The Middletown Press (Middletown, CT)
State has 20 to 25 unsafe sleep deaths per year
Infants’ deaths are linked to suffocation or entrapment
The size of an entire “future kindergarten class” is dying each year in Connecticut from unsafe sleep practices, according to state Child Advocate Sarah Eagan.
The causes of the 20 to 25 unsafe sleep deaths annually are linked to suffocation or entrapment when an infant sleeps with an adult or sleeps with soft bedding, such as blankets or pillows.
“Connecticut is losing a future kindergarten class each year to preventable unsafe sleep deaths in infants,” Eagan said.
Minorities are dying at even higher rates, and in some years, comprise the majority of the deaths, data shows. The statistics raise questions about whether racial disparities in income and health care for pregnant women and babies are contributing to the deaths.
“Lower-income children are at much greater risk for preventable child fatalities,” Eagan said.
Despite efforts to create greater public awareness of safe sleep practices, the number of infants who continue to die has remained steady over the past decade, leading Eagan’s office and the Child Fatality Review Panel to draft a public health alert as part of her agency’s three-year review of infant and toddler deaths in Connecticut.
The alert will likely be issued in June with a report on the infant and toddler deaths.
Providing more education is only a portion of what needs to be done to prevent unsafe sleep deaths, said Kirsten Bechtel, a physician with Yale New Haven Children’s Hospital Pediatric Emergency Medicine, who cochairs the state’s Child Fatality
Review Panel with Eagan.
“We just don’t support families with challenges at all,” Bechtel said.
She said health and child welfare officials need to determine why parents choose unsafe sleep situations, such as placing infants in bed with them, over habits that minimize risk.
“This has been a tough problem to address,” said Bechtel, who surmised that low-income parents need to work and sleep, which could result in a crying infant being placed in an adult bed.
Paid family leave helps relieve some of the pressure off women immediately after childbirth, but there are other steps state and health officials can take as well, Bechtel said.
“We haven’t made any reasonable headway in reducing these deaths,” she said. “We have to understand why parents are making the choices they are when it comes to safe sleep, and
we have to educate them to make better choices.”
Since 1994 when the National Institute of Child Health and Human Development partnered with the American Academy of Pediatrics and other child welfare organizations to launch the “Back to Sleep” campaign, the number of infants nationally who have died from sudden infant death syndrome (SIDS) has dropped by 50 percent, according to the NICHD. The campaign focused on placing infants on their backs to sleep rather than on their sides or stomachs. But even as the amount of SIDS deaths decreased after the campaign, the number of babies who have suffered sudden unexpected infant death, or SUID, due to suffocation or strangulation while sleeping, has increased, the NICHD said, spurring national health officials to wage a new campaign on safe sleep practices.
Unintentional suffocation or unsafe sleep practices cause about 82 percent of infant deaths annually in Connecticut, mirroring the national percentage, according to Eagan and a 2019 American Association of Pediatrics report. Infants from 4 to 18 weeks old, when they can move a bit but can’t roll over, are the most at risk of an unsafe sleep death, Eagan said.
Health care disparities and housing instability can impact mothers and their babies, Eagan said.
Most of the children who have died were receiving health care through Medicaid, a staterun program for low-income individuals and families, Bechtel said.
The Safe to Sleep campaign promoted by the U.S. Department of Health and Human Services calls for parents to always place their infants on their backs for sleep, even naps. The infant should be on a firm mattress in a crib, portable play yard or bassinet with nothing except a fitted sheet. Infants should not be left in a car seat or other upright seat when sleeping, according to the agency.
For the first six months, an infant should sleep in the same room as the parents, but in a bassinet or crib, the guidance said.
Yale’s York Street campus provides parents in need with a portable play yard or bassinet, Bechtel said. In addition, the entire Yale health care system, including four other hospitals, is seeking to be designated as Cribs for Kids hospitals. This designation will allow the hospitals to provide training to staff, and in some cases, offer safe sleep locations such as portable play yards to patients.
Bechtel pointed out the number of child fatalities in Connecticut is U-shaped. There is a high number of infant deaths and an increased number of adolescent deaths starting at age 14, she said.
“There’s a reason that they say the first year is so important,” Bechtel said. “It has the highest rate of dying unexpectedly.”
Since 2015, state law has required Connecticut hospitals to provide parents with safe sleep information for infants before they go home, Bechtel said. But the number of infant deaths involving unsafe sleep factors has remained roughly the same, Eagan said.
Connecticut medical examiners have used more advanced death investigation techniques to determine which cases involve unsafe sleep factors, Eagan said. She said more agencies, including the state Department of Children and Families, are also providing information about safe sleep practices.
“There are lots of initiatives, yet we aren’t seeing a statistically significant change in the number of unsafe sleep deaths,” Eagan said. “It’s still the No. 1 cause of preventable death in otherwise healthy children who leave the hospital after birth.”