Sudden Infant Death Syndrome and Safe Infant Sleep

Table of Contents

1. What the Terms Mean
2. How Often These Deaths Occur
3. The Triple-Risk Model
4. Brainstem Serotonin and Arousal From Sleep
5. What the Study Numbers Mean
6. Sleep Position
7. Soft Bedding, Overheating and Swaddling
8. Smoke Exposure
9. Prematurity
10. Bed Sharing
11. Factors Linked With Lower Risk
12. The American Academy of Pediatrics 2022 Guidance
13. What Is Not Known
14. For Families After a Loss
15. Key Research Papers
16. Connections
17. Featured Videos

What the Terms Mean

Sudden infant death syndrome is defined by what remains after a search for a cause. A 2019 review gives the working definition: the sudden and unexpected death of an infant under 12 months of age that remains unexplained after a complete autopsy, a death scene investigation and a review of the clinical history (Kinney 2019). The name is therefore a finding of "no cause found", and it does not identify one disease.

The definition first appeared in 1969 and was changed about two decades later. In 2004 an expert panel of pathologists and pediatricians wrote a new general definition and added a category called unclassified sudden infant deaths, for cases that miss the criteria and where other natural or unnatural explanations stay uncertain (Krous 2004).

Sudden unexpected infant death is the wider term. In United States research it usually groups three death-certificate codes from the International Classification of Diseases, 10th Revision (ICD-10):

• R95: sudden infant death syndrome.
• R99: ill-defined or unknown cause.
• W75: accidental suffocation or strangulation in bed.

The three overlap in practice. A 2021 report from the American Academy of Pediatrics and the National Association of Medical Examiners describes an assortment of terms that vary between professions, and a diagnostic shift in how these deaths are labelled. The report also notes why this matters to families: without complete information, they can only speculate about the cause and may blame themselves or others (Shapiro-Mendoza 2021).

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How Often These Deaths Occur

The American Academy of Pediatrics states that about 3,500 infants die of sleep-related infant deaths each year in the United States. That figure includes sudden infant death syndrome, ill-defined deaths and accidental suffocation or strangulation in bed. The death rate fell substantially in the 1990s and has been stagnant since 2000, and disparities persist (Moon 2022). A 2019 review gives the United States rate of sudden infant death syndrome alone as 0.39 per 1,000 live births (Kinney 2019).

The fall after the sleep campaigns

Before the early 1990s, parents were commonly advised to put babies to sleep on the front. The American Academy of Pediatrics recommended a non-front position in 1992 (Task Force 2005), and national campaigns such as Back-to-Sleep carried the message to parents. A 2007 review in The Lancet reports that risk-reduction campaigns helped to reduce the incidence of sudden infant death syndrome by 50 to 90 percent (Moon 2007). Figures by country in the sources read here:

• United States, sudden infant death syndrome: 1.2 per 1,000 live births in 1987, and about 0.5 per 1,000 by 2005 (Malloy 2013).
• United States, all sudden unexpected infant death: 154.6 per 100,000 live births in 1990 and 92.4 in 2015. The fall was 44.6 percent from 1990 to 1998, and only 7 percent from 1999 to 2015. State rates ranged from 33.2 to 202.2 in 2013 to 2015 (Erck Lambert 2018).
• Canada: deaths from sudden infant death syndrome after the first month of life fell from 0.97 to 0.54 per 1,000 neonatal survivors between 1985–1989 and 1994–1998. Other causes of death at that age also fell, from 1.19 to 0.86, though less steeply. The authors say a lack of reliable risk-factor data limits how much of the decline can be credited directly to the campaign (Rusen 2004).
• Japan: 0.24 per 1,000 births in 2001, or 7.7 percent of infant deaths, on a downward path after a rise around 1995 (Sawaguchi 2003).

A study using national statistics from 52 countries, 29 of them with enough data for trends over time, found four groups of countries. Two groups mostly showed the familiar peak in the 1980s, and two had low rates with no such peak (Müller-Nordhorn 2020). So the rise and fall was not the same everywhere.

