A number of Child Safeguarding Practice Reviews centre around infants aged 0-2 years who have died by way of Sudden Unexplained Death in Infancy (SUDI).

Safe Sleep for Babies

Preventing Sudden Infant Death Syndrome / Sudden Unexplained Death in Infants

14 Babies died with an initial diagnosis of SUDI in Bexley, Greenwich and Lewisham between December 2020 and December 2022. These are previously healthy babies - please help prevent the tragic deaths of children by making sure you know the Key Facts when discussing safe sleeping with parents

Below provides some insight to SUDI Deaths and their Associated Risk Factors in Lewisham from 2008 to 2022, with the Tri-Borough numbers being included from October 2019.

Tri-Borough Public Health : Key Facts

Check Understanding!

We have had a significant number of deaths in cases where either the mother speaks and understands limited English or where she is dyslexic or described as having a, ‘mild learning disability’.

• It is important to use an interpreter when discussing safe sleep if English is not a parents first language.
• Consideration should also be given if the mother or father has information processing issues, ask her/him to show you and explain back to you how to sleep the baby safely.
• You can use the LSCP Safe Sleep for Babies web page,   The website can be transferred into all known languages and can be a useful tool.

There are good resources for parents, including visual aids and information in 16 different languages on the following website www.lullabytrust.org.uk

Professionals working with new or expectant  parent(s) should be mindful of the impact of  financial pressures on family budgets (poverty, low income, cost of living increases, child care costs) and how this may impact on the parent(s) ability to accesses equipment for babies.  

All agencies should consider what resource’s they can access to support families who need help to get necessary baby equipment,this can include direct support or referring to other organisations including the voluntary sector.   

Resources for parents who may need support or equipment for their baby 

1. Parents who need extra support can obtain a free thermometer from their Midwife.
2. The Lewisham Donation Hub, Unit D Place Ladywell, 261 Lewisham High Street, SE13 6AY Lewisham Donation Hub – Supporting our community since 2020
3. Little Village. the referral must be made by a professional Home - Little Village (littlevillagehq.org)
4. Apply to BBC Children in Need fund Grants - BBC Children in Need
5. Home - Buttle UK

Awareness Resources / Posters to Support the Campaign

To support the Keeping Babies Safe Campaign, the LSCP have developed a public facing Safe Sleep poster for partners to place in prominent areas.  You can download the LSCP Poster HERE.  

Additionally, the Lullaby Trust have a series of public facing posters that can be placed in public facing areas.  Please use as many as you can, or rotate them periodically. 

• The ABCs of Safe Sleep Poster
• Sofa Sharing Poster
• Safer Sleep for Babies Quick Reference Card
• Safer Sleep for Babies Easy Read Card

For more resources of leaflets, easy read cards and posters visit www.lullabytrust.org.uk

Overview

A number of Child Safeguarding Practice Reviews centre around infants aged 0-2 years, who have died or suffered significant harm, by way of non-accidental injury / shaken baby. 

Over recent years, the Tri-Borough have identified a number of children who have attended A&E where either of these have been a factor.

Additionally, in relation to this the NSPCC have also published a report “The Myth of Invisible Men: Safeguarding children under 1 from non-accidental injury caused by male carers”.

We aim to raise awareness and encourage discussions with parents and carers around coping with crying and non-accidental injuries to infants. 

Awareness Resources / Posters

ICON have a series of public facing posters.  Please use as many as you can, or rotate them periodically.

• Comfort Methods Poster
• Babies Cry, You Can Cope Poster
• The Crying Plan
• ICON Easy read Premature Baby Leaflet

For more resources of leaflets, easy read cards and posters visit www.iconcope.org

The Myth of Invisible Men: Safeguarding children under 1 from non-accidental injury caused by male carers – KEY FINDINGS

• Perinatal neonaticides (homicides within 24hrs of birth) are almost exclusively perpetrated by birth mothers.
• Between 2000 and 2015 in England and Wales, 122 babies were killed by fathers (11 of these by step-fathers) giving an average of eight infants per year killed. Of these, 31 died as a consequence of shaking.
• In the only UK analysis we found, covering convicted homicides in England and Wales over the period 1997-2006, infants were more likely to be killed by a father (as the main perpetrator) than by a mother in the approximate ratio 2:1.9
• Biological fathers are more likely to kill infants than stepfathers in ratios ranging from 5:1 to 26.1 in the first year of life in the UK, USA, Australia and New Zealand.
• The ratio of biological fathers to ‘stepfathers’ (including mothers’ non-cohabiting and short-term partners) where babies have been killed in England and Wales is 10:1. This increases to 15:1 when shaking is the cause of death.
• However, when factoring in the very small proportion of infants with a stepfather, the evidence suggests that stepfathers are associated with greater risk than birth fathers. The numbers are lower but the risks are greater.
• The ratio of biological fathers to ‘stepfathers’ evened out or reversed for father-perpetrated homicide of older babies and pre-school children aged 1 to 5 years in England and Wales.
• When the research scope was broadened to look at non-fatal NAI, a clear picture emerges. Fathers outnumbered mothers as perpetrators of identified abuse head trauma (AHT), and this is a consistent finding in international data with the fathers to mothers ratio ranging from 2:1 to 10:1.
• There is also noteworthy data about the gender of babies abused. A consistent and well-evidenced finding from the literature review is that sons are more likely than daughters to be victims of father-perpetrated NAI. The one large international study that includes this data found that boys outnumbered girl victims 56% to 44%; even where mothers had been the identified perpetrator, boys were more likely to be victims than girls (53% boys compared to 47% girls).
• In the cohort of cases for this review, 57% were boys and 43% were girls. In the much smaller sample of men that were interviewed boy victims outnumbered girls 2:1. At this stage, and without further research, it is not possible to draw any specific conclusions, but the difference is of note and warrants further enquiry.

