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Health Indicator Report of Sudden Unexpected Infant Death (SUID)

Even after a thorough investigation, it can be difficult to distinguish SIDS from other sleep-related infant deaths such as suffocation by soft bedding. This is because these deaths are often unwitnessed, and there are no tests to tell SIDS apart from suffocation. To complicate matters, people who investigate SUIDs may report cause of death in different ways and may not include enough information about the circumstances of the event from the death scene.[ ^1^] Therefore, SIDS and the other sleep-related infant deaths that share common risk factors are grouped under the term Sudden Unexpected Infant Death (SUID) and, together, are the focus of the evidence-based safe sleep guidelines of the American Academy of Pediatrics and its goal of reducing all sleep-related infant deaths.


Data for Whites and Blacks do not include Hispanics. Hispanic ethnicity includes all races. **Number of deaths too small to calculate a reliable rate.

Data Sources

  • Birth Certificate Database, Office of Vital Statistics and Registry, New Jersey Department of Health
  • Linked Infant Death-Birth Database, Center for Health Statistics, New Jersey Department of Health


Sudden unexpected infant deaths are those involving an infant less than 1 year of age that occur suddenly and unexpectedly, and whose cause of death is not immediately obvious before investigation. Following a thorough investigation by autopsy, death scene investigation, and review of medical history, a small portion of these deaths turn out to be due to an undetected medical cause. However, the majority of these deaths are finalized with one of the following '''ICD-10 codes: R95''' (Sudden Infant Death Syndrome or SIDS), '''R99''' (unknown cause), or '''W75''' (accidental suffocation and strangulation in bed). By definition, SIDS is a sudden and unexpected infant death for which no cause has been found following a thorough investigation.


Number of deaths in the first year of life with Sudden Unexpected Infant Death (SUID) as the underlying cause of death


Total number of live births in the same year

Healthy People Objective: Sudden unexpected infant deaths (includes SIDS, Unknown Cause, and Accidental Suffocation and Strangulation in Bed)

U.S. Target: 0.84 infant deaths per 1,000 live births

How Are We Doing?

In New Jersey, there was a 29% decline in the SUID rate from 0.68 in 2000-2002 to 0.48 in 2012-2014, however the rate rose beginning in 2013-2015 such that it stood at 0.66 in 2015-2017, still well below the U.S. target of 0.84 and the national rate of 0.92. An increase in national rates was also noted in this period. Through the state-mandated work of the [ SIDS Center of New Jersey] (SCNJ), New Jersey began disseminating safe sleep information in 1992 based on the publication of the first American Academy of Pediatrics (AAP) guidelines in advance of the 1994 onset of the National Institute of Child Health and Human Development's "Back to Sleep" campaign. Thus, by 1998, New Jersey's rate had already fallen to one the lowest in the U.S. In association with the development in 2018 by the SCNJ of a free educational mobile phone app, provisional New Jersey data for 2018 indicate that the rate is poised to decline from the 2017 rate. While a rise in safe infant sleep has been associated with declining rates of SUID, compliance does not always predict a lower rate.^2,3^ Social and health determinants such as poverty, access to healthcare, smoking, and preterm birth are examples of important risk factors as well. Elimination of smoking during pregnancy would potentially reduce SUID by 22%.[ ^4^] In New Jersey, 3.6% of mothers report smoking in pregnancy compared to 25% among SUID cases. Racial disparity in these determinants is associated with disparity in the rates of SUID, independent of safe sleep practices. For the period 2014-2016, the preterm birth rate among Black infants in New Jersey was 47% higher than the rate among all other women.[ ^5^] Prematurity is a major risk factor. Infants born between 24 and 27 weeks of gestation have over three times the risk for SUID compared to full term infants.[ ^6^] Elimination of adverse social determinants plays a role in reducing the impact of some risks. For example, in New Jersey, Asian Indians bed share the most, which is a risk elevating behavior, but they have the lowest rate of SUID.^3^ This paradoxical finding may reflect compensatory conditions in this group such as a high level of supine sleep but also less poverty, smoking, or alcohol use. Maternal fatigue makes bed sharing especially dangerous. Thus, the cultural practice among Asian Indians of closely involving grandparents in early child care may reduce maternal fatigue in this population. However, even in this low risk population group, reduced bed sharing further reduces risk, underscoring the importance still of following safe sleep guidelines. It is therefore of note that, in contrast to a national rise in the percentage of infants who usually slept in a shared bed, particularly in families of Black infants[ ^7^], New Jersey experienced a decline of 31.4%[ ^8^] in the usual use of bed-sharing in this population from 2003 to 2010, the period comparable to the national study. In 2017, New Jersey surpassed its Healthy NJ 2020 targets for supine placement. In the NJSHAD Health Indicator Report for 2017, 75% surveyed parents reported most often placing an infant to sleep on the back, surpassing the HNJ2020 target of 74.1%. The 6% increase from 2016 represents the largest year to year improvement. Both White and Black infants surpassed their targets, and Hispanic infants approximated theirs. Mothers who placed infants on the side or stomach rather than supine most of the time were more likely to be Black or Hispanic, 19 or younger, a WIC recipient and lacking insurance or receiving Medicaid, reinforcing poverty as a risk factor.

