5.11 SIDS - THE IMPACT OF 'REDUCE THE RISKS OF COT DEATH' GUIDELINES

5.11.1 The parents who participated in home interviews provided information On their parenting practices regarding sleep position, place where the baby slept, thermal environment, and smoking habits. Information regarding smoking during pregnancy and feeding practices at the time of birth were ascertained/clarified with medical records.

5.11.2 Smoking

Self-reported information on smoking habits during pregnancy was available for 27 (82%) families (mothers 27, fathers 22), and during the baby's lifetime, for 26 families (mothers 26, fathers 22). Figure 5 illustrates these smoking patterns. In 78% (n=21) of cases, mothers smoked during their pregnancy, with 68% (n=15) of fathers smoking during this time. Corresponding figures for 1994 are 69% and 59%, for 1993, 75% and 59% and for 1992, 77% and 66%. After the baby was born, 77% (n=20) of mothers smoked while 68% (n=15) of fathers smoked. Smoking among women and men aged 16 - 44 years in Ireland averaged 41% in 1993/4. During pregnancy mothers reported smoking an average of 14 cigarettes a day (range 2 - 30). After the baby's birth, the average figure rose to 23 per day (range 2 - 40). Both during pregnancy and after the baby's birth fathers reported smoking an average of 16 (range 3 - 40) cigarettes a day. While some parents reported that they did not allow smoking in a room where the baby was, 69% stated that the baby was regularly in a room where people smoked. The corresponding figures in 1994 and 1993 was 69% and in 1991 70%.

5.11.3 Sleep Position

Parents were asked about the baby's sleeping habits. Table 3 illustrates the sleeping position for 26 babies (79% of all cases), comparing the position they were put to sleep with the position in which they were found dead. Babies who were found dead in the prone position (lying on their stomach) accounted for 27% of cases, which is higher than the 2994 figure of 24%, equal to the 1993 figure (27%) but lower than the 1992 (43%). The number of babies who were placed to sleep on their side and found dead in a different position (n=5), i.e. prone or supine (on their stomach or back), again reinforces the argument of the instability of the lateral (side) position. While the greatest number of babies were found dead in the supine position, there was a 2.3 fold increase in babies found dead prone compared to the number of children who were put to sleep prone. Information regarding babies' sleeping patterns in the two weeks prior to death also reveals that 26% of babies who were placed to sleep on their side did not remain in this position.

5.11.4 Examination of the usual sleeping position of all cases reveals that, for only one case (4)%, prone position was their usual sleeping position. This figure is lower than the figures noted in 1994 (13%), in 1993 (8%) and in 1992 (19%).

5.11.5 Place where Baby Slept

International data on bed-sharing as a risk factor SIDS lacks agreement and bed sharing in itself may not be a risk. The Register's 2995 information regarding the usual sleeping place for SIDS children reveals that:

• 31% of cases (n=8) always slept with other people (parents or siblings).
  
• 4% (n=1) often slept with parents (> two nights per week).
• 19% (n=5) sometimes slept with parents.

In the child's last sleep period 35% (n=9) of cases slept with an adult during the entire sleep period, while a further 4% (n=1) spent more than one hour of their sleep time with an adult. The corresponding figures for 1994, 1993 and 1992 are 29%, 19% and 16%.

5.11.6 Thermal Environment

Data on personal clothing and bedding which the baby had during sleep and at the time of the baby's death was available for 26 cases. While there were individual variations in the amount of clothing and bedding used, generally parents tended to increase the tog values during the night time sleep compared to the day time sleep. During the day sleep, 42% (n=11) of children had a tog value less than 10, while at night the reverse was true with a tog value> 10 evident for 73% (n=19) of children. During the child's last sleep period, 69% (n=18) of the children had a tog value greater than 10. These findings are in keeping with 1994 and 1993 figures which did not report an increase in tog values during the child's last sleep period.

5.11.7 Feeding

Information on babies' feeding pattern was recorded for 26 cases (Appendix L). At the time of birth, 18% (n=6) of babies were being breastfed. After one week this figure fell to 12%. This figure is lower than the national breastfeeding figure (32%) for 1991.