The Dutch 11th safe sleeping survey; factors with a potential risk for suffocation

Background: In the Netherlands, the incidence of Sudden Unexpected Death in Infancy (SUDI: R95, R96, R98, R99, W75, W78, W79) was 0,2 in 2004 and 0.15 per 1000 live births in 2016. Since 2004 the incidence of SIDS/Cot death (R95) is less than 20 infants a year. As times are changing, new potentially risky infant care behaviors develop, such as bed and sofasharing and the use of soft devices etc.

Objective: The aim of this survey is to measure the prevalence of suffocation related risk factors following the methodology put forward by Cowan’s ‘Through the tubes’: cover (soft bedding), pinch (prone sleeping), bend (car seats, wrong use of breastfeeding pillow, baby carrier) and press (bed- or sofa sharing). Furthermore, smoking remains hindering oxygen sufficiency for babies in pregnancy, which is also related to the risk of suffocation.

Methods: From February to April 2017 a random sample survey among parents of infants (0-12) was conducted. 9000 flyers were send with a request to fill in an online questionnaire (52 questions) were distributed to parents together visiting 139 well-baby clinics throughout the country. To increase the response of parents in disadvantaged neighborhoods, support of a research assistant was offered to fill out the questionnaire in 21 well-baby clinics.

Results: In total 1289 respondents filled in the online questionnaire (14,3%) in of which 1209 were complete. Comparison with national data shows that in this survey first children were overrepresented (55,5% v. 45,3%), the amount of low educated mothers was similar (14,1 % v. 13,2%), high educated mothers were overrepresented (57,2 v. 47,8) and mothers with a migration background were
underrepresented (13,5% v. 29,3%). Comparison between the survey of 2017 and 2011 shows that paternal smoking increased, maternal smoking decreased and parents who both smoke decreased. From 2011 to 2017: duvet use increased from 2,2% to 4,5% and use of a pillow from 1,5% to 2,0%. Furthermore, 2,6% used a baby bumper in the baby bed and 37,8 used stuffed animals in bed (cover). Prone sleeping increased from 2,3% in 2011 to 7,2% in 2017 (pinch), bed sharing reduced from 16,7% to 7,8%, and ‘falling asleep at the same surface’ increased from 36,3% to 46,3%, and incidentally falling asleep on sofa or chair increased from 26,4% to 49,9%. In 2017 7,8% sometimes placed the baby to sleep on a sofa or chair (press). In 2017 13,7% used a co-sleeper or click-bed. Of the parents 41,9% sometimes placed the child to sleep in the stroller, 28,0% in the car seat, 27% in a baby carrier, 6,0% on a feeding pillow and 0,4% on a bean bag (bend). Only 9,3% never placed an infant to sleep on one of these products.

Conclusion: Continuous attention should be given to safe sleeping, with special attention tot new fashions and products that may potentially increase the risk of SIDS or accidental suffocation.