Safe infant sleep initiatives and evidence based on death reviews

Initiatives to reduce infant deaths in the sleep-related environment address different aspects of risks. Most initiatives target asphyxia and strangulations while some support reduction of risk associated with infant vulnerability characteristics. Initiatives from the National Institutes of Health “Back to Sleep” campaign, National “Crib for Kids”, Consumer Product Safety Commission, and Home Safety Council are described. Recommendations based on emerging knowledge of risks of sudden unexpected infant death (SUID), from the American Academy of Pediatrics Policy Statements are described, including those for infants born with developmental delay, prematurity, low birth weight, and birth defects. Evidence to support safe sleep initiatives is often based on child death review (CDR) results. CDR data on the sleep-related circumstances of more than 3000 SUID cases occurring in 2005-2007 show: More than half were on adult beds (41%) or couches and chairs (12%); 25% were in cribs. Almost half occur while sharing a sleeping surface with others. Only 25% were found on their back when discovered although the sleep position was unknown in about 30% of cases, indicating a need for better death scene investigations. Death was attributed by medical examiners and coroners to SIDS in 27% of cases, asphyxia in 24%, and unknown or undetermined cause in 31% of cases, indicating a need for improved autopsies and medical histories.