Prevention of Sudden Unexpected Death in Infancy Multi Agency Guidance

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Prevention of Sudden Unexpected Death in Infancy Multi Agency Guidance

This chapter was added to the manual in June 2022.

Introduction
Who is the guidance for?
Terms used in this guidance
Organisational Responsibilities
Prevention for all families
Core health prevention offer for all Families
Prevention following birth - in hospital
Prevention if parents choose co-sleeping
Breaks in routine
Prevention and bedside sleeping
Prevention in Warm Weather
Prevention when using car seats
Prevention when using slings
Prevention when swaddling
Protection for infants living in families with predisposing risk, situational risk and vulnerability
Protection and parental Smoking
Protection and Prescribed medication
The role of core health and social care practitioners in protection
In Summary
Appendix 1: Safe Sleep Training Programme
Appendix 2: Universal Pathway for Safer Sleeping Risk Assessment and Action Plan
Appendix 3: Safer Sleep Risk Assessment and action plan
Appendix 4: Resources and Information Sheets
Appendix 5: Further Reading and Information

1. Introduction

This guidance has been commissioned by the Barnsley Safeguarding partnership as a deliverable of the multi-agency Sudden Unexpected Death (SUDI) in Infancy task and finish group.

It forms a prevent and protect framework to ensure that all partner organisations working with families in Barnsley are able to provide parents/carers with evidence-based interventions and information that prevents the Sudden Unexpected Death of an infant resulting from unsafe sleep practices. A tiered training programme is available to support practitioners in the implementation of this guidance (Appendix 1: Safe Sleep Training Programme).

Nationally every year approximately 230 healthy babies die as a result of SUDI in their sleep. Both a national (1) thematic review and a local (2) analysis of SUDI deaths, reach consistent conclusions these being;

‘tragic deaths occur within the family home and predominantly happen when parents co-sleep in unsafe environments with their infants. They are usually healthy babies and although the deaths could not have been anticipated, sadly most of them could have potentially been prevented.’

‘these deaths occur in families whose circumstances put them at risk, not just of SUDI, but of a host of other adverse outcomes. Many of the recognised risk factors for SUDI overlap with those for child abuse and neglect.’

Traditionally safe sleep practice has been seen as the working domain of health practitioners; this guidance sets out the expectations of all agencies who work directly with or who as part of their role encounter families expecting a baby or families with an infant. It sets out recommendations that are in line with the National Child Safeguarding Practice Review Panel July 2020 report Out of routine: A review of sudden unexpected death in infancy (SUDI) in families where the children are considered at risk of significant harm.

In a significant proportion of SUDI it is documented that safe sleep advice has been provided to families however due to a range of adverse health and social circumstances the advice had not been fully implemented by the family. As well as providing an overview of evidence based safe sleep information this guidance seeks to support practitioners to work with greater impact and more effectively assess and manage the broader predisposing and situational risk factors associated with SUDI.

Practitioners from all agencies should aim to work proactively and collaboratively with families to identify and take appropriate and supportive actions to implement safe sleep practices for infants. This guidance applies to all sleeping periods, - during the day and night - in all sleep environments i.e. Moses basket, cot, car seat, pushchair, sofa or armchair, both at home or away.

By successfully engaging parents in safe sleep conversations practitioners can help to safeguard by protecting them from risks associated with sudden unexpected death in infancy (SUDI).

The aim of this guidance is to;

Set out clear expectations of all partner agencies, who as part of their role encounter families expecting a baby or who already have an infant;
Provide up to date, evidence- based advice and information about safer sleeping, which should be shared with all parents and carers;
Support core health and social care staff in the application of a collaborative safe sleep prevent and protect framework with families.

2. Who is the guidance for?

This guidance is for all practitioners who provide support or services to mothers, fathers, infants and wider family members/carers who provide care for an infant and /or toddler. This includes all workers in the statutory, voluntary, community or private sector. There is an expectation that all services providing support to families incorporate this guidance into practice and promote the safe sleep message as appropriate to their role.

