Sudden infant death syndrome: How much mothers and health professionals know

Background: Behavioral risk factors are associated with sudden infant death syndrome (SIDS). Education about the risk factors of SIDS is important for prevention. Our aim was to determine the knowledge and attitude of parents and health professionals about SIDS. Methods: A total of 174 health professionals and 150 mothers were enrolled in this study. Mothers' data were collected by telephone interview and health‐care professionals were interviewed by the same investigator. Results: Only 39% of mothers were aware of SIDS. Forty‐six percent of the mothers preferred a supine sleeping position for their infant and 16% of the parents were bed‐sharing with their infants. Seventy‐three percent of health professionals selected side, 17% supine and 10% prone sleeping position as the safest sleeping position. Frequencies for awareness of risk factors were: bed‐sharing (75%), soft bedding (70%), pillow use (52%), toys in bed (90%), high room temperature (67%) and smoking (88%). Total knowledge score of health professionals who selected supine sleeping position as the safest was significantly higher (P < 0.001). Conclusion: Most of the mothers were unaware of SIDS and less than half preferred a supine sleeping position for their infant. Only 72% of health professionals recommended a certain sleeping position during family interviews. Health professionals are more often recommending the side sleeping position or prone. Education of families and health professionals for the risk factors of SIDS may reduce the number of deaths from SIDS in Istanbul.     

Quality of interaction between at‐risk infants and caregiver at 12–15 months is associated with 3‐year autism outcome

Background: Recent models of the early emergence of autism spectrum disorder (ASD) propose that infant intrinsic risk susceptibilities in behaviour may be amplified by interaction within the early social environment into an increasingly atypical developmental trajectory. This study examines whether 6‐ and 12‐month parent–infant interactions in at‐risk siblings differ from those with low‐risk and whether – in at‐risk siblings – such interactions predict later 3‐year classification of ASD or no ASD. Method: Within the British Autism Study of Infant Siblings (BASIS), 6‐min videotaped episodes of parent–infant free play in infants at 6–10 months (45 at‐risk siblings and 47 low‐risk siblings) and 12–15 months (43 at‐risk siblings and 48 low‐risk siblings) in a laboratory setting were rated on the Manchester Assessment of Caregiver‐Infant Interaction (MACI), blind to participant information. Standard tests were administered for concurrent behavioural signs of ASD features and developmental level. Systematic consensus diagnostic classification of ASD was made at 3 years for the at‐risk siblings. Results: Parent nondirectiveness and sensitive responsiveness differed in relation to ASD/risk status (at‐risk ASD, at‐risk no‐ASD and low‐risk) at both 6 and 12 months. At 6 months, infant liveliness was lower in the at‐risk groups; at 12 months, infant attentiveness to parent and positive affect were lower in the at‐risk group later diagnosed with ASD. Dyadic mutuality and intensity of engagement showed a group effect at 12 months. Dyadic mutuality, infant positive affect and infant attentiveness to parent at 12 months (but not 6 months) predicted 3‐year ASD outcome, whereas infant ASD‐related behavioural atypicality did not. Conclusions: This is the first prospective evidence that early dyadic interaction between at‐risk infants and their parents is associated with later diagnostic outcome in ASD. Possible explanations for these findings and their theoretical implications are considered.     

Factors associated with breast milk intake among 9–10‐month‐old Malawian infants

Exclusive breastfeeding is recommended during the first 6 months of life; thereafter, continued breastfeeding along with nutritious complementary foods is recommended. Continued breastfeeding contributes a substantial proportion of nutrient needs and promotes healthy growth and development, but the quantity of breast milk consumed may be highly variable and little is known about the factors associated with breast milk intake after 6 months of age. The present study was conducted to assess factors associated with breast milk intake of Malawian infants at 9–10 months of age. Breast milk intake was measured using the dose‐to‐mother deuterium oxide dilution method in a subsample of 358 Malawian infants who were participating in a randomized controlled trial of lipid‐based nutrient supplements. Regression analysis was used to assess associations between breast milk intake and several maternal and infant variables. Mean (standard deviation) breast milk intake was 752 (244) g day^–1. In multiple regression, breast milk intake was positively associated with infant weight (+62 g per kg body weight, P < 0.01) and maternal height (P < 0.01) and negatively associated with maternal education and age (P < 0.01). There was a non‐significant (P = 0.063) inverse association between energy from non‐breast milk sources and breast milk intake. In this rural Malawian population, infant weight is the main predictor of breast milk intake, even after the first 6 months of life.     

