Unsafe Sleep Practices and an Analysis of Bedsharing Among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths

Kemp, James S.; Unger, Benjamin; Wilkins, Davida; Psara, Rose; Ledbetter, Terrance; Graham, Michael; Case, Mary Anne; Thach, Bradley T.

doi:10.1542/peds.106.3.e41

Cited by 144 publications

(102 citation statements)

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“…Participant demographic characteristics have been described previously. 40,42,43 In summary, mean maternal age was 27.4 years (range: 18 -42 years), and 74.7% were never married. Sixty-five percent of the mothers had a high school diploma, and an additional 24.1% had a 4-year college degree.…”

Section: Samplementioning

confidence: 94%

Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

et al. 2011

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OBJECTIVE: The goal of this qualitative study was to examine factors influencing decisions by black parents regarding use of soft bedding and sleep surfaces for their infants. METHODS: We conducted focus groups and individual interviews with black mothers of lower and higher socioeconomic status (SES). Mothers were asked about many infant care practices, including sleep surface and bedding. RESULTS: Eighty-three mothers were interviewed, 73 (47 lower and 26 higher SES) in focus groups and 10 (7 lower and 3 higher SES) in individual interviews. The primary reason for using soft surfaces was infant comfort. Parents perceived that infants were uncomfortable if the surface was not soft. Many parents also interpreted “firm sleep surface” to mean taut; they were comfortable with and believed that they were following recommendations for a firm sleep surface when they placed pillows/blankets on the mattress as long as a sheet was pulled tautly over the pillows/blankets. The primary reasons for using soft bedding (including bumper pads) were comfort, safety, and aesthetics. In addition to using bedding to soften sleep surfaces, bedding was used to prevent infant rollover and falls, particularly for infants sleeping on a bed or sofa. Some parents used soft bedding to create an attractive space for the infant. CONCLUSIONS: Many black parents believe that soft bedding will keep their infant safe and comfortable. There is much misunderstanding about the meaning of a “firm” sleep surface. Additional educational messages apparently are needed to change parental perceptions and practices.

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Section: Samplementioning

confidence: 94%

Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

et al. 2011

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“…1 We determined death rates for SIDS, accidental suffocation (AS), and "cause of death undetermined" (UD) in AA and non-AA infants under 2 years of age. The deaths occurred during a 4-year period (1994 -1997) in a socioeconomically diverse population (St Louis City and County).…”

Section: Methodsmentioning

confidence: 99%

“…We used data from standardized death scene investigations. 1 All cases were reviewed by a Missouri State Child Fatality Review Program panel before final diagnosis. For each of these 3 types of death we also recorded: position of body when found; whether the infant shared a sleep surface with another person at death, termed "bedsharing"; and type of sleep surface where death occurred.…”

Section: Methodsmentioning

confidence: 99%

“…1 Recently, however, efforts to reduce racial disparity in sudden unexpected infant deaths attributable to SIDS have been given increased emphasis. Accordingly, we have used this death scene data set to determine the degree of racial disparity in such deaths and to assess the potential contribution of modifiable risk factors in contributing to this disparity in SIDS and related causes of death.…”

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confidence: 99%

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Racial Disparity and Modifiable Risk Factors Among Infants Dying Suddenly and Unexpectedly

Unger

Kemp²,

Wilkins

et al. 2003

Pediatrics

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ABSTRACT. Background. Racial disparity in rates of death attributable to sudden infant death syndrome (SIDS) has been observed for many years. Despite decreased SIDS death rates following the "Back to Sleep" intervention in 1994, this disparity in death rates has increased. The prone sleep position, unsafe sleep surfaces, and sharing a sleep surface with others (bedsharing) increase the risk of sudden infant death. The racespecific prevalence of these modifiable risk factors in sudden unexpected infant deaths-including SIDS, accidental suffocation (AS), and cause of death undetermined (UD)-has not been investigated in a populationbased study. Death rates attributable to AS and UD are also higher in African Americans (AAs) than in other races (non-AA). The potential contribution of unsafe sleep practices to this overall disparity in death rates is uncertain.Objective. The objective of this study was to compare death rates attributable to SIDS and related causes of death (AS and UD) in AA and non-AA infants and the prevalence of unsafe sleep practices at time of death. Our hypothesis was that there is a large racial disparity in these modifiable risk factors at the time of death, and that public awareness of this could lead to improved intervention strategies to reduce the disparity in death rates.Methods. In this population-based study, we retrospectively reviewed death-scene information and medical examiners' investigations of deaths in St Louis City and County between January 1, 1994, and December 31, 1997. The deaths of all infants <2 years old with the diagnoses of SIDS, AS, or UD were included. Sleep surfaces other than those specifically designed and approved for infant use were termed nonstandard (adult beds, sofas, etc). Denominators for our rate estimates were the number of births (AA and non-AA) in St Louis City and County during the study period.Results. The deaths of 119 infants were studied (81 AA and 38 non-AA). SIDS rates were much higher in AA than non-AA infants (2.08 vs 0.65 per 1000 live births), as was the rate of AS (0.47 vs 0.06). There was a trend for increased deaths diagnosed as UD in AA infants (0.36 vs 0.06). Bedsharing deaths were nearly twice as common in AAs (67.1% vs 35.1% of deaths), as were deaths on nonstandard sleep surfaces (79.0% vs 46.0%). Forty-nine percent (49.1%) of all infants who died while bedsharing were found on their backs or sides compared with 20.4% of infants who were not bedsharing. Overall, the fraction of infants found in these nonprone positions was not different for AA infants and non-AA infants (43.3% vs 38.5%). In AA and non-AA infants, factors that greatly increase the risk of bedsharing, such as sofa sharing or all-night bedsharing, were present in all or many bedsharing deaths.Conclusion. Among AA infants dying suddenly and unexpectedly, the high prevalence of nonstandard bed use and bedsharing may underlie, in part, their increased death rates. Public health messages tailored for the AA community have stressed first and foremost using nonprone sleep pos...