Part of the fall is a change in labels

From 1999 to 2015 in the United States, the sudden infant death syndrome rate dropped 35.8 percent while accidental suffocation and strangulation in bed rose 183.8 percent, and the unknown-cause rate did not change significantly (Erck Lambert 2018). The authors point to a documented diagnostic shift between these categories around 1999 to 2001. A separate analysis of records from 1983 to 2012 found that sudden infant death syndrome rates mostly moved along with other infant deaths after the first month, with a distinct difference in 1994 to 1996 when Back-to-Sleep began, and with other differences that seemed related to how deaths were diagnosed (Goldstein 2016).

The burden is uneven. Among 4,086,504 United States babies born preterm from 2005 to 2014, non-Hispanic Black and Alaska Native or American Indian babies had higher adjusted odds of sudden unexpected infant death than non-Hispanic White babies (1.5 and 1.44 times). The authors state that further research is needed to identify what drives these differences (Hwang 2023).

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The Triple-Risk Model

The most widely used explanation was proposed by Filiano and Kinney in 1994. It says a death of this kind needs three things to overlap (Filiano 1994):

1. A vulnerable infant. The vulnerability is hidden, and the baby appears well.
2. A critical period of development, when the body's automatic control of breathing, heart rate and temperature is still maturing.
3. An outside stressor, such as a difficult sleep environment.

In this model, the vulnerability lies silent until the baby enters the critical period and meets a stressor. The 1994 paper also allows that different underlying disorders may produce the same result. The American Academy of Pediatrics uses the model in its 2022 statement, describing the vulnerability as often showing up in impaired arousal, heart and breathing, or autonomic responses (Moon 2022).

The model is a framework for reading the findings below, and the paper that proposed it states that an infant dies in this way only when all three factors are present (Filiano 1994). A stressor alone, on this model, does not lead to death.

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Brainstem Serotonin and Arousal From Sleep

The brainstem sits at the base of the brain and runs functions such as breathing without conscious thought. Serotonin is one of the chemical messengers it uses. Researchers have studied brainstem tissue from autopsies for decades, and the main findings are these:

• More serotonin nerve cells, fewer receptors. In tissue from San Diego collected from 1997 to 2005 (16 to 31 babies who died of sudden infant death syndrome per analysis, and 6 to 10 comparison babies), the affected babies had about twice the count of serotonin neurons (mean 148.04 versus 72.56) and a lower density of serotonin 1A receptor binding sites in the regions involved in automatic body control. Boys who died had lower binding in one region than girls who died, which the authors call preliminary evidence related to the higher risk seen in boys (Paterson 2006).
• Less serotonin in the tissue. A second autopsy study (41 babies who died of sudden infant death syndrome, 7 comparison babies and 5 hospitalized infants) found serotonin levels 26 percent lower in the raphé obscurus, a brainstem region. Levels of tryptophan hydroxylase, the enzyme that makes serotonin, were 22 percent lower. Serotonin 1A receptor binding was 29 to 55 percent lower in three regions (Duncan 2010).
• Higher serotonin in the blood. Blood serum serotonin was 95 percent higher in 61 affected babies than in 15 comparison babies at autopsy, and 31 percent of the affected babies (19 of 61) were far above the comparison range. The same paper reports that brainstem serotonin abnormalities were tied to about 40 percent of deaths in the group's earlier work (Haynes 2017).

The research group behind much of this work concludes that an important subset of these babies has a "core lesion" in the lower brainstem, which could lead to a failure of protective responses during sleep (Kinney 2019). The word "subset" matters, as this does not describe every baby who dies. These studies also compare small numbers of babies after death, so they show differences, and they cannot show when the differences began or test any treatment.

Arousal: waking enough to respond

One study recorded the sleep of 16 infants days or weeks before they died, and compared them with matched control infants. Full arousals reaching the outer brain (the cortex) were less frequent in the babies who later died. Partial arousals that stopped below the cortex were more frequent and longer during rapid-eye-movement sleep, the stage of sleep linked with dreaming. The authors describe this as suggestive of incomplete arousal processes (Kato 2003).

A blood marker at birth

In 2022 a case-control study measured an enzyme, butyrylcholinesterase, in dried blood spots taken 2 to 3 days after birth. It compared 67 sudden unexpected deaths with 10 matched surviving babies each. Lower enzyme activity was associated with death in the groups where the case was reported as sudden infant death syndrome (odds ratio 0.73 per unit), and not in the other deaths (Harrington 2022). The authors call it a potential biomarker. The study did not test screening, and it does not provide a test that can tell parents about their own baby.

