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Abstract
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In their analysis of national and state trends in US sudden unexpected infant death (SUID) rates in this month’s issue of Pediatrics, Erck Lambert et al1 demonstrate that declines in SUID rates have plateaued for the past 2 decades. The state-by-state data in which large disparities in SUID rates are shown should both raise alarm in the 22 states where rates are increasing and bring light to prevention efforts in the 9 states with the largest declines.
Widespread education about safe sleep environments (eg, the Back to Sleep campaign) was associated with large decreases in SUID rates between 1990 and 2002. However, the effectiveness of such campaigns may have peaked as they have encountered cultural barriers, Internet misinformation, and countercampaigns. In light of this, how should we, as health care and public health professionals, proceed?
First, we should recognize that among developed countries, the United States has the highest SUID rate. In a recent international comparison, researchers found that among 8 developed countries, the United States had the highest mean 2002–2010 postneonatal mortality rates (of which SUID comprises the majority) at 2.25 per 1000 live births, ∼70% higher than the other countries; only New Zealand, at 2.14 per 1000 live births, came close.2 To understand these differences, we must begin to look at variations in national policies. Of these countries, the United States is the only one that does not provide universal health care,3 home visitors in the neonatal period,4 and universal paid maternity leave.5 All of these are important protective factors for infant mortality.6–8 Additionally, these policies may have positive downstream effects on parental practices. The education received during prenatal care and by home visitors establishes a social norm for safe sleep. Parents are continually encouraged (and assisted in their efforts) by home visitors to breastfeed and to place the infant supine. Many healthy infant care practices (eg, breastfeeding, supine sleep position, safe infant sleep location) cease when the mother returns to work because of poor work support, new caregivers,9,10 or the need for increased parental sleep.11–14 In the United States, most mothers must return to work when the infant is 1 to 4 months of age, which coincides with the highest risk period for SUID.15
It is unlikely that, in the current political climate, universal changes in health care, home visitor programs, and parental leave policies on the national scale will occur. Thus, we should look at changes that we can make locally.
Language: en |