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a Psychosocial
and Pathology Departments, University Hospital Utrecht/Wilhelmina
Children's Hospital, University Hospital for Children and Youth,
Utrecht, Netherlands, b University Hospital
Leiden, Department of Paediatrics, Leiden, Netherlands, c Centre for Biostatistics, University of Utrecht,
Utrecht, Netherlands, d Department
of Methodology, Faculty of Psychology, University of
Amsterdam, Amsterdam, Netherlands
Correspondence to: Dr l'Hoir, University Hospital Utrecht/Wilhelmina Children's Hospital, PO Box 18009, 3501 CA Utrecht, Netherlands.
Accepted 10 June 1998
This study aimed to assess whether previously established risk
factors for sudden infant death syndrome (SIDS) are still valid now
that the incidence in the Netherlands has dropped to 0.26 per 1000 liveborn infants. A distinction was made between immutable and mutable
risk factors. This case-control study (part of the European Concerted
Action on SIDS) comprised 73 SIDS cases and 146 controls and lasted
from March 1995 to September 1996. Adjustments were made for sleeping
position and bedding factors by treating them as covariables. Apart
from these factors, well known risk factors that remain of importance
in the Netherlands are: male sex, young maternal age, twins, and low
socioeconomic status. These factors are largely immutable. Other well
known risk factors which might reflect attitudes to child care and
could possibly be mutable are: smoking, alcohol consumption by the
mother, bottle feeding, and change of babycare routine. Intervention
strategies should focus on early signalling, thereby assisting parents
in changing these unfavourable parenting attitudes. Information on optimal child care and extra support by public health nurses
specifically aimed at families at risk could help to decrease further
the incidence of SIDS in the Netherlands.
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