During the first year of the COVID-19 pandemic, the United States saw a spike in the number of black infants who died suddenly — worsening a longstanding disparity, a new government study finds.
The increase was seen in what’s called sudden unexpected infant death, or SUID. It’s a term used when a baby younger than one year dies from no immediately obvious cause, often during sleep. SUID includes cases of the much better-known SIDS (sudden infant death syndrome), as well as incidents where babies accidentally suffocate during sleep, and deaths where no cause can be determined.
Overall, the United States has seen a drop in those sudden infant deaths since the 1990s, according to the U.S. Centers for Disease Control and Prevention. That success is attributed largely to public health campaigns encouraging safer infant sleep practices. For years, parents have been advised to put their baby to sleep on the back, not the tummy; keep cribs free of blankets and other loose bedding; and avoid bed-sharing with their baby.
Despite the declining overall rate of SUID, however, racial disparities have persisted.
Why the spike in black infant deaths?
Now, in this latest study, the CDC found that sudden deaths among black infants rose between 2019 and 2020, but held steady or declined among babies of other races and ethnicities.
The result was a widening in the disparity that already existed pre-pandemic, says Sharyn Parks, one of the CDC researchers who worked on the study.
In 2020, black families had double the risk of losing an infant to SUID, versus the average for the country as a whole. For every 100,000 black infants born that year, 214 died suddenly — up from about 190 per 100,000 in 2019, the study found.
Meanwhile, SUID rates were lower, and did not spike in 2020, among white, Hispanic or Asian American infants.
There is no single reason that black infants are dying at a higher rate, experts say.
“It’s obviously a complex issue,” said Dr. Rebecca Carlin, a pediatrician at Columbia University Irving Medical Center, in New York City. She is co-author of an editorial published with the CDC study in the journal Pediatrics.
Carlin said that while safe sleeping practices are critical to preventing SUID, there are also social and economic disparities at work.
For one, black women in the United States are less likely to have access to early prenatal care, which, among other benefits, can reduce the risk of preterm birth. Preterm birth is a risk factor for SUID, Carlin noted.
Similarly, when black families cannot get to routine pediatrician visits, they may not learn about safe sleep practices.
Meanwhile, Carlin said, many black moms lack paid maternity leave from their jobs. That means they have to rely on other caregivers, who may not always know how to put infants to sleep safely. Plus, those same moms may find it impossible to breastfeed — which helps lower the risk of SUID.
The pandemic only worsened the situation, Parks and Carlin added.
“We know the COVID-19 pandemic and mitigation efforts — such as stay-at-home orders — disproportionately affected racial and ethnic minority communities,” according to Parks.
On top of having even more difficulty accessing health care, she says, people of color suffered more job losses, and stress over paying the rent and buying food. Some people lost their homes, and may have moved in with family or friends.
“These factors may have led to more unsafe sleep practices like bed-sharing, thereby increasing the occurrence of SIDS and other sudden unexpected infant deaths,” Parks added.
Plus, Carlin said, many black Americans who did keep their jobs were “essential workers” who had no option to work from home. So mothers had to go to work at a time when childcare centers closed, and many scrambled to find a replacement — perhaps, Carlin noted, family or friends with little infant care experience.
On top of that, she said, those same moms were probably exhausted and emotionally drained: If their babies slept better in bed with them, they may have made that choice.
Parks said the CDC is continuing its routine monitoring of SUID, and it remains to be seen whether rates among black babies changed as the pandemic wore on.
But even if things improved from 2020, Carlin pointed out, the disparity has always been there.
What’s needed, she says, are “systems where new mothers are supported and can focus on parenting instead of paying the rent.”
How to protect your child
A safe sleep environment lowers the risk of SIDS. You can help create a safe sleep environment in the following ways according to the American Academy of Pediatrics (AAP):
• Put your baby on their back for all naps and at night: AAP recommends placing infants to sleep in a supine position for every sleep until the child reaches one year of age. Side sleeping is not advised and is not safe.
• Use a firm, flat sleep surface: A firm, flat, non-inclined sleep surface is recommended to reduce the risk of suffocation or wedging/entrapment.
• Feed your baby breast milk: Breastfeeding is associated with a reduced risk for sudden infant death syndrome (SIDS) and is recommended, unless contraindicated or the parent is unable to do so.
• Never sleep with your baby: It isn’t recommended that you share a bed with your baby under any circumstances.
• Instead of bed sharing, room share with your baby: Infants should sleep in the parents’ room, but on a separate surface designed for infants, ideally for at least six months.
• Keep soft objects and loose bedding out of your baby’s sleep area: Soft objects such as pillows, comforters, and loose bedding should be kept away from the infant’s sleep area.
• Don’t let your baby get overheated: Overheating can increase the risk of SIDS. Your baby only needs one more layer than you would wear in the same environment to be comfortable.
• Try giving your baby a pacifier at nap time and bedtime: A pacifier should be offered at nap time and bedtime to reduce the risk for SIDS.
• Don’t smoke or use nicotine during pregnancy or after your baby is born: Smoke and nicotine exposure and alcohol, marijuana, opioids, and illicit drug use should be avoided during pregnancy and after birth.