Sudden Unexpected Infant Deaths Rise, Disproportionally Impacting Non-Hispanic Black Babies, Study Finds

A pediatrician shares evidence-based recommendations for parents and caregivers for safer sleep.

A new study published in Pediatrics found an overall 15% increase in sudden infant death syndrome (SIDS) from 2019 to 2020. It also found that non-Hispanic Black babies died suddenly and unexpectedly at nearly three times the rate of non-Hispanic white infants in 2020, highlighting the widening racial disparity in infant deaths. SIDS, which often happens during sleep or in the baby’s sleep area, is now the third leading cause of infant death in the United States and the leading cause of death for babies between 1 month and 1 year of age.

“There has always been a disparity in the rate of sleep-related deaths in the United States, and it is disheartening to see it increase even further,” says Dr. Rebecca F. Carlin, a pediatrician at NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian Morgan Stanley Children’s Hospital.

Dr. Rebecca F. Carlin

Each year, 3,400 babies younger than 1 year of age die suddenly and unexpectedly in their sleep, according to the Centers for Disease Control and Prevention (CDC). Sudden unexpected infant deaths include SIDS, accidental suffocation in a sleeping environment, and other deaths from unknown causes.

The reason for the rise in sleep-related deaths among non-Hispanic Black infants is unknown, according to the study, but it happened during the COVID-19 pandemic, which disproportionately affected communities of color. The study noted that the pandemic exacerbated crowded housing, food insecurity, unemployment, and other factors.

“The most recent available data indicates that more than 95% of sudden unexpected infant deaths have at least one modifiable risk factor and are thus potentially preventable,” says Dr. Carlin. “As a society, we need to better support new parents and address the systemic issues that lead to this disparity, so that parents are able to implement recommended safe sleep practices.”

Dr. Carlin, who is also an assistant professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons, co-authored a separate report, also in Pediatrics, with 19 evidence-based recommendations for parents and caregivers, which is supported by the CDC. Dr. Carlin shared some of the report’s recommendations with Health Matters.

“These updated recommendations are meant to help reduce the risk of sleep-related deaths and to help inform conversations between families and providers around safe sleep practices,” she says. “The recommendations include practices such as putting the infant in their own crib, on their back, and removing any loose bedding.”

Place infants on their backs for sleep on a firm, flat mattress with fitted sheets and no other bedding or objects.
Infants should always be placed to sleep on their backs until the child reaches 1 year of age, the report states, advising not to place them prone (on their bellies) or on their sides. Once an infant is able to roll both ways (front to back and back to front), they do not need to be flipped back over if they roll themselves. “Infants should be on a firm, flat, non-inclined sleeping surface with only fitted sheets,” says Dr. Carlin. Make sure that no other bedding or soft objects, such as pillows, pillowlike toys, quilts, or comforters, to name a few, are surrounding the baby. Doing this can reduce the risk of suffocation, wedging, or entrapment from loose or soft objects.

Whenever possible, feed breast milk instead of formula.
Studies have shown that breastfeeding is associated with a decreased risk of SIDS. One study found that breastfeeding babies for just two months reduced the risk of SIDS by half. “Studies have shown that the longer a baby is exclusively fed human milk, the lower their SIDS risk,” says Dr. Carlin. “But receiving any human milk has also been found to reduce the rate of SIDS compared to babies who are only fed formula.” The American Academy of Pediatrics recommends infants be fed with human milk exclusively for about six months, continuing until they are 2 years old or older.

Share a room, but not a bed.
When infants sleep in the same room as their parents or caregivers, but not in their parents’ bed, the risk for SIDS drops by as much as 50%, the Pediatrics report states. Since sleep-related deaths are highest before 6 months of age, room sharing during this period is especially important. “Parents or caregivers can more easily feed their infants and check in on them while they sleep in their crib or bassinet since they are in the same room,” says Dr. Carlin.

Use a pacifier.
Offering a pacifier to the infant during naptime and bedtime is also encouraged. Studies have found that pacifiers can protect infants from SIDS. “Babies do not have to keep the pacifier in their mouth the whole time they are sleeping,” says Dr. Carlin. “If they go to sleep with the pacifier, it has been found to cause a reduction in SIDS prevalence.” For breastfeeding infants, it is recommended that pacifier introduction be delayed until breastfeeding is firmly established, which can take varying amounts of time.

Practice supervised tummy time.
The safest way to put babies to sleep is on their backs, but it is important for parents and caregivers to do daily tummy time when babies are awake. This will help them develop gross motor skills and avoid a flat head, also known as positional plagiocephaly. By 7 weeks of age, infants should be doing at least 15 to 30 minutes total every day. “Tummy time can generally begin as soon as infants are home from the hospital and can increase incrementally,” says Dr. Carlin. “It helps their neck muscles get stronger, so they get better head control, and builds their abdominal muscles.”

Stay up to date with vaccinations.  
Infants should be immunized in accordance with guidelines from the American Academy of Pediatrics and the Centers for Disease Control and Prevention. There is no scientific evidence of any link between vaccinations and SIDS. In fact, vaccinations, the report states, may have a protective effect against SIDS.

Read the complete list of recommendations here.

Rebecca Carlin, M.D., is a pediatrician at NewYork-Presbyterian/Columbia University Irving Medical Center and NewYork-Presbyterian Morgan Stanley Children’s Hospital, and an assistant professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons.

At A Glance

Featured Expert


Consult an Expert

Find a Doctor or call