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Safeguarding babies and infants

Babies are almost entirely dependent on their immediate caregivers. A parent’s capacity to respond appropriately to the emotions and needs of their babies has a profound impact. Becoming a new parent is a major transition; there are times when every parent feels under pressure and may struggle to cope with the stresses and responsibilities of their role. But, for very young parents, or parents facing additional challenges in their lives such as mental illness and domestic abuse, this can be a particularly difficult time

Research suggests that the primary caregiver-child relationship and the parents’ capacity to provide love, care and nurture are of major importance. There is good evidence that intervention during this life stage can make a real difference to children’s lives. Services, such as those delivered by health visitors and children’s centres, provide critical information and advice to help parents manage the stresses involved in the transition to parenthood.

The antenatal period provides a window of opportunity for practitioners and families to work together to;

  • Form relationships with a focus on the unborn baby
  • Identify risks and vulnerabilities at an early stage
  • Understand the impact of parental risk factors to the unborn baby when planning for their future;
  • Explore and agree safety planning options;
  • Assess the family’s ability to adequately protect the unborn baby and provide appropriate parenting once the baby is born.
  • Identify if any assessments or referrals are required prior to birth
  • Ensure effective communication, liaison and joint working with any services working with the family
  • Agree plans for support which reduce the potential risk of harm to the unborn/new born

The aim of this protocol is to enable practitioners to work together with families to safeguard unborn/new born babies where risk is identified. The protocol sets out how to respond to concerns for unborn babies, with an emphasis on clear and regular communication between professionals working with the pregnant person and their family. This protocol outlines the agreed process between health agencies, social care and other partner agencies who are working with the pregnant person and their family on the planning, assessment and actions required to safeguard the unborn/new born baby.

The roles and responsibilities of those professionals involved with the family are clearly laid out in the protocol. There is an interactive Risk Assessment Flowchart to help you in ensuring that families receive the right support at the right time.

A concealed pregnancy is when a person knows they are pregnant but does not tell anyone; or a person advises someone about the pregnancy but conceals the fact they are not accessing antenatal care or where a person appears genuinely unaware they are pregnant.

A denied pregnancy is when a person is unaware of or unable to accept the existence of their pregnancy.

This can become apparent at any stage of the pregnancy. Concealment of pregnancy may be revealed late in pregnancy; in labour; or following delivery. The birth may be unassisted and may carry additional risks to the baby and person’s welfare.

The reason for any concealment will be a key factor in determining the risk to the unborn/child, the person who has given birth and any other children in the household; in all cases, a holistic risk assessment should be undertaken to ascertain the reason for the concealment.

An unborn baby has no legal standing in the UK. Law cannot force an expectant person to have any medical intervention at birth unless they lack capacity, which has been assessed in line with the Mental Capacity Act, and if there is an unassisted delivery; the lack of professional involvement may lead to undiagnosed complications which could have serious outcomes for mother and/or baby where medical intervention is judged to be necessary and in the person’s best interest. It is only possible to make appropriate contingency plans and to ensure that the individual is fully aware of the consequences of their actions. In all cases, legal advice should be sought.

Where a person is in the third trimester (more than 27 weeks pregnant) and there are concerns about late presentation or lack of engagement, a referral to MASH needs to be considered.

In the situations where a person presents during labour then a referral to MASH must be made.

If a person presents following unassisted delivery at the end of a concealed pregnancy then a referral to MASH must be made.

Sudden infant death syndrome (SIDS), or cot death, is the sudden and unexplained death of a baby where no cause is found. While SIDS is rare, it can still happen day or night and there are steps parents and carers can take to help reduce the chance of this tragedy occurring.

We would encourage you to discuss sleeping arrangements with all parents of babies you come into contact with, and ask parents to also have those discussions with extended family members who may also be supporting care.

Things you can do:

  • Always place the baby on their back to sleep
  • Keep the baby smoke free during pregnancy and after birth
  • Place the baby to sleep in a separate cot or Moses basket in the same room as you for the first 6 months
  • Breastfeed the baby, if you can
  • Use a firm, flat, waterproof mattress in good condition

Things to avoid:

  • Never sleep on a sofa or in an armchair with the baby
  • Don’t sleep in the same bed as the baby, especially if the parent/carer has been smoking, drinking or taking drugs, is extremely tired or if the baby was born prematurely or was of low-birth weight
  • Avoid letting the baby get too hot
  • Don’t cover the baby’s face or head while sleeping or use loose bedding

All parents/carers must be told that co-sleeping with a baby when under the influence of alcohol or drugs (this also includes prescribed medications that may make them drowsy) is particularly dangerous and could result in inadvertent overlay and death of the baby. Parents/carers should be asked about patterns of drinking as well as weekly intake. They could consider having a nominated non-drinking/drug-taking adult to look after the baby at times when they plan to drink or take drugs.

The ICON campaign aims to help parents and carers to cope with a crying baby. The call for the campaign comes from a number of infant deaths and serious case reviews where a baby has died or been seriously injured as a result of abusive head trauma.