3. Terms used in this guidance

Throughout this guidance the following definitions apply:

Sudden Unexplained Death in Infancy (SUDI) -this is the term used when an infant dies and no cause is found after a detailed post mortem. Each year, in the UK unsafe sleep practices are a contributing factor to the death of more than 240 infants (Out of Routine - A Review of Sudden Unexpected Deaths in Infancy ). By promoting safer sleep advice, practitioners can support parents and carers to take steps to reduce the risk of this tragedy occurring;
Infant: a child up to the age of 12 months;
Toddler: a child between the age of 12 -24 months;
Carer: this describes anyone caring for an infant; including mothers, fathers, grandparents, foster carers or any other family member or friend who provides care for an infant;
Co-sleeping: describes any one or more person falling asleep with an infant in any environment (e.g. sofa, bed or sleep surface at any time). This may be a practice that occurs on a regular basis or it may happen occasionally; may be intentional or unintentional;
Overlying: describes rolling onto an infant and smothering them, for example in bed (legal definition taken from the Children and Young Persons Act 1993, sections 1 and 2b) or on a chair, sofa or beanbag.

4. Organisational Responsibilities

Each individual organisation has a role to play in preventing SUDI and supporting safe sleeping practice for all infants within all families across Barnsley.

The majority of opportunities for working collaboratively with families and supporting safe sleep infant practices sits with core health and social care teams such as midwives, and health visitors, family centre community outreach workers, social workers and community neonatal nursing team.

There are important opportunities when family contacts are made by workers from organisations such as police, probation, housing, fire service, drugs and alcohol services, smoking cessations services etc. These contacts may be in the family home or any other environment. Workers should ensure that they are alert to the infant’s sleep space and make every contact count. All workers should be able to support parents maintain a safe sleep environment for their infants through the provision of key safe sleep messages, enabling parents to understand SUDI risk factors and understand how to escalate concerns about unsafe infant sleeping practices.

It is the responsibility of the organisation to ensure that workers are familiar with the guidance and the key messages. Any concerns should be raised in line with relevant policies and procedures. Some organisations will have their own guidance on safe sleeping and should follow this in conjunction with this multi-agency guidance.

It is recommended that all partner agencies create the role of a safe infant sleep champion to support their organisation in their compliance with this guidance. The designated safe sleep champion will be provided with regular updates on current safe sleep evidence-based information and links to supportive materials for service users. Their role is to disseminate training and information providing regular safe sleep updates to workers in their organisation who in their day to day duties are likely to encounter families with an infant and/ or toddler up to their 2nd birthday.

Timely and clarity of information sharing on issues impacting on the infant’s/toddler’s safe sleep is an important factor in the safeguarding infants and toddlers.

All agencies and organisation should ensure that safe sleep advice, conversations and support provided to parents/carers is included in organisational and parent held written records.

Handovers/transfer of information to other agencies relating to the infant/toddler of families moving between services and/or out of area should include a record of any safe sleep risks and action plans, support and conversations with parents/carers.

See appendix for full details and links to current evidence based safe sleep information.

SUDI and the continuum of risk

A key recommendation of the National Child Safeguarding Practice Review Panel July 2020 report; Out of routine: is a prevent and protect model incorporating a continuum of risk. The prevent and protect model is an underpinning principle of this guidance.

5. Prevention for all families

All practitioners and workers are expected to be able to provide the same consistent message in relation to safe sleeping and to challenge any factors that contribute to unsafe sleeping. Unsafe sleep practices may be observed in any environment, home, office or public space and at any time of the day or night. On each and every occasion of an observed unsafe sleep practice workers and practitioners must be able to offer current evidence based information enabling the parents to recreate the sleep space and safeguard against SUDI.

The safest place for the infant to sleep is in a cot or Moses basket in parents/carers room for at least the first 6 months. NB the period an infant remains in the parent/carers room should be adjusted for infants born before their due date.

The safest position for baby to sleep is on their back with their feet to the foot of the cot

No bumpers, toys, nappies, loose bedding or other items in the cot.

No pillows or duvets

No products to maintain position e.g. nests or cushions to prop/support.

