Infant suffocation: Accidental or Child Neglect?

October 15, 2017

About 60% of child maltreatment related deaths are due to fatal injuries sustained when infants and children aren't being appropriately supervised, a type of maltreatment called 'neglectful supervision.'  The remaining 40% of deaths are due to physical abuse.  In the United States, between 1,500 and 3,000 infants and children die due to abuse and neglect each year, with children age 0-3 years at greatest risk (1).


The types of injuries that kill infants and children are the same for both accidental and non-accidental causes of death.  According to the Centers for Disease Control and Prevention (CDC), suffocation is the leading cause of injury-related infant death in the United States (2).  


Why?  Well, babies can’t escape danger.  They won’t even struggle against it.  If their nose and mouth are accidentally covered by a parent’s arm or body, a blanket, or stuffed animal, or they get wedged between a mattress and the wall, they don’t turn their heads so they can breathe.  They can’t.  And it happens so fast!  It takes only a few short minutes for a baby to have irreversible brain damage or death from lack of oxygen.

Accidental infant suffocation deaths typically occur in an unsafe sleep environment. The most common unsafe sleep environment that results in infant death is bed-sharing with one or more adults on a couch, chair, or bed.  It is impossible to make a bed-sharing environment safe (3).


When sleeping in a crib, the cause of infant suffocation is often a soft object such as a stuffed animal, blanket, pillow, sheepskin, bumper pad, or sleep positioner.  All have been convincingly, definitively linked to an increased risk of death and should not be used.  


Swaddling can also increase the risk of infant death from suffocation, especially after 8 weeks of age when some babies start rolling over.  


Non-accidental infant suffocation deaths occur in the same types of environments, but the situation is aggravated by a caregiver being drunk or otherwise intoxicated.  When an infant suffocates in this circumstance, caregivers can be charged with homicide by child neglect (4) (5). 


Luckily, it is easy to keep our babies safe and prevent these deaths by following the Safe Sleep recommendations from the American Academy of Pediatrics (6): 

  • Your baby should always sleep alone, on their back, on their own separate sleep surface. 

  • Sleep in the same room as your baby, but never on the same surface (bed, couch, or chair). 

  • Baby's mattress should be firm with a tightly fitting sheet. 

  • To keep your baby warm, use a long sleeved onesie, footed pajamas, or sleep sack.  No blankets, quilts, or pillows.

  • There should be absolutely nothing in the crib except a plain pacifier. 

  • Keep cords from monitors, noise makers, and window coverings away from your baby’s sleep space.

  • Stop swaddling before your baby is 8 weeks old. 

  • Don't smoke while pregnant or allow smoking around an infant.


We all want the best for our precious children.  Like Maya Angelou said, “Do your best.  When you know better, do better.”


Dyann Daley, MD is a board certified pediatric anesthesiologist, physician innovator, and experienced child maltreatment prevention executive.  Learn more at and


(1) Commission to Eliminate Child Abuse and Neglect Fatalities. (2016). Within our reach: A national strategy to eliminate child abuse and neglect fatalities. Washington, DC: Government Printing Office.


(2) 10 Leading Causes of Death by Age Group, United States – 2015. National Vital Statistics System, National Center for Health Statistics, CDC. Produced by: National Center for Injury Prevention and Control, CDC using WISQARS™.


(3) Colvin JD, Et Al., Sleep Environment Risks for Younger and Older Infants Pediatrics Aug 2014, 134 (2) e406-e412; DOI: 10.1542/peds.2014-0401


(4) Sumpter Mom charged with infant's suffocation 


(5) The National Center for Fatality Review and Prevention. Child Abuse and Neglect Fact Sheet.


(6) American Academy of Pediatrics, Section on Child Death Review and Prevention.  Safe Sleep



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