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Sudden, Unexpected death rate for infants per 1,000 live births


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Story Behind the Curve

Last Updated: November 2019

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

Sudden, unexplained infant deaths (SUIDs) are those for which no cause of death was obvious when the infant died. Sudden infant death syndrome (SIDS) (formerly known as crib death) has been recorded as a frequent cause of SUIDs. SIDS is "the sudden death of an infant under 1 year of age which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, 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)

Nationally, there are more than 4,500 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 when sleeping in an unsafe sleep environment. Public health and medical professionals are in a positon 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 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.
  4. Keep soft objects such as pillows and loose bedding out of your baby's sleep area.
  • Vermont Department of Health
  • Vermont Child Health Improvement Program
  • American Academy of Pediatrics, Vermont Chapter
  • Community organizations that assist parents with infants
  • Child care providers
  • Primary providers of pediatric clinical care
  • Vermont birth hospitals
What Works

For the events of SUID that are associated with unsafe infant sleep environment, outreach and education strategies for parents and caregivers of newborns and infants offer information about the risks of unsafe sleep and how to safely sleep an infant. Outreach to those who work with families of infants/newborns such as physicians, nurses, child care providers, childbirth educators with the latest safe sleep information is also a key strategy in reaching parents with this information. Education should follow the AAP guidelines on safe sleep available at:

In 2017, the Vermont Department of Health, DIvision of Maternal and Child Health, embarked on a major education and outreach campaing for health care professionals and for parents of infants. Focus groups of parents and providers informed the educaton campaign by analyzing participants' knowledge and appraoches to creating safe sleep environments. From this fomrative research, a full campaign was created, consisting of pamplets, 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 inititiated 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.) The Vermont reserach reports and educational materials can be foudn at:

  • 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.

Why Is This Important?

This indicator is part of Healthy Vermonters 2020 (the State Health Assessment) that documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. Click here for more information.

Notes on Methodology

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.

Scorecard Result Container Indicator Measure Action Actual Value Target Value Tag S R I P PM A m/d/yy m/d/yyyy