Hong Kong: Supine tradition holds firm

A study conducted by a team of doctors in Hong Kong and published in the BMJ (1989;298:721) confirmed that so called cot deaths were rare among infants in Hong Kong. The team examined infants aged 1 to 12 months found dead unexpectedly at home from 1 December 1986 to 30 November 1987 in whom there was no immediately obvious cause of death. The sudden infant death syndrome was diagnosed in 21 of the 51 dead infants in whom necropsy was performed. With more than 70000 births reported in that period, the incidence of the sudden infant death syndrome was determined to be 0.3/1000 live births—higher than the 0.04/1000 previously reported. The team thought that this discrepancy was probably due to differences in diagnostic criteria at necropsy.

Doctors believe that the low incidence in Hong Kong may be partly due to the tendency of Asian parents there to lay their children on their backs. The study puts forward a similar view. “We were one of the first to suggest the supine position was protective,” says Edith Lau, a lecturer at the Chinese University of Hong Kong and a doctor on the team conducting the 1989 study. “We also postulated that greater environmental stimulation makes a difference.” Hong Kong is so densely populated that families are frequently forced to share their living space, even their beds, so the environment in which a child sleeps is often filled with activity.

Doctors say that the low incidence has also rendered campaigns to increase awareness less important in Hong Kong, where an estimated 98% of the population is Chinese. But they also warn against complacency. “We need to find out more,” said Dr Lee.