This was prompted by government, in the wake of sudden death in infancy data, in an attempt to identify what type of support was needed to reduce the incidence in all families.  

Today’s report from Newcastle, Oxford, Bristol Universities and UCL on promoting safer sleep for babies, particularly focuses on families facing significant adversity, who may be receiving support from Children’s Social Care Services. 

While rates of sudden unexpected death in infancy (SUDI) declined steeply in the 1990s and continued to decline until 2014, families living in the most deprived neighbourhoods continue to experience a disproportionately higher rate; the National Child Mortality Database found that 42% of SUDIs occurred in deprived neighbourhoods, compared with 8% in the least deprived.  

Researchers interviewed parents, talked to local professional services and studied data on decision-making and safer sleep interventions.

Dr Ruth McGovern, co-author and Senior Lecturer in Public Health Research at Newcastle University said: “It can be difficult for parents in contact with child protection services to have open conversations about risk with practitioners involved in their care. The findings of this research are important in highlighting barriers to these conversations and the need to take account of pressures to be a ‘good parent’ when talking with parents about safer sleeping practices.”

Jane Barlow, Professor of Evidence Based Intervention and Policy Evaluation at the Department of Social Policy and Intervention, said, ‘The findings of this research suggest that it may be beneficial for practitioners working to promote safe sleep practices with parents who are faced with a range of adverse life circumstances some of whom may also have a social worker, to focus on exploring in an open and honest way, the reasons that parents might, for example, co-sleep with an infant, and how to do so safely.

‘While this is consistent with national guidance on safe infant sleep practice, it represents a less didactic approach to working with these families, and relies on the development of a trusting relationship between the parent and practitioner.’

Recommendations

According to the report, a range of motivational factors play a key role in influencing decision-making about the infant sleep environment, including parents’ own needs for adequate sleep, and the need to bond with their babies. Research also suggests professionals responsible for conversations about infant sleep safety have concerns about providing personalised and tailored support and managing risks in families with a social worker.

The researchers recommend:

• Open conversations between parents and professionals could be used to support safer sleep for babies who have a social worker. 
• These open conversations would need to acknowledge and discuss the reality of people’s lives in order to understand and address the motivation behind parental decisions and actions.
• Conversations should include credible, trusted sources and sound evidence to explain how and why safer sleep practices aim to protect infants. Social pressures with regard to “good parenting” may act as barriers to open and frank conversations between parents and professionals.

Dr Anna Pease, Research Fellow Bristol Medical School, Bristol University, said, ‘Families have a right to evidence-based information about how to reduce their baby’s risk of sudden infant death. We know that overall, safer sleep advice has worked to save the lives of thousands of babies, but this approach has not been as effective for families with more vulnerable infants. This research really shows how we need to focus on supporting those families who need extra support: tailoring the messages to their circumstances, working with caregiver’s own motivations and instincts, and making sure that these messages come from credible and trusted sources of support.’

The research finds in-depth conversations about safer sleep might best be delivered to families in receipt of social care by a practitioner, such as a Health Visitor, who can provide continuity of care and who has established a trusting relationship with them. Peer and family support networks are also important to reinforce messages and provide practical advice.

The report suggests professionals could engage parents to identify motivations and provide personalised support that is still consistent with national guidance, but that is based on the needs of individual families.

This would be likely to require specific training and support for professionals and a change of organisational culture to allow professionals to manage risk more confidently. Such conversations need to be consistent with guidelines from NICE and The Lullaby Trust whilst also being sensitive to the needs and context of individual families.

The report ‘Promoting safer sleeping for babies in high-risk groups in England’, 2023, by Kate Shiells; Simon Barnett; Hannah Cann; Ruth McGovern; Anna Pease; Jenny Woodman; and Jane Barlow, was funded by the National Institute for Health and Care Research (NIHR) Children and Families Policy Research Unit