What the evidence from England and the UK tells us

Safer sleep is a fundamental part of safeguarding babies in any setting where they sleep. For early years educators, the importance of safe-sleep practice is particularly clear because sleep takes place away from the child’s usual home environment and may involve several different adults. The strongest UK evidence does not suggest that nurseries are inherently dangerous places for infant sleep; rather, it shows that the sleep environment and the way an infant is positioned, covered and supervised can materially affect risk.

The evidence from England

Some of the most influential research into sudden unexpected death in infancy (SUDI) was conducted in England through the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) studies. The main CESDI SUDI case-control study covered five former Health Regions in England, representing approximately 17.7 million people, and examined 325 sudden infant deaths alongside 1,300 control infants. The research examined infant care practices and the sleeping environment in considerable detail (Blair et al., 2006; Blair et al., 1999).

This English evidence is important for nurseries because it identifies practical aspects of the sleep environment that educators can control: sleep position, bedding, temperature, smoking exposure and the circumstances in which an infant is sleeping.

1. Always place babies on their backs to sleep

The evidence from England strongly supports placing babies on their backs (supine) for sleep. A population-based study in Avon found that the reduction in prone sleeping during the period surrounding the UK ‘Back to Sleep’ campaign was associated with a substantial fall in sudden infant death. The researchers concluded that supine sleeping was the safest position (Wigfield et al., 1992).

A later CESDI study involving three regions of England also found increased risk associated with both prone and side sleeping compared with supine sleeping (CESDI, 1996). The findings support a simple nursery rule: unless there is a specific medical instruction, babies should be placed on their backs for every sleep.

2. Keep the sleep space clear and manage bedding carefully

Research from Avon and Somerset found that prone sleeping and heavier wrapping were associated with increased risk of sudden unexpected infant death. Heating the room throughout the night was also associated with increased risk (Fleming et al., 1990). This is consistent with the wider UK evidence that bedding and thermal conditions are important components of the infant sleep environment.

For nursery practice, this supports keeping cots clear of unnecessary soft or loose items and avoiding excessive layers. Educators should follow the setting’s current safer-sleep policy and the statutory EYFS requirements.

3. Treat each baby’s sleep routine as individual

The safest practice is not simply to know that a child ‘has a sleep’. Educators should know the child’s usual sleep position, settling routine and any relevant information provided by parents. This information should be communicated clearly to the staff who may settle or check the child.

Research from Birmingham found that parents could receive conflicting or insufficient cot-death prevention advice, which sometimes resulted in uncertainty about how to put advice into practice (Miller, Fraser, & Moy, 2008). For nurseries, this reinforces the value of clear, consistent conversations with parents rather than relying on assumptions about what families know.

4. Consider temperature and overheating

Thermal conditions have been investigated repeatedly in UK research. Early CESDI-related work identified overheating and the thermal environment as important factors in sudden infant death, and later reviews from the University of Bristol continued to identify the thermal environment as a modifiable component of risk (Sawczenko & Fleming, 1996; Fleming, Tsogt, & Blair, 2006).

In a nursery, educators should therefore consider room temperature, clothing and bedding together rather than treating any one factor in isolation.

5. Understand that risk factors can combine

The English CESDI research is particularly useful because it demonstrates that risk is not usually about one isolated behaviour. Sleep position, bedding, smoking exposure, bed-sharing circumstances and other factors can interact. This means that a safe-sleep policy needs to be applied consistently rather than treating individual checks as isolated compliance tasks.

Blair et al. (2006), using data from five English Health Regions, demonstrated how combinations of risk factors within the sleeping environment can be particularly important for infants born preterm or at low birth weight.

6. Work in partnership with parents

UK research also demonstrates why communication matters. A systematic review led by researchers at the University of Bristol and University of Birmingham found that engagement with families around SUDI prevention is strengthened by trusted, face-to-face relationships and accessible services (Garstang et al., 2021).

For an early years setting, this means that safer sleep should be discussed during settling-in and reviewed when a child’s circumstance changes. Parents should understand how their child’s sleep will be managed, while educators should explain clearly when the setting’s statutory or safeguarding requirements mean that a requested practice cannot be followed.

A note about childcare-specific evidence

It is important to be precise about what the UK evidence does and does not show. Much of the strongest research from England examines infant sleep environments generally rather than deaths occurring specifically in nurseries. The evidence therefore supports applying safer-sleep principles rigorously in childcare settings, but it would be misleading to claim that the English studies establish that nursery care itself causes an increased risk of SUDI. Childcare-specific studies from other countries have examined this question, but their findings should not be presented as if they were UK data.