A concealed pregnancy is when a woman knows she is pregnant but does not tell any agency / professional; or when she tells another professional but conceals the fact that she is not accessing antenatal care; or when a pregnant woman tells another person or persons and they conceal the fact from all health agencies.

Where there is a strong suspicion of a concealed pregnancy it is necessary to share this, irrespective of whether consent has been given, with other agencies known to have involvement with the mother so that a fuller assessment of the available information and observations can be made.

Risks

The potential risks to a baby through the concealment of a pregnancy are difficult to predict and wide-ranging.  One key implication is that there is no obstetric history or record of antenatal care prior to the birth of the baby. 

Some women may present late for booking (after 24 weeks of pregnancy) and these pregnancies need to be closely monitored to assess future engagement with health professionals, particularly midwives and whether or not referral to another agency is indicated. 

In a case of denied pregnancy the effects of going into labour and giving birth can be traumatic.

The reason for the concealment will be a key factor in determining the risk to the child and that reason will not be known until there has been a systemic multi-agency assessment / Pre-Birth Assessment.

Possible implications

• Concealed pregnancy can lead to a fatal outcome (for both mother and/or baby), regardless of the mothers intention. The lack of antenatal care can mean that any potential risks to mother and baby may not be detected.
• Concealment may indicate uncertainty towards the pregnancy, immature coping styles and a tendency to disassociate, all of which are likely to have a significant impact on bonding and parenting capacity.
• An unassisted delivery can be dangerous for both mother and baby, due to complications that can occur during labour and delivery.
• Lack of maternal willingness / ability to consider the baby’s health needs, or lack of emotional attachment to the child following birth.
• Where concealment is a result of alcohol or substance misuse there can be risks for the child’s health and development in utero as well as subsequently.
• There may be implications for the mother revealing a pregnancy due to fear of the reaction of family members or members of the community.

When concealment is revealed

• In some circumstances, agencies or individuals are able to anticipate the likelihood of Significant Harm with regard to an expected baby which must be addressed as early as possible to maximise time for full assessment, enabling a healthy pregnancy and supporting parents so that (where possible) they can provide safe care.
• The circumstances leading to a concealed pregnancy need to be explored individually as there may be potentially serious child protection outcomes as a result of a concealed pregnancy and a detailed interagency assessment should be undertaken.

All agencies should ensure that information about the concealment is shared with other relevant agencies, to ensure its significance is not lost and to ensure that potential future risks can be fully assessed and managed.

Pre-Birth Assessments

• Where agencies or individuals anticipate that perspective parents may need support services to care for their baby or that the baby may have suffered, or likely to suffer, significant harm, a referral to the local authority children’s social care must be made as soon as the concerns are identified. See Responding to Concerns of Abuse and Neglect Procedure, Potential risk to an unborn child.
• The importance of conducting pre-birth assessments has been highlighted by numerous research studies and case / practice reviews which have shown that children are most at risk of fatal and severe assaults in the first year of life, usually inflicted by their carer givers.
• It is important to consider the circumstances of BOTH prospective parents, not just the mother. Where possible, information should be obtained directly from each perspective parent rather than relying on a third party account.

Circumstances which might indicate an increased risk

• A child has previously sustained non-accidental injuries in the care of either parent / carer (this includes sudden, unexpected death of a child where safeguarding concerns were raised).
• Previous children have been removed from the care of the parent(s) either by a private arrangement or by a court order.
• A child in the household is the subject of a Child In Need or Child Protection Plan, or is a Looked After Child.
• Either parent is the subject of a Child in Need or Child Protection Plan, or is a Looked After Child or Care Leaver.
• The mother is a child under the age of 16 who is found to be pregnant.
• A parent or another adult in the household, or regular visitor, has been identified as posing a risk to children.
• There is concerns about the parent(s) ability to protect the baby.
• There are concerns regarding domestic violence and abuse.
• Either or both parents have mental health problems that might impact on the care of a child.
• Either or both parents have a learning disability that might impact on the care of the child.
• Either or both parents abuse substances, alcohol or drugs.
• Any other concerns exist that the baby may be at risk of Significant Harm, including a parent previously suspected of fabricating or inducing illness in a child.
• If the pregnancy is denied or concealed.

This list is not exhaustive, and professionals will need to apply their professional judgement.