Sleep-related infant deaths and socio-economic disadvantage

On average, 13 infants die suddenly and unexpectedly each year in South Australia. Most of these deaths occur in the infants’ sleep environments, and in almost all cases at least one safe sleeping risk factor is identified. As we discussed in a previous blog post, these risk factors are not necessarily causes of death in their own right, but rather behaviours that increase the risk of infants dying after being placed to sleep. These risks can be eliminated with education about, and adoption of, safe sleeping practices.

Through prevention campaigns by organisations like Red Nose, Kidsafe, and SA Health, the number of infant deaths involving safe sleeping risks has declined over the past fifteen years (Figure 1 – use the interactive app below to view figures). However, unsafe infant sleep practices – including unsafe bedding and bed-sharing – are still common and continue to contribute to the deaths of infants.

The most common risk factor identified in infant deaths – unsafe bedding – refers to any loose items present in the infant’s sleep environment. When placing a baby to sleep, it is important to ensure there are no choking hazards in the cot – these include any toys, pillows, and loose blankets. Between 2005 and 2019, unsafe bedding was present in over three quarters of all sleep-related infant deaths in South Australia (see Figure 2).

Almost half of all sleep-related infant deaths occur in the State’s most socio-economically disadvantaged areas. Infants in these areas are four times as likely to die suddenly and unexpectedly than infants who live in the least disadvantaged areas (see Figure 3).

The decline in infant deaths over the years proves that prevention messaging and education work – but there is an ongoing need for targeted efforts to stop preventable sleep-related infant deaths, especially in South Australia’s most disadvantaged areas.

If you have not done so already, please read about the safe sleeping guidelines to help ensure that every baby sleeps safely.

Safe Sleeping of Infants

The South Australian Safe Infant Sleeping Standards are a comprehensive set of standards for placing infants less than 12 months old to sleep. These standards were developed to help reduce the occurrence of sudden unexpected deaths of infants during sleep. Several factors occur frequently in the circumstances of these deaths. These factors are not causes of death in their own right.  Rather, they increase the risk of infants dying after being placed to sleep. The Standards provide a consistent suite of messages that health professionals can use to guide the decisions families make about safe infant sleeping.

Through the careful work of South Australia police, a great deal of information about the circumstances of sudden unexpected infant deaths is recorded that can help prevent these deaths from happening. Between 2005 and 2016 in South Australia, there were 128 cases where an infant died after being placed to sleep, where no apparent cause could be found for the death. The Child Death and Serious Injury Review Committee has analysed data about the factors that occurred in the circumstances of these deaths. The interactive visualisation allows you to investigate these factors and see how they co-occur. Some important intersections include:

  1. The infant not being placed to sleep in an approved bed is the factor that most frequently occurs together with a number of other factors.
  2. In more than half the cases in which the factor was breast-feeding, a parent also smoked.

These data have driven the recommendations by the Child Death and Serious Injury Review Committee in 2006 and 2016 that all families be provided with an approved bed for their infant to sleep in, along with information about safe infant sleeping. This is particularly true for families living in the most disadvantaged areas of South Australia. As shown in the Committee’s last quarterly blog post, sudden unexpected infant deaths occur more frequently in the State’s most disadvantaged areas.