EAS Nelson

Many western countries have incorporated sudden infant death syndrome (SIDS) risk factors into very successful "Reduce the Risks" campaigns. Although SIDS rates have fallen dramatically - mainly as the result of avoidance of prone sleeping - the mechanism by which prone sleeping causes SIDS is not known. However the enigma of SIDS may be seen as a non-issue in Hong Kong where most mothers "know" that babies sleeping on their fronts are at risk of suffocation. But is it that simple? Suffocation, a plausible explanation of death for a baby found facedown into or covered by bedding, does not explain other SIDS risk factors such as smoking, winter and heavy dressing? And what about bed-sharing, an apparently safe Hong Kong child care practice, which has been linked with SIDS elsewhere? It is apparent that child care practices, within any particular cultural group, are a complex interaction of constantly evolving factors. The International Child Care Practices study used standardised methodology to collect data from 18 centres. These data highlight some fascinating differences in these SIDS-related child care practices e.g. high rates of bed-sharing in some communities, use of pillows and frequency of solitary sleeping. The study emphasises both the complexity of child care, and the difficulty in documenting many of these factors quantitatively. It is suggested that a "safe infant sleeping environment" should be viewed as a total package of interrelated factors and not as a list of separate items. For example what advice should be given once infants roll-over from back to front? It is speculated that this may be influenced by cultural factors and child care practices e.g. methods of play, methods of comforting infants and types of clothing and bedding used? Prone infants sleep more soundly than supine infants - could better heat conservation in the prone position be a factor, and might a well-wrapped supine infant be less inclined to roll-over? Answers to these and other questions are still needed and, until we understand actual mechanisms of SIDS, it will be difficult to provide unequivocal advice.