Exploring infant safe sleeping practice in a multicultural setting: findings from the maternal and infant health monitoring system in Abu Dhabi

BACKGROUND: Safe infant sleep recommendations are well established in many high-income countries, several of which are multicultural countries. However, less is known about infant sleep practices in non-Western, highly multicultural settings, where, the majority of residents are expatriates from diverse world regions. The United Arab Emirates (UAE) represents a unique pediatric context, with more than 80% of residents being expatriates from over 200 nationalities, and limited national guidance on infant sleep. METHODS: Using cross-sectional data collected between 2023 and 2024 data from the Abu Dhabi Maternal and Infant Health Monitoring System, we determined the prevalence of five infant sleep practices: (1) back sleep position, (2) separate approved sleep surface, (3) room sharing with an adult without bed sharing, (4) room sharing with bed sharing and (5) no soft objects or loose bedding. We used multivariable logistic regression to estimate the associations between sociodemographic and behavioral factors and each of the infant sleep practices. RESULTS: The least prevalent safe sleep practices were using a separate approved sleep surface (8.4%) and avoiding soft bedding (11.5%). Region of origin was associated with all sleep practices. Reported receipt of healthcare-provider advice was infrequent and was not associated with adherence to any sleep practice. CONCLUSION: In a multicultural, high-income setting in the Middle East, adherence to infant safe sleep recommendations is selective and is associated with cultural background. These findings highlight the need for culturally responsive pediatric guidance and suggest that US-derived safe sleep recommendations may require contextual adaptation to improve effectiveness in diverse populations.