WASHINGTON — Infant deaths blamed on accidental strangulation and suffocation in bed have increased sharply in the United States, federal health officials are reporting today, reigniting a heated debate over the rising number of parents who sleep with their babies.
An analysis of death certificates nationwide found that the rate of fatalities attributed to unintentional suffocation and strangulation in the first year of life quadrupled between 1984 and 2004.
While the study did not examine what is causing the increase, the trend roughly coincided with a sharp rise in bed-sharing, which has become more popular to help mothers bond and breast-feed. Such deaths can occur when a sleeping parent rolls on top of a baby, a pillow falls on an infant’s face, a blanket gets wrapped around the child’s neck or when the baby gets wedged between a mattress and a wall.
“There’s been a huge increase in the reports of these deaths,” said Carrie Shapiro-Mendoza of the Centers for Disease Control and Prevention in Atlanta, who led the study being published in the February issue of the journal Pediatrics. “The message for the public is that accidental suffocation and strangulation is potentially preventable by providing babies with a safe sleep environment.”
Shapiro-Mendoza and her colleagues found that the rate of accidental strangulation and suffocation deaths increased from 2.8 to 12.5 per 100,000 live births during with the 20-year study period, increasing the number of deaths from 103 in 1984 to 513 in 2004.
Most of the increase occurred after 1996, which is about the same time deaths from sudden infant death syndrome (SIDS) appeared to plateau after falling by about half, the result of a nationwide campaign to encourage parents to put their babies to sleep on their backs. It also coincided with efforts to investigate sudden infant deaths more thoroughly.
The findings provide the first national confirmation for a trend that has been suspected by officials in many cities in recent years.
“We’re seeing a lot more of these cases,” said Rachel Moon, a spokeswoman for the American Academy of Pediatrics. “These kinds of deaths have been skyrocketing. I think we should be really worried.”
The findings prompted several experts to call for increased efforts to discourage parents from sleeping in the same bed with their babies or in other unsafe places, such as couches, and to educate parents how they can sleep near their children safely.
“Strangulation deaths are going up and bed-sharing is going up,” said John Kattwinkel of the University of Virginia, who chaired an American Academy of Pediatrics panel that recommended against bed-sharing in 2005. “It’s certainly logical to draw a conclusion that there is a link. Parents should not bed-share with their babies.”
Instead, experts recommend that babies sleep in the same room as their parents, perhaps in a crib or bassinet adjacent to the bed to facilitate breast-feeding. But babies should have a separate sleep surface with a firm mattress and be placed on their backs with no blankets, pillows, stuffed animals or other objects that could suffocate them.
But proponents of bed-sharing challenged the link between the practice and the increased deaths from accidental strangulation and suffocation. There could be other explanations, they said, and bed-sharing has many benefits, including helping mothers to breast-feed and form crucial bonds with their children.
“Parents are sleeping with their babies because this is what they are designed to do. This is what they are supposed to do,” said anthropologist James McKenna of the University of Notre Dame. “There are many ways mothers sleep with their babies. Some are dangerous, and some are very safe and beneficial.”
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