This ‘Baby Safe Sleeping Guidance’ for the multidisciplinary workforce who have contact with parents, carers, and relatives of babies (by using the term baby, we are referring to babies from birth to 2 years old).

1. Introduction

1.1 The guidance is to ensure practitioners have the confidence and knowledge needed to support babies' parents/carers in making informed choices regarding safer sleep arrangements and to raise awareness of the factors associated with Sudden Unexpected Deaths in Infancy (SUDI).  You may know this as Sudden Infant Death Syndrome (SIDS) which is the unexpected/unexplained death of a baby up to 1 year old.

1.2 There is no advice which guarantees the prevention of SUDI. Safe sleep advice is shared with all new parents during pregnancy and the first few days and weeks of a baby’s life by universal maternity and health visiting services.  To reduce avoidable deaths, we need everyone working with families in Tees to help ensure safety advice and consistent, evidence-based messages are followed.

1.3 The Purpose of this guidance is to:

  • Provide the multidisciplinary work force in Tees with clear and consistent evidence-based information.
  • Provide workers with the confidence and knowledge to facilitate an open and honest discussion to support babies parents/carers to make informed safer sleep choices for their babies.
  • Ensure consistent advice about safer sleeping arrangements is given across Tees by all workers.

 

2. Background

2.1 The sudden infant death of a baby is one of the most devastating tragedies that could happen to any family. Despite substantial reductions in the incidences of SUDI in the 1990s, as a result of the Back to Sleep Campaign, at least 300 babies die suddenly and unexpectedly each year in England and Wales. The Child Safeguarding Practice Review Panel’s national thematic review of sudden unexpected death in infancy (SUDI),  shows that ‘increasingly these deaths occur in families whose circumstances put them at risk, not just of SUDI, but of a host of other adverse outcomes’. Of the 568 serious incidents in this review, 40 involved babies dying suddenly and unexpectedly, making this one of the largest groups of children notified. Co-sleeping was a feature in 38 of these 40 cases. Parental alcohol and drug use were common, as were parental mental health difficulties. Additional safeguarding concerns were also present, including cumulative neglect, domestic violence, parental mental health concerns and substance misuse. The report recognises that the contexts within which these families were living meant that understanding and acting on safer sleep messages was severely challenged for many reasons, even when those messages were ‘rigorously delivered’ by health professionals.

 

3. Responsibilities of Multi-Disciplinary Workforce

3.1 It is the responsibility of the multidisciplinary workforce to discuss and record, in line with the record-keeping guidelines of their employing organisation, the information they give to the baby’s parents/carers on safer sleeping arrangements at key contacts. This refers to all professionals who come into contact with a family or anyone who has caring responsibilities for a baby.

3.2 Information must be provided in a manner understood by the baby's parent or carer. Where possible and appropriate, an approved interpreter should be used for babies whose parents or carers do not understand English. Families with other language and communication needs, including learning disabilities, should be offered information to aid understanding.

3.3 Anyone in contact with parents/carers should take every opportunity to discuss and observe (when in the home)  safer sleeping arrangements for babies and highlight best practice recommendations and risks based on current evidence. This guideline should be used alongside the NHS guidance Reduce the risk of Sudden Infant Death Syndrome (SIDS) and the Lullaby Trust’s guidance on How to reduce the risk of SIDS.

 

4. Responsibility of Core Health Staff and Other Professionals

4.1 Assessment and safer sleeping discussions with both parents/carers must start early in pregnancy and continue through the postnatal period. It is recommended that as a minimum, this information should be discussed and recorded by:

  • Maternity to include safer sleep risk assessment (appendix 1):
  • During the antenatal period
  • Prior to discharge from in-patient services
  • During post-natal community visits
  • Neonatal Staff:
  • Prior to discharge

Health Visitor Teams to include safer sleep risk assessment (appendix 1) :

  • Antenatal contact
  • Primary birth visit
  • 6-8 week review
  • Any subsequent follow-up contacts

GP and Practice Nurses:

  • 6 -8 week review

 Any contact with parent/carer when sleep is discussed and/or where there are factors which affect risk, e.g. substance use, prescribed or otherwise.  Foster Carers, Kinship Carers

Foster Carers

  • Foster carers will be aware of and follow the lullaby trust safe sleep guidance and the contents of this policy.

Nursery settings and Child Minders

  • Nursery Workers and Child Minders will be aware of and follow the lullaby trust safe sleep guidance and the contents of this policy.

