Skip to main content

An image of Helen Ball and co-partners at the Eyes on the Baby report launch event

Professor Helen Ball from Durham’s Infancy and Sleep Centre has played an intrinsic role in the research around sudden infant death and safer sleep conditions and environments for babies and infants. Here Helen shares why a multi-agency approach by Local Authorities, Early Years and family-facing services, is needed in ensuring all ‘Eyes on the Baby’.

Following the ‘Back to Sleep’ and other infant sleep safety media campaigns during the late twentieth century, rates of Sudden Unexpected Death in Infancy (SUDI) plummeted in the UK (and many other wealthy western nations). As a result, most sudden and unexpected deaths of babies in England now cluster in our most impoverished communities where simple public health messages can be difficult to implement, which contributes to growing health disparities.

Infant mortality rates are a sensitive indicator of the health of a population and a marker of the effectiveness of a nation’s health and social care systems, reflecting the social, economic and environmental conditions in which children live – and thereby highlighting health inequalities and disparities. In wealthy countries such as the UK, infant mortality rates declined dramatically over the recent historical past because of public health measures such as sanitation, infection control, and immunisation – falling in the UK from around 30/1000 in the mid-twentieth century, to 4/1000 today.

Improving infant survival

Most infant deaths in the UK today are closely associated with well-known precursors: preterm birth, foetal growth restriction and congenital abnormalities, which also disproportionately affect the most disadvantaged families in society. Reducing poverty and inequality is crucial to improving infant survival.

SUDIs are a sub-group of infant deaths that number approximately 1 in 2000 (or 300 babies per year) and involve babies who in the 24 hours prior to their death appeared to be well, and whose deaths were accidents or unexplained. A recent National Child Mortality Database Report revealed that 42% of SUDIs occurred in the most socioeconomically deprived neighbourhoods, compared with 8% in the least deprived.  

Because the majority of SUDI have no clear underlying cause, research on reducing SUDI has focused on identifying potentially modifiable factors frequently involved in the care of babies who die, but not with those who don’t. Being placed on their front or side for sleep rather than their back, being smoke exposed during pregnancy or after birth, being placed to sleep in hazardous situations such as in a cot full of soft toys or loose bedding, on a sofa with an intoxicated parent, or in a room all alone are all linked to increased chance of SUDI. The way to help most families avoid this is to teach them about infant sleep safety.

However, some families miss the opportunity to receive this information

  1. because they don’t or can’t engage with the antenatal or postnatal care opportunities they are offered,
  2. because they were given it but not at a time or in a way they could absorb it and so they don’t recall it,
  3. because the circumstances of their lives or the context in which they find themselves, makes it difficult or impossible for them to act on.

These families need additional support to prevent SUDIs and reduce the growing regional and socio-economic disparities in infant death rates across the UK. 

A multi-agency approach

In 2020 a report from the National Child Safeguarding Practice review panel recommended that tackling SUDI in the UK is too challenging and complex to expect that any further reductions in infant deaths in the UK can be accomplished by health professionals alone.  

Due to a lack of funding and heavy workloads, there is a lack of sufficient contact with the most vulnerable families as the opportunities to build relationships with and offer services to has been greatly eroded in recent years. These issues lessen the ability to make a difference to the most vulnerable groups.

They recommended bringing SUDI prevention for vulnerable families under the safeguarding umbrella and adopting a multi-agency approach to SUDI prevention.

All Eyes on the Baby project

Our response to this call was the Eyes on the Baby project that aimed to implement a multi-agency approach to tackling this issue in County Durham, in the North-East of England. The project is a collaboration between Durham Infancy & Sleep Centre, Durham Integrated Care Board, Durham County Council Public Health Team and partners, and is funded by National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria (NENC).

The initial outcomes of this project were highlighted in a report launched on 9 June 2023. Of 12 recommendations for running a successful MAW SUDI prevention project for vulnerable families our top three are:

  1. Cast the net wide and invite all staff who may have contact with potentially vulnerable families. Those who provide support in a crisis are particularly important as they are often involved with families who are ‘out of routine’.
  2. Set clear expectations about the type of SUDI prevention activities each job role is expected to take on and provide appropriate training.
  3. Establish evaluation of training and engagement at multiple time-points along the implementation pathway, and as an ongoing process  We found Normalisation Process Theory to be useful for assessing how SUDI prevention was accepted and embedded by staff.

Image caption: Professor Helen Ball and project co-partners together launched the 'Eyes of the Baby' report at an event in Durham, UK, with stakeholders in attendance.

Find out more 

Our Anthropology Department is one of the largest in the UK and is ranked 23rd globally (QS World University Rankings by Subject 2023).  

Fieldwork is core to our taught programmes, and we offer research-led teaching and hands-on experience to equip our students with the knowledge and skills they need for a successful future.  

Feeling inspired? Visit our Anthropology webpages for more information on our undergraduate and postgraduate programmes.