Sudden Unexpected Infant Deaths on the Rise Among Black Babies

Study shows during the first year of the pandemic, the rate of sudden unexplained infant deaths increased in Black babies more than in any other racial or ethnic group.

Woman holding her baby

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The COVID-19 pandemic has been difficult for all of us. We witnessed unprecedented times, and the impact of the virus itself has had lasting effects on our physical and mental health. But, the pandemic also affected the health of our children. We're seeing more and more evidence of this as research is being done.

According to a study by the American Academy of Pediatrics (AAP), there was a 15% increase in the rate of sudden infant death syndrome (SIDS) from 2019 to 2020. The results were especially shocking when it came to Black infants. The rate of sudden unexplained infant death (SUID) was found to be higher than any other ethnic or racial group. Researchers believe this may have been due indirectly to the COVID pandemic, but more is needed to determine if there is a definitive link.

There is some good news in the study though. The overall rate of SIDS actually declined between 2015-2019 before the jump in 2020—and the overall rate of SUID didn't change much, with the exception being the rate of SUID in Black babies.

What Is Sudden Unexpected Infant Death (SUID)?

Anytime a baby dies, it's tragic and traumatic. As the name states, with SUID, the baby's death is sudden and unexpected. SUID is an umbrella term that includes both known and unknown causes of death. The exact cause isn't often known until after a full investigation. Sudden and unexpected deaths account for approximately 3,400 infant deaths each year. It typically occurs during sleep and often affects seemingly healthy babies under a year old.

Nicole Sparks, M.D., an Atlanta-based OB-GYN says SUID is the overarching category, and SIDS comes under that category. “SIDS is more a diagnosis of exclusion," she explains. "If we can’t find any other cause for an infant death less than a year old it is labeled as SIDS.”

Some causes of SUID end up classified as suffocation, entrapment, infection, ingestion, disease, heart issues, trauma, or SIDS. SIDS is the death of a baby younger than one year that is totally unexplained, even after a complete and thorough investigation.

Although there are some risk factors associated with SIDS such as sleeping on soft surfaces, sleeping on their stomachs, or being exposed to secondhand smoke, it still remains largely unexplained even after that extensive investigation by medical professionals.

According to one study though there may actually be a biological factor linked to SIDS. The 2022 study out of Australia looked at blood samples from 67 newborns who died unexpectedly. Five of those babies' deaths eventually were categorized as SIDS. Researchers looked at the levels of a specific enzyme called butyrylcholinesterase (BChE). The scientists compared those samples to more than 650 babies in a control group. They found the babies who died from SIDS had lower BChE levels than those in the control group, as well as the babies who died of other causes.

The study noted the results opened up the possibility of a way to identify babies at risk for SIDS. However, more research is needed.

Why Was the SUID Rate Higher in Black Infants?

The study published in Pediatrics looked at numbers from the Centers for Disease Control and Prevention (CDC) between 2015-2020. What they found was particularly concerning for Black families.

SUID rates among Black babies rose from 1.6 per 1000 births in 2015-2016 to 2 per 1000 births in 2020. It doesn't sound like much but it's a 25% increase within just five years. Those numbers are also significantly higher than White and Latinx populations during that same period. The study does not explain exactly why there was a racial disparity in the SUID rate increase between non-Latinx Black infants and non-Latinx White infants, but this follows the same pattern of racial inequality across healthcare.

"The pandemic and related mitigation efforts (e.g., stay-at-home orders) disproportionately affected racial and ethnic minority communities...through exacerbation of housing insecurity, food insecurity, unemployment, limited healthcare access, altered childcare, and social or emotional health stressors," says Carrie Shapiro-Mendoza, Ph.D., the lead author of the study and chief of the field support branch at the CDC's Division of Reproductive Health. "These factors may have led to more unsafe sleep practices like bedsharing, thereby increasing the occurrence of SIDS and other sudden unexpected infant deaths and widening disparities."

Nicole Sparks, M.D.

While there is no clear explanation for the disproportionate rise in Black infants [SUID] in 2020, we do know that Black communities were disproportionately impacted by the pandemic.

— Nicole Sparks, M.D.

