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Unsafe sleep practices underlie most sudden unexpected infant deaths in the U.S., with three-quarters of infants affected by multiple unsafe practices at the time of death, and almost 60% sharing a sleep surface with another person. These are the key findings from our recent study published in Pediatrics.

Sudden unexpected infant death, or SUID, occurs in infants less than 1 year old who die suddenly and unexpectedly without an obvious cause before investigation, accounting for about 3,400 deaths annually in the U.S.. These infants die from sudden infant death syndrome, or SIDS, accidental suffocation and strangulation in bed, or other ill-defined and unknown causes.

Infants sharing a sleep surface with parents, other adults or other infants or children is highly discouraged by the American Academy of Pediatrics and numerous other agencies because it can increase the risk of these deaths.

So the high occurrence of surface sharing – also called bedsharing – in our study is alarming. The study included 7,595 infants who died from SUID during the period 2011 to 2020 and who were in the Centers for Disease Control and Prevention’s SUID Case Registry, which collects data from child death review teams in 23 states, cities or counties.

We examined characteristics of infants who were bedsharing at the time of death.

Compared with nonsharing infants in our study, bedsharing infants were more likely to have the following characteristics:

Among nonsharing infants in the study, only one-third were sleeping in the recommended back position, and three-quarters were in sleep areas that had soft bedding such as pillows, comforters or bumper pads at the time of death.

Three-quarters of all the sudden unexpected infant deaths in our study were affected by multiple unsafe sleep factors.

Rates of sudden unexpected infant deaths overall in the U.S. have changed only minimally in the past 20 years, but racial-ethnic disparities [in these deaths are widening] due to increasing rates among non-Hispanic Black infants.

Our study suggests that the majority of these deaths are preventable by following the guidelines for safe infant sleep as outlined by the American Academy of Pediatrics and the National Institute of Child Health and Human Development.

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