Newborn behaviour to locate the breast when skin‐to‐skin: a possible method for enabling early self‐regulation

Aim: The aim of this study was to provide a more detailed analysis of the infant’s behavioural sequence that begins immediately after birth and terminates with grasping the nipple, suckling and then falling asleep. Method: Twenty‐eight full‐term infants were videotaped immediately after birth. A video protocol was developed to examine infant behaviours identified from five random videotapes. Results: When birth crying had stopped, the babies showed a short period of relaxation and then successively became alert. They went through an ‘awakening phase’, an ‘active phase’ with movements of limbs, rooting activity and looking at the mother’s face, a ‘crawling phase’ with soliciting sounds, a ‘familiarization phase’ with licking of the areola, and a ‘suckling phase’ and last a ‘sleeping phase’. Five factors related to the time spent to locate the breast: more number of looks at the breast 10–20 min after birth (p < 0.0001); and exposure to meperidine (p = 0.0006) related to increased time. Early start of crawling (p = 0,0040); increased number of ‘soliciting sounds’ (p = 0.0022); and performing hand–breast–mouth movements (p = 0.0105) related to shorter time. Conclusion: Inborn breastfeeding reflexes were depressed at birth, possibly because of a depressed sensory system. It is hypothesized that when the infant is given the option to peacefully go through the nine behavioural phases birth cry, relaxation, awakening, activity, crawling, resting, familiarization, suckling and sleeping when skin‐to‐skin with its mother this results in early optimal self‐regulation.     

Type of milk feeding affects hematological parameters and serum lipid profile in Japanese infants

Background: Type and volume of infant feeding determines infant growth, hematological parameters, and serum lipids. Methods: Study subjects consisted of 103 infants who were born vaginally at term, with birthweight >2200 g. Milk feeding amount, type, and anthropometry were measured at 1 and 6 months. Hematological tests and serum lipid profile were assessed at 1 and 6 months. Thirty‐four infants were breast‐fed and 36 were formula‐fed at 6 months. Results: Breast‐fed infants demonstrated similar growth patterns compared with partially breast‐fed or formula‐fed infants, despite the lower milk intake. Infants with higher breast milk intake at 6 months, however, tended to have lower hemoglobin levels. In contrast, higher formula intake at 6 months was related to lower serum total cholesterol. Conclusions: Japanese breast‐fed infants were more likely to be anemic at 6 months, while formula‐fed infants were likely to have low serum lipid levels. Iron‐fortified infant foods may be useful to prevent anemia in breast‐fed infants. Fat quality of infant formulas should be improved to enhance lipid status of formula‐fed infants.     

Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study

OBJECTIVES: To identify the risk factors for sudden infant death syndrome (SIDS) following a national campaign to prevent SIDS. METHODS: For 2 years (October 1, 1991 through September 30, 1993) data were collected by community child health nurses on all infants born in New Zealand at initial contact and at 2 months. RESULTS: There were 232 SIDS cases in the postneonatal age group (2.0/1000 live births) and these were compared with 1200 randomly selected control subjects. Information was available for 127 cases (54.7%) and 922 (76.8%) of controls. The previously identified modifiable risk factors were examined. The prevalence of prone sleeping position of the infant was very low (0.7% at initial contact and 3. 0% at 2 months), but was still associated with an increased risk of SIDS. In addition, the side sleeping position was also found to have an increased risk of SIDS compared with the supine sleeping position (at 2 months: adjusted odds ratio (OR) = 6.57; 95% confidence interval (CI) = 1.71, 25.23). Maternal smoking was found to be the major risk factor for SIDS. Bed sharing was also associated with an increased risk of SIDS. There was an interaction between maternal smoking and bed sharing on the risk of SIDS. Compared with infants not exposed to either bed sharing or maternal smoking, the adjusted OR for infants of mothers who smoked was 5.01 (95% CI = 2.01, 12.46) for bed sharing at the initial contact and 5.02 (95% CI = 1.05, 24. 05) for bed sharing at 2 months. In this study breastfeeding was not associated with a statistically significant reduction in the risk of SIDS. The other risk factors for SIDS identified were: unmarried mother, leaving school at a younger age, young mother, greater number of previous pregnancies, late attendance for antenatal care, smoking in pregnancy, male infant, Maori ethnicity, low birth weight, and shorter gestation. CONCLUSIONS: After adjustment for potential confounders, prone and side sleeping positions, maternal smoking, and the joint exposure to bed sharing and maternal smoking were associated with statistically significant increased risk of SIDS. A change from the side to the supine sleeping position could result in a substantial reduction in SIDS. Maternal smoking is common in New Zealand and with the reduction in the prevalence of prone sleeping position is now the major risk factor in this country. However, smoking behavior has been difficult to change. Bed sharing is also a major factor but appears only to be a risk to infants of mothers who smoke. Addressing bed sharing among mothers who smoke could reduce SIDS by at least one third. Breastfeeding did not appear to offer a statistically significant reduction in SIDS risk after adjustment of potential confounders, but as breastfeeding rates are comparatively good in New Zealand, this result should be interpreted with caution as the power of this study to detect a benefit is small.     

