Infants are dying of this more often since the pandemic
In 1994, the Back to Sleep program, now called Safe to Sleep, began educating parents and other caregivers of the safest ways to put their baby to sleep. One of the most common recommendations was to place babies on their back, not their stomachs or sides. Other recommendations include having babies sleep in a crib or bassinet with a firm mattress that is empty of all toys, bumpers and blankets.
“They made that recommendation from front to back and within a period of five to seven years they cut the amount of SIDS in half,” said Pediatrician Jacqueline Sloan, MD, at Seaside Pediatrics in West Yarmouth. “It is literally one of the most successful public service campaigns in the history of our nation, where public health was improved significantly by that recommendation.”
As successful as that campaign was, the CDC figures show that about 3,400 infants still die unexpectedly every year. Unfortunately, the news in recent years is even more grim. From 2019 to 2020, the number of sudden unexpected infant deaths crept up 15 percent. Even worse, the number of Black babies dying was almost three times the number of White babies.
Even though nobody knows for sure why the uptick is occurring, doctors believe the pandemic has a lot to do with it, Dr. Sloan said. The pandemic exacerbated social issues like overcrowded housing, food insecurity and other stressors. One culprit could be bed sharing.
“The recommendation 100 percent is to have babies sleep in a space like a bassinet or a crib that is next to the parent’s bed, but not in the bed,” she said.
Dr. Sloan said that it can be a tough sell to tired parents because studies show that both the parent and the baby sleep better when the baby is in the parent’s bed. There are also some cultures that are more comfortable with bed sharing. But the risk of suffocation or strangulation is just too high to take a chance for slightly better sleep.
“Air mattresses are especially bad for babies to sleep on because if they deflate even a little bit during the nighttime, the baby can roll from one side or the other and have their face or body become entrapped,” she said. “When an air mattress deflates, all of a sudden you are sinking into it.”
Other dangerous places for babies to sleep include swings, car seats or bouncy seats or any kind of reclined surface. The danger is they could flex their neck forward but not be able to support their head and pull it back, which can cause a type of suffocation.
Bumper Pads and Blankets
Parents also balk at some of the other safety recommendations like no bumper pads, stuffed animals or blankets that that may be gifts or heirlooms, but it is much safer to put the baby to bed in a blanket sleeper or sleep sack. Those work very well to keep babies warm, but also safe.
“Overheating is definitely a risk for SIDS, so if you do use a blanket sleeper or sleep sack, you do not use a blanket in addition,” Dr. Sloan said. “The baby just needs to be dressed warmly but not too warmly with an environmental temperature that is comfortable for an adult to sleep in. Generally, 67 to 70 degrees is the recommendation.”
“Swaddling is also a risk factor for SIDS, so it’s recommended not to swaddle and certainly not to swaddle after the baby starts to roll from the back to the side which happens oftentimes in the first couple of weeks of life.”
Other risk factors according to Dr. Sloan include:
- Positioners to hold a baby in a certain position
- Maternal smoking during or after pregnancy
- Mothers under the age of 20
- Babies born at less than 36 weeks of gestation
A Combination of Factors
“Usually, SIDS is a combination of factors,” Dr. Sloan said. “It is rare that it is only one factor. So, if you’re a baby who is premature, your mother should not be smoking and you absolutely should be sleeping on a flat surface. It’s thought that 95 percent who die from SIDS have more than one risk factor.”
Things that are not risk factors include vaccinations, acid reflux or having a cough or cold. Both breast feeding and using a pacifier to fall asleep are known to be protective.
Some parents buy home heart rate monitors under the false impression they will offer protection from SIDS. They don’t. In fact, Dr. Sloan said, they can increase stress in the family because they frequently send off false alarms.
“You can get alarms three or four times weekly that your baby is not breathing and you’re jumping out of bed and it disrupts everybody’s sleep and they have not been shown to improve the outcome of SIDS,” she said.
The peak incidence of SIDS is from two and four months of age, Dr. Sloan said. It’s very rare in the first month of life and 90 percent of all cases occur in the first six months.
New terminology surrounding infant deaths has caused some confusion. Until recently, SIDS was the commonly used term for sudden infant death but SIDS is actually a subcategory of Sudden Unexpected Infant Death (SUID). SUID can mimic SIDS but it is not the same, Dr. Sloan said. With SUID, the cause of death is known. It can encompass illness, suffocation, strangulation or entrapment. With SIDS, there is no known cause.