How Do We Compare With the U.S.?

In 2015-2017, New Jersey's SUID rate of 0.66 deaths per 1,000 live births was well below the national rate of 0.92. New Jersey's SUID rates for infants of White, Black, or Hispanic mothers were also below U.S. rates for these groups. For the U.S. and New Jersey, respectively, the White non-Hispanic rates were 0.9 vs. 0.6, the Black non-Hispanic rates were 1.9 vs. 1.7, and the Hispanic rates were 0.5 vs. 0.4. However, as with fetal demise, stillbirth, and infant deaths from any cause, the rate of SUID among infants of Black mothers was higher than for other racial/ethnic groups both in the U.S. and New Jersey.

What Is Being Done?

In 1994, the "Back to Sleep" campaign was enacted encouraging parents to place babies on their backs to sleep. This practice has been termed one of the seven most important research findings in pediatrics in the past 40 years and is associated with a reduction in Sudden Unexpected Infant Death (SUID). This campaign was based on the evidence-based, risk-reducing recommendations the AAP began issuing in 1992. Now termed the "[ Safe to Sleep]" campaign, the [ guidelines] have expanded to address other risk factors for SUID and are described in the Evidence-based Practices section below. The SIDS Center of New Jersey (SCNJ) operates under a health services grant from the NJDOH and carries out the state's mandate to provide bereavement support, study risk factors, and provide multilingual and culturally, racially, and ethnically-sensitive risk-reducing education. Its research has contributed to the development of safe sleep guidelines by the AAP. The SCNJ collaborates with and serves the educational needs of physicians, nurses, social service and child care providers, health care systems, including hospitals and clinics, home visiting programs, maternal and child health consortia, licensing systems, social service organizations, first responders, government agencies, community groups, clergy, and educational institutions with allied public health missions in promoting safe infant sleep. It addresses barriers to compliance and participates in allied national initiatives. Its 24-hour hotline is noted below. Its programs, educational [ flyers], [ videos], tool kits, and services, also noted below, can be accessed via its website: [] In addition to its long-standing programs and services, the SCNJ's newest initiatives include a free [ mobile phone app for safe sleep], in English and Spanish, which includes graphics and voice-overs to overcome any literacy challenges. Its release in 2018 has been associated with a subsequent decline in SUID, based on provisional data for 2018. The app received a Public Health Innovator Award from the New Jersey Department of Health. It can be accessed by typing SIDS Info into the search bar of the app store associated with one's phone. A brief education video was developed for hospitals. The SCNJ collaborates with public health initiatives to address racial and ethnic disparities, and works in support of Nurture New Jersey, the First Lady's Family Health Fairs in high risk communities, and programs associated with Healthy Women Healthy Families and Doulas. Racial disparity in rates is associated with disparities in social determinants of health, including economic resources, access to healthcare, access to healthy food, lifespan health, smoking, prematurity, and neighborhood crime, as well as disparities in safe sleep practices. The SCNJ partnered with other organizations to present a Black Infant Mortality Conference in June 2017 and provided testimony to the NJ State Senate Health Committee to bring greater awareness of the disparities in social determinants that can affect infant mortality and to facilitate efforts to address these as well as the impact of implicit bias. The SCNJ continues this focus as a member of the NJ Perinatal Quality Collaborative Perinatal Disparities Work Group. In a related project, the SCNJ developed a Student Safe Sleep Ambassador program whereby students in high infant mortality communities learn about safe sleep and inform their neighborhoods.