"While there is no clear explanation for the disproportionate rise in Black infant [SUID] in 2020, we do know that Black communities were disproportionately impacted by the pandemic," adds Dr. Sparks. "The pandemic then further impacted social determinants of health. Smoking and preterm births are also higher in the Black communities (both risk factors for SUID)."

The study noted researchers need to keep watching the SUID rate for non-Latinx Black infants. It also says: "Interventions are needed to address persistent racial and ethnic disparities in SUID."

Dr. Shapiro-Mendoza agrees more research is necessary. "The significantly increased rate of SUID...deserves further attention because it could be attributable to the COVID-19 pandemic and its impact on social determinants of health."

The Rate of SIDS Jumped in 2020

The study also found that between 2015 and 2019, the rate of SIDS was actually on the decline. However, the number dramatically rose by 15% from 2019 to 2020, the first year of the pandemic. The authors concluded "the increased prevalence might be due to environmental exposures or parental stressors associated with living through a pandemic" which could lead to changes in sleeping positions or other behaviors and known risk factors for SIDS.

"Our analysis did not find evidence that COVID-19 illness was responsible for the rise in SIDS rates," says Dr. Shapiro-Mendoza. "The non-increasing SUID rates together with the small number of SUID that also had a COVID-19 cause-of-death code makes it unlikely that increased SIDS rates...were directly related to infant COVID-19 infection."

Another explanation for these findings includes the disruption in life caused by social distancing measures. Parents were less likely able to access health care services such as home visits from health care professionals who offer advice about safe sleep practices; reduced lactation initiation due to financial hardship; or increased exposure to secondhand smoke resulting from more people smoking at home because they couldn't go out.

A third reason for the increase in the rate of SIDS in 2020 was new changes in reporting practices that went into effect in 2019. The study notes if that new guidance was followed, it could have also led to the jump in 2020, unrelated to the pandemic.

The study only included the first year of the pandemic and did not include numbers from the 2021 Delta and Omicron waves. COVID cases and deaths were higher among children during these 2021 waves than during 2020. "When more years of data and more comprehensive data sources become available, we may be able to better determine if there were direct or indirect effects of COVID-19 infection on SUID," Dr. Shapiro-Mendoza says.

What Can Parents Do to Decrease Risk of SUID and SIDS?

There are several things researchers have found that can decrease the risk of SIDS, and most of them are around safe infant sleep. That includes not putting any bedding, blankets, stuffed animals, and toys in the crib. "According to the CDC, unsafe bedding has remained a leading cause of sudden infant death, especially in infants under 4 months," Dr. Sparks says. Also, place babies on their backs and put them down on a firm surface, covered only with a fitted sheet.

When it comes to bedsharing, the AAP advises against it but does acknowledge co-sleeping does happen and is the norm for some families. The AAP offered co-sleeping guidelines that include not sleeping with your baby on the couch or a chair, making sure the baby's breathing isn't obstructed by any bedding, and they say if you fall asleep while feeding your baby putting them on their back immediately when you wake up.

The National Institutes of Health offers these other ways to reduce the risk:

  • Avoid smoking during and after your pregnancy.
  • Stay drug and alcohol-free during pregnancy.
  • Feed your baby human milk, when possible.
  • Get regular medical care for you and your baby.
  • Offer the pacifier at night and during naps only once the baby is feeding well.
  • Avoid products that claim to "prevent" SIDS.
  • Avoid swaddling when baby can roll over (about 3 months)
  • Give baby plenty of tummy time when awake.
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  1. Shapiro-Mendoza CK, Woodworth KR, Cottengim CR, et al. Sudden unexpected infant deaths: 2015–2020. Pediatrics. Published online March 13, 2023

  2. Centers for Disease Control and Prevention (CDC). About SUID and SIDS.

  3. National Institutes of Health (NIH). Common SIDS and SUID Terms and Definitions.

  4. Harrington CT, Hafid NA, Waters KA. Butyrylcholinesterase is a potential biomarker for sudden infant death syndrome. eBioMedicine. 2022

  5. National Institutes of Health (NIH). Ways to Reduce Baby's Risk.

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