Remove outdoor clothing when inside

Provide parents with information relating to things they should NEVER do;

NEVER sleep on a sofa or chair with a baby;
NEVER share a bed with your baby if either you or your partner smokes;
NEVER share a bed with your baby if you or your partner has drunk alcohol;
NEVER share a bed with your baby if you or your partner has taken legal (prescribed or un prescribed) medication/drugs that make you sleepy, or taken illegal drugs;
NEVER sleep with your baby if they are premature or low birth weight;
Car seats – follow guidance on correct use;
Slings – follow guidance for correct use.

Information should always be provided to parents/carers in a manner that they can easily understand. For parents/carers who do not have English as a first language, an approved interpreter should be used. The Lullaby Trust website has links to leaflets available in over 20 languages.

Similarly, families with other learning or communication needs should be offered information in such a way as best facilitates their understanding.

If a worker has contact with a family during which concerns about the infant’s sleeping situation become apparent the worker should reiterate clear safe sleep guidance. If a parent/carer/s are unable or unwilling to follow safe sleep advice and are placing an infant at risk of harm despite advice given, then professional judgement regarding the nature of the unsafe sleep factors present should be applied and concerns escalated as appropriate. Each worker should follow their Organisational safeguarding procedure as they would for any other safeguarding risks and clearly communicate with parents/carers any plans for escalating concerns.

All staff should make a record of the information and discussions they have with parents/carers in relation to safer sleeping.

6. Core health prevention offer for all Families

Safer Sleep Risk Assessments should be commenced in the antenatal period by the midwife. Pregnancy provides an opportune time to introduce parents and carers to safer sleep information, as this will help inform their purchasing of appropriate safer sleep equipment and creating a safer sleep space in readiness for the arrival of their new baby. This opportunity should also be used to support parents and carers to develop realistic expectations of newborn sleeping behaviours and to start the development of Safer Sleep Plans that incorporate nighttime feeding and the safe management of night waking and parental exhaustion;
The Health Visitor’s planned antenatal contact provides another opportunity to promote safe sleep before the baby is born. At this contact it is recommended that the health visitor reviews and updates the safe sleep risk assessment and safe sleep action. The Health Visitor should affirm parents progress with any safe sleep plans and provide support to parents with any safe sleep issues, such as smoking and provide guidance on creating a safe sleep space for baby;
Completion of the Safer Sleeping Risk Assessment and Safer Sleep Plans should be reviewed by midwives and health visitors at each contact with the family during the infant’s 1st year of life;
New families moving into the area with an infant or toddler should be provided with a safe sleep risk assessment and safe sleep plan;
Safer Sleep Risk Assessments are not static, and they need to be reviewed and updated to account for seasonal changes and any changes in the family’s circumstances;
Safer Sleep Risk Assessments should also support parents/carers to make Safer Sleep Plans for circumstances where their normal routine is changed, i.e. when they are away from their usual environment or there are changes to the parent/corers’ circumstances;
Progress with safer sleep arrangements made by parents and carers should be affirmed;
Safe sleep risk assessment and safe sleep action planning tool can be found in the appendix;
Consistent safe sleep messages should be shared with non-resident parent/partner or other family member where the child has a shared care arrangement or where a parent is being supported by another key adult who would need to be part of the same safe sleep message

7. Prevention following birth - in hospital

Mothers should be encouraged to spend time in skin to skin contact with their new infant in an unhurried environment as soon as possible after delivery. Midwifery practitioners should be vigilant in ensuring skin to skin contact is safe and the possibilities of any accidents are minimised. Examples of possible risk exposure includes, on ward transfer, after operative delivery, after sedative medication and during extreme tiredness. Skin to skin contact is encouraged on the postnatal ward and during the post-natal period to establish the parent-infant bond, to settle infants and to establish breast feeding. Mothers should be encouraged to stay close to their infants whatever their preferred infant feeding choice. Separation of a mother and her infant should only occur where the health or safety of either prevents care being offered in the postnatal areas.

Literature consistent with the Safer Sleeping Guidance and the relation between SUDI, co-sleeping and other associated factors should be provided and discussed with all mothers to reiterate advice given previously.