Evidence-based Practices

The most recent safe infant sleep [ guidelines] and [ technical notes] were published by the American Academy of Pediatrics (AAP) in 2016 and include research conducted by the SIDS Center of New Jersey. The campaign describes the safest sleep environment for infants from birth to 12 months of age. In addition to placing infants on their backs to sleep, the guidelines recommend avoidance of an infant sharing a bed with a sleeping adult or child; avoidance of a sofa or chair for infant sleep; removal of loose bedding, pillows, quilts, soft objects, and bumpers from the infant's sleep area; use of a firm mattress that fits the crib space, is intended for the product, and is covered only with a tightly fitted sheet; avoidance of overheating the infant; and avoidance of exposure to tobacco smoke. In place of bed sharing, room sharing with the baby is advised so that the parent can be close by the infant. Breastfeeding is also recommended. While parents may bring the infant into bed for feeding and comforting, the AAP recommends that the infant be returned to the near-by crib, bassinet, portable crib, or play yard that meets current safety standards, once the parent is ready to sleep. These standards can be obtained from the Consumer Product Safety Commission ([ online] or 800-638-2772). Parents should consider offering a pacifier but should wait one month if breastfeeding and should avoid the use of clips or strings to attach a pacifier to the infant's clothing as these pose a strangulation risk. Tummy time when the infant is awake and supervised is also recommended to facilitate motor development. The AAP urges all caregivers to discuss these [ guidelines] and any challenges to achieving them with their infant's health care providers.

Available Services

Sudden Infant Death Syndrome Center of New Jersey (SCNJ) Hotline: 800-545-7437 / Office line: 732-249-2160[[br]] Mission: *Risk reduction and preventive education *Research *Bereavement support [[br]] Visit [] or call the hotline to obtain additional information and services. To access hospital Safe Sleep Tool Kits; the American Academy of Pediatrics safe infant sleep guidelines; and SIDS Center safe sleep flyers, videos, information on its free mobile phone app, and related material: []. Examples of SCNJ's educational programs are *Free [ mobile phone app] *Nurses and Physicians LEAD the Way, education programs for physicians and nurses for birthing hospitals, *Neighborhoods LEAD the Way, which reaches into communities at highest risk to address the challenges of racial disparity often in collaboration with local clergy, and *Education for child protective services, primary care centers, doula programs, home visiting programs, community health workers and providers associated with Healthy Women Healthy Families. [[br]] The SCNJ provides educational materials in English, Spanish, Arabic, Haitian Creole, and Hindi with other languages available as requested. Educational videos, hospital tool kits, webinars, and other message facilitating material are distributed and available on the [ SCNJ website]. In addressing the major risk of household smoke exposure, the SCNJ collaborated with [ Mom's Quit Connection] to extend the penetration of knowledge and interventions. The SCNJ also targets specific groups of caregivers, such as grandparents, and works with faith-based communities to reach caregivers at community levels. The free SIDS Center of New Jersey [ safe sleep mobile phone app] can be accessed by typing "SIDS Info" into the phone's search bar. To arrange an education program, call 732-249-2160.

Health Program Information

[[br]] *[ SIDS Center of New Jersey] *[ National Institutes of Health "Safe to Sleep" campaign] *[ NJDOH SIDS information] *[ NJ Department of Children and Families]
Page Content Updated On 08/19/2019, Published on 08/19/2019
The information provided above is from the Department of Health's NJSHAD web site ( The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Wed, 25 November 2020 9:09:07 from Department of Health, New Jersey State Health Assessment Data Web site: ".

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