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Sudden Unexpected Infant Death (SUID) includes the full spectrum of all infant death causes, which include “Determined” causes [e.g. Sudden Infant Death Syndrome (SIDS) at 42% and Accidental Suffocation and Strangulation at 24%], as well as “Undetermined” causes at 34% [1]. Literature is replete with studies that address the risk factors associated with SIDS, accounting for at least 42% of infant mortality [1]. Scarce to find, however, is public health education or learning opportunities that address the mechanism of brain injury and death by Positional Asphyxiation (PA). Better yet, in the current day of popular social media platforms and cell phone apps, there should be readily available video education on the topic where the focus is on PA risk factors and prevention. Viewing should be required of new parents and caretakers, as well as to health professionals, including pediatric clinical trainees who specialize in infant care. Other suggested locations for viewing would be hospital postpartum delivery suites and pediatric waiting rooms.The accidental but preventable phenomenon of PA gives rise to the annual occurrence rate of 2.8 – 3.0% (98-105 deaths) in healthy infants who have no pre-existing medical conditions, including prematurity. They die from SUID primarily in car seats, accounting for 69% of deaths in sitting devices [1]. Webster’s Dictionary defines PA as, “A condition of deficient oxygen supply to the brain and body which occurs when a person’s physical position prevents normal breathing.” Each tragic occurrence is first suspected, then largely confirmed by a combination of investigative reports and the absence of gross or observable findings from post-mortem autopsy--like tissue injury from traumatic injury or inflammatory changes. Additionally, there would be no recorded or known history of a pre-existing medical condition. Given these factors, post-autopsy typically confirms the cause of death as “Undetermined or Unknown.” Perhaps the combination of the low incidence rate of PA and “Undetermined” autopsy reports cause this mechanism of infant mortality to be an “unsung” category of SUID, thus remains in obscurity with respect to disseminated public health education.

Background: Despite recommendations from the American Academy of Pediatrics (AAP) regarding infant safe sleep practices, 39% of sleep-related infant deaths (SRID) occur among African American (AA) families each year. Effective interventions that promote AA parents/caregivers' safe sleep practices for infants could help reduce SRID. Objective: To identify appropriate safe sleep interventions that increased compliance of AAP recommendations to reduce the risk of SRID among AA mothers/caregivers, a literature review was conducted. Methods: PubMed, EBSCOhost, and Google Scholar search engines were utilized to identify evidence-based research studies, published in English from 2000-2019 in the U.S that demonstrated the effectiveness of safe sleep interventions for AA parents/caregivers based on the AAP recommendations. Findings: The literature review revealed that multiple-element interventions such as free cribs and related materials, and safe sleep education increased adherence to AAP recommendations as evidenced by the majority mothers using the crib and adopting safe sleep recommendations. Conclusion and Recommendations: Although multiple interventions including education are valuable, culturally appropriate research is needed to better understand what specific intervention(s) will work to increase adherence to the AAP safe sleep recommendations among the remaining 39% of AA parents/caregivers who contribute disproportionately to the SRID disparity. Behavioral and environmental barriers preventing the adoption of safe sleep interventions also need to be studied in this target group of AA parents/caregivers. It is recommended that findings from these highly targeted evidence-based culturally appropriate studies be used to focus on funding, prevention programming, and policies toward the causes of SRID to close the disparity gap.

Sudden Unexpected Infant Death (SUID) includes the full spectrum of all causes of infant death, which include “Determined” causes [e.g. Sudden Infant Death Syndrome (SIDS) at 42% and Accidental Suffocation and Strangulation at 24%], as well as “Undetermined” causes at 34% [1]. Literature is replete with studies that address the risk factors associated with SIDS, accounting for at least 42% of infant mortality,[1] but scarcely do published reports address risk factors associated with Positional Asphyxia (PA).This illustrative narrative addresses the 2.8 – 3.0% (98-105) healthy infants who have no pre-existing medical conditions, including prematurity, who die from SUID primarily in car seats, and whose suspected cause of death is PA. Webster’s Dictionary defines PA as, “A condition of deficient oxygen supply to the body which occurs when a person’s physical position prevents adequate breathing.” This tragic phenomenon is suspected when the autopsy of an infant reveals no discovery of a traumatic injury, when there is no pre-existing medical pathology, and when the cause of death is determined to be “Undetermined or Unknown.”