The safest place for an infant to sleep whilst in hospital is in a cot by the side of the mother’s bed or in a sidecar crib. If a mother chooses to share her bed with her infant whilst in hospital, for cuddling or feeding purposes, the following factors at the time that bed sharing occurs need to be considered:

Clinical condition of the mother.

Other contra-indications to bed sharing.

Feeding method.

The safety of the physical environment.

Staff should ensure that:

Not only the benefits of bed sharing are discussed but also the associated risk of co-sleeping and SUDI (including other associated factors) to allow a fully informed choice.

Written information on bed sharing is provided (documentation must be made in the care plan/records that the information has been given and discussed).

The effects of analgesia are discussed and documented.

If the mother makes a fully informed choice to bed share with her infant, all information given and discussed should be clearly documented. The mother and infant should be monitored by staff as frequently as is practicable. Effective communication with other members of staff including when handing over care is essential. The bed should be lowered as far as possible and the mother should be asked to keep the curtains or door open so that staff can observe if she inadvertently falls asleep whilst bed sharing. Although a mother needs to take overall responsibility for protecting her infant/s, if there are any professional concerns regarding the safety of an infant this should be addressed and raised through local procedures.

8. Prevention if parents choose co-sleeping

Core professionals should recognise that a number of parents will make an informed decision to co-sleep with their babies. Core professionals are well placed to support parents to understand this risk of this and offer guidance on how risks might be mitigated

The following advice provided by the Lullaby Trust (Lullaby Trust website 2021)

For safer co-sleeping:

Keep pillows, sheets, quilts away from your baby or any other items that could obstruct your baby’s breathing or cause them to overheat. A high proportion of infants who die as a result of SUDI are found with their head covered by loose bedding;
Follow all other lullaby trust safer sleep advice to reduce the risk of SUDI such as sleeping baby on their back;
Avoid letting pets or other children in the bed;
Make sure baby won’t fall out of bed or get trapped between the mattress and the wall.

When not to co-sleep

It is important for you to know that there are some circumstances in which co-sleeping with your baby can be very dangerous:

Either you or your partner smokes (even if you do not smoke in the bedroom);
Either you or your partner has drunk alcohol or taken drugs (including medications that may make you drowsy);
Your baby was born premature (before 37 weeks);
Your baby was born at a low weight (2.5kg or 5½ lbs or less);
Never sleep on a sofa or armchair with your baby, this can increase the risk of SIDS by 50 times.

You should never sleep together with your baby if any of the above points apply to you or your partner.

If a mother makes an informed decision to bed share with her infant whilst she is breastfeeding it is important to provide appropriate guidance that enables her and her partner to make balanced decisions leading to the development of a safer sleep plan based on the facts about co-sleeping. If the mother breastfeeds in bed the safest position for her to adopt is the ‘recovery position’ so that she is less likely to roll forwards onto the baby.

Drink and drugs also affect normal functioning and decision-making. Discuss the importance of planning care for their baby at such times, for example by asking a sober adult to help.

Co-sleeping is much more dangerous when parents smoke or have smoked during pregnancy, in Barnsley 100% of infants who died in unsafe sleep circumstances had a parent who smoked. All workers should help parents understand the risks and offer every support for them to cut down or stop, especially in pregnancy.

SUDI is more common in babies who were born low birthweight or premature; therefore, parents of these babies should avoid co-sleeping especially in early infancy.

If a parent has a health condition such a diabetes or epilepsy co-sleeping should be avoided.

Core health and social care professionals should try and take time to discuss the issues with these parents and to help them look for practical solutions to issues that are affecting them such as lack of a cot, bed or space for sleeping.

9. Breaks in routine

Any break in routine can lead to an increased risk of SUDI. Events such as the infant being unsettled or having a minor childhood illness might lead to the parents changing from their usual safe sleeping routine and to inadvertently introduce a new risk.

Events such as visiting friends and family overnight or going on holiday can also present an extra risk to babies.

