How to Prevent Infant Accidental Suffocation and Strangulation in Bed (ASSB)

The greatest fear for any parent is something happening to their child.  Sudden Infant Death Syndrome (SIDS) especially strikes fear into the heart of every parent since it’s the leading cause of death for babies one month to one year of age and its cause continues to remain a mystery. 

There is a great deal of confusion however, between SIDS and other sleep-related infant deaths such as accidental suffocation and strangulation in bed or ASSB.  While the rate of SIDS has declined over the years, accidental suffocation and strangulation in bed has increased dramatically – 184% from 1999 to 2015, according to the American Academy of Pediatrics.

 It’s important not only for parents to understand this difference between SIDS and ASSB but also healthcare providers when they are discussing safe sleep with families.

What is Sudden Infant Death Syndrome (SIDS)?

SIDS is the sudden unexplained death of a baby younger than 1 year of age that doesn’t have a known cause after a complete investigation (complete autopsy, examination of the death scene, and review of the clinical history.) While the exact cause of SIDS remains a mystery, researchers have developed the Triple Risk Model which provides insight into the most vulnerable infants.

SIDS is a subset of Sudden Unexpected Infant Deaths (SUID) as is accidental suffocation and strangulation in bed.  While the exact cause of SIDS is still not understood there are ways to reduce the risk.  The American Academy of Pediatrics developed updated Safe Sleep recommendations in 2016 and include:

  • Place your baby on his or her back for all sleep times—naps and at night.
  • Use a firm, flat sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
  • Keep your baby’s sleep area (for example, a crib or bassinet) in the same room where you sleep until your baby is at least 6 months old, or ideally, until your baby is one year old.  The AAP states that this one recommendation can reduce your baby’s risk by 50%.
  • Keep soft bedding such as blankets, pillows, bumper pads, and soft toys out of your baby’s sleep area.

You can learn about the other safe sleep recommendations here

While these recommendations can reduce the risk for SIDS they can prevent accidental suffocation and strangulation in bed.  Here are the most important things to keep in mind:

  • The danger of bed sharing is not just rolling over on your baby.  Many people ignore warnings about bed sharing because they mistakenly believe the only way a baby would die is by overlay.  In fact, most cases of ASSB are not from overlay but other items in the baby’s environments such as pillows or blankets and a soft surface such as a memory foam mattress or pillow top.  If a baby is in bed
    with you it’s important to make it as safe as possible by removing all pillows, blankets and comforters from the baby’s area and not having multiple people in the bed. This illustration shows how to tell whether a mattress is too soft.
  • Even blankets in a crib can cause a baby to suffocate.  The quilt that grandma made and the lovey that soothes your baby need to be kept out of your baby’s sleep area.  We frequently hear stories about how a baby died at a caregiver’s house or at daycare because they were given a blanket from home as a comfort item to sleep with.
  • Having your baby sleep on your shoulder might be cozy but it’s dangerous. There’s nothing better than the relaxing feeling of a sleeping baby on your chest.  Unfortunately, it poses a danger of suffocation because their face may be covered. This usually occurs when the parent falls asleep too.  If your baby falls asleep for more than a few minutes move her to her crib or bassinet.
  • Sitting devices are not safe for sleep.  What parent hasn’t let their baby continue to sleep in their carrier or car seat?  Everyone has done it and most people don’t realize how dangerous it is.  With the head elevated, an infant is in a position that could lead to asphyxia. The straps on sitting devices also can strangle infants.  This includes car seats. Most car seat manufacturers and experts agree that when you are on a long car trip a baby should sleep no more than approximately 90 minutes without being taken out to stretch, even if that means waking him/her up. Additionally, even if your baby is asleep once you get home or where ever you’re going, you should take your baby out of his/her car seat. 

Bereavement support for families who have lost a baby is one of the cornerstones of our work at First Candle.  Too often we sit with grief-stricken parents who never imagined accidental suffocation could happen to their baby.  Every parent and caregiver must know that dangers.

First Candle is a 501 (c)(3) committed to ending Sudden Infant Death Syndrome and other sleep-related infant deaths while providing bereavement support services for families who have lost a baby.

Your donation will help support our Straight Talk for Infant Safe Sleep outreach work and our grief program.