SIDS increased for black infants early in pandemic and cause unknown, CDC says

Despite a record infant mortality rate in 2020, a new study reveals an unexpected increase in unexplained deaths among black infants in the first year of the coronavirus pandemic.

The rate of SIDS, or Sudden Infant Death Syndrome, rose 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 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 where the cause of death cannot be definitively explained. It is not used when a child has accidentally been suffocated by a pillow cushion, for example.

In data collection, SIDS and incidents of accidental choking or strangulation fall under the umbrella term SUID, or Sudden Unexplained Infant Death Syndrome.

SIDS data is not broken down by race and ethnicity, but SUID numbers are. This is where the researchers found the increase in unexplained deaths among black infants, but not for other racial or ethnic groups.

The finding “came absolutely a surprise to us,” said study author Sharyn Parks Brown, senior epidemiologist for the CDC’s Perinatal and Child Health Team. The racial and ethnic breakdown of those deaths had been consistent for decades, she said.

The reasons for the jump are unknown. It could be a statistical anomaly – an unexplained error in the data – that should be monitored for several more years to see if 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.

According to the guidelines, finding babies on or near soft bedding was not enough to qualify these deaths as accidental suffocation without evidence that the children’s airways had indeed been blocked. These cases, according to the recommendations, should be classified as SIDS.

“If the new guidelines had been followed, this could have led to an increase in reports of SIDS,” the study authors wrote.

Whatever the reason, complex racial disparities clearly persist. Black people have been disproportionately affected by the pandemic, both through illness and the economic stress that has accompanied the pandemic.

According to an editorial published alongside the study, black people are more than twice as likely as white people 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.

Editorial co-author Dr Rebecca Carlin, an affiliate pediatrician at Columbia University in New York, said: “If you don’t have a safe place for your baby to sleep, how are you make you sleep safe?”

Additionally, black communities have higher rates of smoking and premature births. Both are risk factors for Sudden Infant Death Syndrome.

Safe Sleep Practices

Parks Brown and his team published a study in 2021 that found unsanitary bedding is a leading cause of unexpected deaths in babies 4 months and younger.

For this age group, soft items, such as blankets, pillows, bumpers and stuffed animals, should not be placed in cribs when babies are sleeping or left unattended, according to the American Academy of Pediatrics. Children this age do not have the strength and motor skills to move away from choking hazards.

AAP guidelines state that very young infants should be put to sleep on their back until their first birthday. They should sleep alone in their bed on firm, flat surfaces with fitted sheets only. Sofas and armchairs put babies at an extremely high risk of suffocation, as they could get caught between seat cushions or under sleeping adults.

Experts also advise keeping babies’ cribs in caregivers’ rooms for at least six months.

Other ways to reduce the risk of Sudden Infant Death Syndrome, from AAP:

• Breastfeeding, when possible, has been shown to reduce the risk of sudden infant death syndrome. The AAP also cited 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 baby cribs have not been recalled for safety risks.
• Help babies strengthen the muscles they’ll one day use to roll over and get away from potential hazards with supervised “tummy time.” This practice can begin, according to the AAP, soon after babies are able to go home from the hospital.

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