Despite a record low infant mortality rate in 2020, a new study finds an unexpected jump in unexplained deaths in Black infants during the first year of the coronavirus pandemic.
The rate of SIDS, or sudden infant death syndrome, increased by 15% in a single year, from 33.3 deaths per 100,000 babies born in 2019 to 38.2 such deaths in 2020, according to the research from the Centers for Disease Control and Prevention published Monday in the medical journal Pediatrics.
SIDS is a well-known term, and it is used in cases in which the cause of death cannot be definitively explained. It is not used when a child is found to have accidentally been suffocated by a pillow cushion, for example.
In data collection, both SIDS and incidents of accidental suffocation or strangulation fall under the umbrella term SUID, or sudden unexplained infant death.
SIDS data is not broken down by race and ethnicity, but SUID numbers are. That is where researchers found the increase in unexplained deaths in Black infants but not for any other racial or ethnic groups.
The finding "was absolutely a surprise to us," said the study's author, Sharyn Parks Brown, senior epidemiologist for the CDC's Perinatal and Infant Health Team. The racial and ethnic breakdowns of such deaths had been consistent for decades, she said.
Reasons for the jump are unknown. It could be a statistical anomaly — an unexplained blip in the data — that would need to be monitored for several more years to see whether the increase holds.
It could also reflect adjustments the National Association of Medical Examiners made in 2019 to how sudden infant deaths are classified on death certificates.
The guidance said finding babies on or near soft bedding was not enough to qualify such deaths as accidental suffocation without evidence that the children's airways had, indeed, been blocked. Those cases, according to the recommendations, should be classified as SIDS.
"If the new guidance was followed, this could have led to increased reporting of SIDS," the study authors wrote.
Whatever the reason, complex racial disparities clearly persist. Black people were disproportionately affected by the pandemic, both by illness and the economic stress that accompanied the pandemic.
According to an editorial published alongside the study, Black people are more than twice as likely as whites to live in poverty.
"And among families with children, homelessness is 50% more likely among those who identify as non-Hispanic Black," the authors wrote.
A co-author of the editorial, Dr. Rebecca Carlin, a pediatrician affiliated with Columbia University in New York, said, "If you don’t have a safe place for your baby to sleep, how are you going to have them sleep safely?"
What's more, Black communities have higher rates of smoking and preterm births. Both are risk factors for sudden infant death.
Safe sleep practices
Parks Brown and her team published a study in 2021 that found unsafe bedding is a leading cause of unexpected deaths in babies 4 months old and younger.
For this age group, soft items, such as blankets, pillows, crib bumpers and stuffed animals, should not be placed in cribs when babies are sleeping or otherwise left unattended, according to the American Academy of Pediatrics. Children that age do not have the strength and motor skills to move away from suffocation hazards.
The AAP guidelines say very young infants should be put to sleep on their backs up until their first birthdays. They should sleep in their beds alone on firm, flat surfaces with fitted sheets only. Couches and armchairs put babies at extremely high risk of suffocation, because they could become trapped between seat cushions or under sleeping adults.
The experts also advise keeping babies' cribs in caregivers' rooms for at least six months.
Other ways to reduce the risk of sudden infant death, from the AAP:
- Breastfeeding, when possible, has been shown to reduce the risk for sudden infant death. The AAP also cited the evidence that pacifiers given during naps and at bedtime may be beneficial.
- Weighted blankets and sleepers should not be used on or near sleeping babies.
- Make sure babies' cribs have not been recalled for safety hazards.
- Help babies strengthen the muscles they will someday use to turn over and away from potential dangers with supervised "tummy time." This practice may begin, the AAP says, soon after babies are able to go home from the hospital.
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