Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK

In the UK, infants of South Asian parents have a lower rate of sudden infant death syndrome (SIDS) than White British infants. Infant care and life style behaviours are strongly associated with SIDS risk. This paper describes and explores variability in infant care between White British and South Asian families (of Bangladeshi, Indian or Pakistani origin) in Bradford, UK (the vast majority of which were Pakistani) and identifies areas for targeted SIDS intervention. A cross-sectional telephone interview study was conducted involving 2560 families with 2- to 4-month-old singleton infants enrolled in the Born in Bradford cohort study. Outcome measures were prevalence of self-reported practices in infant sleeping environment, sharing sleep surfaces, breast feeding, use of dummy or pacifier, and life style behaviours. We found that, compared with White British infants, Pakistani infants were more likely to: sleep in an adult bed (OR = 8.48 95% CI 2.92, 24.63); be positioned on their side for sleep (OR = 4.42 2.85, 6.86); have a pillow in their sleep environment (OR = 9.85 6.39, 15.19); sleep under a duvet (OR = 3.24 2.39, 4.40); be swaddled for sleep (OR = 1.49 1.13, 1.97); ever bed-share (OR = 2.13 1.59, 2.86); regularly bed-share (OR = 3.57 2.23, 5.72); ever been breast-fed (OR = 2.00 1.58, 2.53); and breast-fed for 8+ weeks (OR = 1.65 1.31, 2.07). Additionally, Pakistani infants were less likely to: sleep in a room alone (OR = 0.05 0.03, 0.09); use feet-to-foot position (OR = 0.36 0.26, 0.50); sleep with a soft toy (OR = 0.52 0.40, 0.68); use an infant sleeping bag (OR = 0.20 0.16, 0.26); ever sofa-share (OR = 0.22 0.15, 0.34); be receiving solid foods (OR = 0.22 0.17, 0.30); or use a dummy at night (OR = 0.40 0.33, 0.50). Pakistani infants were also less likely to be exposed to maternal smoking (OR = 0.07 0.04, 0.12) and to alcohol consumption by either parent. No difference was found in the prevalence of prone sleeping (OR = 1.04 0.53, 2.01). Night-time infant care therefore differed significantly between South Asian and White British families. South Asian infant care practices were more likely to protect infants from the most important SIDS risks such as smoking, alcohol consumption, sofa-sharing and solitary sleep. These differences may explain the lower rate of SIDS in this population.