Child Death by Suffocation

Child deaths due to suffocation result when a child is in a place or position where he or she is unable to breathe. In 2000, there were 1,580 suffocations, including 842 unintentional deaths, 568 suicides, 107 homicides, and 63 deaths in an undetermined manner in the United States. Most of the unintentional suffocations are caused by:

  • Choking: a child chokes on an object such as a piece of food or a small toy.
  • Co-sleeping: a person who is sleeping with a child rolls onto the child and unintentionally smothers the child.
  • Confinement: a child is trapped in an airtight place such as an unused refrigerator or toy chest.
  • Covering of face or chest: an object covers a child's face or compresses the chest, such as plastic bags, heavy blankets or furniture.
  • Positional asphyxia: a child's face becomes trapped in soft bedding or wedged in a small space such as between a mattress and a wall or between couch cushions.
  • Strangulation: a rope, cords, hands or other objects strangle a child.

Sleeping Environments

The majority of these suffocations happen to infants while they are in unsafe sleeping environments. These infants suffocate when another person lays over them or when they smother in bedding or furniture. Co-sleeping deaths are most often caused when an infant sleeps with adults or older siblings (bed-sharing). Bedding deaths occur when infants sleep with too much bedding or when they sleep in beds other than cribs. They suffocate because the bedding is usually too bulky or soft for infants. Hazardous sleeping surfaces include waterbeds, couches, large pillows, or soft or heavy comforters. This is the fourth leading type of accidental death for all children, following motor vehicle crashes, fires and drowning.

Infants should be places Alone, on their Backs, in a child-safe Crib that is free of objects such as blankets, pillows, stuffed animals, or loose bedding, Infants should never be placed to sleep on sofas, waterbeds, or bean bag chairs.


It is reported that infants sleeping in adult beds are 20 times more likely to suffocate than infants who sleep alone in cribs. Some proponents of bed-sharing argue that it promotes breastfeeding. However, researchers have shown that many of the benefits received from bed-sharing can be derived from the practice of having the infant sleep on a separate, firm surface, but in the same room with the mother.

Small Objects & Choking

For choking and strangulation deaths, toddlers and preschoolers are at the highest risk. Because they are active, they become entangled in cords and gain access to small objects. Food and uninflated balloons remain the number one and two choking hazards, again usually for toddlers. Product safety improvements including rigorous scrutiny and recalls by the Consumer Product Safety Commission on toys with choking hazards, removal of draw rings from children's clothing, and safety cord hangers for window blinds have reduced the number of these types of suffocations in recent years.

Major Risk Factors

  • Child's ability to gain access to objects causing choking or confinement
  • Easy access by infants and toddlers to cords and ropes
  • Easy access by infants and toddlers to small objects, balloons, and toys with small parts
  • Family's ability to provide safe sleep or play environment for the child
  • Faulty design of cribs, beds, or other hazards
  • If hanging, the child's developmental age consistent with activity causing strangulation
  • Infants sharing sleep surfaces with other persons
  • Number of and ages of persons sleeping with child
  • Obesity, fatigue, or drug or alcohol use by persons supervising or sleeping with child
  • Place where the child was sleeping or playing
  • Position of a child when found
  • Prior child deaths or repeated reports of apnea episodes by a caregiver
  • Quality of supervision at the time of death
  • Toy chests without safety latches and heavy furniture not secured to floors or walls
  • Type of bedding, blankets, and other objects near the child
  • Unsafe infant bedding: may include couches, waterbeds, poor-fitting crib mattresses, infant beds filled with clutter, heavy or numerous blankets, and soft mattresses