Abusive head trauma (AHT) – also known as ‘shaken baby syndrome’ – causes catastrophic brain injuries, which can lead to death, or significant long term health and learning disabilities. AHT is not restricted to specific socio-economic groups – it can occur in any environment, when a parent or carer is on the edge due to infant crying.

ICON is an evidence based programme consisting of a series of brief ‘touchpoint’ interventions that reinforce the simple message making up the ICON acronym.

* I – Infant crying is normal

* C –Comforting methods can help

* O – It’s OK to walk away

* N – Never, ever shake a baby

Research points to persistent crying in babies being a potential trigger for some parents/care givers to lose control and shake a baby.

Remind parents and carers that it’s always OK to ask for help. If they are worried about a crying baby they should speak to:

  • friends and family
  • Health Visitor
  • GP
  • Midwife

Please click here for more information.

Research shows that it is very unusual for infants who are not independently mobile to sustain bruises accidentally. Therefore any actual or suspected bruising, or other injury, in an infant who is not independently mobile should be suspected as caused by physical abuse.

Injuries to children must never be interpreted in isolation and must always be assessed in the context of medical and social history, developmental stage, explanation given, full clinical examination, and relevant investigations. Any explanation for actual or suspected bruising or other injury in an infant who is not independently mobile needs to be assessed by a health professional with appropriate competency, usually a consultant paediatrician.

If you encounter an incidence of bruising in an infant who is not yet independently mobile, you should refer to the HIPS Protocol for the management of actual or suspected bruising and act accordingly.

To effectively prevent the next generation of school children in England becoming overweight, and to leverage other associated health benefits, we need at least to meet the following basic nutrition-related goals:

  • Families are better nutritionally prepared for pregnancy.
  • Fewer babies are born large for gestational age or small for gestational age.
  • Rapid catch-up growth in infancy is avoided, particularly in infants born small for gestational age.
  • Have an understanding that it is not possible to overfeed a breastfed baby while establishing breastfeeding and to encourage responsive breastfeeding, not only for nutrition but for comfort and closeness.
  • More mothers who want to are enabled to:
    • Start breastfeeding and continue breastfeeding their baby in the early weeks
    • Give their baby only breastmilk until around 6 months of age (i.e. breastfeed exclusively)
    • Continue to breastfeed their baby alongside feeding solid foods until at least 1 year of age
    • To be supported to continue breastfeeding up to 2 years and beyond if they wish.
  • Families who feed their babies infant formula are enabled to do so safely (i.e. making feeds up fresh each time) and responsively (Pace feeding) using an appropriate product (1st stage milk until 1 years old).
  • Families introduce a variety of nutrient-dense foods when their infant is around 6 months of age.
  • In the second six months of life, and into their second year, infants and young children are not given ultra-processed foods, but are given high-quality, minimally processed and unprocessed foods in appropriate amounts, and are fed responsively.
  • Women, infants and young children are not compromised nutritionally because they live in low income households.

Aiming for a healthy weight in infants and children is essential for their future health and wellbeing.

The prevalence of overweight and obesity in children in Portsmouth is in line with national data. In reception year, almost a quarter (24.2%) of children are overweight or obese and over 1 in 10 (10.7%) children are obese. By year 6, over a third are overweight or obese (35.9%) and over 1 in 5 (21.6%) are obese7,2 (there are roughly 2500 children/year group in Portsmouth, so around 250 4 year-olds are obese and around 500 10-year olds).There are differences in the prevalence of obesity between males and females and ethnic groups, as well as an association with deprivation.

Important risk factors for obesity in children include: eating an energy dense diet, lack of opportunity for exercise, sedentary activity, more than 8 hours of TV/week in toddlers and short sleep duration (e.g. less than 10.5 hours/night age 3). It is important that all practitioners working with families, address these behaviours whenever they are encountered. For practical purposes, the following risk factors have been identified when targeting services:

  • Parental obesity (this is the strongest risk factor for obesity in children)
  • Birthweight over 4kg
  • Rapid early growth (weight crossing more than two centiles upwards in the first year)
  • Child has a medical condition that pre-disposes to obesity (unless otherwise advised by the treating clinicians)

Sometimes excessive weight in children is a safeguarding and neglect issue, and the Portsmouth City Obesity Pathway discusses this in more detail, when to be concerned and when and who to refer to.

THE OLIVE Programme

The OLIVE programme is a universal and, if required, a targeted offer delivered by the HV service, incorporating responsive feeding, keeping active, supporting mental health, portion sizes, dental health and any other issues that will support children and their families to maintain a healthy weight.

For specific situations you should refer to the relevant protocol in the HIPS Safeguarding Children Procedures manual

If the infant appears seriously ill or injured:

  1. Seek emergency treatment at an emergency department (ED)
  2. Contact MASH and notify them of your concerns

Worried about a child – If you are concerned that a child or young person has suffered harm, neglect or abuse, please contact

Portsmouth Multi Agency Safeguarding Hub (MASH)

If a child is at immediate risk of harm, call the Police on 999