P2A001: Sudden Unexpected Infant Deaths in Inclined Sleepers, 2005-2020

Background: Approximately 3,400 sudden unexpected infant deaths (SUID) occur in the United States (US) every year. According to the American Academy of Pediatrics (AAP) recommendations for reducing sleep-related infant deaths, parents and caregivers should place infants on a firm, flat surface for every sleep. However, from January 2005 through June 2019, the Consumer Product Safety Commission (CPSC) received over 1,000 incident reports related to inclined sleep products, including 73 infant deaths. These reports led to product recalls in 2019, and a re-announcement of the original recalls in 2023 after additional reports of infant deaths. The National Fatality Review-Case Reporting System (NFR-CRS) documents circumstances of infant and child deaths reviewed by multidisciplinary Child Death Review (CDR) teams in the US. The objective of this study was to use CDR data, derived from the NFR-CRS, to describe the characteristics of SUID that occurred in inclined sleepers.

Methods: We identified SUID that occurred in inclined sleepers from 2005 through 2020 from the NFR-CRS. Inclined sleepers were defined as freestanding, sling shaped baby holders, fitted on a metal frame on an incline, and that rock back and forth. We describe demographic, birth, incident, caregiver, and supervisor characteristics.

Results: From 2005 through 2020, 0.4% (N=113) of SUID in the NFR-CRS occurred in inclined sleepers. Among these infants, most were male (58%) and under 4 months old (66%). More than half were non-Hispanic white (58%), 20% were non-Hispanic Black, and 21% were born preterm ( < 37 weeks gestation). Most incidents occurred at the infant’s home (88.5%) under the supervision of a biological parent (78%). In 34 deaths (30%), the CDR team indicated the infant’s airway was partially or fully obstructed when found. Of deaths in which the airway was obstructed, 50% were obstructed by the inclined sleeper material and 41% were obstructed by other soft bedding present in the sleep environment (these options are not mutually exclusive; additional obstructors suppressed to maintain confidentiality). Eleven deaths occurred in 2020.

Conclusion: Less than 1% of SUID from 2005 through 2020 occurred in inclined sleep products. Deaths occurred even after the CPSC began recalls in 2019. Providers should continue advising parents and caregivers on the importance of a safe infant sleep environment, which includes the use of a firm, flat surface, and avoidance of soft bedding. Improved dissemination of recalls of infant products that are not safe sleep environments may reduce the risk of sleep related deaths.