Philadelphia, like most major cities, has a team that regularly reviews the most tragic events many of us can imagine: the deaths of children. The goal is to look for any patterns that might help prevent these deaths, and the circumstances that allowed them to occur.
A recent report from the city's Department of Public Health shows that we still have a long way to go, specifically when it comes to the number of infants who die at what should be a safe time, when they are put to sleep.
Infant sleep-related deaths declined from an average of 42 each year in the city's 2006-10 report to 35 a year in the most recent chart, covering 2011-15. That works out to three babies dying every month.
This is 75 percent higher than the national average.
The vast majority – 90 percent – of Philadelphia's sudden unexplained infant deaths occur before 6 months of age, and are most common at between 2 and 3 months. These tragic deaths are three times as likely in black children, and almost two times as likely in Latino infants. But the greatest predictor is income: Babies in low-income families are five times as likely to die this way.
The agony of these sudden deaths haunts families, and the emergency room workers who must tell stunned parents and grandparents that the infant they'd kissed goodnight will not be going home.
Nearly 20 years ago, I was a pediatric resident on the night shift, when the emergency room doors burst open at 5 a.m. one day. In rushed a paramedic carrying a motionless, blanket-wrapped bundle, the parents' agonized wails blending with the ambulance sirens. That mother and father's agony, their desperation, remain with me still, a memory refreshed every time I see another such sad story, even in the pages of a report.
Some infant deaths are truly unexplainable. But most could have been prevented with simple precautions.
Seven in 10 sleep-related infant deaths in Philadelphia occurred when a child was put in an unsafe place, usually an adult bed, where it is all too easy for a child to be accidentally smothered by another person, or by soft pillows, toys or clothes. Such objects are not even safe in a crib – nearly half of crib deaths happen in a cluttered space.
In more than half of sudden infant deaths, the baby was found on his or her stomach or side, which more than doubles the risk, compared with babies put to sleep on their backs. Second-hand smoke exposure also is a major risk factor for sudden death – it's found in more than half of the cases.
But this isn't even news.
More than a generation ago — in the mid-1980s — health authorities in the Netherlands made a major education effort to get parents to put babies to sleep on their backs, and an abrupt decrease in sudden death followed. Not long after, studies published in Australia, New Zealand, and the United Kingdom showed a significant link between sudden death and stomach sleeping. In March 1991, the New Zealand Cot Death Prevention Program began and rates decreased by 50 percent.
An American Academy of Pediatrics Task Force on Infant Sleep Position and Sudden Infant Death Syndrome began to evaluate these studies on stomach sleeping as a risk factor for SIDS. In June 1992, the task force recommended that U.S. babies be placed on their backs to sleep. Just as in Europe, rates of these deaths in the United States also decreased by 50 percent.
So why are 3,700 infants still dying each year of what we now call sudden unexplained infant deaths?
Clearly, we have more work to do to educate parents so we can save more babies' lives — and more parents from a lifetime of guilt over not fully understanding how what seems like caring behavior can in fact be deadly.
Why, why do parents still put their baby to sleep in unsafe circumstances? There are several misconceptions that still need to be debunked. For instance, when a baby is sick, a parent may think it's best to monitor the child closely, in the adult's bed. In fact, putting the baby in a crib or one of the baby boxes more hospitals are distributing, placed next to the bed, would be both safe and convenient.
Before a newborn leaves a hospital, it's standard for the parents to be given some form of safe sleep message. But maybe that doesn't always happen, or maybe it's overshadowed by older family members accustomed to thinking children sleep better on their stomachs (which is a myth). Or maybe exhausted, sleep-deprived, stressed parents desperate for a night's rest place their child in bed with them, just once.
Safe sleep for infants is as easy as ABC — but the rules have to be followed every single time.
- Always have an infant sleep alone.
- Always have an infant sleep on their back.
- Always have an infant sleep in a crib (or bassinett or Pack-n-Play or baby box).
Breastfeeding dramatically reduces the risk of SUID, according to the pediatrics academy. Another tip: Keep baby in the parent's room (in its own crib, of course) for the first six months.
Not smoking during pregnancy, and not allowing anyone in a house with an infant to smoke, also decreases risk. Using a pacifier during naps and sleep has also been shown to decrease risk.
For more information, go to the Safe to Sleep Campaign's website, at nichd.nih.gov, where you'll find useful tips and videos for parents, grandparents, caregivers, health-care providers – all of us who want to keep babies safe.