Sudden Unexpected Infant Death in Inclined Sleepers: 2009-2023

In 2019, the Consumer Product Safety Commission (CPSC) recalled inclined sleepers following reports of infant deaths. In 2023, recalls were reannounced after additional reports of infant deaths. This study used child death review (CDR) data to describe sudden unexpected infant deaths (SUIDs) that occurred in inclined sleepers.

We identified SUIDs that occurred in inclined sleepers from 2009 to 2023 from the Pediatric National Fatality Review-Case Reporting System (Pediatric NFR-CRS). Frequencies and proportions were calculated to describe demographic, incident, and supervisor characteristics.

From 2009 to 2023, 158 SUIDs occurred in inclined sleepers. One hundred and eight deaths (68%) occurred from 2009 to 2019; 50 deaths (32%) occurred after 2019. Most infants were younger than 4 months (67%). Most incidents occurred at the infant's home (86%) under the supervision of a parent (83%). Nearly 30% were reported as placed supine to sleep and subsequently found unresponsive nonsupine. In 51 deaths (32%), the CDR team indicated the infant's airway was obstructed when found: 55% by the inclined sleeper material and 35% by other soft bedding in the sleep environment (not mutually exclusive).

Infant deaths occurred in inclined sleepers even after the CPSC issued manufacturer recalls in 2019. Health care providers, home visitors, health insurers, and family-serving organizations should continue advising caregivers on the importance of a safe infant sleep environment, including use of a firm, noninclined surface, and avoidance of soft bedding. Improved dissemination of recalls of infant products that represent unsafe sleep environments may reduce the risk of sleep-related deaths.