International Child Care Practices Study: infant sleeping environment

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Abstract

Background: The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature.

Methods: Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to “reduce the risks of SIDS” were available at the time of the survey.

Results: Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2–88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58–100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%.

Conclusions: It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of “typical” bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

Introduction

The International Child Care Practices Study (ICCPS) collected comparative information on child care practices from 21 centres in 17 countries. These include countries with recognised low rates of sudden infant death syndrome (SIDS) such as Hong Kong and Japan [1], as well as information from other countries that previously had higher rates of SIDS such as New Zealand [2]. This report provides details on some of the less well established SIDS risk factors (bedsharing, use of a pillow) and protective factors (sleeping in the same room as an adult). These practices have been associated with an increased or decreased risk of SIDS in one or more studies, but there is still debate about what advice should be given to parents. Information is also presented on the main daytime and night-time caregivers.

Section snippets

Methods

The International Child Care Practices Study (ICCPS) methods have been previously described [3]. Subsequent to this publication, data from Odessa in the Ukraine has been included. The study was designed to recruit families so that the infants would be 3 months old during the coldest 2 months of the year. Invitation to participate was made during the week after birth. A “birth questionnaire” was completed at the time of recruitment by interview and collected mainly socio-demographic data. A

Results

Details of room sharing are shown in Table 1. Two questions related to room sharing were asked. The first was which room the infant slept in: the parents' room, the infant's own room, or another room. The second question asked more directly the number of adults (over 12 years) and children (under 12 years) who shared a room with the infant. High rates of room sharing (one or more adults in the room with the infant) were noted in both Group A (97% Stockholm, 93% Tokyo/Yokohama, 91% Copenhagen)

Discussion

This study collected descriptive data on child care from a range of different countries and cultures. Although every attempt was made to standardise the methods, significant variations in data collection occurred. Thus, although we consider that the international comparison of child care practice is possible using these standardised methods, we also note that, in view of the heterogeneity of the samples, it is important to avoid over-interpretation of any differences identified, and to view

Acknowledgements

This project was an initiative of the SIDS Global Strategy Task Force whose support is greatly appreciated. The Research Grants Council and the Society for the Relief of Disabled Children in Hong Kong provided some funding.

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