Each year, about 3,500 U.S. infants die of SUID, which includes sudden infant death
syndrome (SIDS) and accidental suffocation and strangulation in bed. To protect infants,
AAP policy calls for infants to sleep on their backs on a firm surface with no toys or soft
bedding. They should share their parents’ room but not their bed. The Academy also
recommends breastfeeding, routine immunization and avoiding smoke exposure.
In 1990, 154.6 of every 100,000 infants died of SUID, according to the CDC’s analysis
of mortality data. By 1998, following the Back to Sleep campaign (now known as Safe
to Sleep), the rate declined 44.6%. However, from 1999 to 2015 rates declined only
7% to 92.4 deaths per 100,000 live births. The Healthy People 2020 goal is 84 per
From 2013-’15, SUID rates among states ranged from 33.2 to 202.2 per 100,000. During
those years, 18 states met the federal target, and California, Colorado, Florida,
Kansas, Missouri, New York, Oregon, Washington, Washington, D.C., and Wisconsin saw
significant declines in SUID rates compared to 2000-’02.
SUID rates in Alabama, Alaska, Arkansas, Kentucky and Louisiana increased significantly
since 2000-’02, and each had rates above 150 per 100,000 births.
Authors said more research is needed on the impact of each state’s SUID reduction
programs, demographic changes and emerging issues like opioid use.
“Increased understanding about the factors that have influenced these state-specific
trends is needed in order to leverage successful interventions for adaptation by other
states,” authors wrote.
In a related commentary, Rebecca Carlin, M.D., FAAP, and Rachel Y. Moon, M.D., FAAP, lead author of the Academy’s
SIDS policy and chair of the AAP Task Force on Sudden Infant Death Syndrome, note
the U.S. has a higher SUID rate than other developed countries. It also is the only
one that lacks universal health care, universal paid maternity leave and neonatal
home visiting, which are associated with decreased infant mortality.
As such programs do not appear to be on the horizon, they called for more effective
strategies to discourage maternal smoking and substance use and better communication
of safe sleep practices to combat misinformation.
“In the absence of a dramatic change in our healthcare delivery system that would
enable more emphasis on public safety and prevention,” they wrote, “in order to improve
infant mortality rates, we must commit to learning from local successes and applying
them more broadly.”