Children aren’t supposed to die. When children die unexpectedly, Public Health—Seattle & King County pays extra attention. The department looks for lessons to help families and communities prevent future tragedies, using a process that brings together an extraordinary range of expertise.

The program is called Child Death Review, and their most recent report – based on analyzing 125 unexpected or unexplained deaths of children under the age of 18 – puts a spotlight on the critical importance of how and where we put babies to sleep.

The Child Death Review (CDR) convenes several times each year, with a team of experts who focus each meeting on a group of cases that have a common manner of death. The team typically includes critical partners from Seattle Children’s Hospital, the King County Medical Examiner’s Office, law enforcement, schools and small community organizations like Seattle Counseling Service.

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Sleep, more than any other time, is when infants die unexpectedly of causes that can often be prevented. Out of 125 unexpected deaths across three years, 42 were associated with sleep. (More children overall die of birth complications or medical conditions, but those aren’t considered directly preventable.)

The second and third highest preventable categories were suicide (with 33 deaths) and traffic-related (with 23 deaths).

What’s going wrong at sleep time?

Often, it has to do with where the baby is sleeping.

It’s too easy for babies to suffocate or overheat. They can’t lift themselves or reposition their heads, especially on soft surfaces, and that’s dangerous when …

• babies are sharing beds with adults, where they can get trapped
• babies have soft bedding, pillows or other items in their cribs or beds
• babies are left in car seats or on nursing pillows

Imagine your head is so heavy you can barely lift it, and then you get trapped at an angle where you can’t breathe, or with your face in something that completely covers it.

Infants who were born premature or with low birth-weight have a higher risk of dying suddenly, as do infants whose are exposed to second-hand smoke.

These sleep-related deaths are all categorized as Sudden Infant Death Syndrome (SIDS) or Sudden Unexpected Infant Deaths (SUID). For each of these deaths in King County, the CDR team reviewed the particular details to see if there were preventable risk factors – including tired parents, housing instability, and substance use.

The report includes safe-sleep recommendations

For example:

• Avoid bed-sharing – consider “room-sharing” options instead (more than half the SUID/SIDS cases included bed-sharing as a factor)
• Avoid soft sleep surfaces and/or loose bedding
• Healthcare providers should ask parents about sleep practices and advise about risks

More detailed guidance from Dr. Rachel Moon at the American Academy of Pediatricians

It’s important for each family to discuss how the safe sleep recommendations will work in their own living situation. Providers and outreach workers can ask, “Given how and where your baby sleeps, how can we make it as safe as possible?”

Public Health is supporting these efforts through training for healthcare providers and through a growing pilot program that offers Baby Bed Boxes. These are lightweight bassinets that can be placed near an adult bed, including in between parents, or any other location. One key to the success of the boxes is to increase conversations between providers and families about how to create a safe sleep environment for newborns and infants.

Children and teens also die in cars, and while swimming

The most recent CDR report also offers a number of important recommendations about other causes of unexpected of child deaths in King County, such as:

• Traffic-related deaths — support the intermediate drivers licensing laws, which require teenagers to gradually earn the privileges of carrying their friends in the car and driving at night
• Drownings — urge wide promotion of lifejackets, including in communities that may not receive mainstream messaging
• Suicides — promote safe (locked) storage of guns and restore funding for mental health and substance abuse counseling in schools

Published April 7, 2017