Last Updated: February 2023

Author: Division of Maternal and Child Health, Vermont Department of Health

Sudden unexpected infant deaths (SUIDs) are any unexpected death in infancy. Sudden infant death syndrome (SIDS) (formerly known as crib death) has been recorded as a frequent cause of SUIDs.  According to the American Academy of Pediatrics, SIDS “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" SIDS should not be diagnosed if these criteria are not met. In recent years, CDC and researchers have realized that many of the "SUID" or "SIDS" deaths should be classified as Accidental Suffocation and Strangulation in Bed (ASSB).www.cdc.gov/sids/data.htm
Nationally, there are about 3,400 infant deaths annually attributed to some form of SUID. In Vermont, infant deaths associated with unsafe sleep environment range from 4-7 annually. Mechanisms that can lead to accidental suffocation or strangulation include the following:

• Suffocation by soft bedding—such as when a pillow or waterbed mattress covers an infant's nose and mouth.
• Overlay—when another person rolls on top of or against the infant.
• Wedging or entrapment—when an infant is wedged between two objects such as a mattress and wall, bed frame, or furniture.
• Strangulation—such as when an infant's head and neck become caught between crib railings.

Infants up to one year of age are at an increased risk of suffocation and strangulation when sleeping in an unsafe sleep environment. Public health and medical professionals are in a position to reduce this risk by educating parents and caregivers about how to provide a safe sleep environment for infants. Elements of a safe sleep environment include:

1. Always place babies on their backs to sleep for every sleep.
2. Use a firm, flat sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
3. Have the baby share your room, not your bed. Your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else. Certain situations put infants at higher risk for injury including if the baby is younger than 4 months, someone in the bed drank alcohol or used drugs that make it harder to wake up, or the baby was born early or with low birth weight .
4. Keep soft objects such as pillows and loose bedding out of your baby's sleep area.

The State Health Improvement plan is a cross departmental effort to improve the health outcomes of Vermonters. Decreasing infant mortality is a priority of the State Health Improvement Plan, representing the importance of ensuring the health and safety of Vermont’s children and families. Click here for more information.

• Vermont Department of Health
• Vermont Child Health Improvement Program (VCHIP)
• American Academy of Pediatrics (AAP), Vermont Chapter
• Community organizations that assist parents with infants
• Safe Kids VT
• Northern Counties Healthcare
• Vermont Division of Children and Families
• Prevent Child Abuse VT
• Child care providers
• Primary providers of pediatric clinical care
• Vermont birth hospitals

Providing outreach and education to parents and caregivers of newborns and infants can reduce unsafe infant sleep environment associated SUID events. Outreach can teach families about the risks of unsafe sleep, as well as how to create a safe sleep environment. It is also important to provide outreach to those who work with families, such as health care providers, nurses, childcare providers, and childbirth educators so they are able to reinforce the latest safe sleep recommendations. Education should follow the AAP safe sleep guidelines available at https://www.aap.org/en/patient-care/safe-sleep/.

In 2017, the Vermont Department of Health, Division of Maternal and Child Health, embarked on a major education and outreach campaign for health care professionals and for parents of infants. Focus groups of parents and providers informed the education campaign by analyzing participants' knowledge and approaches to creating safe sleep environments. From this formative research, a full campaign was created, consisting of pamphlets, Facebook posts, a new website, and slide presentations for informing parents and training providers. In addition, through a collaboration with the Vermont Child Health Improvement Program, work was initiated to create and implement infant safe sleep training for nursing staff and supports for parents of newborns and infants who are admitted to the hospital (for newborn delivery or medical treatment.) 

In 2022, representatives from the Vermont Department of Health, University of Vermont Medical Center, Safe Kids VT, Northern Counties Healthcare, Vermont Division of Children and Families, VCHIP, AAP, Prevent Child Abuse VT and other related stakeholders created a safe sleep committee. This committee aims to improve coordination of messaging and promotion of safe sleep best practices throughout the state of Vermont.

• Create and maintain a system of comprehensive outreach and education to parents of newborns and infants about safe sleep practices
• Ongoing surveillance of sudden unexpected infant deaths and infant deaths associated with sleep environment (data found in death certificates)
• Support and expansion of statewide capacity to perform death scene investigation for all unexpected/unexplained infant deaths
• Use of population data for information on parents' safe sleep practices with newborns/infants (such as PRAMS)
• Maintain parent education materials on safe sleep that contain up to date information and that use appropriate language to describe the risk of unsafe sleep environments for infants.
• Outreach and education training sessions for those who work with pregnant women and families of infants/newborns such as physicians, nurses, child care providers, childbirth educators, etc. Education sessions offered to these groups statewide.
• Collaborate with birth hospitals statewide to create up to date safe sleep hospital policies for their in-patient units that service newborns and infants.

Similar to statewide efforts, local partners are using data to drive local strategy. For regional data on Maternal and Infant Health indicators, check out our Public Health Data Explorer.

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.

Data are 3-year averages. Multiyear rates are for the period ending in the year indicated.