Infant Bed Suffocation Rates On The Rise

By Margarita Nahapetyan

The rates of sudden infant death syndrome (SIDS) due to accidental suffocation and strangulation in bed (ASSB) have quadrupled between 1984 and 2004, reports a new study published in the February issue of Pediatrics.

The reason for the sharp increase in accidental death in bed, is not known for sure yet. However, the researchers say that the trend roughly coincides with a sharp rise in bed-sharing, which makes breast feeding more convenient for many mothers and increases the parent-child bond. In addition, many parents sleep with their infant babies for economic reasons, such as lack of money for cribs and bassinets, or no other room being available.

The dangers of an infant sleeping with an adult, whether it will be in the bed, on the couch, or in the crib, arise when a sleeping parent accidentally rolls over on top of a baby or when a pillow covers the baby's face. In other cases, a blanket can get wrapped around the infant's neck, or a baby may become wedged between mattress and wall or bed frame. The doctors also do not recommend to leave infants sleep on their stomach.

"There has been a huge increase in the reports of these deaths," said Carrie K. Shapiro-Mendoza of the Centers for Disease Control and Prevention in Atlanta, and a lead researcher of the study. "The message for the public is that accidental suffocation and strangulation is potentially preventable by providing babies with a safe sleep environment."

For their study, the authors analyzed data from death certificates for U.S. babies aged one year and younger. In the two decades between 1984 and 2004, infant deaths attributed to strangulation or suffocation in bed, increased from 2.8 deaths to 12.5 deaths per 100,000 live births.

The dramatic increase occurred between 1996 and 2004 (14 per cent average increase per year). During this period of time, sudden and unexpected infant mortality rates overall remained relatively stable, with a possible decrease trend after 2003, and deaths attributed to SIDS declined.

The study revealed that ASSB deaths have been most common among black baby boys younger than 4 months. Overall, African American babies had a higher mortality rate from this type of death compared with white babies (27.3 deaths per 100,000 births against 8.5 deaths per 100,000 births), and the rate was higher for boys than for girls (12.5 against 9.6 deaths per 100,000 live births).

The report also found that baby mortality attributable to accidental suffocation and strangulation in bed was highest among babies younger than 3 months, and most accidents happened at the age of one month. Researchers also noted that more frequent deaths occurred from Sunday through Wednesday compared with Thursday through Saturday.

Shapiro-Mendoza said that a "comprehensive" investigation of the site of death is critical while determining a cause of death. Often, she says, autopsy results cannot distinguish the difference between strangulation or physiological causes such as heart illnesses.

All mysterious infant mortality cases used to be classified as SIDS cases, she said, adding that coroners and medical examiners need to be more careful about diagnosing cause of death in order to help scientists fight infant death cases. "A death scene investigation, an autopsy, and a review of medical records are essential to correctly classify these deaths," she said.

"Strangulation deaths are going up and bed-sharing is going up," said John Kattwinkel of the University of Virginia, who chaired an American Academy of Pediatrics panel that recommended against bed-sharing in 2005. "It is certainly logical to draw a conclusion that there is a link. Parents should not bed-share with their babies."

The experts say that the safest sleep environment for babies is in sleep in the same room as their parents, but in a separate sleep surface with a firm mattress, and be placed on their backs with no blankets, pillows, comforters and stuffed animals, all the objects that might cause their suffocation.

"There is probably nothing more devastating than finding a dead infant in the morning," Kattwinkel said. "We should do everything we can to avoid it."