Module 1: A New Approach
Conversations Approach

1.1 Defining the Problem

Sleep-related sudden unexpected infant deaths (SUID) are the leading cause of post-neonatal mortality in the United States. Please note: We will be using the term, sleep-related deaths, throughout these modules. See Going Deeper in your left navigation bar for a detailed definition of this and other key terms in the module.

Approximately 3,500 infants die each year due to sleep-related deaths

In 2013, there were a total of 3,442 or 87.0 SUID deaths per 100,000 live births. In addition, rates vary greatly by race and ethnicity. In 2013, SUID rates for non-Hispanic black (172.5) and American Indian/Alaska Native (AIAN) (169.6) women were twice as high as for non-Hispanic white women (84.5).

Infant Mortality and Sudden Infant Death Syndrome, 1983-2010

Infant mortality grant

Used with Permission from the National Center for Education in Maternal and Child Health. (October 2013). SUID/SIDS Statistics. Accessed April 20, 2016.

Caregivers adopting safe sleep practices and breastfeeding can save lives

15% of overall infant mortality is related to sleep-related deaths. While the biological causes of sleep-related deaths are not always clear, researchers have identified protective behaviors that can reduce the risk of sleep-related deaths. Breastfeeding is a protective factor against sleep-related deaths and is important for the overall health and well-being of infants throughout their life spans.

Breastfeeding protects babies from many diseases including ear infections, upper and lower respiratory infections, asthma, and leukemia with the benefits related to how long the baby is breastfed and to exclusive breastfeeding. Sub-optimal breastfeeding has been estimated to contribute to close to 500 of sleep-related deaths. So figuring out how to help families embrace safe sleep and breastfeeding is essential.

We are not making progress in decreasing sleep-related deaths

While there was an initial drop in sleep-related deaths after the Back to Sleep Campaign was launched, that decline has stopped—we seem stuck at current levels. At the same time, safe sleep and breastfeeding are not universally embraced by caregivers, despite their importance. It is time to think about additional approaches to supporting caregivers to adopt safe sleep and breastfeeding. Please note: When we use the term, caregivers, in these modules, we mean, individuals who put babies to sleep: Mothers, fathers, grandparents, siblings, other relatives, legal guardians, foster parents, babysitters, and early care and education providers.

Trends in Sudden Unexpected Infant Death by Cause, 1990-2014

Not making progress

Used with Permission from Centers for Disease Control and Prevention, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2016, February 08). Data and Statistics. Accessed April 20, 2016.

Racial and ethnic disparities persist

In addition, there are significant differences based on race and ethnicity. In 2013, SUID rates for non-Hispanic black and American Indian/Alaska Native (AI/AN) infants were twice as high as for non-Hispanic white infants. Conversely, SUID rates for Puerto Rican, Mexican, Asian Pacific Island (API), and Central and South American infants were notably lower than non-Hispanic white infants.

Many factors contribute to these disparities. Included is the impact of bias and racism on families. Systemic racism contributes to overall poorer health and well-being, lower socio-economic status and safety of where families live. It is vital to take these factors into account when promoting safe sleep and breastfeeding—only an individualized approach can address these contexts within which families live.

Sudden Unexpected Infant Death by Race/Ethnicity, 2010-2013

Racial disparities

Used with Permission from Centers for Disease Control and Prevention, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion. (2016, February 08). Data and Statistics. Accessed 20 April 2016.

Additional citations for this section of Module 1 can be found in the Going Deeper that you can access from the left navigation bar.

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