Dear Mr Layton Re: Regulation 28: Report to Prevent Future Deaths issued on 23rd April 2015 in relation to the death of Efan Robert James.

I write in response to your Regulation 28 letter issued on 23rd April 2015 in relation to the death of Efan Robert James on 12th October 2014. You were concerned about the content of the 2014 Welsh Government guidance leaflet given to parents to reduce the risk of sudden unexpected death in infancy (SUDI). The Wales Child Death Review published a report on sudden unexpected infant death in January 2015 (available at http://www.wales.nhs.uk/sitesplus/888/opendoc/256680). The report emphasised that these sad events of infant death are a complex problem with many possible factors. The review concluded that the advice leaflet provided by Welsh Government was based on the best possible current evidence about minimising risk in the baby’s environment, and reducing factors contributing to risk. The report emphasised that even when all the advice is adhered to, sadly there are still some unexplained infant deaths. This Welsh Government leaflet emphasises the importance of safe sleeping for babies, and gives overall advice about keeping a smoke free environment, placing the baby to sleep on their back, on a safe sleeping surface, and avoiding co-sleeping if under the influence of alcohol or drugs, or when there is a risk of overlaying through parental fatigue. The Welsh Government advice to parents is consistent with the latest NICE guidance. There is no blanket recommendation to avoid co-sleeping, as this can interfere with breastfeeding, which is of course beneficial to the baby and mother. The leaflet clearly identifies when co-sleeping is inadvisable because of the increased risks of sudden unexpected infant death. The Welsh Government guidance leaflet should be used and read as a whole.

Following your Regulation 28 letter I asked the Wales Child Death Review team to review the Welsh Government leaflet in light of your comments. They have concluded that the leaflet should continue to be used, and they did not recommend any changes to it. They have reiterated the importance of disseminating the advice mentioned above about how to reduce the risk of sudden unexpected infant death through safe sleeping practices and maintaining a smoke free environment. This message continues to be disseminated by primary care health professionals across Wales. Welsh Government is continuing to explore effective ways of supporting parents to protect their babies from sudden unexpected infant death. I have also discussed the matter with other CMOs in the UK and clarified the situation with regard to NICE guidelines. My understanding is they have no plans to revise the guidance as there is no new evidence available. Please do not hesitate to contact me if you require any further information.