden infant death syndrome (SIDS), entrapment, suffocation, and strangulation. Sleep surfaces that aren’t level can cause positional asphyxia, which is when a baby’s body position gets in the way of their breathing.

“SUID deaths in the U.S. are still higher than in most other countries, and this is unacceptable,” said researcher Fern Hauck, M.D., MS, a safe-sleep expert at UVA Health and the University of Virginia School of Medicine, in a news release. “Clinicians and others caring for infants need to have thoughtful conversations with families at risk to understand the barriers to following safe-sleep guidelines and find ways to work together to overcome them.”



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