Infant Suffocation Incidents Related to Co-Sleeping or Breastfeeding in the Side-Lying Position in Japan

Abstract

Co-sleeping and breastfeeding in the side-lying position have recently been pointed out as risk factors for suffocation in sleeping infants; however, there is no actual report on an "incident." "Incident" is defined as a tense or sobering experience without a consequential fatal suffocation accident. It is important to understand infant suffocation incidents to prevent accidents during co-sleeping and breastfeeding in the side-lying position. We investigated factors and frequency of infant suffocation incidents associated with co-sleeping and breastfeeding in the side-lying position using a self-administered questionnaire survey of 895 mothers during their infant's 1-, 4-, or 10-month health checkups. Co-sleeping and breastfeeding in the side-lying position were practiced by 28.3% and 56.0% of mothers, respectively; thus, 84.3% of the mothers surveyed were practicing either co-sleeping or breastfeeding in the side-lying position. Of those who received guidance from a medical professional, 36.1% practiced only co-sleeping while 60.1% practiced only side-lying breastfeeding. In the co-sleeping group, 10.6% had faced infant suffocation incidents, while 13.2% in the breastfeeding in the side-lying position group had faced similar incidents. Regarding factors associated with suffocation incidents while co-sleeping, the frequency of occurrence was significantly more in mothers of 1-month and 4-month-old infants compared with those of 10-month-old infants. Of mothers who faced suffocation incidents while breastfeeding in the side-lying position, 45% also had faced similar incidents while co-sleeping. These results demonstrate the importance of thoroughly educating mothers about the risks associated with co-sleeping and breastfeeding in the side-lying position for preventing infant suffocation.

Social and environmental risk factors for unintentional suffocation among infants in China: a descriptive analysis

“…In our study, we found that the incidence of accidental suffocation and strangulation in bed was higher in winter, which is similar to American and Japanese reports [ 21 , 37 ] We also found that 93.8% of cases reportedly experienced accidental suffocation and strangulation while the infants were cosleeping with their parents, which was similar to findings reported from previous surveys [ 38 ]. However, the extent of cosleeping in China is 57.8% [ 39 ], which is much higher than that in developed countries: 20–30% of mothers in the UK [ 40 ], 13.5–40% in the US [ 41 ], and 8.8–19% in New Zealand [ 9 ]. Takatsu et al estimated that the mortality associated with infants who were cosleeping was 10.2 times higher than that of those who were not cosleeping [ 42 ].…”

Unexpected death of an infant suffocated in the course of breastfeeding when the mother fell asleep

“…It is now time to admit that some cases of accidental suffocation have been labelled as SIDS. 14 If we are to prevent deaths due to infants being overlaid and suffocated, we must explore the infants' sleeping environments, through clinical and mandatory death scene investigations, with the help of forensic pathologists. Countries where this is mandatory have shown that the incidence of SIDS has declined and accidental suffocation has increased, due to more information about the circumstances surrounding the death.…”

Circumstances and factors of sleep-related sudden infancy deaths in Japan

“…Such co-sleeping is a common style of sleep. Tokutake et al [17] reported that 84% of mothers practice co-sleeping, of whom half also practice breastfeeding. The father was found to be the first responder in up to 20% of cases, and in most of these cases the father also co-slept and discovered the infant death upon awakening.…”

“…However, 40% of infants were found in the prone position, of which frequency was higher than that reported in an earlier study. [17] Li et al [31] reported that 60% of SIDS infants were found in the prone position in the United States. It is possible that turning over by infants during sleep is a causal factor.…”

“…While the childcare environment differs according to region and time, there are few epidemiological data describing infant deaths during sleep in Japan. [ 17 ] Takatsu et al [ 18 ] exhibited the trends of SUID cases from 1982 to 2006. This population-based retrospective study was conducted to investigate the latest trends of sleep-related SUDI cases using the checklist form including the maternity passbook at multiple centers.…”