A study was carried out in Bradford to describe and explore the differences in infant care practices between White British and South Asian families (of Bangladeshi, Indian or Pakistani origin). 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 lifestyle behaviours are strongly associated with SIDS risk.

In Bradford the overall SIDS rate was reported to be 0.5/1000, being 0.2/1000 among South Asian infants and 0.8/1000 among white British infants (1998-2003). A large telephone interview study was conducted (n=2,560) of families with 2 to 4-month-old singleton infants enrolled in the Born in Bradford cohort study. Outcome measures investigated were prevalence of self-reported practices in infant sleeping environment, sharing sleep surfaces, breastfeeding, use of dummy or pacifier, and lifestyle behaviours.

The researchers found significant differences in a range of care practices. 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 breastfeed (OR = 2.00 [1.58, 2.53]); and breastfeed for 8 weeks or more (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]); 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.

This is by far the largest comparative study of ethnic differences in infant care in the UK to date, and the size of the sample is a major strength. The researchers report that 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. This study identifies these issues as clear targets for SIDS risk reduction among White British families. The study also shows that South Asian families prioritise close proximity, breastfeeding and maternal behaviours congruent with infant health and low SIDS risk as normal cultural practice.

Ball HL, Moya E, Fairley L et al (2011) Infant care practices related to sudden infant death syndrome in South Asian and White British families in the UK. Paediatric and Perinatal Epidemiology. DOI: 10.1111/j.1365-3016.2011.01217.x