Margaret D'Arrigo-Martin knows firsthand the pain of losing an infant.
In 2003, her baby Alexis Claire was a very healthy 6½-week-old. D'Arrigo-Martin said she would often nurse Alexis and place her in a crib next to her own bed.
On the night Alexis died, however, the infant was more fussy than usual, and D'Arrigo-Martin placed her next to her in the bed in order to comfort her. When she awoke two hours later, she was horrified to find her baby not breathing.
"If I knew I was putting her in an unsafe situation by letting her sleep next to me, I never would have done it," she said.
She performed CPR and called 911, but unfortunately, nothing could be done to bring Alexis back.
D'Arrigo-Martin knew how important it was to keep her baby on her back and keep blankets and pillows away. But she did not know that it could also be dangerous to have her baby sleeping in the bed next to her.
"If I were to do it again, I would definitely [have put her] in a bassinet next to the bed, knowing what I know now," she said.
Unfortunately, stories like D'Arrigo-Martin's are not uncommon. Infant deaths related to suffocation and strangulation in bed have quadrupled in the last two decades, researchers at the U.S. Centers for Disease Control and Prevention reported in a study published Monday in the journal Pediatrics.
However, lead study author Dr. Carrie Shapiro-Mendoza said the reported increase does not necessarily mean that more infants overall are dying. Rather, she said, medical examiners now have more information available to better classify deaths in which suffocation or strangulation has occurred.
"This provides support for child death review teams and better death scene investigations," Shapiro-Mendoza said. She added that the research suggests there needs to be more education of parents about safe sleep environments.
"Hopefully, it will reinvigorate the method of safe sleeping," she said.
The study looked at infant death rates between the years of 1984 and 2004 and found that deaths classified as accidental suffocation and strangulation in bed (ASSB) increased four-fold over this time period. But over the same time period, infant deaths classified as sudden infant death syndrome (SIDS) have declined. The total rate of unexplained death among infants has not changed significantly.
In the paper, ASSB includes suffocation by various means, such as when the baby's airway is blocked by soft bedding or a pillow, or if an adult rolls on top of the child. The classification of SIDS, on the other hand, indicates that there is no known cause of death after a thorough investigation.
So, why is it so important to further define the circumstances of death in these situations? Shapiro-Mendoza said that knowing what risk factors lead to ASSB and SIDS can help doctors tell new parents how to prevent these deaths from happening.
Dr. Sessions Cole, chief medical officer of St. Louis Children's Hospital, agreed.
"This will be a stimulus to get everyone to adhere to CDC recommendations for death scene investigations for children," Cole said.
But even as more information comes to light, there are still unanswered questions.
Currently, Shapiro-Mendoza said, the jury is still out on the exact risk factors for suffocation and strangulation in babies. These deaths occurred on beds, but they also occurred on cribs and sofas.
The study also finds that black male infants less than 4 months of age are most affected by ASSB, for reasons Shapiro-Mendoza said are still unclear.
But what is known is that parents can take steps to reduce the chance that their baby will die from suffocation or strangulation.
"We recommend room sharing instead of bed sharing," said Laura Reno, vice president of public affairs for First Candle, an organization devoted to parental education. "[Parents need to] learn how to create a safe sleep zone, making sure babies sleep in a separate space on their back, on a firm mattress, free from any soft bedding."
She added that if parents do not want to sleep too far away from their baby, they can place that safe sleep space right next to their bed.
"It will protect [the baby] and promote breastfeeding," Reno said.
Dr. Suresh Kotogal, a professor of neurology and a pediatric sleep specialist at Mayo Clinic, agreed.
"[This study] will fuel interest in this area again," Kotogal said. "[Safe] sleeping environments need to be emphasized by all primary care physicians and at the time babies [are] going home from the hospital."