Advertisement

Types of Objects in the Sleep Environment Associated With Infant Suffocation and Strangulation

      Abstract

      Objective

      To investigate the circumstances of death and types and roles of objects present in the sleep environment at the time of death for infants who died from suffocation or strangulation during sleep.

      Methods

      This study analyzed 1736 reported incidents of accidental suffocation and strangulation in bed (ASSB) of infants younger than 1 year of age. These fatalities occurred from 2000 through 2012 and were reported to the United States Consumer Product Safety Commission.

      Results

      The mean age of ASSB death was 3.76 months (SD, 2.51). Infants younger than 5 months accounted for 67.3% (1168 of 1736) of all reported fatalities and 58.3% (1009 of 1731) were male. Deceased infants were often found in a crib or bassinet (30.6%; 383 of 1253) or in the prone orientation (84.9%; 595 of 701). The most common objects associated with infant ASSB were pillows (24.5%; 425 of 1736), mattresses (21.0%; 364 of 1736), blankets (13.1%; 228 of 1736), and walls (11.5%; 199 of 1736). Wedged (43.3%; 616 of 1424) or positioned on top of an object (25.9%; 369 of 1424) were the most common positions associated with death. Infants were often found wedged between a mattress and wall (30.2%; 181 of 599) or oriented face-down or prone on top of a pillow (52.2%; 187 of 358). Sleep surface sharing was associated with 6.5% (112 of 1736) of ASSB deaths.

      Conclusions

      Pillows and blankets are objects in sleep environments frequently associated with unintentional suffocation and strangulation of infants. Increased efforts should be made to remove these and other objects from sleep environments of infants.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Kochanek KD, Murphy SL, Xu J, Tejada-Vera B. Deaths: final data for 2014. National vital statistics reports. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf. Accessed January 9, 2017.

      2. Borse NN, Gilchrist J, Dellinger AM, et al. CDC childhood injury report: patterns of unintentional injuries among 0-19 year olds in the United States, 2000-2006. Available at: http://www.cdc.gov/safechild/images/CDC-childhoodinjury.pdf. Accessed January 9, 2017.

        • Shapiro-Mendoza C.K.
        • Kimball M.
        • Tomashek K.M.
        • et al.
        US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: are rates increasing?.
        Pediatrics. 2009; 123: 533-539
        • Centers for Disease Control and Prevention
        Guidelines for death scene investigation of sudden, unexplained infant deaths: recommendations of the Interagency Panel on Sudden Infant Death Syndrome.
        MMWR. 1996; 45: 1-31
        • Malloy M.H.
        • MacDorman M.
        Changes in the classification of sudden unexpected infant deaths: United States, 1992-2001.
        Pediatrics. 2005; 115: 1247-1253
        • Carlberg M.M.
        • Shapiro-Mendoza C.K.
        • Goodman M.
        Maternal and infant characteristics associated with accidental suffocation and strangulation in bed in US infants.
        Matern Child Health J. 2012; 16: 1594-1601
        • Moon R.Y.
        • AAP Task Force on Sudden Infant Death Syndrome
        SIDS and other sleep-related infant deaths: evidence base for 2016 updated recommendations for a safe infant sleeping environment.
        Pediatrics. 2016; 138: e20162940
        • AAP Task Force on Sudden Infant Death Syndrome
        SIDS and other sleep-related infant deaths: updated 2016 recommendations for a safe infant sleeping environment.
        Pediatrics. 2016; 138: e20162938
        • Kim S.Y.
        • Shapiro-Mendoza C.K.
        • Chu S.Y.
        • et al.
        Differentiating cause-of-death terminology for deaths coded as sudden infant death syndrome, accidental suffocation, and unknown cause: an investigation using US death certificates, 2003-2004.
        J Forensic Sci. 2012; 57: 364-369
        • Drago D.A.
        • Dannenberg A.L.
        Infant mechanical suffocation deaths in the United States, 1980-1997.
        Pediatrics. 1999; 103: 1-9
        • Byard R.W.
        Hazardous infant and early childhood sleeping environments and death scene examination.
        J Clin Forensic Med. 1996; 3: 115-122
        • Scheers N.J.
        • Rutherford G.W.
        • Kemp J.S.
        Where should infants sleep? A comparison of risk for suffocation of infants sleeping in cribs, adult beds, and other sleeping locations.
        Pediatrics. 2003; 112: 883-889
        • Nakamura S.
        • Wind M.
        • Danello M.A.
        Review of hazards associated with children placed in adult beds.
        Arch Pediatr Adolesc Med. 1999; 153: 1019-1023
        • Blair P.S.
        • Mitchell E.A.
        • Heckstall-Smith E.M.
        • Fleming P.J.
        Head covering - a major modifiable risk factor for sudden infant death syndrome: a systematic review.
        Arch Dis Child. 2008; 93: 778-783
        • Kemp J.S.
        • Unger B.
        • Wilkins D.
        • et al.
        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.
        Pediatrics. 2000; 106: E41
        • Gilbert R.
        • Salanti G.
        • Harden M.
        • See S.
        Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002.
        Int J Epidemiol. 2005; 34: 874-887
        • AAP Task Force on Sudden Infant Death Syndrome
        The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk.
        Pediatrics. 2005; 116: 1245-1255
        • Shapiro-Mendoza C.K.
        • Colson E.R.
        • Willinger M.
        • et al.
        Trends in infant bedding use: National Infant Sleep Position study, 1993-2010.
        Pediatrics. 2015; 135: 10-17
      3. U.S. Consumer Product Safety Commission. Guide to Public Information. Available at: https://www.cpsc.gov/Newsroom/FOIA/Guide-to-Public-Information/. Accessed August 8, 2017.

