SIDS Risk: It's More Than Just the Sleep Environment

* Abbreviations: ICD-10 — : International Classification of Diseases, 10th Revision SIDS — : sudden infant death syndrome It is widely acknowledged that dramatic declines in the rate of sudden infant death syndrome (SIDS) in the United States resulted from recommendations that infants not be placed prone to sleep, first by the American Academy of Pediatrics in 1992,1 followed by the national Back to Sleep campaign 2 years later.2 Other recommendations, such as room-sharing without bed-sharing and avoidance of soft bedding, were introduced and reinforced over the next 2 decades and, with supine positioning, have been the mainstay of SIDS risk reduction guidelines.3,4 However, there has been much concern in recent years because the rate of SIDS (International Classification of Diseases, 10th Revision [ICD-10] R95) has plateaued and rates of other sleep-related infant deaths, such as accidental suffocation and strangulation in bed (ICD-10 W75) and ill-defined deaths (ICD-10 R99), have increased.2 Indeed, the rate of postneonatal mortality, which encompasses all of these diagnoses, has not declined since the late 1990s.2 The risk factors for these different categories of death are strikingly similar,5 and researchers have documented a diagnostic shift, ie, deaths that were previously classified as SIDS 2 to 3 decades … Address correspondence to Rachel Y. Moon, MD, Division of General Pediatrics, PO Box 800386, University of Virginia, Charlottesville, VA 22908. E-mail: rym4z{at}virginia.edu