Interaction between bed sharing and other sleep environments during the first six months of life

This investigation was carried out to determine the relationship between bed sharing and other places of infant sleep in the first six months of life, and to identify patterns of change in the place of infant sleep for infants who do and do not routinely bed share in the first six months of life. The sleep--wake behaviour and place of infant sleep were recorded, at weekly intervals, for bed sharing (n=25) and non-bed sharing (n=68) infants between 2 and 24 weeks after birth. Bed sharing infants spent a significantly increased proportion of their total sleep time per 24 h in other sleep environments which favoured close parental proximity and significantly less time in solitary sleep. Non-bed sharing infants spent a substantial proportion of their time sleeping alone from 2 weeks of age whereas the transition to sleeping alone occurred after 16 weeks for bed sharing infants. We have found that bed sharing acts as a proxy for increased close parental proximity during the first six months of life. This may be of significance in studies which examine the relationship between bed sharing and sudden infant death syndrome.     

Factors determining HIV viral testing of infants in the context of mother‐to‐child transmission

Aim: The aim of this study was to investigate factors determining HIV viral testing of infants in the context of Prevention of Mother‐to‐Child Transmission of HIV (PMTCT). Methods: Post‐delivery HIV infected mothers 18 years and above with babies aged 3–6 months were interviewed on HIV viral testing of infants and factors associated with it. Results: Among 311 HIV infected women 61.7% had their infant tested for HIV between 4 and 8 weeks. Bivariate analyses found that older age of the mothers, lower depression scores, higher PMTCT knowledge, low PMTCT risk behaviour (maternal and infant nevirapine adherence, health facility delivery and exclusive formula feeding), HIV status disclosure and attending a support group were associated with PCR test participation. In multivariate analyses higher PMTCT knowledge, infant nevirapine adherence, and not exclusive breast feeding were associated with polymerase chain reaction test participation. Conclusion: Various determinants of acceptance of participation in HIV viral testing of infants in the context of PMTCT were identified that can guide infant testing and diagnosis counselling and support services of PMTCT programmes.     

Bottle‐feeding an infant feeding modality: An integrative literature review

Bottle‐feeding is an infant feeding modality that has been in existence since ancient times, and currently, a significant number of infants are being fed via a bottle with either breastmilk or formula. Although research on bottle‐feeding has continued, it exists in fragmented, often small studies that focus on singular aspects of feeding an infant using a bottle, with limited information on the bottle‐feeding act. Systems theory was the approach used to define the act of bottle‐feeding and identify the parts within this act. Health databases were searched using MeSH terms. A summary of the studies are included. The findings of this review revealed that healthy term bottle‐feeding infants use similar tongue and jaw movements, can create suction and sequentially use teat compression to obtain milk, with minimal differences in oxygen saturation and SSB patterns, when compared with breastfeeding infants. Bottle and teat characteristics were revealed to affect infant feeding and milk intake. An infant's milk intake during feeding was shown to have a strong association with the interaction between the infant and parent/caregiver. With the issue of who controls the feed, mother or infant, likely to affect an infant's ability to self‐regulate their milk intake. Redefining bottle‐feeding as a holistic system identifies the interrelationship of the various parts which will improve the understanding of the reciprocal nature of infant feeding. To optimize bottle‐feeding outcomes, further research is required on parents' and health professionals' knowledge and understanding of the parts within the act of bottle‐feeding.     

Association of 6 months of exclusive breastfeeding with higher fat‐free mass in infants in a low‐resource setting with high HIV prevalence in South Africa

Exclusive breastfeeding for 6 months is recommended by the World Health Organisation (WHO) for optimal health and growth of infants, but it is not a common practice in South Africa. A breastfeeding counselling programme was run to inform, encourage and support mothers to exclusively breastfeed their infants for 6 months, and mother–infant pairs were invited to participate in a research project to determine breast milk intake volumes using the dose‐to‐mother deuterium dilution stable isotope technique. This technique yields objective measurements of breast milk intake volumes and also enables determination of exclusivity of breastfeeding, which is most frequently determined by maternal recall and can be subject to bias. Exclusivity of breastfeeding at 6 weeks, 3 months and 6 months following birth of the infants was correlated with infant fat‐free mass at 12 months, which was determined by the dose‐to‐infant deuterium dilution stable isotope technique. Results showed that infants who were exclusively breastfed for 6 months had a higher per cent fat‐free mass at 12 months compared with infants who were not exclusively breastfed for 6 months (P < 0.05). This objective determination of both breastfeeding patterns and infant body composition gives weight to the WHO recommendation of exclusive breastfeeding for 6 months as it demonstrated adequate fat‐free mass in infants at 12 months, even in an area with high HIV prevalence. © 2016 John Wiley & Sons Ltd     

A qualitative study exploring infant feeding decision‐making between birth and 6 months among HIV‐positive mothers

Despite efforts to support breastfeeding for HIV‐positive mothers in South Africa, being HIV‐positive remains a barrier to initiating and sustaining breastfeeding. The aim was to explore decision‐making about infant feeding practices among HIV‐positive mothers in a rural and urban settings in KwaZulu‐Natal, South Africa. HIV‐positive pregnant women were purposively sampled from one antenatal clinic in each setting. A qualitative longitudinal cohort design was employed, with monthly in‐depth interviews conducted over 6 months postdelivery. Data were analysed using framework analysis. We report findings from 11 HIV‐positive women within a larger cohort. Participants were aged between 15 and 41 years and were all on antiretroviral therapy. Before delivery, nine mothers intended to exclusively breastfeed (EBF) for 6 months, and two intended to exclusively formula feed (EFF). Three mothers successfully EBF for 6 months, whereas four had stopped breastfeeding, and two were mixed breastfeeding by 6 months. Mothers reported receiving strong advice from health workers (HWs) to EBF and made decisions based primarily on HWs advice, resisting contrary pressure from family or friends. The main motivation for EBF was to protect the child from HIV acquisition, but sometimes fear of mixed feeding led to mothers stopping breastfeeding entirely. Infant feeding messages from HWs advice were frequently inadequate and out of date, and failed to address mothers' challenges. Minimal support was provided for EFF. In conclusion, HWs play a pivotal role in providing infant feeding support to HIV infected mothers, but need regular updates to ensure if advice is correct and appropriate.     

The prevalence and characteristics associated with parent-infant bed-sharing in England

Aims: To investigate the characteristics of parent–infant bed-sharing prevalence in England. Methods: Data on night-time sleeping practices from a two year, local, longitudinal study and a three-year, national, cross-sectional study were obtained. A total of 261 infants in North Tees were followed up at 1 and 3 months of age, as were 1095 infants aged 1 week to 1 year from five English health regions. Results: Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants. Conclusion: Bed-sharing is a relatively common practice in England, not specific to class, but strongly related to breast feeding.     

Spoonfeeding is associated with increased infant weight but only amongst formula‐fed infants

Infant feeding experiences are important for the development of healthy weight gain trajectories. Evidence surrounding milk feeding and timing of introduction to solids is extensive; however, the impact of the method of introducing solids on infant growth has been relatively underexplored. Baby‐led weaning (where infants self‐feed family foods) is proposed to improve appetite regulation, leading to healthier weight gain and a reduced risk of obesity. However, the evidence is mixed and has methodological inconsistencies. Furthermore, despite milk being a large part of the infant diet during the period infants are introduced to solid foods, its influence and interaction with introductory style have not been considered. The aim of this study was to explore growth among infants aged 3–12 months according to both style of introduction to solid foods and milk feeding; 269 infants were weighed and measured, and body mass index (BMI) computed. The results showed that overall, infants who were spoon‐fed (compared with self‐fed) at introduction to complementary feeding (CF) had greater length (but not weight or BMI). However, when milk feeding was accounted for, we found that infants who were both spoon‐fed and fully formula fed had greater weight compared with spoon‐fed, breastfed infants. There was no significant difference in weight among self‐fed infants who were breastfed or formula fed. The results highlight the importance of considering infant feeding as a multicomponent experience in relation to growth, combining both milk feeding and method of CF. This relationship may be explained by differences in maternal feeding style or diet consumed.     

