BOSTON -- Health officials are alarmed about rising numbers of infants suffocating in their sleep, despite decades of campaigns to educate parents about safe sleeping habits.
A recent report by the state Office of the Child Advocate, an independent watchdog, found that of 40 deaths of children under state care or custody in fiscal year 2017, at least 18 were attributed to sudden unexpected infant deaths.
Investigations by the state Department of Children and Families revealed that in a majority of those 18 deaths, a parent or adult was either sleeping with a child or had put the infant in an unsafe sleeping environment, the report noted.
Nationally, the rate of sudden unexpected infant deaths rose from 87.5 per 100,000 live births in 2014, to 92.6 deaths per 100,000 live births in 2015, according to the latest data from the U.S. Centers for Disease Control and Prevention.
In 2015, at least 3,700 infant deaths across the country were attributed to sudden unexpected infant death.
Sudden unexpected infant death involves accidental deaths of otherwise healthy infants under age 1.
In most cases, the deaths are attributed to suffocation caused by unsafe bedding or sleeping in a bed with a parent or other adult who inadvertently blocks an infant's airway.
SUID also includes sudden infant death syndrome, or SIDS, which involves the death of an infant under age 1 where the exact cause isn't known.
Health officials say while progress has been made in recent decades, a recent uptick shows that more work must be done to prevent infant deaths.
"We need to do a better job of getting the message out to parents," said Dr. Carole Allen, a retired pediatrician and trustee at the Massachusetts Medical Society.
As a basic rule, she said, parents should put babies to sleep on their backs on a flat surface, and never sleep with their babies in their beds.
"When my children were babies, we put them to sleep on their bellies," said Allen, a former director of pediatrics for Harvard Vanguard Medical Associates. "We didn't know enough to put them on their backs."
Another issue is parents who expose their infants to tobacco smoke, which can linger on a smoker's clothes for days.
"If someone in bed with the baby is a smoker, whether or not they are actually smoking, that presents a huge risk," Allen said.
The deaths reported by the Department of Children and Families only account for children under state care or custody, and it's not clear exactly how many SUID cases there are in Massachusetts. State records on those cases are spotty.
A 2015 report by the state Department of Public Health -- which appears to be the latest -- found 64 infants deaths were attributed to SUID from 2011-2012, an annual average of 52.6 per 100,000 infants.
A DPH spokeswoman said 30 to 40 infant deaths a year are attributed to SUID, but suggested the number of deaths have "decreased slightly since 2006."
The CDC has monitoring programs in 16 states, including New Hampshire, Pennsylvania and Colorado. Massachusetts is not among them.
New Hampshire reported at least 53 sleep-related infant deaths from 2011 to 2016, according to the latest data from the state Department of Health and Human Services. In 85 percent of those cases, infants were sleeping in beds with soft or loose sheets and blankets, the agency reported.
A recent study by Harvard Medical School highlighted how there’s been little, if any, shift nationally in the rate of sudden unexpected infant deaths since federal guidelines were issued more than two decades ago.
The study, which used federal records from 1995 through 2014, found the rate of babies dying from suffocation has actually increased since safe-sleep guidelines were published by the American Academy of Pediatrics in 1992.
The frequency of SUID in the first month of life is higher than generally recognized, at an average of 444 cases per year nationally, according to the study. At least 66 of those deaths occurred on day the baby was born, while another 130 occurred in the first week.
The researchers found that after a 23 percent decline in SUID from 1995 to 2002 among infants between 1 month and 1 year old, deaths increased in the following years.
Groups that counsel new parents say it's not clear why the deaths are increasing.
"Parenting practices tend to be observed or handed down from one generation to another," said Sarita Rogers, who manages a young parent coaching program for the nonprofit Children’s Trust Healthy Families program. "So, if they've seen someone else sleeping with their children in ways that we would consider unsafe, they might assume that's OK."
In other cases, cultural practices or socio-economic factors contribute to misconceptions about proper sleeping habits for babies.
Rogers said it's important to talk with parents and show them how to properly prepare a safe sleeping environment.
"It's not enough to just give parents information and tell them to read it," she said. "You really have to engage them in a dialogue."
A spokeswoman for the Department of Children and Families said the agency is "concerned" about the increase in SUID among children under state's watch and is working with the Health Department to "implement additional strategies to raise awareness of this potentially life-threatening sleeping practice."
The agency’s social workers undergo training on safe sleeping and are required to check the sleep environment for children under age 1 and talk with parents and caregivers, according to the spokeswoman.
One new approach that seems to be gaining support is the use of so-called "baby boxes" -- wooden or cardboard boxes with firm mattresses and fitted sheets. The boxes are designed to give newborns a safe place to sleep in their first months of life.
On Beacon Hill, lawmakers are considering a proposal that would require state health officials to create a new pilot program educating parents on safe sleeping practices while providing baby boxes or other products aimed at reducing infant deaths.
"Any increase in infant mortality is unacceptable, especially for a state like Massachusetts," said state Rep. Diana DiZoglio, D-Methuen, a co-sponsor of the bill. "We need to be doing everything we can to prevent it from happening and education is a big part of the equation."
Christian M. Wade covers the Massachusetts Statehouse for North of Boston Media Group’s newspapers and websites. Email him at firstname.lastname@example.org.
Reduce the Risk
Parents and caregivers are advised take the following actions to reduce the risk of sleep-related infant deaths:
* Place your baby on his or her back for all sleep times -- for naps and at night.
* Use a firm sleep surface, such as a mattress in a safety-approved crib, covered by a fitted sheet.
* Have the baby share your room, not your bed. Your baby should not sleep in an adult bed, on a couch, or on a chair alone, with you, or with anyone else.
* Keep soft objects, such as pillows and loose bedding out of your baby’s sleep area.
* Do not smoke during pregnancy, and do not smoke or allow smoking around your baby.
For more information: www.cdc.gov/sids/Parents-Caregivers.htm
Source: U.S. Centers for Disease Control and Prevention