Characteristics of Infant Deaths during Sleep While Under Nonparental Supervision.

Document Type


Publication Date



DOI: 10.1016/j.jpeds.2018.01.051


Objective: To compare risk factors for infant sleep-related deaths under the supervision of parents and nonparents.

Study design: We conducted a secondary analysis of sleep-related infant deaths from 2004 to 2014 in the National Center for Fatality Review and Prevention Child Death Review Case Reporting System. The main exposure was supervisor at time of death. Primary outcomes included sleep position, location, and objects in the environment. Risk factors for parental vs nonparental supervisor were compared using χ2 and multivariable logistic regression models. Risk factors associated with different nonparental supervisors were analyzed using χ2.

Results: Of the 10 490 deaths, 1375 (13.1%) occurred under nonparental supervision. Infants who died under nonparental supervision had higher adjusted odds of dying outside the home (OR 12.87, 95% CI 11.31-14.65), being placed prone (OR 1.61, 95% CI 1.39-1.86) or on their side (OR 1.35, 95% CI 1.12-1.62), or being found prone (OR 1.74, 95% CI 1.50-2.02). Among infants who died under nonparental supervision, those supervised by relatives or friends were more often placed on an adult bed or couch for sleep and bed sharing (P < .0001), and to have objects in the sleep environment (P = .01).

Conclusions: Infants who died of sleep-related causes under nonparental supervision were more likely to have been placed nonsupine. Among nonparental supervisors, relatives and friends were more likely to use unsafe sleep environments, such as locations other than a crib or bassinet and bed sharing. Pediatricians should educate parents that all caregivers must always follow safe sleep practices.

Journal Title

The Journal of pediatrics



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MeSH Keywords

Asphyxia; Bedding and Linens; Caregivers; Cause of Death; Cross-Sectional Studies; Female; Humans; Infant; Infant, Newborn; Male; Retrospective Studies; Risk Factors; Sleep; Sudden Infant Death


accidental suffocation or strangulation in bed; safe sleep; sleep environment; sudden infant death syndrome; sudden unexpected infant death

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