This report from NCMD Honorary Senior Public Health Specialist Dr Helen Duncan takes a look at the factors that make infants vulnerable to sudden, unexpected and unexplained death, building on the findings of NCMD thematic report Sudden and Unexpected Deaths in Infancy and Childhood.
The report aims to describe and evaluate the factors which may increase the vulnerability of infants to this kind of death, examining pre-existing risk factors in the child, their family or their social or physical environment, which make them more vulnerable than average to poor outcomes or harm.
The report finds that:
- 98.1% of cases had at least 1 vulnerability factor identified from among clinical, statutory, family or social and environmental vulnerability factors.
- The most commonly occurring clinical vulnerability factors include an underlying health condition (60.9%) and the infant being described by their parents or carers as unwell on the day of death (50.0%). Over a third of cases identify smoking in pregnancy (39.1%), a recent illness (39.1%) and prematurity (37.5%).
- More than four in ten cases are known to social services (statutory domain) (43.8%), either previously or currently.
- The most commonly occurring family or social vulnerability factors, identified in over half of cases, are smoking in either parent (62.5%), mother smoking (51.6%), father smoking (51.6%), poor mental health in either parent (56.2%) and poor mental health in mother (50.0%). Over a third of cases identified previous domestic abuse (not directly related to the death) (40.6%) and smoking in both parents (39.1%). Drug misuse and alcohol misuse have been identified as separate issues; recorded for either parent they are identified in over a quarter of cases (26.6% and 26.6% respectively).
- The most common occurring environmental vulnerability factor, identified in over three quarters of cases, is not necessarily following advice and guidance on safe sleeping (78.1%) and, identified in over half of cases, co-sleeping (51.6%). In 15.6% of cases the co-sleeping was unplanned, and the carer was under the influence of drugs or alcohol. Over a third of cases identify poor home environment (45.3%) and carer under the influence of alcohol or drugs (39.1%).
The authors of this report wish to acknowledge that the death of each child is a devastating loss that profoundly affects bereaved parents as well as siblings, grandparents, extended family members, friends and professionals. They also wish to thank all the families who shared their data and experiences, and the Child Death Overview Panels who submit detailed evidence on every death to the database.