Autopsy findings of co-sleeping-associated sudden unexpected deaths in infancy: relationship between pathological features and asphyxial mode of death

Aim: Co‐sleeping is associated with increased risk of sudden unexpected death in infancy (SUDI)/sudden infant death syndrome (SIDS). The aim of this study is to examine autopsy findings from a single UK specialist centre to determine the relationship between co‐sleeping and cause of death. Methods: Retrospective analysis of >1500 paediatric autopsies carried out by paediatric pathologists over a 10‐year period. SUDI was defined as sudden unexpected death of an infant aged 7–365 days; deaths were categorised into explained SUDI (cause of death was determined) and unexplained SUDI (equivalent to SIDS). Results: There were 546 SUDI; sleeping arrangements were specifically recorded in 314; of these, 174 (55%) were co‐sleeping‐associated deaths. Almost two thirds (59%) of unexplained SUDI were co‐sleeping compared to 44% explained SUDI (95% confidence interval (CI) 1.0–27.2%, P= 0.03); however, this difference remained statistically significant only for the first 5 months of life (95% CI 3.5–33.2%, P= 0.01). In unexplained SUDI aged < 6 months, there were no significant differences between co‐sleeping and non‐co‐sleeping deaths with respect to ante‐mortem symptoms, intrathoracic petechiae, macroscopic lung appearances, pulmonary haemosiderin‐laden macrophages, and isolation of specific bacterial pathogens; however, fresh intra‐alveolar haemorrhage was reported more commonly in co‐sleeping (54%) than in those that were not (38%; 95% CI 1.4–30.5%, P= 0.03). Conclusions: Co‐sleeping is associated with unexplained SUDI/SIDS in infants aged < 6 months, suggesting that co‐sleeping is related to the pathogenesis of death in younger infants. The finding that intra‐alveolar haemorrhage is more common in co‐sleeping suggests that a minority of co‐sleeping‐associated deaths may be related to an asphyxial process.     

Feeding on one side or both sides in a breast‐feeding session

Background: The aim of the present study was to examine the effects of breast‐feeding method (on only one or on two sides in a single feeding session) on growth, sleep duration and sucking period, and stool frequency. Methods: Exclusively breast‐fed healthy infants, aged 1–6 months, were included in the study during child health follow‐up visits. Mothers were given a questionnaire on sleep duration, sucking periods, and stool frequencies of their infants. Results: The height‐for‐age and weight‐for‐age z scores were significantly higher in infants breast‐fed from one side during a single session than from both sides (P= 0.002, P < 0.001; respectively). Infants sucking on only one breast in a breast‐feeding session defecated significantly less at night (P= 0.005), their maximum sucking periods at night were shorter (P= 0.049). Conclusion: Breast‐feeding at one side only during a single breast‐feeding session increases growth, decreases stool frequency and the maximum sucking period at night and does not influence the overall sleep pattern.     

Prechewing infant food,consumption of sweets and dairy and not breastfeeding are associated with increased diarrhoea risk of 10‐month‐old infants in the United States

Prechewing of food by caregivers is a common infant feeding practice both globally and in the United States, where the highest rates of the practice are found among African‐Americans and Alaska Natives. The objective of this study was to determine if prechewing of infant food is associated with increased diarrhoea prevalence of 10‐month‐old infants in the United States. The study used cross‐sectional data from the Infant Feeding Practices Study II to test for associations between prechewing and 2‐week‐period prevalence of infant diarrhoea. At 10 months of age, infants who received prechewed food (n = 203) had a diarrhoea prevalence of 16.1%, compared with 10.9% of children who did not receive prechewed food (n = 1567) [relative risk (RR) = 1.48, 95% confidence interval (CI) 1.03–2.11]. After adjusting for covariates, including breastfeeding and consuming sweets and dairy, prechewing was associated with a 58% higher risk (RR = 1.58, 95% CI 1.10–2.26) of 2‐week diarrhoea prevalence. Consumption of sweets (RR = 1.35, 95% CI 1.03–1.78) and dairy (RR = 1.41, 95% CI 1.03–1.93) was also associated with increased diarrhoea risk. Continued breastfeeding at 10 months of age was associated with a reduced risk of diarrhoea (RR = 0.68, 95% CI 0.50–0.91). Prechewing of infant food is associated with increased diarrhoea among 10‐month‐old infants. The high RR found in this study suggests that prechewing may be an important factor in public health efforts to reduce the burden of diarrhoeal disease. However, further research is needed to establish that prechewing causes increased diarrhoea risk and to explore potential benefits of prechewing.     

