After a baby’s born, most parents are really good about taking the child to the doctor for wellness visits. Nancy L. Swigonski, MD, professor of Pediatrics at IU School of Medicine, suggests that screening parents at the baby’s wellness visits at one-month, two-months and four-months—for smoking, depression, nutrition and other health factors—and providing safe sleep information may help improve risk factors associated with this period of risk for infant mortality.
While nearly half of all infant mortality cases are related to perinatal risks, the other half result from factors that exist after a baby’s born. SUIDs (sudden unexplained infant death), assaults and accidents, congenital malformations, and other causes, including infections, make up the other half of infant mortalities.
Sudden Unexplained Infant Death
Sudden Unexplained Infant Death, or SUID, is the death of an infant <1 year of age that occurs suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation. About 14 percent of infant mortality cases (one out of eight) is considered sudden unexpected infant death. Most, if not all, of these deaths are completely preventable and related to unsafe sleep.
For example, accidental suffocation and strangulation in bed occurs when an infant is suffocated by soft bedding, such as a pillow or blanket that covers an infant’s nose and mouth, or by a person rolling on top of or against the infant. Infant suffocation also occurs as a result of wedging or entrapment, when an infant is between two objects such as a mattress and wall or a bed frame. Strangulation occurs when an infant’s head and neck become wrapped in blankets or tangled in car seat straps.
IU School of Medicine is conducting training throughout Indiana with different people and crime scene investigations to better identify the cause of infant deaths related to unsafe sleep and other types of Sudden Unexplained Infant Death. School faculty train and collaborate with EMS personnel as well as child protective services.
SIDs one of the categories that falls under Sudden Unexplained Infant Death. Even after a thorough investigation, it can be hard to tell SIDS apart from other sleep-related infant deaths, such as overlay or suffocation by soft bedding. This is because these deaths are often unwitnessed and there are no tests to distinguish SIDS from suffocation. To complicate matters, people who investigate SUIDs may report cause of death in different ways and may not include enough information about the circumstances of the event from the death scene. Unfortunately, differences in classification and coding of causes and manners of infant death, as well as inconsistent investigation techniques, have led to an underreporting of SUIDs in Indiana.
Trends in sudden infant death are moving in the wrong direction. In the 1990s, the Back to Sleep campaign and the Safe to Sleep program had an impact; infant deaths related to unsafe sleep went down. But incidence rates are beginning to rise again.
Safe Sleep Practices
The American Academy of Pediatrics provides expanded recommendations to reduce all sleep-related infant deaths by including unsafe sleep environments overall and not just factors related to SIDs.
- Back to sleep for every sleep.
- Use a firm sleep surface.
- Room-sharing with the infant on a separate sleep surface.
- Keep soft objects and loose bedding away from the infant’s sleep area.
- Consider offering a pacifier at naptime and bedtime
- Avoid overheating.
- Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS.
- Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth.
- Media and manufacturers should follow safe sleep guidelines in messaging / advertising.
- Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and unintentional deaths.
In too many cases of infant mortality, the sleeping environment is related to the infant’s death. The caretaker is usually the parent in these cases, and half of the deaths occurred while the infant was in an adult bed.
Social Ecologic Model
Department of Pediatrics faculty are now pursuing relationship- and community-based models to influence infant mortality. At the individual level, we know that people read books more than they read brochures, so providing books that model safe sleep recommendations is helpful. At the relationship level, IU School of Medicine faculty are collaborating with community groups to make a positive impact.
Pediatricians from IU School of Medicine are working with the Marion County Health Department on the Fetal Infant Mortality Review Team, a community-based group focused on improving service systems and resources for women, infants and families by examining fetal and infant deaths, determining preventability, and engaging individuals to take action.