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

Abstract

Background This retrospective study aimed to determine the epidemiological features of deaths caused by unintentional suffocation among infants in China. Methods The data used in this study were obtained from China’s Under 5 Child Mortality Surveillance System (U5CMSS) from October 1, 2015, to September 30, 2016. A total of 377 children under 1 year of age who died from unintentional suffocation were included in the survey. Primary caregivers were interviewed individually using the Unintentional Suffocation Mortality among Children under 5 Questionnaire. EpiData was used to establish the database, and the results were analysed using SPSS 22.0. Results Most (85.9%) unintentional infant suffocations occurred in rural areas, and 67.5% occurred in infants 0 to 3 months old. Among the primary caregivers of the infants, most (82.7%) had a junior middle school education or below, and 83.1% of them lacked unintentional suffocation first aid skills. Of the 377 unintentional suffocated-infant deaths, the causes of death were accidental suffocation and strangulation in bed (ASSB) (193, 51.2%), inhalation suffocation (154, 40.8%), other unintentional suffocation (6, 1.6%), and unknown (24, 6.4%). Among the infant deaths due to ASSB, overlaying (88.6%) was the most frequently reported circumstance. A total of 93.8% of cases reported occurred during co-sleeping/bed sharing with parents, and in 72.8% of the cases, the infants were covered with the same quilt as their parents. In our study, most inhalation suffocation deaths (88.3%) involved liquid food (such as breast milk and formula milk). A total of 80.5% of infant deaths reportedly occurred after eating; in 28.2% of those cases, the infants were held upright and patted by their caregivers, and 57.2% of them were laid down to sleep immediately after eating. Conclusions To reduce the occurrence of unintentional suffocation, local government should strengthen knowledge and awareness of unintentional suffocation prevention and safety among parents and caregivers. Additionally, health care providers should educate parents and caregivers about safety issues of unintentional suffocation, and relevant policies should be introduced to provide environments and activities that reduce the risk of suffocation, such as promoting the Safe to Sleep Campaign. It is important to enhance the focus on infant unintentional suffocation as a health issue.

Unintentional injury deaths among children under five in Hunan Province, China, 2015–2020

“…We have looked at the causes of suffocation and found most deaths due to suffocation occur in bed and through the inhalation of milk. It is consistent with previous studies 26 , 27 . It may be mainly related to the negligence and poor first-aid knowledge of caregivers 27 – 29 .…”

“…It is consistent with previous studies 26 , 27 . It may be mainly related to the negligence and poor first-aid knowledge of caregivers 27 – 29 . From 2015 to 2020, the injury-related mortality rate due to suffocation increased year over year, while Wang et al reported a steady suffocation mortality rate among children under five in China, 2006–2016 28 .…”

Temperature-related mortality in China from specific injury

“…The higher temperature-related suffocation mortality in children might be related to more warmth measures (e.g. more blankets and clothing) in winter, as accidental suffocation in bed is the leading cause of suffocation deaths in infants 41 . Young adults and male are more likely to expose themselves to dangerous water bodies at high temperature 42 , 43 .…”

Injury Mortality of Children and Adolescents Aged 0–19 Years — China, 2010–2021

“…Our findings indicate that the reasons for injury-related mortalities vary among the five age groups, reflecting different levels of exposure to certain hazards during various stages of child development. Infants under one-year-old, for instance, are more prone to unintentional suffocation due to underdeveloped respiratory systems, making them susceptible to potentially fatal obstructions while eating, playing, or sleeping ( 13 ). Older children, on the other hand, are more likely to engage in dangerous activities when left unsupervised, especially near roads or bodies of water ( 1 ).…”

“…Our results corroborate earlier findings that injuryrelated death rates are significantly elevated among children in rural regions and boys, compared to their urban and fema counterparts (5). The heightened injury mortality rates among young people in China's rural areas are linked to insufficient adult supervision of children who are left behind (12), as well as a lack of adequate public facilities including readily accessible medical centers. The higher injury fatality rates among boys could be attributed to their increased physical activity, impulsivity, and heightened energy levels, predisposing them to engage in high-risk behaviors (5).…”