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What the Study Numbers Mean

Nearly every number below comes from a case-control study. Researchers interview the families of babies who died, then compare answers with those of families whose babies are alive. Randomized trials are not possible for most of these questions. Three cautions apply:

• An odds ratio compares groups. An odds ratio of 2 means the odds of having met the factor were about twice as high among the babies who died as among the babies who lived. A figure below 1 means the factor was linked with lower risk. An odds ratio does not state how likely any one baby is to die.
• The starting risk is low. In one large pooled analysis, a large relative figure still corresponded to an estimated 0.23 deaths per 1,000 live births, or about 1 in 4,300 (Carpenter 2013).
• Linked is not the same as caused. Families who follow health advice may differ in other ways, a pattern one review calls a "healthy adopter" effect (Gilbert 2005).

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Sleep Position

Sleeping on the front (prone) is the most studied factor:

• Systematic review: by 1970 the pooled odds of death were 2.93 times higher for front sleeping than back sleeping. The pooled odds ratio was 2.95 in studies from before advice changed and 6.91 in studies from after (Gilbert 2005).
• Europe, 20 regions, 745 deaths and 2,411 living babies: odds ratio 13.1 for front sleeping and 45.4 for turning from the side to the front. About 48 percent of cases were attributed to sleeping on the side or front (Carpenter 2004).
• England, Avon and Somerset, 1990: relative risk 8.8 for front sleeping (Fleming 1990).
• Chicago, 260 deaths and 260 living babies: unadjusted odds ratio 2.4, and still significant in the adjusted model (Hauck 2003).
• Germany, 333 deaths and 998 living babies: only 4.1 percent of babies were placed on the front, and those babies were at high risk. Babies not used to the position were at very high risk (Vennemann 2009).

By 2005 the American Academy of Pediatrics no longer recognized side sleeping as a reasonable alternative to sleeping fully on the back (Task Force 2005).

The history is an important part of this finding. Books recommended front sleeping from 1943 to 1988, based on untested theory. The 2005 review judges that advice as contrary to evidence available from 1970, and it estimates that a systematic review of the evidence from 1970 might have prevented over 10,000 infant deaths in the United Kingdom and at least 50,000 in Europe, the United States and Australasia (Gilbert 2005). Parents in those years were following what they were told.

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Soft Bedding, Overheating and Swaddling

Soft surfaces and bedding. In the Chicago study the unadjusted odds ratios were 5.1 for a soft sleep surface, 2.5 for a pillow, and 2.5 for a face or head covered by bedding. A soft surface and pillow use stayed significant in the adjusted model (Hauck 2003). In south west England, 21 percent of babies who died had used a pillow for the last sleep, compared with 3 percent of comparison babies (Blair 2009). The German study adds duvets to the list, along with front sleeping on a sheepskin, though it notes that small numbers in some groups mean further studies are needed (Vennemann 2009).

Overheating. A 1990 English study of 72 sudden unexpected deaths and 144 living babies found a relative risk of 1.14 for each tog of clothing and bedding above 8 tog (a tog is a measure of how warm a covering is), and 2.7 for heating left on all night. Among babies over 70 days old, the risk was raised by factors of 15.1 for front sleeping and 25.2 for more than 10 tog, compared with babies of that age on the back or side under less than 6 tog. The authors concluded that overheating and the front position were each independently associated with increased risk (Fleming 1990).

Swaddling. A meta-analysis of 4 studies found a pooled odds ratio of 1.58 (95 percent confidence interval 0.97 to 2.58), which does not reach statistical significance. The authors found the studies differed substantially. The risk varied by position: 12.99 on the front, 3.16 on the side and 1.93 on the back. Limited evidence suggested about twice the risk over 6 months of age. Imprecise definitions of swaddling make these numbers hard to interpret (Pease 2016).

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Smoke Exposure

The largest single analysis used United States records of 20,685,463 births and 19,127 sudden unexpected infant deaths from 2007 to 2011 (Anderson 2019):

• Any smoking during pregnancy: adjusted odds ratio 2.44.
• The odds doubled between no smoking and 1 cigarette a day, and rose with each added cigarette up to 20 a day, then levelled off.
• Compared with those who continued, mothers who reduced had lower odds (0.88), and mothers who quit had lower odds (0.77).
• The authors estimate 22 percent of these deaths in the United States are attributable to smoking in pregnancy, on the stated assumption that the link is causal.

