Bridging the Gap: Racial Disparities in SIDS Across the U.S.

Patient Expert

The rate of sudden infant death syndrome (SIDS) has dropped considerably since the early 1990s, yet the National Center for Health Statistics has revealed that SIDS rates for non-Hispanic black women are currently 83 percent higher than non-Hispanic white women.

A study published in the Maternal and Child Health Journal in 2015 set out first to determine why such a disparity exists, and if the advice offered to families of newborns is sufficient.

The study collected data from 60 new African-American mothers through focus groups and 20 interviews with medical providers who served new mothers.

New mothers were asked questions about sleep safety such as:

  • Where does your baby sleep?
  • Were you informed about the best place for your baby to sleep?
  • Do you put your baby to sleep on his/her back, side, or front?
  • Were you informed about the best sleeping position for your baby?

Medical providers were asked questions such as:

  • What are the key issues you counsel new mothers about?
  • Do you think most mothers understand the SIDS recommendations?
  • Do you think most mothers follow the SIDS recommendations?
  • Do you feel that you face cultural barriers when working with your patients?

SIDS safety guidelines

Although highly debated upon among different cultures, locations and generations, the recommendations issued by the American Academy of Pediatrics (AAP) to protect against SIDS include putting babies to sleep on their backs, using firm bedding, and not bed-sharing with other adults or children.

Researchers found that although the large majority of mothers were aware of and understood the content of safe sleeping recommendations, 95 percent still reported bed-sharing with their infants.

The study found three general reasons why new mothers carried out techniques that varied from the medical advice they received about safe sleeping:

  • Convenience (I am tired and don't want to walk to the crib)
  • Perceived safety (stomach sleeping may prevent choking)
  • Infant sleep quality (baby sleeps better on her stomach)

Of particular concern to the researchers was the fact that many mothers who knew they were contradicting medical advice claimed that they took steps to reduce the risk of SIDS — but based on the data, the steps they took actually increased risk.

For example, many of the mothers reported using soft blankets and pillows to cushion the baby when sharing a bed. Common recommendations include swaddling the baby or using just a fitted sheet, as loose blankets can potentially cover the infant's face and increase suffocation risk.

How to reduce the risk of SIDS in African-American infants

Medical providers often mentioned bed-sharing as the biggest challenge they faced in addressing SIDS risk among African-American infants. In fact, they often noted that bed-sharing might be an ingrained tradition in African-American culture, which may make it difficult for them to address. In other cases, bed-sharing among African-American families may come out of necessity instead of an inclination or desire, claims Dr. Lori Feldman-Winter, a Cooper University Health pediatrician.

Interestingly, medical providers revealed that although they believed family advice often superseded clinical advice, many mothers reported being more likely to follow medical advice if their families recommended bed-sharing because they recognized that familial advice may be outdated.

As the authors of this study mentioned, the AAP safe sleeping advice fails to consider family context or adaptation of the recommendations.

Study authors also argued that data supported reasoning behind current safe sleeping recommendations need to be explained better to new families, and that it may be time to switch the focus from instructing parents on safe sleeping techniques to a strategy of risk-reduction. This could be done by offering adaptive “safer sleep strategies,” (for example, not using pillows and blankets when bed-sharing) rather than simply reiterating current guidelines.

As the study's authors pointed out, as soon as initial recommendations are ignored, parents may not be aware that they can still practice techniques to reduce the risk of SIDS.

To reduce the risk of SIDS in African-American infants, and help to bridge the gap in this data disparity, we as medical professionals need to do a better job of explaining the rationale behind the recommendations, as well as acknowledge and incorporate family and cultural preferences into current adaptive counselling strategies.

What do you think? Have you had to decide between conflicting advice on sleeping practices for your baby? Let us know in the comments below!

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Martin is the creator of Insomnia Land’s free sleep training for insomnia. His online course uses CBT techniques to teach participants how to sleep without relying on sleeping pills. More than 4,000 insomniacs have completed his course and 97 percent of graduates say they would recommend it to a friend.