Exploring any changes to the infant’s usual sleeping situation with parents can help them re-evaluate their baby’s safety in changed circumstances.

10. Prevention and bedside sleeping

Bedside sleeping is when the infant sleeps in a bedside cot. This allows parents to be close to their infant without sharing the same bed.

The idea is that the bedside cot attaches securely to the parental bed, at the same level as the mattress with the side next to the bed open. Parents can then reach out to their infant without the bother of getting out of bed.

There’s limited research on bedside cots but possible benefits include:

Making life easier when movements are limited after a caesarean section;
Closeness might help with bonding;
Baby is nearer and may be more easily settled back to sleep;
The baby will be nearby for night feeds;
It might encourage breastfeeding.

The same health and safety guidelines for bed-sharing apply if parents use a bedside cot as they do for co-sleeping.

(NCT Website June 2021)

11. Prevention in Warm Weather

All practitioners need to be aware of the increased risks of SUDI in warm weather. Infants can overheat easily. Parents and carers should be helped to understand this and be provided with additional information on how to ensure safer sleep in warm weather.

Make sure the infant has enough fluids. Bottle fed babies should be given additional cooled boiled water. Fully breastfed babies do not need extra fluids;
Regulate the temperature of the room in which the infant sleeps in to 16-20 degrees by using a room thermometer;
Avoid leaving the infant to sleep in the car seat, car, pushchair or pram. Ensure removal of hats and any outdoor clothing once indoors or in a warm car;
Open internal doors and windows, so a natural, flowing breeze is created but avoid air conditioning, as it can be dehydrating;
Make sure the infant’s head is not covered;
If it is “too warm” for bedding, dress the infant appropriately, just a nappy and vest may be sufficient and remove loose covers from the cot, ensure bibs are removed before an infant is placed in cot to sleep;
Hot weather can lead to a change in sleeping circumstances removing the normal sleeping routines and possibly leading families to sleep downstairs on the sofa with the baby due to it being hotter upstairs;
Safe sleep applies in all situations – car, home and pram etc.

It is important that families NEVER cover a pram or buggy with a blanket to keep the sun out. This can stop the air from circulating and lead to overheating. It also creates a barrier so that the parent/carer can no longer see and observe their infant.

12. Prevention when using car seats

Car seats are essential for safety when travelling, but infants should not sleep in a car seat for long periods as many aren’t flat, which can mean the infant is slumped over. It is recommended on longer journeys to take regular breaks and use these to remove the infant from the car seat. If possible have an adult sit with the infant in the back of the car, or use a mirror in order to keep an eye on them. If the infant changes its position and slumps forward, then parents / carers should stop the car as soon as it is safe to do so and take the infant out of the car seat. Infants should not sleep in car seats when they are not travelling.

Remember:

Only use car seats for the purpose of transportation;
Follow the manufacturer’s guidance on correct positioning;
Never leave an infant asleep in the car seat when not in the car;
Do not use a car seat as an alternative to a cot or a high chair;
Do not leave infants in their car seat for long periods or unsupervised;
On long journeys, ensure regular breaks. Lullaby Trust recommend that infants are not in a car seat for longer than 2 hours. Also remove outdoor clothing to prevent overheating.

13. Prevention when using slings

There is currently a lack of significant data on the use of slings and SIDS. However, parents or carers who wish to use slings should be advised to follow the guidance on their safe use as a precaution.

Although there is no reliable evidence that slings are directly associated with SUDI, there have been a number of deaths worldwide where infants have suffered a fatal accident from the use of a sling.

These accidents are particularly due to suffocation, and particularly in young infants.

The risk appears to be greatest when an infant’s airway is obstructed either by their chin resting on their chest or their mouth and nose being covered by a parent or carers’ skin or clothing.

The safest infant carrier to use will keep the infant firmly in an upright position where a parent / carer can always see the infant’s face, and ensure their airways are free. Complete guidance is available by visiting The Royal Society for the Prevention of Accidents.

When wearing a sling or infant carrier, keep in mind the TICKS guidelines:

Tight;
In view at all times;
Close enough to kiss;
Keep chin off the chest;
Supported back.

