To the Editor We read with interest the article by Gao et al,1 who described an increase in unintentional infant suffocation from 1999 to 2015 in the United States, which was “primarily a result of increases in deaths from suffocation and strangulation in bed.”1 Unfortunately, this study did not fully acknowledge that increased rates in accidental suffocation and strangulation in bed (ASSB) have been partly attributed to diagnostic shifts.2 Since about 1999, cause-of-death certifiers (medical examiners and coroners) have been moving away from reporting sudden infant death syndrome (SIDS) as a cause of death to other sudden unexpected infant death (SUID) causes such as ASSB.2 In 1990, 84% of SUIDs were certified as SIDS and 2% as ASSB. In 2015, 42% of SUIDs were certified as SIDS and 25% as ASSB.2
Womack LS, Pinckard JK, Shapiro-Mendoza CK. Measuring Trends in Infant Mortality Due to Unintentional Suffocation. JAMA Pediatr. 2018;172(9):887. doi:10.1001/jamapediatrics.2018.1651
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