The High Toll of Sudden Infant Death

Sudden unexpected infant death (SUID) is not frequently an issue that is addressed by pediatric gastroenterology.  However, it is very common and needs to  be considered as we see infants with reflux, irritability, diarrhea, and dyschezia.

A recent report (DR Roehler et al. J Pediatr 2019; 212: 224-7) puts the magnitude of this problem into perspective.

Key points:

  • From 2013-2015, there was an average of 3523 US infants each year who died from SUID, peaking at 1-2 months of life.
  • The average annual risk of SUID during the first year of life was more than 5 times the peak risk of mortality from firearms homicide, motor vehichle-traffic, drugs/opioid overdose, and suicide.
  • More black infants died of SUID in the first year than black children who died from firearm homicides in all of childhood through age 19 years.
  • SUID deaths from 2013-2015 (10,568) was similar to the total number of motor vehicle-traffic deaths in all of childhood (10,714) and greater than the total number of any of the other causes.
  • Rates of SUID deaths were much higher for non-hispanic blacks than non-hispanic whites or hispanics.  Peak rates reached 481 per 100,000 per month compared with 215 per 100,000 per month and 130 per 100,000 per month respectively in these three groups (Figure 1).

Related study: AB Erck Lambert et al. Pediatrics 2019; 13.pii.e20183408.  In a SUID database analysis, 14% (250) of SUID cases from 2011-2014 were due to suffocation, most commonly due to soft bedding (69%), overlay (19%), and wedging (12%).

My take: The first year of life, particularly the first 3 months, is a very dangerous time for infants.  More attention to SUID could prevent a great amount of tragedy.

Related blog posts:

Useful website: Charlieskids.org This website has a book called “Sleep Baby Safe and Snug” which incorporates updated recommendations on safe sleep practices.

Children should sleep in the same room but on a separate surface from their parents for at least the first six months of their lives, and ideally the first year. They say that this can halve the risk of SIDS…You can read the AAP’s full guidance here. These are a few more of the pediatricians’ recommendations:

  • Infants under a year old should always sleep lying on their backs. Side sleeping “is not safe and is not advised,” the AAP says.
  • Infants should always sleep on a firm surface covered by only a flat sheet. That’s because soft mattresses “could create a pocket … and increase the chance of rebreathing or suffocation if the infant is placed in or rolls over to the prone position.”
  • Any other bedding or soft objects, like pillows or stuffed animals, could obstruct a child’s airway and increase the risk of SIDS and suffocation, according to the AAP.
  • The pediatricians say breastfeeding reduces the risk of SIDS.
  • The same goes for pacifiers at nap time and bedtime, although the doctors say the “mechanism is yet unclear.” They add that “the protective effect is observed even if the pacifier falls out of the infant’s mouth.”
  • Smoking – both during pregnancy and around the infant after birth – can increase the risk of SIDS. Alcohol and illicit drugs during pregnancy can also contribute to SIDS, and “parental alcohol and/or illicit drug use in combination with bed-sharing places the infant at particularly high risk of SIDS,” the pediatricians say.

Pittock Mansion, Portland, OR

 

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