Wrapping up October and

SIDS (Sudden Infant Death Syndrome) Awareness Month

How a parent puts their baby to sleep is a personal decision, with family, culture, history, economics, emotions and many other factors impacting that decision. Our hope is that all parents are informed and able to make decisions that feel safest for them. Safe Sleep Education requires humility, curiosity, patience and building trust.

This newsletter will provide some general information and data around SIDS/SUID, as well as resources that can be shared with families who have experienced the loss of a pregnancy or infant. We will be offering SIDS/SUID trainings over the next few months- please reach out if you or your organization are interested in attending.

What is SIDS?

Sudden Infant Death Syndrome (SIDS) is the term used to describe the sudden death of a baby younger than 1 year of age that doesn't have a known cause, even after a full investigation. Healthcare providers, law enforcement, and others investigate infant deaths to figure out what caused them.

What is SUID?

Sudden unexpected infant death (SUID) is a term used to describe the sudden and unexpected death of a baby less than 1 year old in which the cause was not obvious before investigation. These deaths often happen during sleep or in the baby’s sleep area.

National Data: SIDS Rates

This map provides an overview of SUID rates across the states. California has a lower rate than most states.

State Data: SIDS Rates by Ethnicity 2016-2020 in CA

SIDS/SUID rates differ by race/ethnicity. Research has looked into the role that social determinants of health, including structural racism and oppression, may have on SIDS/SUID rates. When working with families, it is important to do what we can to make sure all families feel safe, heard and supported.

Sonoma County Data: 2010-2022

Sonoma County rates of infant deaths in the sleep environment are below. These different categories are due to different ways that a death is classified by the coroner or team leading the investigation.

Why Does SIDS/SUID Happen? What do we know?

image from https://www.edweek.org/research-center/

Latest Research That Could Explain Susceptibility

We are still learning about the causes of SIDS. The below study offers some new information:

"This is the first study to identify a biochemical marker in SIDS infants, prior to their death, which differentiates them from control cases and from other causes of death. In terms of SIDS and the triple risk model we interpret this decreased activity of BChE to mean that the inherent vulnerability of a SIDS infant is autonomic cholinergic dysfunction. Thus, the finding presents the possibility of identifying infants at future risk for SIDS and it provides a specific avenue for future research into interventions prior to death."

Click title of article below for full PDF

Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome Harrington,et al. eBioMedicine,Volume 80,2022,

Triple Risk Model For SIDS

The triple risk model is one accepted hypothesis on the cause of sudden infant death syndrome (SIDS). Filiano and Kinney's Triple Risk Model describes the intersection of three risks: (1) a vulnerable infant, (2) a critical developmental period in homeostatic control, and (3) an exogenous stressor(s). In other words, SIDS may occur when an infant has an unknown medical condition that places them at higher risk (like a genetic condition that affects their breathing) , and they go through an important developmental period, and an outside stressor occurs (such as exposure to secondhand smoke).

Filiano JJ, Kinney HC. A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model. Biol Neonate. 1994;65(3-4):194-7.

Social Determinants of Health

Sudden infant death and social justice: A syndemics approach

(click title above for pdf)

Using public databases and the literature, Bartick and Tomori, (2018) examined SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Below is their conclusion:

Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co‐occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.

Safe Sleep Education

Below are excerpts from the latest update to the American Academy of Pediatrics' (AAP) Safe Sleep Recommendations:

Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths In the Sleep Environment

“Culturally appropriate, respectful, and non-judgmental communication between clinicians and parents is important when discussing safe infant sleep.”

“Research on the social determinants of health, health care delivery system inequalities, and the impact of structural racism and implicit bias as related to health care access, education, and outcomes that contribute to health disparities, and understanding how to best address these disparities in a socioculturally appropriate manner, should be continued and funded.” Moon, et al (2022)

To see their full list of recommendations- click here.

What are some ways to reduce the risk of SIDS/SUID?

Placing a baby to sleep on their back

Feeding a baby breastmilk

Regular prenatal care

Using a flat, firm sleep surface with a fitted sheet

Keep medical appointments, immunizations and check-ups up to date

Offering a clean pacifier to sleep once breastfeeding is going well

Giving babies supervised tummy time

Having a baby sleep in the same room as their parent for first 6 months

Breast/Chest feeding as protective of SIDS is one of the most important facts to share with all pregnant and birthing people at the start of their journey, even before conception occurs!

A child's sleeping environment is recommended to look like this when in the crib. On their back without any other items in the crib and ensuring there are no gaps in crib where child could become trapped. It is safest for a child to share their room with the parent(s) for atleast the first 6 months.

A child's sleeping environment could also look like the pictures below. According to MIHA (Maternal and Infant Health Assessment) data from 2016-2028, 37% of respondents reported that their baby always or often shared their bed. Educating families about safest bedsharing is a critical component of Safe Sleep Education. Below are some some examples and resources of safer ways to bedshare.

The parent is side lying forming a natural C curve around the infant, protecting the infant from moving up into the pillow with the adult arm above the infant's head and the adult legs blocking the infant from sliding down away from parents.

Remember- accidental bed sharing can be much more dangerous than when a thoughtful plan is put in place to prepare for those inevitable moments when it "just happens".

The following are known hazards of Bed Sharing:

  • Sleeping on their Stomachs
  • Pillows, blankets, other siblings, or pets in adult bed
  • Exposure to smoke
  • Sleeping with an adult in the bed who has consumed alcohol, drugs, or certain medications
  • Sleeping on a soft surface
  • Sleeping with an infant in a couch or recliner chair

"Overall, the research conducted to date on bedsharing and breastfeeding indicates that nighttime proximity facilitates breastfeeding duration and exclusivity. Discussions about safe bedsharing should be incorporated into guidelines for pregnancy and postnatal care. Existing evidence does not support the conclusion that bedsharing among breastfeeding infants (i.e., breastsleeping) causes sudden infant death syndrome (SIDS) in the absence of known hazards.''

Blair, Peter S, Ball, H, McKenna, J, et al. (2019) Bedsharing and Breastfeeding: The Academy of Breastfeeding Medicine Protocol #6, Revision 2019. Breastfeeding Medicine., 15(1): 1-12 


Pregnancy and Infant Loss: A conversation around the experience of pregnancy and infant loss

Register here

David Kessler- Grief Expert

David Kessler is one of the world’s foremost experts on grief and loss. His experience with thousands of people on the edge of life and death has taught him the secrets to living a happy and fulfilled life, even afterlife’s tragedies. He is the author of six books, including the new bestselling book, Finding Meaning: The Sixth Stage of Grief. He coauthored two books with Elisabeth Kubler Ross, including On Grief and Grieving updated her 5 stages for grief. His first book, The Needs of The Dying received praise from Saint (Mother) Teresa.

David Kessler was gracious enough to speak at our annual SIDS conference this month free of charge to share his wisdom with the SIDS coordinators who are tasked to offer support to these families.

Please visit his website for free resources, online support groups, podcasts, and videos.

LOCAL Grief Support Services

Our MCAH Website has a list of local and online grief support resources available to families in need.

Click Here

Thank you for your time and attention to this Newsletter!

Have a Happy and Safe Halloween!

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Your Sonoma County Community and Family Health Team!