Sleep Medicine

Pediatric Pearls: Sleep-Related Deaths

A 32-year-old first-time mother and her 3-month-old daughter come in for a well visit. At the visit, she asks whether it is okay to allow her daughter to sleep in her car seat, and if she can remove the car seat and bring it inside to allow the infant to continue sleeping.

How would you advise your patient?

(Answer and discussion on next page)

Brittany Perry, DO, is a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Answer: Sitting devices should not be used for sleep.

In November 2016, the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome published safe sleep guidelines1 in an effort to reduce the risk of sleep-related infant deaths. The recommendations include ensuring that the infant is placed in the supine position on a firm surface such as a crib or bassinet, avoiding soft objects and loose bedding in the sleep environment, and room sharing but not bed sharing with parents for at least 6 months but no longer than 1 year.

Furthermore, sitting devices (including car seats, strollers, swings, infant carriers, and infant slings) are not recommended for sleep and can put the infant at risk for suffocation or airway obstruction.1 Despite these recommendations, approximately 3500 sleep-related deaths occurred in infants younger than 1 year of age in 2017.2

The Research

In a recent analysis, Liaw and colleagues3 analyzed data obtained from the National Center for Fatality Review and Prevention on deaths occurring during sleep in infants younger than 1 year of age. There were 11,779 sleep-related deaths included in the analysis, and 348 (3%) had occurred in sitting devices.

The Results

The most common cause of death in sitting devices occurred in car seats (62.9%). In less than 10% of these cases, the car seat was used as directed. The most common risk factors for deaths in sitting devices were the supervisor being asleep (33.6%), maternal pregnancy complications (24.4%), infant exposure to secondhand smoke (22.9%), and gestation of less than 37 weeks (22.9%). Most deaths in sitting devices occurred in the child’s home. There were higher odds of death in sitting devices that occurred under the supervision of a child care provider compared with deaths that did not occur in sitting devices.

This study highlights the danger of sitting devices when used for sleep. The results of this study support the need to provide anticipatory guidance to caregivers and child care providers about safe sleep.

Bottom Line—Educating families about the risks of sitting devices when not used for their intended purpose may play an important role in reducing sleep-related infant deaths.

References:

  1. 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(5):e20162938. https://doi.org/10.1542/peds.2016-2938.
  2. Sudden unexpected infant death and sudden infant death syndrome. Centers for Disease Control and Prevention. https://www.cdc.gov/sids/data.htm. Updated April 10, 2019. Accessed July 17, 2019.
  3. Liaw P, Moon RY, Han A, Colvin JD. Infant deaths in sitting devices. Pediatrics. 2019;144(1):e20182576. https://doi.org/10.1542/peds.2018-2576.