The prevalence and characteristics associated with parent-infant bed-sharing in England.

AIMS: To investigate the characteristics of parent-infant bed-sharing prevalence in England. METHODS: Data on night-time sleeping practices from a two year, local, longitudinal study and a three-year, national, cross-sectional study were obtained. A total of 261 infants in North Tees were followed up at 1 and 3 months of age, as were 1095 infants aged 1 week to 1 year from five English health regions. RESULTS: Data from both studies found that almost half of all neonates bed-shared at some time with their parents (local = 47%, 95% CI 41 to 54; national = 46%, 95% CI 34 to 58), and on any one night in the first month over a quarter of parents slept with their baby (local = 27%, 95% CI 22 to 33; national = 30%, 95% CI 20 to 42). Bed-sharing was not related to younger mothers, single mothers, or larger families, and was not more common in the colder months, at weekends, or among the more socially deprived families; in fact bed-sharing was more common among the least deprived in the first months of life. Breast feeding was strongly associated with bed-sharing, both at birth and at 3 months. Bed-sharing prevalence was uniform with infant age from 3 to 12 months; on any one night over a fifth of parents (national = 21%, 95% CI 18 to 24) slept with their infants. CONCLUSION: Bed-sharing is a relatively common practice in England, not specific to class, but strongly related to breast feeding.     

Focused breastfeeding counselling improves short‐ and long‐term success in an early‐discharge setting: A cluster‐randomized study

Length of postnatal hospitalization has decreased and has been shown to be associated with infant nutritional problems and increase in readmissions. We aimed to evaluate if guidelines for breastfeeding counselling in an early discharge hospital setting had an effect on maternal breastfeeding self‐efficacy, infant readmission and breastfeeding duration. A cluster randomized trial was conducted and assigned nine maternity settings in Denmark to intervention or usual care. Women were eligible if they expected a single infant, intended to breastfeed, were able to read Danish, and expected to be discharged within 50 hr postnatally. Between April 2013 and August 2014, 2,065 mothers were recruited at intervention and 1,476 at reference settings. Results show that the intervention did not affect maternal breastfeeding self‐efficacy (primary outcome). However, less infants were readmitted 1 week postnatally in the intervention compared to the reference group (adjusted OR 0.55, 95% CI 0.37, ?0.81), and 6 months following birth, more infants were exclusively breastfed in the intervention group (adjusted OR 1.36, 95% CI 1.02, ?1.81). Moreover, mothers in the intervention compared to the reference group were breastfeeding more frequently (p < .001), and spend more hours skin to skin with their infants (p < .001). The infants were less often treated for jaundice (p = 0.003) and there was more paternal involvement (p = .037). In an early discharge hospital setting, a focused breastfeeding programme concentrating on increased skin to skin contact, frequent breastfeeding, good positioning of the mother infant dyad, and enhanced involvement of the father improved short‐term and long‐term breastfeeding success.     

Infant gender, shared sleeping and sudden death

Aim: To determine whether there is a gender imbalance in infant deaths in shared sleeping compared to solitary sleeping situations. Methods: Examination of autopsy reports of 133 infants aged between 7 and 364 days autopsied over a 19‐year period from January 1991 to December 2009 was undertaken where death had either been attributed to SIDS, or had been classified as undetermined or unascertained. Cases were divided into two groups of solitary sleepers and shared sleepers, and the ratio of male to female cases was compared. Results: Ninety‐five solitary sleepers were aged from 1 to 11 months (average 4.1 months) and consisted of 63 males (age range 1 to 11 months) and 32 females (age range 1 to 10 months). The 38 shared sleepers were aged from 1 week to 12 months (average 2.6 months) and consisted of 17 males (age range 2 weeks to 5 months) and 21 females (age range 1 week to 10 months). The male to female ratio in the solitary sleepers was approximately 2:1 and in the shared sleepers was 0.8:1, a statistically significant difference (p = 0.02). Conclusion: The lack of a male predominance typical of SIDS cases in infants who were sleeping with others, compared to those who were sleeping alone, suggests that these situations may be different. It is possible, therefore, that different lethal mechanisms may be involved in some shared sleeping situations.