Baby who slept with mum died of asphyxia after falling into gap between bed and wall: Coroner

SINGAPORE - A four-month-old baby girl who slept beside her mother died after she fell into a recess between the woman’s bed and a wall.

In their report on April 20, 2022, forensic pathologists believed that baby Nur Ailynn Imani Othman had somehow become trapped in the recess in a head-down position for some time.

This blocked her breathing and blood circulation, which resulted in hypoxia (low levels of oxygen in the body tissues) leading to her death.

In his findings dated April 3, 2023, State Coroner Adam Nakhoda said that according to the pathologists, this type of death resulting from an unusual position of the body over an extended period of time is known as positional asphyxia.

He ruled Ailynn’s death a misadventure.

The State Coroner said Ailynn had been sleeping in her parents’ master bedroom and that there was no baby cot there.

Instead, there was a queen-size bed which was placed with its head and left side against walls.

At the corner where the two walls met, there was a gap at the left wall, creating a recess.

The recess was about 22cm wide and 25cm deep from the top of the mattress on the bed to the bedroom floor.

At around 5am on Dec 20, 2021, the mother woke up when she heard Ailynn crying. She prepared a bottle of milk to feed the baby. Her husband was at work.

She then left the baby with the bottle to feed herself. Before the mother fell asleep again, she saw the baby lying on her side and facing her.

The State Coroner said it was probable the mother had loosened or released Ailynn from her swaddle so she could hold the milk bottle and feed herself.

The mother woke up at around 6am and saw the baby’s legs pointing upwards from the recess. She quickly lifted her daughter and saw the child was unresponsive.

The mother yelled for help and her tenant, who rushed into the bedroom, saw dried milk coming out of the child’s nose. He then told her to call for an ambulance.

He also performed cardiopulmonary resuscitation on the baby as directed by an emergency call operator. 

An ambulance crew arrived at 6.30am and Ailynn was rushed to Ng Teng Fong General Hospital. She was pronounced dead at 7.44am.

The forensic pathologists noted that the baby had been co-sleeping with her mother on the bed.

The State Coroner said the pathologists highlighted that with co-sleeping, there was an increased risk of suffocation from adult-sized pillows and blankets and also overlaying, which happens when the sleeping parent turns over and lies over the infant.

Dr Nirmal Kavalloor Visruthan, a senior consultant at KK Women’s and Children’s Hospital (KKH), had also provided an expert report on the proper positioning of an infant during sleep.

He said that when infants are less than a year old, parents should avoid putting them to sleep in a prone position. Sleeping in a supine or face-up position was safest, for both night sleep and naps, he added.

Dr Nirmal said it was also safer for an infant to sleep in a separate cot in the same room as the parents for the first year or for at least the first six months.

Infants could be taken to a bed for activities such as breastfeeding, but they should be placed back in the cot to sleep.

Parents should also place infants on a firm, flat, non-inclined sleep surface, preferably in a safety-approved crib with a tight-fitting mattress, covered with a fitted sheet and with no other bedding or soft objects.

A firm surface would maintain its shape and not conform to the shape of the infant’s head. Parents should avoid placing infants on soft bedding.

The State Coroner said parents should also ensure that there are no gaps between the mattress and the wall of the bassinet, playpen, portable crib, play yard or bedside sleeper.

He said Dr Nirmal also advised that couches and armchairs were extremely dangerous places for an infant and that the baby should never be left to sleep on these.

Tips on safe sleep for babies:

1. Keep the baby alone when he or she is sleeping;

2. Take the baby back to the cot after feeding or play;

3. Keep the baby there during sleep or naps.

Source: Dr Nirmal Kavalloor Visruthan, senior consultant at KK Women’s and Children’s Hospital