This is a quick-read version of Promoting safe sleeping and preventing sudden unexpected death in infancy: Messages from the Child Safeguarding Practice Review Panel’s national thematic review: Strategic Briefing (2020), which highlights its key messages. To gain a greater understanding of the topic you can download and read the full briefing.

Introduction

This briefing shares key messages from the Child Safeguarding Practice Review Panel’s national thematic review of sudden unexpected death in infancy (SUDI), published in July 2020.

At least 300 infants die suddenly and unexpectedly each year in England and Wales and whilst overall numbers have been falling since the 1990s, sudden unexpected deaths in infancy are always devastating for families.

Of the 568 serious incidents notified to the Panel between June 2018 and August 2019, 40 involved infants dying suddenly and unexpectedly, making this one of the largest groups of children notified. Co-sleeping was a feature in 38 of these 40 cases. Parental alcohol and drug use were common, as were parental mental health difficulties. Additional safeguarding concerns were also present including cumulative neglect, domestic violence, parental mental health concerns and substance misuse.

What current practices are used to reduce the risk of SUDI?

A range of interventions to reduce the risk of SUDI in families with children at risk were identified by the report including infant sleep space and safer sleep education programmes; intensive or targeted home visiting services; peer educators; health education and raising awareness interventions and targeted health education messages using digital media.

• Effective interventions were identified as being characterised by approaches that are ‘personalised, culturally sensitive, enabling, empowering, relationship building, interactive, accepting of parental perspective, non-judgemental and are delivered over time’.
• Strategies that were embedded within usual services, which began prior to the birth of the child and which continued after, were most effective.
• Unsafe sleep environments which increase the risk of SUDI include ‘co-sleeping in the presence of other risks (including bed sharing), overwrapping (head covered, use of pillows or duvets)’ and ‘soft sleep surfaces (soft or second-hand mattress)’.
• Some preventative interventions have combined risk reduction approaches with the provision of safer sleeping spaces for babies, such as bassinettes. Positive initiatives include the baby box programme launched in Scotland in 2017 which is modelled on the Finnish baby box introduced in the 1930s. In New Zealand, work on safe sleeping has built upon the Maori-led SUDI prevention initiative developed in 2005 which uses the Wahakura (a traditional Māori woven basket) and the Pēpi-Pod as safer sleep devices.
• The report emphasises that out-of-routine situations – such as staying with family or friends, or following a party where there is alcohol consumed – can increase the risk of bed sharing or sofa sleeping.
• Findings showed that parents are more likely to act on advise they receive from someone they trust and believe.

Recommendations from the Child Safeguarding Practice Review Panel’s report

The report calls for a new multi-agency approach to SUDI prevention that embeds it in ‘respectful and authoritative relationship-based safeguarding practice’. SUDI prevention is not something that can be left to public health practitioners alone, but should be understood as part of broader safeguarding work including policies for responding to social and economic deprivation, housing need, domestic violence and parental mental health concerns. Also called for by the report are new government tools and processes to support practitioners to incorporate this new approach.

The report proposes a ‘prevent and protect’ practice model, which the authors say has the potential to improve the way services work with families with children at risk of significant harm.

As research evidence suggests that underlying social and environmental factors may have an effect on SUDI independently of risks such as low birth-weight or smoking in pregnancy, the model includes socioeconomic deprivation, overcrowded housing and adverse childhood circumstances within the pre-disposing risks of SUDI.

Safeguarding partners, working with commissioners and other local providers, can use the model to develop more flexible strategies for reducing the risk of SUDI across the local population.

The model proposes that safer sleep advice and risk assessment are joined up with wider safeguarding considerations and plans to work with families.

Conclusion

Effective multi-agency strategies, tailored to the needs and circumstances of individual families, with a particular focus on families with children at risk, are now needed to promote safer sleeping and reduce the risk of SUDI.