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“…Currently, approximately half of all sudden and unexpected infant deaths in the US occur when the infant is sharing a sleep surface with someone else. (21)(22)(23)(24) There is growing evidence that roomsharing without bedsharing is associated with a reduced risk of SIDS. (9,15,16) Several countries, including the US, currently recommend that infants sleep in a crib or bassinet next to the parents' bed.…”

mentioning

confidence: 99%

Infant Sleep Location: Associated Maternal and Infant Characteristics with Sudden Infant Death Syndrome Prevention Recommendations

Colson

Corwin

et al. 2008

The Journal of Pediatrics

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Objective-To identify factors associated with infant sleep location.Methods-Demographic information and infant care practices were assessed for 708 mothers of infants ages 0 to 8 months at Women, Infants and Children centers (WIC). Generalized linear latent mixed models were constructed for the outcome, sleeping arrangement last night (bedsharing with infants vs. roomsharing without bedsharing, and versus sleeping in separate rooms).Results-Two-thirds of the mothers were black. 48.6% roomshared without bedsharing; 32.5% bedshared; and 18.9% slept in separate rooms. Compared with infants who slept in separate rooms, infants who roomshared without bedsharing were more likely to be Hispanic (OR 2.58,) and younger (3.66 and 1.74 times more likely for infants 0-1 month and 2-3 months old respectively as compared with older infants). Compared with infants who bedshared, those that roomshared without bedsharing were more likely to be 0-1 month old (1.57, 1.05-2.35), and less likely to be black (0.43, 0.26-0.70) or have a teenage mother (0.37, 0.23-0.58).Conclusions-Approximately one-third of mothers and infants bedshare despite increased risk of sudden infant death syndrome (SIDS). The factors associated with bedsharing are also associated with SIDS likely rendering infants with these characteristics at high risk for SIDS. Keywords infants; SIDS; bed sharingThe incidence of SIDS in the US has declined 50% since 1992, when the American Academy of Pediatrics (AAP) first recommended that infants be placed in a nonprone position for sleep.(1) Despite the tremendous success of the subsequent Back to Sleep campaign, the initial decline in SIDS rates has leveled off in the last 5 years. Washington, DC 20010, Tel: 202-476-3931, Fax: 202-476-3386, lfu@cnmc As the rate of prone positioning has declined, other previously unrecognized risk factors for sudden unexplained infant death have emerged in recent epidemiologic studies. Despite the fact that bedsharing between an infant and adult facilitates breastfeeding and enhances parent-infant interactions,(6, 7) this sleeping arrangement has been identified in epidemiologic studies as being hazardous in certain situations, particularly when one or both parents are smokers,(8-12) on excessively soft surfaces, such as waterbeds, sofas, and armchairs, (9,10,(13)(14)(15) or when the infant is less than 2-3 months of age. (9,12,(14)(15)(16)(17) In addition, there is an increased risk for sudden unexpected infant death when there are multiple bedsharers(13) and when bedsharing occurs for the entire night.(9, 11) The risk for infant death may also be increased when the bedsharer has consumed alcohol or is overtired. Because of this increased emphasis on the importance of the infant's sleep location, it is necessary to understand factors associated with bedsharing, roomsharing without bedsharing, and solitary sleeping (i.e., infant sleeps in a separate room from parents). The primary aim of this study was to determine the maternal and infant characteristics associated with each of ...

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Unsafe Sleep Practices and an Analysis of Bedsharing Among Infants Dying Suddenly and Unexpectedly: Results of a Four-Year, Population-Based, Death-Scene Investigation Study of Sudden Infant Death Syndrome and Related Deaths

Cited by 144 publications

References 46 publications

Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

Decisions of Black Parents About Infant Bedding and Sleep Surfaces: A Qualitative Study

Racial Disparity and Modifiable Risk Factors Among Infants Dying Suddenly and Unexpectedly

Infant Sleep Location: Associated Maternal and Infant Characteristics with Sudden Infant Death Syndrome Prevention Recommendations

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