        • Skadberg B.T.
        • Markestad T.
        Consequences of getting the head covered during sleep in infancy.
        Pediatrics. 1997; 100: e6
        • Pasquale-Styles M.A.
        • Tackitt P.L.
        • Schmidt C.J.
        Infant death scene investigation and the assessment of potential risk factors for asphyxia: a review of 209 sudden unexpected infant deaths.
        J Forensic Sci. 2007; 52: 924-929
        • Batra E.K.
        • Teti D.M.
        • Schaefer E.W.
        • et al.
        Nocturnal video assessment of infant sleep environments.
        Pediatrics. 2016; 138: e20161533
        • Epstein J.
        • Jolly C.
        • Mullan L.
        A review of images of sleeping infants in UK magazines and on the Internet.
        Community Pract. 2011; 84: 23-26
        • Joyner B.L.
        • Gill-Bailey C.
        • Moon R.Y.
        Infant sleep environments depicted in magazines targeted to women of childbearing age.
        Pediatrics. 2009; 124: e416-e422
        • Chung M.
        • Oden R.P.
        • Joyner B.L.
        • et al.
        Safe infant sleep recommendations on the Internet: let's Google it.
        J Pediatr. 2012; 161: 1080-1084
        • Moon R.Y.
        • Gingras J.L.
        • Erwin R.
        Physician beliefs and practices regarding SIDS and SIDS risk reduction.
        Clin Pediatr (Phila). 2002; 41: 391-395
        • Moon R.Y.
        • Kington M.
        • Oden R.
        • et al.
        Physician recommendations regarding SIDS risk reduction: a national survey of pediatricians and family physicians.
        Clin Pediatr (Phila). 2007; 46: 791-800
        • Willinger M.
        • Ko C.
        • Hoffman H.J.
        • et al.
        Factors associated with caregivers' choice of infant sleep position, 1994-1998: the National Infant Sleep Position Study.
        JAMA. 2000; 283: 2135-2142
        • Byard R.W.
        • Winskog C.
        Floor mattresses: another potentially dangerous infant sleeping environment.
        J Paediatr Child Health. 2011; 47: 554-556
      4. U.S. Consumer Product Safety Commission. Seven manufacturers announce recalls to repair cribs to address entrapment, suffocation and fall hazards industry launches new initiative to secure drop sides with free immobilization devices. Available at: http://www.cpsc.gov/en/Newsroom/News-Releases/2010/Seven-Manufacturers-Announce-Recalls-to-Repair-Cribs-to-Address-Entrapment-Suffocation-and-Fall-Hazards-Industry-Launches-New-Initiative-to-Secure-Drop-Sides-with-Free-Immobilization-Devices/. Accessed January 9, 2017.

      5. KIDS in Danger. A KID report card: children's product recalls in 2015. Available at: http://www.kidsindanger.org/docs/research/KID_Report_Card_0316.pdf. Accessed January 9, 2017.

        • Scheers N.J.
        • Woodard D.W.
        • Thach B.T.
        Crib bumpers continue to cause infant deaths: a need for a new preventive approach.
        J Pediatr. 2016; 169: 93-97.e91
      6. U.S. Consumer Product Safety Commission. Joint Statement of Chairman Elliot F. Kaye, Commissioner Robert S. Adler, Commissioner Marietta S. Robinson and Commissioner Joseph P. Mohorovic recommending parents and caregivers not use padded crib bumpers. Available at: https://cpsc.gov/s3fs-public/Joint%20Statement%20on%20Padded%20Crib%20Bumpers%20FINAL%2011.3.16.pdf. Accessed January 9, 2017.

      7. AAP News. Jenco M. AAP disappointed in CPSC's decision not to ban crib bumpers. Available at: http://www.aappublications.org/news/aapnewsmag/2016/11/07/CribBumpers110716.full.pdf. Accessed January 9, 2017.

        • Ostfeld B.M.
        • Perl H.
        • Esposito L.
        • et al.
        Sleep environment, positional, lifestyle, and demographic characteristics associated with bed sharing in sudden infant death syndrome cases: a population-based study.
        Pediatrics. 2006; 118: 2051-2059