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28 Jul 2023

Infant sleep expert shares new guidance to reduce sudden unexpected death in infancy


Professor Helen Ball from Durham University’s Infancy and Sleep Centre, has published new guidance which sets out how local authorities and  safeguarding leads can develop a multi-agency approach for the prevention of sudden unexpected death in infancy (SUDI).

The guidance is part of the ‘Eyes on the Baby’ project and has been developed in response to the Government’s National Child Safeguarding Practice Review panel recommendations in 2020,  which advocated for a multi-agency approach to SUDI prevention, particularly when working with families who may be at higher risk of SUDI because of their circumstances.

The work has been funded by the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC).

The ‘Eyes on the Baby’ report, details 12 key recommendations for implementing multi-agency SUDI prevention. These include:

  • Involving staff in all family-facing services with day-to-day contact with families and babies in SUDI prevention measures.
  • Setting out clear expectations on roles and responsibilities within those services
  • Providing appropriate and ongoing training, evaluation, and engagement in SUDI prevention.

The report was informed by research, published in BMJ Public Health, which examined where and how multi-agency approaches to SUDI prevention are being used across local authority areas. The research found significant variations in policy and approaches across England’s local authorities and safeguarding partnerships – with only a few local authorities having well-designed policies, detailed guidance or training for staff.

The project has been developed in County Durham to provide tailored training and guidance for people working in family-facing services and that have everyday contact with families and babies, giving guidance on what to see, what to do and what to say. It is now being introduced across Northumberland, too.

Background to the project

Rates of SUDI have fallen sharply in the UK over the last 30 years, largely due to wide-scale infant sleep messaging over recent years, such as the Lullaby Trust’s ‘Back to Sleep’ campaign.

As a result, most sudden and unexpected deaths of babies in England now cluster in the most deprived communities – where simple public health messages can be difficult to implement.

Factors that increase the rate of SUDI include babies being placed on their front or side for sleep rather than their back, being exposed to smoke during pregnancy or after birth, being placed to sleep in situations such as in a cot full of soft toys or loose bedding, sleeping on a sofa, sleeping with an intoxicated parent, or sleeping in a room alone.

The way to help most families avoid this is to teach them about infant sleep safety and how to avoid the sleep situations that can increase the risk of SUDI.

However, some families miss the opportunity to receive this information for a number of often complex reasons, including:

  • They don’t or can’t engage with the antenatal or postnatal care opportunities they are offered.
  • They were given the advice but not at a time or in a way they could absorb it and so they don’t recall it.
  • The circumstances of their lives or the context in which they find themselves, makes it difficult or impossible for them to act on the advice – for example their living space or conditions, access to financial resources, or circumstances linked to their own mental wellbeing.

These families need additional support to prevent SUDIs and reduce the growing regional and socio-economic disparities in infant death rates across the UK.

Why do we need a multi-agency approach?

In 2020 a report from the National Child Safeguarding Practice review panel recommended that tackling SUDI in the UK is too challenging and complex to expect that any further reductions in infant deaths in the UK can be accomplished by health professionals alone.

Due to a lack of funding and heavy workloads, there is a lack of sufficient contact between health professionals and the most vulnerable families, and the opportunities to build relationships with and offer services to has been greatly eroded in recent years.

These issues lessen the ability to make a difference to the most vulnerable groups.

As a result, the National Safeguarding Practice Review recommended adopting a multi-agency approach to SUDI prevention.

The Eyes on the Baby project was developed in response to this recommendation. Its aim was to develop and implement a multi-agency approach to tackling this issue in County Durham as a pilot area.

Since the recommendation of the 2020 Child Safeguarding Practice Review Report, only a handful of local authorities have attempted to implement a multi-agency approach for SUDI prevention. None have publicly documented and evaluated the process of implementation to date.

Read more about the research team’s analysis of local authority implementation across the country, published in BMJ Public Health July 2023

Developing the project

This project brought together key partners including Durham University’s Infancy and Sleep Centre, Durham Integrated Care Board, Durham County Council Public Health Team and partners to develop this multi-agency approach.

As part of the work, SUDI Prevention in County Durham was mapped to identify key contact points where safer sleep information was shared and by whom.

This highlighted the infrequency of universal safer sleep discussions – both antenatally and postnatally.

It also highlighted that staff felt they lacked knowledge and confidence regarding safer sleep guidance.

