Dubai, United Arab Emirates (CNN) — Every year, thousands of children die suddenly and unexpectedly. In 2020, the number of deaths among young children exceeded 3,300. Rates maintained their high levels in the first year of the “Covid-19” pandemic, although the overall infant mortality rate fell to a record low.
A study published Monday in the journal Pediatrics found that the rate of darker-skinned children in particular was higher, widening the stark inequality that already exists.
One in six infant deaths were classified as Sudden Unexpected Infant Deaths, or SUIDs, a broad classification of deaths that includes Sudden Infant Death Syndrome, better known as SIDS, along with accidental asphyxia, bed suffocation and other unknown causes.
And while the SUID rate among white children fell to its lowest level since 2017, in 2020 the rate for black children was the highest since then. The study found that rates, which were nearly twice as high for dark-skinned children in 2017, rose to nearly three times as high in 2020.
Sharyn Parks-Brown, an epidemiologist in the Department of Reproductive Health at the US Centers for Disease Control and Control (CDC), and a co-author of the study, said the research team re-analyzed the data several times to make sure they were interpreting the results correctly.
For decades, rates of sudden unexpected infant death (SUID) have remained stable within every ethnic and racial group, and have always been higher among Amerindian children. However, in 2020, the death rate among black infants exceeded the infant mortality rate among American Indians.
“Normally, ideally, we look at data going back five years to anticipate what kind of trends are emerging. So these are very preliminary results, but it’s something we’ll have to keep watching,” Parkes-Brown said.
In a statement commenting on the research, the doctors said the US’s high rates of sudden and unexpected infant death, and the growing inequality, “reflect our societal failings.”
They wrote that social and economic disparities “are not limited to limited access to health care and education, but also to many families who do not have a stable and safe place for their children to sleep.”
Untangling the underlying causes
In 2020, 41% of all sudden unexpected infant deaths were attributed specifically to sudden infant death syndrome (SIDS), 27% were identified as accidental asphyxia, bed strangulation, and 31% were classified as unexplained causes .
Deaths specifically attributed to sudden infant death syndrome increased between 2019 and 2020, as it became the third leading cause of infant death after it was the fourth cause.
However, the new study suggested that this particular trend may shed light on what we don’t know about these deaths.
The lines between the three classifications within the SIDS category are blurry, and the proportions have changed over the years. Experts say there is wide variation in how medical examiners and the coroner code it, and it is less distinct than is thought.
Cheryl L. said: Clark, associate director of epidemiology, evaluation and metrology for the Association of Maternal and Child Health Programs, who was not involved in the new study, said the root causes and distinction between SIDS and an unknown cause of death are not well defined.
According to the new study, the unexpected increase in sudden infant death deaths in 2020 is likely due to changing diagnostic criteria.
While the SIDS rate increased by about 15% between 2019 and 2020, the broader SIDS rate, which also includes deaths attributed to accidental asphyxia and other unknown causes, increased by only 3% that year, an increase It is not considered statistically significant, according to the researchers.
However, the latest data underscores the importance of sustained focus and a better understanding of the subject matter.
“In some ways, it was reassuring that the sudden unexpected infant death rate had not gone up,” Parkes-Brown said.
“But it further underscores what we’ve seen over the past two decades: We haven’t succeeded in reducing these deaths.”
Untangling the specific causes behind all sudden unexpected infant deaths is critical.
“You can’t control something that you don’t know what caused it,” she concluded, noting that “it’s important to know what happened in each death. That includes doing a thorough autopsy and doing a really detailed crime scene investigation to find out what happened to the infant.”
Focus on safe sleep
Despite trying to better distinguish within the broader category of sudden unexpected infant death, experts say there is a subtle underlying thread.
“Most sudden infant deaths are caused by at least one risk factor: unsafe sleep,” said Dr. Rebecca Carlin, MD, a pediatrician at Columbia University’s Vagelos College of Physicians and Surgeons. “More than 95 percent of them are.”
This may include a baby sleeping on his tummy, sleeping in a parent’s bed instead of a crib, having soft bedding or pillows in a crib, or a parent smoking.
Carlin, who co-authored the commentary accompanying the study published Monday, said unsafe sleep practices are risk factors because they reduce the ease with which children can be woken when they need to, usually every two hours.
“There is always one risk factor, often multiple, that can really be avoided with additional community help,” she said.
“It’s hard being a new parent. It’s hard to talk about these issues without talking about the support we provide to new parents as a community,” she added.
Going back to work after six weeks or less, after the baby is born, and waking up every three hours with them isn’t really feasible, she said. It’s understandable why parents resort to unsafe sleep practices in an effort to get their children to sleep longer.
Many of the social and economic factors that disproportionately put black children and their families at risk of generally poor health outcomes, the experts said, have only been exacerbated during the pandemic.