A meta-analysis of 35 case-control studies reports odds ratios of 2.25 for smoking during pregnancy and 1.97 for smoking after birth, with higher risk at heavier smoking and when babies slept beside a mother who smoked (Zhang 2013). The health effects of smoke in the air around children are covered on the Secondhand Smoke page.

Nicotine addiction is hard to break. These numbers describe an exposure across large populations, and they are not a judgement of any mother.

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Prematurity

In United States records from 2005 to 2007, including 5,203 deaths after the first month attributed to sudden infant death syndrome, babies born at 24 to 28 weeks had an adjusted odds ratio of 2.57 compared with full-term babies. In 1987 the comparable figure was 2.32, so the relative risk had not fallen with the overall rate (Malloy 2013).

Among United States preterm babies born from 2005 to 2014, the rate of sudden unexpected infant death was 2.0 per 1,000 live births, ranging from 0.82 in Vermont to 3.87 in Mississippi (Hwang 2023). In south west England, 26 percent of babies who died were preterm, compared with 5 percent of comparison babies (Blair 2009). More on early birth is on the Preterm Labor page.

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Bed Sharing

This is the most debated factor, because the studies do not fully agree. Those that measured it find a strong risk on a sofa and a sharp rise alongside alcohol or smoking. They differ on bed sharing when none of those is present.

• Five pooled studies, 1,472 deaths and 4,679 living babies: 22.2 percent of babies who died were bed sharing, compared with 9.6 percent of comparison babies (adjusted odds ratio 2.7). For a breastfed baby under 3 months with non-smoking parents and no other risk factors, the adjusted odds ratio against room sharing was 5.1. The estimated absolute risk rose from 0.08 to 0.23 per 1,000 live births (Carpenter 2013).
• Two pooled United Kingdom studies, 400 deaths and 1,386 living babies: the odds ratio was 18.3 on a sofa and 18.3 next to a parent who drank more than two units of alcohol. Next to someone who smoked, it was 8.9 for babies under 3 months and 1.4 for older babies, the latter not significant. With none of these hazards present, bed sharing was not significant overall (1.1), nor under 3 months (1.6, 95 percent confidence interval 0.96 to 2.7), and pointed toward lower risk in older babies (0.1) (Blair 2014).
• England 1999, 325 deaths and 1,300 living babies: babies who shared the bed and were then put back in their own cot had no increased risk (0.67). The odds ratio was 9.78 for sharing the whole sleep or being found in the parental bed, and 48.99 for sharing a sofa. The authors found no evidence of hazard in infants of non-smoking parents (Blair 1999).
• Scotland, 123 deaths and 263 living babies: the overall odds ratio was 2.89, and 10.20 for babies under 11 weeks, against 1.07 for older babies. The link remained where the mother did not smoke (8.01) and where the baby was breastfed (13.10). Sharing a couch had an odds ratio of 66.9, with a very wide range of 2.8 to 1,597 (Tappin 2005).
• Europe, 20 regions: if the mother smoked, the odds ratio at 2 weeks of age was 27.0. For mothers who did not smoke in pregnancy it was 2.4 at 2 weeks, and significant only in the first 8 weeks of life (Carpenter 2004).
• South west England, 80 deaths: 54 percent of babies who died were cosleeping, compared with 20 percent of comparison babies. Much of this difference may be explained by recent parental alcohol or drug use (31 percent versus 3 percent) and by sofa sleeping (17 percent versus 1 percent) (Blair 2009).
• Chicago: sharing with parents alone had an unadjusted odds ratio of 1.9, and other bed-sharing combinations 5.4. Only the second stayed significant in the adjusted model (Hauck 2003).

Across these studies, risk concentrates in the youngest babies, on sofas, and alongside smoke or alcohol. The disagreement concerns whether a risk remains for very young babies when no such hazard is present.