14. Prevention when swaddling

Some parents and carers believe swaddling infants can help them settle to sleep. Whilst workers do not need to advocate for or against swaddling, all workers should urge parents and carers to follow the advice below.

If parents and carers decide to adopt swaddling, this should be done for each day and night time sleep as part of a regular routine:

Use thin materials;
Do not swaddle above the shoulders;
Never put a swaddled infant to sleep on their front;
Do not swaddle too tight;
Check the infant’s temperature to ensure they do not get too hot.

15. Protection for infants living in families with predisposing risk, situational risk and vulnerability

The risk of SUDI is increased in families who experience socio-economic deprivation, living in poor or overcrowded accommodation, parents with Adverse childhood experience, parents with reduced ability to detect harm in their own interpersonal relationship, parental mental health problems, alcohol or substance misuse, ongoing and cumulative neglect, parental criminal behaviours, relationship breakdown and/or new partners (national Safeguarding child review panel 2020.

These factors may be exacerbated when there is limited engagement with services, including late ante-natal booking and/or mistrust of professionals. Prematurity or other vulnerabilities in the infant are additional risk factor. (Out of Routine ref).

Professionals such as police, fire services, housing, drug and alcohol services, smoking cessation services, probation are well placed and have a significant role to play in identifying predisposing and situational SUDI risk factors. Professionals should discuss and provide the family with safe sleep information.

Furthermore, in cases where the risks are assessed to be of concern due to situational risks and vulnerabilities professionals should consider a referral to children’s social care.

In some instances, the case may already be open to children’s social care. If a new referral is made to children’s social care this will be screened and a decision made whether this should progress for further assessment. The screening process will take account of safe sleep risk factors. If the family is an existing open case to children’s social care any new information received should inform whether a new assessment is required. In both instances the assessed risks will determine what additional safeguarding actions should be considered. Discussion with the multi-agency team around the child will take place and will inform planning in order to safeguard the child. Where the child is subject to a child in need plan or child protection plan these plans will be updated accordingly to incorporate safe sleep expectations.

16. Protection and parental Smoking

Locally, parental smoking was identified as a predisposing risk factor in 100% of all incidents of SUDI that occurred in Barnsley 2018-2020. All agencies coming into contact with a family should provide information to parents on the association between SUDI and smoking. All workers should reiterate the ‘never co-sleep with their infant’ to a parent who is a smoker.

Support and information on accessing smoking cessation services should always be provided.

17. Protection and Prescribed medication

Prescribed medication may have a sedative effect and impair parent/s/carers level of consciousness.

This is likely to reduce parental/carer responsiveness and awareness of the infant in bed. Parent/s/carer/s are less aware of or less able to respond to the infant’s needs appropriately. All workers should ensure that parents understand the risks to their infant and advise against co-sleeping when taking any medication that may cause drowsiness,

Medication that may have sedative effects include: sleeping tablets, anti-depressants, some cough remedies, some anti-histamines and some analgesics. Advise parents to always read the pharmaceutical warning leaflet.

Anaesthesia given during day surgery or dental surgery could also increase drowsiness.

All prescribing practitioners should provide parents with information relating to sedative effects of medication and advise against co-sleeping with their infant.

Core professionals should explore the use of prescribed medications and support the parents to develop safe sleep action plans which include avoidance of co-sleeping.

18. The role of core health and social care practitioners in protection

Core health and social care practitioners who work with children and families are expected to be able to provide parents and carers with consistent safer sleep messages, and to have the skills to engage parents in safe sleep conversations and to provide respectful challenge if they have concerns in relation to unsafe sleeping arrangements and/or factors that increase the risk of SUDI to the baby such as smoking, alcohol and substance misuse. This includes sharing information and concerns with the relevant lead professional for the infant.

