Infant mortality in the U.S. has significantly declined over the past two decades, but an alarming rise in Sudden Unexpected Infant Death (SUID) has been observed, particularly from 2020 to 2022.
Researchers link the overall progress in infant health to better medical care, yet factors such as the COVID-19 pandemic, opioid use, and unsafe sleep practices fueled by social media may be contributing to the rise in SUID.
Rising Concerns: SUID on the Increase
Infant mortality in the United States declined by 24.2% from 1999 to 2022, according to a study by researchers from Virginia Commonwealth University and the Children’s Hospital of Richmond at VCU. Their findings were published today (January 27) in the Journal of the American Medical Association Pediatrics. However, the study also revealed a concerning trend — mortality rates from Sudden Unexpected Infant Death (SUID) increased by 11.8% between 2020 and 2022.
“Although a prior CDC study – using data until 2020 – found that Sudden Unexpected Infant Death was increasing for Black infants, this new study – adding data from 2021 and 2022 – found that the rise is more generalized and occurred in infants overall,” said Elizabeth Wolf, M.D., associate professor in VCU School of Medicine’s Department of Pediatrics, pediatrician at Children’s Hospital of Richmond at VCU and lead author on the study.
The study was conducted by a team of experts, including Steven Woolf, M.D., director emeritus of the VCU Center on Society and Health and professor in the Department of Family Medicine at VCU; Anabeel Sen, M.B.B.S., professor in the VCU School of Public Health’s Department of Epidemiology; and Frederick Rivara, M.D., from the University of Washington’s Department of Pediatrics and the Seattle Children’s Research Institute.
What Is Behind the Rise in SUID?
Wolf attributes declining overall infant mortality rates to improved screening and treatment for illnesses affecting pregnant people, better obstetric management, and neonatal care. The causes for the increase in SUID are harder to pinpoint. Possible explanations identified in this study include the rise of COVID-19 and other respiratory viruses, parental opioid use, and the effect of social media on infant sleep practices.
“In social media posts, infants can be seen in unsafe sleep positions, for example on their stomach instead of on their back, and in unsafe sleep environments such as adult beds, couches, and baby swings,” Wolf added.
This information builds upon a child mortality study the same group of researchers published in May 2024, which showed racial and ethnic disparities among youth, ages 1 to 19, were greatest in the category of injuries. This new research finds large disparities in many causes of infant death as well, especially SUID.
While SUID mortality rates are up across all racial and ethnic groups, the rate for Black infants is 10 times higher compared to Asian infants and three times higher than white infants. The authors suggest these disparities could reflect unsafe sleep position, prematurity, tobacco exposure and/or infant feeding, but further research is needed.
Finding Solutions: Next Steps in Infant Health
As a pediatrician at Children’s Hospital of Richmond at VCU, Wolf places an emphasis on safe sleep education at well-child visits with her patients and families. She also sees opportunities to strengthen public health messaging on the importance of safe sleep and tighten regulations around unsafe or misleading infant products.
“An infant dying from SUID is a horrific tragedy and causes incomprehensible trauma to the family. Although not all SUID is preventable, there are some ways to reduce an infant’s risk,” Wolf said. Efforts to support breastfeeding such as lactation support and paid parental leave could help lower the risks of SUID.
Expanding health insurance access and providing doulas to support mothers pre- and postnatally could also reduce infant mortality. Wolf also emphasizes that infants should receive all recommended vaccines on time to reduce their risks of serious infection.
Reference: “Sudden Unexpected Infant Death and Disparities in Infant Mortality in the US, 1999-2022” by Elizabeth R. Wolf, Frederick P. Rivara, Anabeel Sen and Steven H. Woolf, 27 January 2025, JAMA Pediatrics.
DOI: 10.1001/jamapediatrics.2024.6200
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