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Factors Linked With Lower Risk

Breastfeeding

A meta-analysis of 18 case-control studies found a multivariable summary odds ratio of 0.55 for any breast milk for any duration, and a univariable figure of 0.27 for exclusive breastfeeding of any duration (Hauck 2011). A later analysis of individual records from 8 studies, 2,267 deaths and 6,837 living babies, looked at duration (Thompson 2017):

• Less than 2 months: 0.91, not significant.
• 2 to 4 months: 0.60.
• 4 to 6 months: 0.40.
• More than 6 months: 0.36.

The authors report that breastfeeding for at least 2 months was associated with half the risk, and that it did not need to be exclusive. Many mothers cannot breastfeed, or cannot do so for long, and a shorter time or formula feeding says nothing about any one baby's death. Milk production itself is explained on the lactation animation page.

Pacifiers

A meta-analysis of 7 case-control studies found a multivariate summary odds ratio of 0.39 for a pacifier during the last sleep and 0.71 for usual pacifier use. The authors estimate 1 death prevented for every 2,733 infants using a pacifier for sleep, based on the United States rate. No prospective studies were found (Hauck 2005). The German study found the same direction (Vennemann 2009). In a United Kingdom analysis, pacifier use was linked with lower risk only among babies who were co-sleeping (Blair 2014). These studies do not establish why a pacifier would matter.

Room sharing

Sleeping in a separate room from the parents had an odds ratio of 10.49 in the 1999 English study (Blair 1999). The European study attributes roughly 36 percent of cases to the baby sleeping in a separate room (Carpenter 2004). In Germany, sleeping in the living room carried higher risk than sleeping in the parental bedroom, on small numbers (Vennemann 2009). The 2022 American Academy of Pediatrics guidance includes room sharing without bed sharing (Moon 2022).

Vaccination

Claims have been made that immunizations cause sudden infant death syndrome. A meta-analysis of 9 case-control studies, 4 of which adjusted for other factors, instead found a summary odds ratio of 0.54 (95 percent confidence interval 0.39 to 0.76), roughly half the risk. The authors note the link may be causal, while a "healthy vaccinee effect" may also play a part (Vennemann 2007). Serious infection in very young babies is covered on the Whooping Cough page and the page on pertussis in newborns and young infants.

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The American Academy of Pediatrics 2022 Guidance

The American Academy of Pediatrics published its current policy statement and a companion evidence report in July 2022 (Moon 2022; Moon 2022b). The statement's summary lists the following.

For all sleep-related deaths, the safe sleep environment it recommends includes:

• Placing the baby on the back ("supine positioning").
• A firm sleep surface that is not inclined.
• Room sharing without bed sharing.
• "Avoidance of soft bedding and overheating."

For sudden infant death syndrome specifically, it adds:

• Human milk feeding.
• "Avoidance of exposure to nicotine, alcohol, marijuana, opioids, and illicit drugs."
• Routine immunization.
• Use of a pacifier.

The 2022 statement also presents new recommendations on non-inclined sleep surfaces, short-term emergency sleep locations, cardboard boxes as a sleep location, bed sharing, substance use, home heart and breathing monitors, and tummy time. It also gives parents and clinicians added information for assessing the risk of specific bed-sharing situations. Guidelines in other countries may be worded differently. This page reports the guideline and does not add advice of its own; decisions about a baby's care belong with parents and their clinicians.

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What Is Not Known

• The cause. The cause of sudden infant death syndrome is unknown (Moon 2007). It probably covers more than one disorder, since one paper describes it as likely comprising heterogeneous disorders that share the same appearance (Haynes 2017).
• How to identify a vulnerable baby in life. The serotonin and enzyme findings come from groups studied after death. None of the studies read here tests a way to predict risk in one living child.
• How much of the fall came from which change. Sleep position, smoking, diagnosis habits and wider declines in infant death all moved over the same years (Goldstein 2016; Rusen 2004).
• Why rates have plateaued. The rate of reduction has slowed. An international consensus across 25 countries, including researchers, clinicians and parents who lost children, named 10 research priorities. These centered on the underlying mechanisms, better data collection and sharing, and better communication of risk (Hauck 2017).
• What causes the differences between states and populations. The studies reporting them call for further research (Erck Lambert 2018; Hwang 2023).
• Whether a risk remains in bed sharing with no other hazard. As set out above, the pooled studies disagree.

