Unexplained sudden death in infancy (also known as sudden infant death syndrome ) is a subcategory of SUID and is a cause assigned to infant deaths that cannot be explained after a thorough case investigation, including a scene investigation, autopsy, and review of the clinical history. After case investigation, it may be determined that an unexpected death was caused by a specific unnatural or natural etiology, such as suffocation, mechanical asphyxia, entrapment, infection, ingestions, metabolic diseases, arrhythmia-associated cardiac channelopathies, or trauma (unintentional or nonaccidental). Sudden unexpected infant death (SUID) is a term used to describe any sudden and unexpected death, whether explained or unexplained, occurring during infancy ( Table 1). The rationale for these recommendations is discussed in detail in the accompanying technical report. The recommendations and strength of evidence for each recommendation are included in this policy statement. Additional information to assist parents, physicians, and nonphysician clinicians in assessing the risk of specific bed-sharing situations is also included. New recommendations are presented regarding noninclined sleep surfaces, short-term emergency sleep locations, use of cardboard boxes as a sleep location, bed sharing, substance use, home cardiorespiratory monitors, and tummy time. Additional recommendations for SIDS risk reduction include human milk feeding avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs routine immunization and use of a pacifier. This includes supine positioning use of a firm, noninclined sleep surface room sharing without bed sharing and avoidance of soft bedding and overheating. The American Academy of Pediatrics recommends a safe sleep environment to reduce the risk of all sleep-related deaths. The triple risk model proposes that SIDS occurs when an infant with intrinsic vulnerability (often manifested by impaired arousal, cardiorespiratory, and/or autonomic responses) undergoes an exogenous trigger event (eg, exposure to an unsafe sleeping environment) during a critical developmental period. After a substantial decline in sleep-related deaths in the 1990s, the overall death rate attributable to sleep-related infant deaths has remained stagnant since 2000, and disparities persist.
Each year in the United States, ∼3500 infants die of sleep-related infant deaths, including sudden infant death syndrome (SIDS) (International Classification of Diseases, 10th Revision R95), ill-defined deaths (ICD-10 R99), and accidental suffocation and strangulation in bed (ICD-10 W75).
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