INFANT SLEEPING AND FEEDING PRACTISES IN THE SPLIT-DALMATIA COUNTY

Abstract

Cilj: Istražiti navike spavanja dojenčadi i poznavanje rizičnih čimbenika za SIDS od strane roditelja i pedijatara primarne zdravstvene zaštite u Splitsko-dalmatinskoj županiji. Ispitanici i metode: Presječnim istraživanjem obuhvaćeni su pedijatri PZZ i roditelji dojenčadi u SDŽ u razdoblju od veljače do travnja 2018. godine. Pedijatrima je osobno dostavljen upitnik s 18 pitanja koja pokrivaju stavove i savjete o spavanju i dojenju koje daju roditeljima svojih pacijenata te znanje o SIDS-u. Medicinska sestra izabranog pedijatra je roditeljima podijelila upitnik s 46 pitanja o dojenju i navikama spavanja dojenčadi te poznavanju rizičnih čimbenika za SIDS. Upitnici su ispitanicima dostavljeni u frankiranoj i adresiranoj omotnici i nisu snosili troškove slanja ispunjenih anketa. Prikupljeni podatci su uneseni u Excel tablicu i statistički analizirani. Rezultati: Stopa odgovora pedijatara je 51,7% (15/29), a 14 ih je uključeno u statističku analizu. Stopa odgovora roditelja je 49,4% (168/340), a statistički analizirano njih 146. Gotovo 86% pedijatara tvrdi da rutinski razgovara s roditeljima svojih pacijenata o sigurnom spavanju i dojenju. Samo 71% njih savjetuje spavanje dojenčeta na leđima. Svi pedijatri roditelje odgovaraju od zajedničkog spavanja u krevetu s dojenčetom. Samo ih 30,7% (4/13) zna da zajedničko spavanje pospješuje dojenje. Nijedan pedijatar nije ispravno izabrao sve rizične čimbenike za SIDS. Pola ispitanih roditelja su pušači, (73/146), od čega ih 52 ima završenu samo srednju školu, a visokoobrazovanih je 21 (p-vrijednost <0,001); 53,8% ih stavlja dojenče spavati na trbuh ili bok; 18.5% ih stavlja dojenče spavati na jastuk, a 25,7% s plišanom igračkom; 12,3% majki nije uopće dojilo dijete. Samo jedan ispitani roditelj zna da je hranjenje formulom rizični čimbenik za SIDS, a 14/168 ih pogrešno smatra da je rizik spavanje dojenčeta na leđima. Zaključak: Iako je većina ispitanih pedijatara izjavilo da u posljednjih pet godina se dodatno educirala o dojenju i sigurnom spavanju dojenčeta, istraživanje je pokazalo da postoji znatan prostor za napredak u njihovom poznavanju rizičnih čimbenika za SIDS. Također, štetne navike koje roditelji dojenčadi prakticiraju, uz pogrešna uvjerenja i savjete koje pedijatri daju, upućuju na to da je potrebna stalna doedukacija pedijatara i informiranje roditelja o sigurnom spavanju dojenčadi, kao i sustavno promicanje dojenja kao optimalnog načina prehrane djece i zaštitnog čimbenika u prevenciji SIDS-a.Objective: To explore infant sleeping practices plus parents' and primary-care pediatricians' (PCPs) knowledge of SIDS' risk factors in the Split-Dalmatia County. Subjects and Methods: A cross-sectional study was conducted between February and April, 2018, among PCPs and infants' parents in the County of Dalmatia, Croatia. A two-page, 18-question survey was personally delivered to all PCPs (N=29), along with a self-addressed stamped envelope. Topics covered included: whether physicians routinely discuss infant sleeping practices with their patients’ carers, advice given on infant sleeping practices, knowledge of risk factors for SIDS and perception of infant sleep practices in relation to breastfeeding. A 46-question survey for infants' parents was also delivered to PCPs, and their nurses distributed those to the parents in the waiting room. Topics covered included: infant sleeping practices, infant feeding practices and risk factors for SIDS. Collected data were entered in an Excel spreadsheet and analyzed statistically. Results: Fifteen pediatric surveys were returned (response 52%) of which one was incomplete and hence, excluded. Almost all pediatricians stated that they routinely discuss infant sleeping practices with their patients’ carers, which was confirmed by parents. Similarly, almost all respondents stated that they had attended training on breastfeeding or infant sleeping in the last five years. Despite this, almost a third of pediatricians recommend infants be placed on their side during sleep and all pediatricians in our sample advise parents against bed-sharing. Less than a third know that bed-sharing promotes breastfeeding and only 50% know that the greatest risk of SIDS occurs between 2 and 4 months. Of 340 parental questionnaires, 168 were returned (49%), of which 146 were analysed. Almost 80% of parent respondents have bed-shared at least once with their infant and all sleep with their infants in their room. The most common reason for bed-sharing was ˝easier feeding˝, whereas the main parental concern was ˝risk of suffocation˝. Fifty percent of participating parents are smokers, of which 52 completed high school, and 21 had a higher level of education (p< 0.001); 53.8% place their infant to sleep prone or on its side,18.5% with a pillow and 25.7%with plush toys; 12.3% of mothers did not breastfeed their baby at all. Only one parent (and 5/14 pediatricians) knows that giving formula is a risk factor for SIDS, whereas 14/168 incorrectly consider the back position to be a risk factor. No pediatrician nor parent correctly recognized all risk factors for SIDS. Conclusion: Despite the majority of pediatricians claiming to have attended training on safe sleeping practices in the previous five years, many were not aware of known risk factors for SIDS, such as sleeping on a couch with an infant or formula feeding, emphasizing the importance of regular, evidence-based in-service training on this important topic. The harmful habits that infants' parents practice suggest that there is a need for systematic and constant parental education on safe sleeping practices and for the importance of breastfeeding as a protective factor in the prevention SIDS