Death From Infant Sleep Positioners

William T. Basco, Jr., MD, MS

May 01, 2013

Suffocation Deaths Associated With Use of Infant Sleep Positioners -- United States, 1997-2011

Centers for Disease Control and Prevention

MMWR Morb Mortal Wkly Rep. 2012;46:933-937

Infant Sleep Positioners

Infant sleep positioners are marketed to the public with several health claims, including an overall improvement in sleep quality as well as prevention of sudden infant death syndrome (SIDS). Few of these devices have US Food and Drug Administration (FDA) approval, and those that do are designed for the prevention of gastroesophageal reflux or for the treatment of plagiocephaly. None has a specific indication for prevention of SIDS.

Study Summary

This article summarizes 13 cases of suffocation associated with infant sleep positioners reported to the Consumer Product Safety Commission over the study period. The infants were generally very young, with a mean age of 9.5 weeks. The median age was 3 months, and only 1 infant was 4 months old. Of the 13 cases, 8 (62%) were boys, 4 (31%) had been born prematurely, 3 (23%) had a twin, and 4 (31%) had recent respiratory symptoms. Nine of the infants had been placed on their sides to sleep, and 1 infant was placed prone. Several of the sleep positioners had a warning label instructing parents to discontinue use of the device once the child began to move around during sleep. The study authors comment that since 2005, the American Academy of Pediatrics has recommended against positioning infants on their sides for sleep.^[1]

Viewpoint

This is a bit of a nontraditional choice for a Viewpoint, in that it is a relatively brief CDC report. However, this report did receive a great deal of lay press, and it also raises some very interesting concerns.

As the authors acknowledge, this is a very biased sample, because it represents only cases that were reported to the Consumer Product Safety Commission. Therefore, it very likely is a tremendous underrepresentation of the true number of injuries that might be related to these devices. In fact, it is not possible from these data to ascertain the real risk for injury or death associated with these devices.

What is evident from this summary is that positioning an infant between the 2 sides of an infant sleep positioner might allow the infant to roll into 1 of the bolsters of the device, leading to suffocation. It is also concerning that these devices may encourage parents to place infants to sleep on their sides, when the supine position has been demonstrated to be superior to both the prone and side positions for the prevention of SIDS.

The best way to use these data as a practitioner is to consider asking about positioning devices when assessing how new parents have arranged their child's sleep environment to reduce the risk for SIDS. Asking about other practices, such as ensuring a firm mattress surface, minimal bedding thickness, and not placing stuffed animals or pillows in the crib, may be more easily remembered, but asking about the use of infant sleep positioners should be added to discussions between providers and parents. Downloadable flyers about the potential SIDS risks from infant sleep positioners are available from the FDA. A YouTube video on the topic is available for parents.

Abstract

References

1. Task Force on Sudden Infant Death Syndrome.Moon RY.SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128:1030-1039. Abstract