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For Families After a Loss

Parents who have lost a baby often read pages like this one looking for what they did. The science does not support reading it that way. Some of the reasons, drawn from the studies above:

• Factors listed here were also present among many babies who lived. In the pooled analysis, 9.6 percent of the living comparison babies were bed sharing (Carpenter 2013). In south west England, 14 percent of the randomly chosen comparison mothers smoked in pregnancy (Blair 2009).
• The triple-risk model holds that outside stressors matter only when they meet a vulnerability during a critical period, and that the vulnerability lies latent until then (Filiano 1994).
• Autopsy and blood-spot research points to differences inside the baby, some measurable at birth, that no parent could have seen (Duncan 2010; Harrington 2022).
• For nearly half a century, published advice told parents to use a sleep position later linked to the deaths (Gilbert 2005).

The 2021 report by pediatric and medical examiner groups states that families need accurate and open communication about why their infant died, and that clear information allows pediatricians to support families and make referrals for pediatric specialty and mental health care (Shapiro-Mendoza 2021).

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Key Research Papers

1. Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment. Pediatrics. 2022;150(1):e2022057990. PubMed PMID: 35726558
2. Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Evidence Base for 2022 Updated Recommendations for a Safe Infant Sleeping Environment to Reduce the Risk of Sleep-Related Infant Deaths. Pediatrics. 2022;150(1):e2022057991. PubMed PMID: 35921639
3. Kinney HC, Haynes RL. The Serotonin Brainstem Hypothesis for the Sudden Infant Death Syndrome. J Neuropathol Exp Neurol. 2019;78(9):765-779. PubMed PMID: 31397480
4. Krous HF, Beckwith JB, Byard RW, Rognum TO, Bajanowski T, Corey T, Cutz E, Hanzlick R, Keens TG, Mitchell EA. Sudden infant death syndrome and unclassified sudden infant deaths: a definitional and diagnostic approach. Pediatrics. 2004;114(1):234-8. PubMed PMID: 15231934
5. Shapiro-Mendoza CK, Palusci VJ, Hoffman B, Batra E, Yester M, Corey TS, Sens MA; AAP Task Force on Sudden Infant Death Syndrome, Council on Child Abuse and Neglect, Council on Injury, Violence, and Poison Prevention, Section on Child Death Review and Prevention, National Association of Medical Examiners. Half Century Since SIDS: A Reappraisal of Terminology. Pediatrics. 2021;148(4):e2021053746. PubMed PMID: 34544849
6. American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. The changing concept of sudden infant death syndrome: diagnostic coding shifts, controversies regarding the sleeping environment, and new variables to consider in reducing risk. Pediatrics. 2005;116(5):1245-55. PubMed PMID: 16216901
7. Moon RY, Horne RS, Hauck FR. Sudden infant death syndrome. Lancet. 2007;370(9598):1578-87. PubMed PMID: 17980736
8. Malloy MH. Prematurity and sudden infant death syndrome: United States 2005-2007. J Perinatol. 2013;33(6):470-5. PubMed PMID: 23288251
9. Erck Lambert AB, Parks SE, Shapiro-Mendoza CK. National and State Trends in Sudden Unexpected Infant Death: 1990-2015. Pediatrics. 2018;141(3):e20173519. PubMed PMID: 29440504
10. Rusen ID, Liu S, Sauve R, Joseph KS, Kramer MS. Sudden infant death syndrome in Canada: trends in rates and risk factors, 1985-1998. Chronic Dis Can. 2004;25(1):1-6. PubMed PMID: 15298482
11. Sawaguchi T, Namiki M. Recent trend of the incidence of sudden infant death syndrome in Japan. Early Hum Dev. 2003;75 Suppl:S175-9. PubMed PMID: 14693403
12. Müller-Nordhorn J, Schneider A, Grittner U, Neumann K, Keil T, Willich SN, Binting S. International time trends in sudden unexpected infant death, 1969-2012. BMC Pediatr. 2020;20(1):377. PubMed PMID: 32781989
