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Case reviews reveal sudden unexpected infant death risks

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The first ever study of serious case reviews of sudden unexpected infant deaths has highlighted domestic violence, mental health problems and substance misuse as key risk factors.

In addition, most cases occur when intoxicated parents share sleeping surfaces with child, and many happen following a sudden change in family circumstances. For the first time in England, a study has been conducted of official investigations of unexpected infant deaths.

“Eleven families’ siblings were reported as dirty, hungry, inadequately dressed or had severe dental caries”

Joanna Garstang

The research was conducted by the University of Warwick to develop a detailed understanding of the circumstances of sudden unexpected death in infancy cases subject to serious case review.

The study authors, led by Dr Joanna Garstang, found that most SUDI cases occurred in hazardous sleep environments and, as a result, were potentially preventable.

They also found that they occurred in families well known to services with concerns about neglect, substance misuse and poor engagement.

They highlighted that SUDI – defined as the sudden and unexplained death of an infant that had not been considered as a reasonable possibility in the previous 48 hours – remained a “significant problem”, with around 300 to 400 cases annually in England and Wales.

The cause of death remains unexplained in approximately two-thirds of SUDI cases and these were often categorised as sudden infant death syndrome (SIDS), noted the researchers.

“Future research needs to focus on how best to support and engage with these vulnerable families”

Joanna Garstang

They said modifiable risk factors for SIDS were well established including parental smoking, the infant sleeping face-down or on its side, or co-sleeping with a parent who had consumed alcohol or drugs.

But they highlighted that SIDS had declined dramatically since the 1990s after safe sleep campaigns and now occurred largely in association with social deprivation and modifiable risk factors.

The study paper, published in the journal the Archives of Disease in Childhood, examined serious case reviews in England from April 2011 to March 2014.

The researchers gained access to 27 out of the 30 reviews that were held during the time period. They found in 18 cases parents did not engage with professionals, while 18 families suffered alcohol or drug dependency.

There were also 14 cases of parental mental health problems, in 13 cases parents had criminal records and there were nine cases of domestic abuse.

The analysis of the 27 reviews also found that 18 deaths occurred in highly hazardous sleep environments – 16 involved co-sleeping, of which 13 occurred with parents who were drunk or had taken drugs.

“While reaching vulnerable parents can be challenging, the study shows that it could ultimately save babies’ lives”

Jenny Ward

Dr Garstang’s said the research found that long standing 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,” she said.

She added: “Four mothers lacked basic parenting skills, and one father was convicted for child neglect after leaving his young children home alone”.

The researchers concluded that more consideration was now needed on how best to support such vulnerable families.

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

“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,” she said.

“Future research needs to focus on how best to support and engage with these vulnerable families,” she added.

Jenny Ward, director of services at the Lullaby Trust, said the charity welcomed the study.

She said it demonstrated 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,” she said.

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