NEW YORK (Reuters Health) - While some mothers who puff on cigarettes attempt to protect their infants from the smoke, researchers believe they may be ignoring other sources of second-hand smoke--such as baby sitters or relatives in the home.

``Many different sources make significant contributions to the total cigarette smoke exposure of infants,'' study author Dr. Dennis R. Ownby, of the Medical College of Georgia told Reuters Health in an interview. Exposure to secondhand smoke can increase a baby's risk of respiratory problems, ear infections and sudden infant death syndrome. Ownby and his colleagues surveyed parents about their smoking habits and collected urine samples from 97 infants from birth to 2 years of age. Researchers can find signs of smoke exposure by testing urine. Although exposure to passive smoke was most highly correlated with the mothers' and fathers' smoking habits, it was also similarly correlated with the frequency of smoking by at-home day care providers, and by persons visited away from home, the authors report in the December issue of Archives of Pediatrics. ``Even though it is not strictly regulated, smoking is usually not permitted in organized day care facilities. But many children are cared for in informal day care settings, such as by a neighbor or relative,'' Ownby explained. ``If this person is a smoker then the infant is likely to have chronic exposure to cigarette smoke.'' A noticeable proportion of children with nonsmoking parents showed evidence of relatively high levels of environmental tobacco smoke exposure, the report indicates. In fact, infants exposed to smoke from nonfamily members sometimes had levels of cotinine--a breakdown product of nicotine--in their urine that were higher than levels seen in children of smoking parents, the authors note. ``We do not know if there is a level of passive exposure to cigarette smoke that is safe for an infant,'' Ownby said. ''Presumably all exposure increases the risk of health effects--and the more exposure the greater the risk, therefore, reducing exposure to the minimum is likely to benefit a child.'' ``It seems to be especially important to try to find day care where the child will not be exposed to smoking,'' he said.

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