The project committee identified a broad range of staff groups whose work brought them into contact with vulnerable families in County Durham.

These roles spanned a wide range of areas, from paramedics to housing officers.

Job roles were grouped, based on the frequency and degree of contact with vulnerable families and training for these groups of staff was co-produced and offered to these groups of staff via online learning.

Parents also took part in the research, sharing their views on who they believed were the ‘right’ people to talk to families about SUDI. They suggested health professionals and staff who had existing relationships with parents, were best placed. They also highlighted that staff who give safer sleeping advice to vulnerable families need to be non-judgmental and try to offer different solutions.

Read more about the workforce groups and training strands in the Eyes on the Baby project report

Find out more about the Eyes on the Baby training and implementation package

Pre-and post-training surveys assessed staff knowledge and confidence, and follow-up surveys captured staff feedback and engagement. Normalisation Process Theory (NPT) was used to support user engagement and embed SUDI prevention into everyday practice.

The initial phase of the project was then evaluated using surveys, interviews, and group discussions.

Project findings and recommendations

In June 2023, the project team published a report describing the co-production, pilot, and evaluation of the multi-agency SUDI approach in County Durham.

The report offers 12 key recommendations for developing a successful multi-agency SUDI prevention approach for vulnerable families.

You can read all 12 recommendations in the project report

What’s next?

Colleagues from County Durham will continue to roll out and implement a multi-agency approach to SUDI in their locality.

The project team are also working with colleagues in Northumberland to pilot the approach across the county.

The team are keen to continue this work by examining how best to ensure SUDI prevention for vulnerable families becomes integrated into the work of multi-agency teams – and would be keen to hear from any other local safeguarding partnerships. Public Health Teams or CDOPs (Child Death Overview Panels) who would like to discuss implementing this approach in their own areas.

Professor Helen Ball said: “Safer sleep guidance has reduced the number of SUDI deaths dramatically over the past 30 years, but around 300 babies still die every year in the UK.

“To develop effective multi-agency SUDI prevention policies, policymakers should aim to set-out clear and comprehensive guidance on who might be involved from the point a baby is born in any given area, and the roles and responsibilities of the services who support our families and babies. A clear and consistent approach could enhance the reach of SUDI prevention further still, and in turn prevent more unnecessary infant deaths.

“Our research recommends all professionals who work with families and babies be equipped with training to develop their knowledge, skills, and confidence to help remove barriers to safe infant sleep and thereby prevent SUDI. Making SUDI prevention everyone’s business maximises the opportunity to ensure families are familiar with safe sleep information, and are able to implement it, with the ultimate goal of saving babies’ lives.”

Professor Eileen Kaner, Director of the NIHR Applied Research Collaboration (ARC) North East and North Cumbria (NENC) said: “This is an important piece of work which we were very happy to support through our Open Funding Competition. The project has brought together key partners from across County Durham to develop an-evidence based training package for staff that will help to prevent sudden unexpected infant death within harder to reach communities.

“This work is a fantastic example of how research can be used in practice to save lives within some of our most vulnerable groups. This approach developed by Professor Helen Ball and her team can be used by local authorities and safeguarding partnerships across the country, and it’s great news that the approach is already being delivered in areas outside of County Durham.”

The Lullaby Trust, who provide specialist support for bereaved families, promotes expert advice on safer baby sleep and raise awareness of Sudden Infant Death Syndrome (SIDS), are a key supporter of the project.

Jenny Ward, Chief Executive of The Lullaby Trust, said: “This has been a fantastic project to be involved with. The Lullaby Trust has been working hard for over 50 years to try and prevent sudden infant deaths, and we now know that to achieve this we need everyone on board with keeping babies safe. Eyes on the Baby proves that this can work, and we are looking forward to seeing how we can all learn from and expand this work.”

The Eyes on the Baby project in County Durham is a collaboration between Durham Infancy & Sleep Centre (DISC), Durham Integrated Care Board, Durham County Council Public Health Team and partners. The project was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC).

In Northumberland, DISC is collaborating with Northumberland County Council, Northumberland Family Hubs, and Northumbria Healthcare Foundation Trust who have themselves funded the project to train the multi-agency workforce across Northumberland to keep their ‘Eyes on the Baby’ and help prevent sudden infant deaths.

Further details about this ARC-funded project can be found here.

Or visit the Eyes on the Baby website