Almost 60 infants died unexpectedly in Minnesota last year, nearly all because of dangerous sleep practices. A new analysis of infant deaths has prompted two state agencies to warn parents about bedtime practices that can be fatal.
Of the 56 unexpected baby deaths reported last year, 52 involved an unsafe sleep surface or sleep position. That suggests more than 90 percent of those deaths could have been prevented.
That picture is emerging from changes in how medical examiners investigate a death scene. They now consistently meet with parents and caregivers and use dolls to reenact the scene where the infant was found dead.
The Minnesota Department of Health's Susan Castellano said reenactments have given investigators much better information. Infant death reports from 2014 showed that one of two major sleep risks was present in all 52 deaths attributed to unsafe sleep environments.
"About half of those babies were sharing a sleep surface, such as a bed or sofa or recliner, with another person," she said. "The other half were in an unsafe sleep position such as being placed on their side or tummy instead of on their backs, and had loose objects around them."
Castellano, who directs the department's Maternal and Child Health division, said babies should always be put to sleep alone on their backs, in a crib with a firm mattress. Loose objects such as blankets, pillows or toys should be kept away from sleeping infants because they can suffocate a baby. In Minnesota, unexpected infant deaths are attributed to an unsafe sleep environment if even a single toy is present in a crib and found nowhere near the baby's face.
Castellano said that's because by the time death investigators arrive at the scene, the baby has been moved and it's difficult to know exactly where or how the child was found. So surrounding objects are assumed to be a factor.
The Health Department and the Minnesota Department of Human Services say adults should never share a bed with an infant, because they can suffocate a child too.
Risk factors also occur outside the family home. The Human Services Department saw a spike in infants dying in licensed childcare settings a few years ago. There were 11 infant deaths each in 2010 and 2011.
Inspector General Jerry Kerber said that when the department looked back over the decade ending in 2012, researchers identified 83 infants who died unexpectedly in child care settings.
"We found that 75 percent of those occurred in an unsafe sleep arrangement," he said.
Armed with that information, Kerber said, the department proposed new rules requiring childcare providers to participate in an annual safe sleep training program. The Legislature approved the requirement in 2013, and infant deaths in childcare settings have plummeted.
"In 2014 there was one sleep-related death in a family childcare setting, and this year there have been two sleep-related deaths in childcare," Kerber said. "But certainly even one is too many."
In many family settings, it's still common for parents to sleep with infants, despite the warnings.
Supporters of the practice argue it's not dangerous under the right circumstances — for example, if parents aren't overweight or under the influence of drugs or alcohol, and if they sleep on a firm mattress with plenty of room for everyone. But they say public health warnings imply that all bed-sharing situations carry equal risk.
But the Health Department's Castellano said that if parents are looking for a foolproof way to share a bed with an infant, there isn't one.
"It's a risk you just don't want to take," she said. "It's not worth the possible outcome."
The Health Department is also asking retailers to stop contributing to unsafe sleep situations. The agency is urging stores stop selling crib bumpers because infants can suffocate if they press their face against them. Some states ban the product, but Minnesota does not.
Swaddle blankets for babies 6 months and older are not recommended, either, because they limit babies' ability to reposition themselves if they're having trouble breathing.