13. Goldstein RD, Trachtenberg FL, Sens MA, Harty BJ, Kinney HC. Overall Postneonatal Mortality and Rates of SIDS. Pediatrics. 2016;137(1). PubMed PMID: 26634772
14. Hwang SS, Bourque SL, Hannan KE, Passarella M, Radack J, Formanowski B, Lorch SA. Racial and Ethnic Disparities in Sudden Unexpected Infant Death Among US Infants Born Preterm. J Pediatr. 2023;260:113498. PubMed PMID: 37211205
15. Filiano JJ, Kinney HC. A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model. Biol Neonate. 1994;65(3-4):194-7. PubMed PMID: 8038282
16. Paterson DS, Trachtenberg FL, Thompson EG, Belliveau RA, Beggs AH, Darnall R, Chadwick AE, Krous HF, Kinney HC. Multiple serotonergic brainstem abnormalities in sudden infant death syndrome. JAMA. 2006;296(17):2124-32. PubMed PMID: 17077377
17. Duncan JR, Paterson DS, Hoffman JM, Mokler DJ, Borenstein NS, Belliveau RA, Krous HF, Haas EA, Stanley C, Nattie EE, Trachtenberg FL, Kinney HC. Brainstem serotonergic deficiency in sudden infant death syndrome. JAMA. 2010;303(5):430-7. PubMed PMID: 20124538
18. Haynes RL, Frelinger AL 3rd, Giles EK, Goldstein RD, Tran H, Kozakewich HP, Haas EA, Gerrits AJ, Mena OJ, Trachtenberg FL, Paterson DS, Berry GT, Adeli K, Kinney HC, Michelson AD. High serum serotonin in sudden infant death syndrome. Proc Natl Acad Sci U S A. 2017;114(29):7695-7700. PubMed PMID: 28674018
19. Kato I, Franco P, Groswasser J, Scaillet S, Kelmanson I, Togari H, Kahn A. Incomplete arousal processes in infants who were victims of sudden death. Am J Respir Crit Care Med. 2003;168(11):1298-303. PubMed PMID: 12917226
20. Harrington CT, Hafid NA, Waters KA. Butyrylcholinesterase is a potential biomarker for Sudden Infant Death Syndrome. EBioMedicine. 2022;80:104041. PubMed PMID: 35533499
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24. Hauck FR, Herman SM, Donovan M, Iyasu S, Merrick Moore C, Donoghue E, Kirschner RH, Willinger M. Sleep environment and the risk of sudden infant death syndrome in an urban population: the Chicago Infant Mortality Study. Pediatrics. 2003;111(5 Pt 2):1207-14. PubMed PMID: 12728140
25. Vennemann MM, Bajanowski T, Brinkmann B, Jorch G, Sauerland C, Mitchell EA; GeSID Study Group. Sleep environment risk factors for sudden infant death syndrome: the German Sudden Infant Death Syndrome Study. Pediatrics. 2009;123(4):1162-70. PubMed PMID: 19336376
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27. Pease AS, Fleming PJ, Hauck FR, Moon RY, Horne RS, L'Hoir MP, Ponsonby AL, Blair PS. Swaddling and the Risk of Sudden Infant Death Syndrome: A Meta-analysis. Pediatrics. 2016;137(6):e20153275. PubMed PMID: 27244847
28. Anderson TM, Lavista Ferres JM, Ren SY, Moon RY, Goldstein RD, Ramirez JM, Mitchell EA. Maternal Smoking Before and During Pregnancy and the Risk of Sudden Unexpected Infant Death. Pediatrics. 2019;143(4):e20183325. PubMed PMID: 30858347
29. Zhang K, Wang X. Maternal smoking and increased risk of sudden infant death syndrome: a meta-analysis. Leg Med (Tokyo). 2013;15(3):115-21. PubMed PMID: 23219585
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PubMed Topic Searches

1. PubMed: sudden infant death syndrome risk factors
2. PubMed: brainstem serotonin research
3. PubMed: sudden unexpected infant death trends
4. PubMed: bed sharing and sudden infant death syndrome
5. PubMed: bereaved parents after sudden infant death

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Connections

• Pediatrics — the parent section for conditions of childhood
• Secondhand Smoke — what is in the smoke around a child
• Whooping Cough — an infection that is most dangerous in young infants
• Pertussis in Newborns and Young Infants — how the illness looks at this age
• How Breast Milk Is Made — an animation of prolactin and let-down
• Preterm Labor — early birth, one measured risk factor
• Respiratory Syncytial Virus (RSV) Bronchiolitis — a common breathing illness in infants

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