A study, “Infant Suffocation Deaths in the Sleep Environment Attributable to Soft Bedding, Overlay, and Wedging,” in the May 2019 Pediatrics reviewed the cases of 250 infants who died from an external airway obstruction in an unsafe sleep environment between 2011 through 2014.

The study found the deaths might have been prevented with safe sleep practices. The study, published online April 22, examined data for infants up to age 1 whose deaths were classified as “explained suffocation” per the Centers for Disease Control and Prevention’s the Sudden Unexpected Infant Death (SUID) Case Registry classification system all of which were assigned one or more mechanism to which the airway obstruction was attributed including soft bedding, wedging and overlay, or other.

Suffocation accounted for 14% of the total 1,812 deaths reported to the CDC registry. The median age of death was 3 months old and most deaths occurred in the home. Suffocation deaths that were explained were most frequently attributed to airway obstruction by soft bedding, followed by overlay, which occurs when another person rolls onto or against the infant, followed by deaths that occurred by wedging, when an infant is wedged between a mattress and wall.

The most common characteristics in all three forms of suffocation were a non-supine sleeping position and sleeping in an adult bed. The American Academy of Pediatrics (AAP) recommends that infants sleep alone, on their backs in a safety-approved crib, bassinet or portable crib with no soft objects or bedding. Since 1999, the number of US infant deaths classified as SUID has remained relatively flat. However, SUID deaths attributed to suffocation have dramatically increased, at least partly due to changing diagnostic preferences and improved death investigations.