4.2 Safe sleep advice with be a standard action on Initial Health Assessment and Review Health Assessment health care plans for a child under 12 months  months including a safe sleep risk assessment which is shared with multiagency professionals.

 

5 Children’s Social Care/Early Help

At any contact with a parent or carer with a child under the age of 12 months

  • When undertaking an assessment, the following questions should be considered:
  1. Can you show me where the baby sleeps during the day and at night? Or where are you planning for your baby to sleep?
  2. If pregnant, advice should be given about how the future parent can access financial support to purchase a Moses basket/cot, if unable to purchase this by their own financial means, such as government grants re: pregnancy.
  3. Does the baby sleep in other places either day or night? Please will you show me where else they sleep?
  4. Tell me what you already know about how to keep your baby safe while they are asleep. Continue the discussion to highlight other safety measures; use the attributable risk and protective factors identified in the guidance to promote discussion and explore any risk factors and what action needs to be taken to reduce risk; identify with all the adult carers in the home, including male carers, what practical steps can be taken to reduce risk.
  5. Use the safe sleeping pictorial images to develop the discussion. Check if they still have the safe sleeping leaflet (do's and don'ts); if not, make arrangements for it to be replaced.
  6. Ask the parent to talk to other people who care for a baby about the safety measures and to talk with their friends and families who may also have babies.
  7. What arrangements do they make for the baby if they are going to drink alcohol or take drugs? Highlight the specific risks regarding co-sleeping when under the influence of alcohol, drugs and if they smoke; be very clear that under no circumstances, when they are under the influence of alcohol and/or drugs should they sleep with their baby in bed, or on a settee/sofa/armchair, and that the baby should be placed in a cot/Moses basket/crib, which is of a size suitable for the baby, with appropriate bedding, giving the baby room to breathe to ensure the baby cannot suffocate or overheat.
  8. Share information about what you have discussed and any safe sleeping issues you have identified with other workers involved with the family, including those working with the adult carers.
  9. Signpost parents and family members to health improvement, stop smoking and specialist drug and alcohol services as appropriate.

 

All other professionals who come into contact with parents/Carers with babies under 12 months of age:

  • To have an awareness of safe sleeping advice as documented in this policy, be able to recognise unsafe sleep practices and support parents/carers when they observe unsafe sleeping. To contact the Health Visiting Service if a parent/carer requires additional information and guidance.

 

6. Safer Sleep Risk Assessment

6.1 The safer sleep assessment tool has been developed to illustrate risk factors associated with SUDI. This assessment should be completed by the midwife and health visitor during the antenatal period. This tool can support a family to better understand their own level of risk regarding safer sleeping. Following completion of the assessment, any identified needs should be addressed, with action plans set and reviewed within acceptable timescales. Practitioners should aim to see where the baby/child sleeps during the first home visit and should ask a family about any changes to sleep circumstances at every contact. Guidance and support will be offered to families at every stage.

6.2 The completed assessment form is part of the clinical record and will be shared in multidisciplinary meetings where appropriate.

NB: Some providers in Tees already have safer Sleep Assessments, which are evidence based. The expectation is that the Safer Sleep Assessment within this policy should be used in the absence of any other evidence based tool.

PARENTS SHOULD BE ADVISED NEVER TO SLEEP ON A SOFA OR ARMCHAIR WITH THEIR BABY.

6.3 Evidence-based literature consistent with the Safer Sleeping Guidance on reducing the risk of SIDS should be given and discussed with all parents/carers both in the antenatal period and early postnatal period.

6.4 Each discussion must be fully recorded, alongside risk factors identified and advice given.

 

7.  Bed Sharing

‘The safest place for a baby to sleep is on their back in a cot or Moses basket, with no bumpers, pillows, blankets or toys, in the same room at their parents or carers for the first six months, day or night, at home or away”. 

7.1 Falling asleep on a sofa or in a chair with a baby can be very hazardous and should be avoided at all times (night or day).  However, it is recognised that some parents/carers choose to co-sleep with their baby. If a parent or carer chooses to sleep NICE Guidance (2021) advocates that professionals should discuss with parent/carers’ safer practices for bed sharing, including:

  • making sure the baby sleeps on a clean firm, flat mattress, lying face up (rather than face down or on their side). Soft mattresses and mattress toppers should not be used
  • not sleeping on a sofa or chair with the baby
  • not having pillows or duvets near the baby
  • not having other children or pets in the bed when sharing a bed with a baby
  • Make sure that baby cannot fall out of bed or get stuck between the mattress and the wall
  • Baby should not be overdressed (it is recommended that a baby only need one additional layer of clothing to what adults are wearing)

      NICE guidance strongly advise parents/carers NOT to share a bed or any other surface if:

  • their baby was low birth weight and/or premature

If either parent/carer:

  • has drank alcohol
  • smokes
  • has taken medicine that causes drowsiness
  • has used recreational drugs.

7.2 It is recommended that baby's parent/carers are advised not to bed-share or co-sleep if any of the following additional factors are present:

  • If the parent/carer smoked during pregnancy
  • Has any illness (physical or mental) or condition that affects awareness of the baby
  • If the baby has a high temperature (then medical advice should be sought)
  • If the baby's parent/carer has a high temperature
  • If baby's parent/carer response to their baby is impaired, for example they are excessively tired or unwell
  • Parent/carers who chose to exclusively formula feed their baby should be aware that they may not naturally take up a protective sleeping position and this may increase the risk of SIDS.

NB: Never leave your baby alone to feed with a propped-up bottle, and never leave them alone in bed with a bottle. They may choke on the milk. The bottle may be propped up against cushions whilst on a sofa or chair, or propped in their mouth with a blanket, pillow or other object whilst in their car seat, bouncer or crib – all of this is very unsafe. It is recommended that the safest place for your baby to sleep is in a cot in a room with their parent/carer for the first six months. Please note this refers to any time the baby is asleep during the day or night.

 

8. Babies who have been in Neonatal Intensive/Special Care

8.1 In hospital the same universal sleeping message applies — the safest place for baby to sleep is in a cot. However there may be some circumstances where hospital sleep practices differ from those recommended in the home, specifically for the care of pre-term or unwell babies being cared for in a neonatal unit . For example, pre-term infants in neonatal units may be:

  • Nursed with cot heads elevated by inclining the cot head using the bar or using the incline inbuilt into the underside of the cot (there is no need to use pillows or rolled blankets to create an incline).
  • Put to sleep prone to support respiratory function.
  • Swaddled to provide comfort and support their posture during their early days.
  • Nursed in an air temperature higher than that recommended at home.

8.2 The reasons for this developmentally sensitive care of vulnerable infants on neonatal units should be explained to parents and carers so that such practices are not continued in the home environment. Infants in hospital wards are subjected to more monitoring and observation than would otherwise be the case at home, especially at night.

8.3 These differences will be discussed at length with parents prior to discharge home and will highlight the need for differences in care from the neonatal unit to care at home. These discussions will be documented.

 

9. Changes to Routine

9.1 It is recognised that there are times when parents/carers change their normal routines, which include nights out, staying with friends/relatives or holidays. Parents/carers should be advised of the importance of having a baby sleep plan and routine, particularly if a change in sleep environment is planned, and this should include discussing safe sleeping. It is always better that a baby sleeps in their own cot, but if using a travel cot, make sure the mattress is clean, well-fitting, and firm and make sure the baby sleeps on their back. Babies should not be put to sleep on a sofa or propped in a chair or car seat. It is recognised that changes to a routine may not always be planned, and potentially in an emergency situation, e.g. fleeing domestic abuse. 

9.2 Pram/carrycot or a buggy- Ensure the base of the buggy or pram/carrycot is flat and not sloping or tilted. Keep the hood down when indoors and don’t cover the buggy or pram/carrycot. For example, don’t put material or a blanket over the top of the pram to keep out light. The padded sides of a buggy/pram/carrycot may trap more heat, so keep checking your baby’s temperature.

 

10. Safe Sleeping Legislation Guidelines

10.1 Whilst the death of any child is tragic for a family there may be occasions that Police are required to consider a criminal prosecution.

10.2 Co-sleeping whilst under the influence of drugs or alcohol is not only against all guidance, but if it is identified that it is linked to the cause of death, a criminal prosecution may be pursued.

 

11. Babysitters  

11.1 There’s no legal babysitting age, so parents should think carefully about using anyone under 16. If the babysitter is under 16, the parent remains legally responsible for the child's safety. Check that older teenagers are comfortable with the responsibility you give them before leaving your child with them.

 

12. Further Guidance