Sleep Environment Risks for Younger and Older Infants

OBJECTIVE: Sudden infant death syndrome and other sleep-related causes of infant mortality have several known risk factors. Less is known about the association of those risk factors at different times during infancy. Our objective was to determine any associations between risk factors for sleep-related deaths at different ages.

METHODS: A cross-sectional study of sleep-related infant deaths from 24 states during 2004–2012 contained in the National Center for the Review and Prevention of Child Deaths Case Reporting System, a database of death reports from state child death review teams. The main exposure was age, divided into younger (0–3 months) and older (4 months to 364 days) infants. The primary outcomes were bed-sharing, objects in the sleep environment, location (eg, adult bed), and position (eg, prone).

RESULTS: A total of 8207 deaths were analyzed. Younger victims were more likely bed-sharing (73.8% vs 58.9%, P < .001) and sleeping in an adult bed/on a person (51.6% vs 43.8%, P < .001). A higher percentage of older victims had an object in the sleep environment (39.4% vs 33.5%, P < .001) and changed position from side/back to prone (18.4% vs 13.8%, P < .001). Multivariable regression confirmed these associations.

CONCLUSIONS: Risk factors for sleep-related infant deaths may be different for different age groups. The predominant risk factor for younger infants is bed-sharing, whereas rolling into objects in the sleep area is the predominant risk factor for older infants. Parents should be warned about the dangers of these specific risk factors appropriate to their infant’s age.