Health Science Research Grants (Research on Children and Families) Report on Assigned Section

Background: The International Child Care Practices Study collected descriptive data from 21 centres in 17 countries. Methods: This reports details child care practices associated with risk for sudden infant death syndrome (SIDS) for four centres in Asia (Beijing, Chongqing, Hong Kong and Japan). These centres had low, or presumed low, rates of SIDS and, with the exception of Japan, participants in the study were not given prior information on SIDS risk factors. Results: Front (prone) sleep position is the most well recognised SIDS risk factor and was uncommon in all samples (6% or less). Side sleep position is also a risk factor for SIDS and was used for about one fifth of these infants. Smoking, especially by the mother antenatally, is the next most important SIDS risk factor. Very low rates of maternal smoking were noted in these samples (<10%) but disturbingly up to two-thirds of fathers smoked. Sharing a room with the infant has been shown to protect against SIDS, and this was common practice in these four centres (>85%). Bedsharing on the other hand increases the risk of SIDS, especially if the mother smokes. Bedsharing was a common practice in these four samples (37% - 88%). Pillow use has also been implicated with SIDS and yet most infants in these samples used pillows (56% - 95%). Both pacifiers and breastfeeding have protective associations with SIDS. Pacifiers were infrequently used in these Asian populations (13%-42%) and rates of predominant breastfeeding ranged from 4% (Hong Kong) to 47% (Japan). Conclusions: The key SIDS risk factors, prone sleep position and maternal smoking, were uncommon practices in these four samples. Patterns of other SIDS risk factors and protective factors were more variable. Bedsharing was common and it is speculated that methods of bedsharing in these Asian cultures may differ to those practised in western cultures where association with SIDS is noted. Alternatively a low rate of maternal smoking may play a protective role in relation to bedsharing. Likewise types of pillows implicated with SIDS and the types of pillows used for these infants may differ. A relatively low rate of pacifier use was noted in these populations and this may be beneficial from the perspective of breastfeeding. These data highlight interesting trends and patterns in child care practices in these four populations, and provide insights into this complex subject.