Timely safe sleep risk assessments to enable core professionals in the early identification of an infant with predisposing vulnerability, such as maternal ill health, parental smoking, prematurity, previous SUDI in the family etc. Core professionals should collaborate with these families and co- produce personalised safe sleep action plans to reduce the risk of SUDI;
Core professionals undertaking safe sleep risk assessments should discuss the heightened risk of smoking during pregnancy and the infants first year of life, the association between smoking and SUDI should be explained and professionals should explore mitigating factors with parents. Stop smoking advice and referrals should be discussed at every opportunity. All conversations and actions should be noted on safe sleep risk assessment and safe sleep action plan which should be shared with the parents;
Core professionals undertaking safe sleep risk assessment with the family should incorporate substance misuse and alcohol consumption into the safe sleep risk assessment. Referral needs and support to access appropriate support services should be considered and discussed with parents. Safe sleep action plans should be completed accordingly;
Whilst the aim of core professionals is to work in partnership with the family to enable a best safe sleep environment and practices it is vital that core professionals at all times work in accordance with safeguarding policy ensuring paramountcy of the infant’s safety. In cases where a family continue to place their infant at unnecessary risk of SUDI despite being provided with a clear outline of the risks, advice and support, a referral for additional parenting support through safeguarding processes should be made;
All Pre-birth assessments and assessments of infants and toddlers undertaken by children social workers should also include an assessment of risks associated with SUDI and parental understanding and responses to safe sleep. Where concerns emerge, these will be addressed through safety planning and incorporated in to plans going forward (Early Help Assessments, Child In Need plans and Child Protection Plans);
Where a child is subject to a child protection plan the Child Protection Conference chair will have a key role in ensuring safe sleep is incorporated into the plan and will ensure this is appropriately reviewed at core groups and during visits to ensure progress is being made and the risks are reduced;
Where the child is subject to a child in need plan the social worker as lead professional with the multi-agency team around the child will be responsible for ensuring plans lead to reducing risks and where this does not happen the social worker will discuss the case planning with their manager with regards to the current plan and whether any further escalation or protective action is required;
Social worker managers will be responsible for ensuring social workers include an assessment of safe sleep in their assessments and that they receive appropriate training in having safe sleep conversations and understand wider safe sleep research and guidance. Managers will ensure that safe sleep discussions take place in supervision for all cases where there are unborn babies, infants and toddlers;
The Safe Sleep Risk Assessment and Action Plan should form part of any multi-agency plan for infants and families in receipt of additional support from agencies due to vulnerability and/or safeguarding needs;
The Safer Sleep Action Plan should be reviewed and updated at all multi agency meetings with the family. It is the responsibility of all agencies to provide and reiterate safer sleep advice during their contacts parent and carers, providing support to enable the family to provide a safe sleep environment for their infant;
Families need transparent, consistent support and advice to ensure their baby/ infant’s safety in their sleep;
The Safer Sleep Action Plan should state review dates of Safer Sleep Risk Assessments. It should also include actions to escalate concerns if the plan is not being followed by the parents/carers;
All factors that contribute to increasing the risk of SUDI should be openly discussed with the parents/ carers and support provided to reduce risks.

19. In Summary

Approximately 240 babies die each year as a result of unsafe sleep practices. These babies have been found to be otherwise healthy babies.

All workers who encounter families who are expecting a baby or have an infant have a role to play in preventing such deaths occurring.

Appendix 1: Safe Sleep Training Programme

Level 1 All workers

All workers who as part of their role are likely to come into contact with families expecting a baby or with an infant will be provided with access to the safeguarding the 1st year of life and includes a specific section on infant safe sleep training. This is available on BMBC POD. This training should form part of new starters induction programme.

Level 2 training for safe sleep champions

Designated safe sleep champions will be provided with access to level1 training and then a further training session. This session will be interactive and will enable the safe sleep champion to consider how they can best support their organisation to implement infant safe sleep practices.

Level 3 training for Core health and social care professionals.

This will be provided in partnership with leads for Midwifery, Public Health Nursing and Children’s Services. This will encompass the following elements

Identification of the broader continuum of risks associated with SUDI;
Undertaking collaborative safe sleep risk assessments with the family;
Co-producing safe sleep action plans with the family;
Identify those families who require personalised and targeted additional support and refer to services as appropriate;
Motivational Interviewing approach to supporting safe sleep practices.