Introduction

Sudden infant death syndrome (SIDS) is still a leading cause for infant mortality in the United Kingdom (UK) despite the significant reduction in cases since the 1990s. Currently, there are ongoing public health campaigns aimed at promoting safer sleep, as the majority of SIDS cases in the UK occur in unsafe sleep environments. There is little uniformity of practice nationally about which deaths should be classified as SIDS or “unascertained”, with very few deaths recognized as being due to accidental asphyxia. The investigation of sudden and unexpected death in infancy (SUDI) has changed considerably since the early 2000s. Joint agency investigation by police, healthcare, and social care is now standard, with local review of all child deaths mandatory.

Incidence

UK rates

SIDS is a prominent cause of death for infants in the UK (1). There were 247 unexplained deaths of children under 2 years of age in 2014; of these, 230 were unexplained infant deaths, giving a rate of 0.30 deaths per 1,000 live births, the lowest on record (2). There were 17 unexplained deaths of children aged between 12 and 24 months, accounting for 6.9% of all unexplained deaths of children younger than 2 years. Much higher rates of deaths in the 1970s and 1980s (2.30 deaths per 1,000 live births, or 1,593 deaths in 1988) (3) led to a concerted effort to identify modifiable risk factors and translate these into advice for parents. As in other countries, associations between unexplained infant deaths and the prone sleeping position, smoking during pregnancy, and overwrapping led to educational campaigns for parents, the successful implementation of which has led to a rapid decline in these deaths in the last 25 years.

The UK “Back to Sleep” campaign

The introduction of the “Back to Sleep” campaign in the UK in 1991 (see Figure 18.1) led to a dramatic fall in the number of infants dying (see Figures 18.2 and 18.3). The campaign in the UK was promoted at a national level and included a strong media element, as well as guidance for health professionals, to change their recommendations to parents. Anne Diamond, who was a popular TV presenter at the time, had a son, Sebastian, who died of SIDS in 1991. She campaigned strongly for the changes to advice (4), which eventually included a television advertisement in collaboration with the Department of Health (5).