Children and Families Policy Research Unit


NIHR Children and Families Policy Research Unit


Promoting safer sleeping for babies in high risk groups in England

Responsive Facility: Promoting safer sleeping for babies in high risk groups in England (January - December 2022)

Research Team

Professor Jane Barlow, Dr Jenny Woodman, Dr Ruth McGovern, Dr Anna Pease, Dr Katie Shiells, Dr Simon Barrett


Responsive FacilityResponding to vulnerable children and families

Why we did this study

Whilst the ‘Reduce the Risks’ campaign of the 1990s resulted in a fall in the number of unexpected infant deaths, the recent report from the National Child Mortality Database found higher rates of deaths amongst families living in the most deprived neighbourhoods in England. The Out of Routine report concluded that safer sleep interventions that focus solely on the provision of information, are unlikely to influence the behaviours of parents in this population.  It was recommended that theories of behavioural change should be used to support the development of safer sleep interventions, taking into account families’ experiences and perspectives.

What we did

We carried out a mixed methods study with three components:

  1. An analysis of the data from two recent systematic reviews to identify the key components of:

      i) decision-making amongst families with children at increased risk a of SUDI;

      ii) safer sleep interventions for at-risk families; 

  2. interviews to identify beliefs about safer sleep practices with families who have had recent contact with children’s social care; and

  3. A workshop with stakeholders to explore how our findings could be used to modify existing best practice. The above data were then mapped using the COM-B model.

What we found

  • A range of motivational factors (such as parental sleep deprivation and the desire to bond with the infant) play a key role in influencing decisionmaking about the infant sleep environment.
  • Professionals responsible for conversations about infant sleep safety have concerns about providing personalised and tailored support and managing risk in families with a social worker.
  • Credible, trusted sources and sound evidence with regard to how and why safer sleep messages aim to protect infants are key to the delivery of effective communications about safer sleep with families
  • of infants at increased risk of poor outcomes.
  • Social pressures with regard to “good parenting” may act as barriers to parents acknowledging and discussing/planning for “out of routine” circumstances.

Why this is important

These findings suggest that change to current practice is needed if the risk of SUDI in this particular group of families is to be further reduced.

What are the implications

  • Safer sleep messages might best be delivered to families in receipt of social care by a practitioner who can provide continuity of care and who has established a trusting relationship with them;  peer and family support networks are also important;
  • Professionals could incorporate the use of open conversations to identify parental motivations and provide personalised and tailored support based on the needs of different families, focused on minimising risk in all sleep scenarios, thereby moving away from a didactic approach;
  • This is likely to require specific training and support for professionals and a change of organisational culture to allow professionals to manage risk more confidently.

Read the full report here: