Rates of sudden unexpected infant death in the United States increased by nearly 12 percent from 2020 to 2022, according to new research published on Monday in the journal JAMA Pediatrics.
Though the study offered some good news — overall infant mortality rates dropped by 24 percent from 1999 to 2022 — it also raised questions about why more babies appear to be dying during sleep, and why rates of sleep-related death remain notably higher among Black, Native American and Pacific Islander babies than among white and Asian infants.
Dr. Elizabeth Wolf, an associate professor of pediatrics with Children’s Hospital of Richmond at Virginia Commonwealth University who was among the new study’s authors, called the findings “pretty alarming.”
“The death of an infant from SIDS or SUID is unbelievably horrific,” Dr. Wolf continued, using two acronyms that describe sleep-related deaths among infants. “And we as a public health community need to do everything we can to try and reduce the risk factors as much as possible.”
Understanding SUID
The terminology used to describe the circumstances around an infant death in the sleep environment can be difficult for parents to parse, Dr. Wolf said.
The new study looked at rates of sudden unexpected infant death, or SUID, which is a broad term that encompasses all deaths in the sleep environment. That category includes cases of death by sudden infant death syndrome, or SIDS — the puzzling syndrome in which a child under 1 dies with no clear medical or environmental cause — as well as by other causes, including accidental suffocation.
Some of the factors that can put sleeping infants at risk are beyond parents’ control, such as a baby’s premature birth or illness. But other risks are potentially preventable, for example by limiting exposure to nicotine during pregnancy and after, by breastfeeding (which is believed to offer some protection against SIDS) and by giving babies a safe sleep environment.
Rates of sleep-related infant deaths plummeted in the 1990s — thanks to a national education campaign encouraging parents and caregivers to put babies to sleep on their backs instead of their stomachs — but have stagnated since.
Making Sense of the Increase
The new study does not offer any evidence about what is behind the seeming increase in sleep-related infant deaths. But Dr. Wolf and her colleagues offered several hypotheses, including that the rise might be linked to the surge of Covid and other respiratory illnesses, maternal opioid use and the influence of social media in spreading unsafe sleep practices.
“It’s my prayer that this is just a blip that’s really tightly tied to the pandemic, and that it’ll come back down,” said Dr. Michael Goodstein, director of newborn services for WellSpan Health and a member of an American Academy of Pediatrics task force on SUID who was not involved in the new study.
The A.A.P. regularly updates its recommendations on safe sleep: Babies should be placed on their backs, in a crib, a bassinet or a portable play yard with a firm, flat mattress and a fitted sheet. There should be no loose bedding, toys or bumpers, which can increase the risk of suffocation. And though bed sharing is common in many parts of the world, the A.A.P. does not recommend it under any circumstances.
Dr. Wolf said she was particularly concerned about the role that social media may be playing in promoting unsafe sleep practices. She pointed to a 2021 study that found that many Instagram posts showed babies sleeping in environments that didn’t meet the A.A.P.’s guidelines.
Spreading the Word on Safe Sleep
It is not always easy for parents to determine whether products that are advertised to help babies sleep better are actually safe, said Alicia McHatton, a clinical nurse at U.C. Davis Children’s Hospital in Sacramento. She often recommends parents and caregivers check saferproducts.gov, a federal database maintained by the U.S. Consumer Product Safety Commission.
Experts emphasize that many factors contribute to sleep-related infant deaths and acknowledge the challenges families face in keeping babies safe, particularly in the United States, which is among the few remaining countries with no paid parental leave.
Safe sleep practices aren’t just important at night, but throughout the day, said Gail Bagwell, a doctor of nursing practice with Nationwide Children’s Hospital in Columbus, Ohio.
“Every caregiver of that child needs to know that,” she said. “I have personally known people who were practicing safe sleep with their babies at home, came back to work, and the first day back the babysitter called and said, ‘Your baby is heading to the hospital.’”
