Each year in the U.S., about 4,000 infants between 1 and 12 months of age die of initially unexplained circumstances. After a thorough forensic investigation that includes an autopsy, about half of these horrible events remain unexplained. We call these mysterious deaths SIDS — sudden infant death syndrome. An abnormality or immaturity of the part of an infant’s brain that controls breathing during sleep and sleep arousal is thought to be the culprit of SIDS. Since 1992, when the American Academy of Pediatrics launched its “Back to Sleep” campaign encouraging parents to always place their infants in the supine (belly up) position to sleep, the incidence of SIDS has declined by more than 50%.
For the other half of these sudden unexpected infant deaths (SUID), two causes are eventually discovered: accidental suffocation and strangulation in bed. In 2011, the AAP released updated recommendations to prevent SUID, including SIDS, by emphasizing a safe sleep environment for infants. Steps parents could take to prevent these unexpected infant deaths include:
- Supine (on the back) positioning.
- The use of a firm sleep surface (a crib mattress being the safest surface).
- Room sharing without bed sharing.
- Routine immunizations.
- Consideration of a pacifier.
The recommendations include things to be avoided in infants:
- Soft bedding. (Cushions, pillows, and crib bumper pads.)
- Exposure to second-hand tobacco smoke, alcohol, and illicit drugs.
We’ve covered infant-parent bed sharing (co-sleeping) previously on The PediaBlog. A new study in Pediatrics shines a light on probably the most dangerous place for a baby to sleep: the sofa. Prior studies show that the sofa-as-a-bed increases the risk of SUID up to 67 times, especially when the sofa is shared with another person. This new study tells us why sofas were found to be so dangerous:
The soft surface of most sofas may create rebreathing and a potentially asphyxiating environment for infants, especially if they are placed in a nonsupine position. Some sofa surfaces also slope down toward the back cushions, which makes it easier for infants to roll and wedge between the seat and back-supporting surface. In this sample, infants who died on sofas were more likely than those who died on other surfaces to be found in the side position. Sleeping on the side with one’s face against the back cush- ions of the sofa or against another person can result in suffocation.
13% of sleep-related infant deaths examined in the study involved babies sleeping on a sofa. The conclusion:
The sofa is an extremely hazardous sleep surface for infants. Deaths on sofas are associated with surface sharing, being found on the side, changing sleep location, and experiencing prenatal tobacco exposure, which are all risk factors for sudden infant death syndrome and sleep-related deaths.