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‘Hazardous sleeping environment’ behind most sudden unexpected infant deaths

Mental health, drug/alcohol dependency issues prominent, shows first analysis of recent serious case reviews

Caroline White

Monday, 30 July 2018

Most cases of sudden unexpected infant death (SUDI) occur in “hazardous sleeping environments”, and among families already well known to services because of substance misuse and/or poor engagement with health and social care professionals, reveals the first analysis* of official investigations into these deaths in England.

The analysis, published in the Archives of Disease in Childhood, was carried out in a bid to gain a better understanding of the circumstances in which SUDI cases subject to serious case review occur.

There are round 300–400 cases every year in England and Wales. SUDI is defined as the sudden and unexplained death of an infant that had not been considered a reasonable possibility in the preceding 48 hours.

The cause of death remains unexplained in approximately two-thirds of cases, which are often categorised as sudden infant death syndrome (SIDS). Potentially modifiable risk factors for SIDS are well known, and include parental smoking, the infant sleeping face-down or on its side, and sleeping beside a parent who has drunk a lot of alcohol or taken drugs.

But the incidence of SIDS has plummeted since the 1990s in the wake of safe sleep campaigns and is now mostly linked to social deprivation and modifiable risk factors.

The researchers looked at serious case reviews in England from April 2011 to March 2014. These were cases of infants aged 0-2 years for whom no clear medical or forensic cause of death had been found.

The researchers were able to access 27 out of the 30 serious case reviews held during this period. They found that parents didn’t engage with health or social care professionals in 18 cases; 18 families had alcohol or drug dependency issues; parental mental health problems were evident in 14 cases; in 13 cases parents had criminal records; and domestic abuse was an issue in nine cases.

18 of the deaths occurred in highly hazardous sleep environments: 16 of these involved sleeping in the same bed as the parent (s) and in 13, the parents were drunk or high. Longstanding neglect was a prominent feature in 15 of the 27 cases.

“Eleven families’ siblings were reported as dirty, hungry, inadequately dressed or had severe dental caries, and seven families lived in homes described as squalid. Four mothers lacked basic parenting skills, and one father was convicted for child neglect after leaving his young children home alone,” commented lead study author Dr Joanna Garstang, Division of Mental Health and Wellbeing, Warwick Medical School.

Jenny Ward, director of services at charity The Lullaby Trust, said the study findings “demonstrate the urgent need to ensure safer sleep advice reaches all parents and carers, particularly vulnerable families where extra support is often most needed. While reaching vulnerable parents can be challenging, the study shows that it could ultimately save babies’ lives.”

The researchers conclude that more consideration is needed on how best to support such vulnerable families.

“A remaining challenge is how to deliver safe sleep messages to high-risk families who may be hard to reach,” said Dr Garstang.

“Despite 25 years of safe sleep campaigns, some parents are still not receiving, not hearing, not understanding, or choosing not to follow this advice, resulting in many infants being exposed to hazardous sleep situations. Future research needs to focus on how best to support and engage with these vulnerable families.”


*Garstang JJ, Sidebotham P. Qualitative analysis of serious case reviews into unexpected infant deaths. Archives of Disease in Childhood 2018 DOI:10.1136/archdischild-2018-315156

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