What this means for your nursery

• Place babies on their backs for every sleep unless there is a documented medical reason requiring different advice.
• Use an appropriate, firm and flat sleep surface and keep the sleep space clear.
• Avoid excessive bedding, clothing and other conditions that may contribute to overheating.
• Record each baby’s usual sleep position and settling routine and keep the information current.
• Ensure every practitioner who may settle or check a baby understands the child’s sleep plan.
• Carry out sleep checks in accordance with the setting’s policy and the current EYFS requirements.
• Discuss safer sleep with parents during induction and whenever the child’s sleep arrangements change.
• Review the setting’s safer-sleep policy following the September 2026 EYFS changes.

Conclusion

The UK evidence base is unusually strong because England was the setting for some of the major population-based studies that transformed understanding of sudden infant death. The message for early years practice is clear: safe sleep is an active safeguarding responsibility. Babies should be placed on their backs, their sleep spaces should be appropriate and uncluttered, overheating should be avoided, individual routines should be understood, and information should be communicated effectively between parents and educators.

The September 2026 EYFS changes provide an important statutory context for these established principles. Good safer-sleep practice is therefore not simply about having a policy in a folder; it is about ensuring that the evidence is translated into consistent practice every time a baby sleeps.

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References – academic studies and UK evidence

1. Blair, P. S., Fleming, P. J., Smith, I. J., Platt, M. W., Young, J., Nadin, P., Berry, P. J., & Golding, J. (1999). Babies sleeping with parents: case-control study of factors influencing the risk of the sudden infant death syndrome. BMJ, 319(7223), 1457–1461. https://doi.org/10.1136/bmj.319.7223.1457
2. Blair, P. S., Ward Platt, M., Smith, I. J., & Fleming, P. J. (2006). Sudden infant death syndrome and sleeping position in pre-term and low birth weight infants: an opportunity for targeted intervention. Archives of Disease in Childhood, 91(2), 101–106. https://doi.org/10.1136/adc.2004.070391
3. Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) SUDI Research Group. (1996). Environment of infants during sleep and risk of the sudden infant death syndrome: results of 1993–5 case-control study for confidential inquiry into stillbirths and deaths in infancy. BMJ, 313, 191–195. https://pubmed.ncbi.nlm.nih.gov/8696193/
4. Fleming, P. J., Tsogt, B., & Blair, P. S. (2006). Modifiable risk factors, sleep environment, developmental physiology and common polymorphisms: understanding and preventing sudden infant deaths. Early Human Development, 82(12), 761–766. https://doi.org/10.1016/j.earlhumdev.2006.09.012
5. Garstang, J., Ellis, C., Watson, D., Pease, A., Ingram, J., Cabral, C., Blair, P. S., & Fleming, P. J. (2021). Improving engagement with services to prevent Sudden Unexpected Death in Infancy (SUDI) in families with children at risk of significant harm: a systematic review of evidence. Child: Care, Health and Development, 47(3), 369–382. https://doi.org/10.1111/cch.12875
6. Miller, L. H., Fraser, A., & Moy, R. (2008). How does cot death prevention advice influence parents’ behaviour? Child: Care, Health and Development, 34(5), 613–618. https://doi.org/10.1111/j.1365-2214.2008.00838.x
7. Pease, A., Garstang, J. J., Ellis, C., Watson, D., Ingram, J., Cabral, C., Blair, P. S., & Fleming, P. J. (2021). Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative metasynthesis. BMJ Paediatrics Open, 5(1), e000983. https://doi.org/10.1136/bmjpo-2020-000983
8. Sawczenko, A., & Fleming, P. J. (1996). Thermal stress, sleeping position, and the sudden infant death syndrome. Sleep, 19(10 Suppl), S267–S270. https://pubmed.ncbi.nlm.nih.gov/9085528/
9. Wigfield, R. E., Fleming, P. J., Berry, P. J., Rudd, P. T. R., & Golding, J. (1992). Can the fall in Avon’s sudden infant death rate be explained by changes in sleeping position? BMJ, 304(6822), 282–283. https://doi.org/10.1136/bmj.304.6822.282

Statutory and current guidance

Department for Education. (2026). Early years foundation stage (EYFS) statutory framework. GOV.UK. https://www.gov.uk/government/publications/early-years-foundation-stage-framework–2

The Lullaby Trust. Safer sleep for babies: evidence-based safer-sleep information for parents and professionals. https://www.lullabytrust.org.uk/

Important note. This article is intended for professional education and should be read alongside the nursery’s current safer-sleep policy, risk assessments, the 2026 EYFS statutory framework and current clinical/public-health guidance. The academic evidence cited here primarily concerns infant sleep environments and SUDI risk in England/UK; it should not be interpreted as evidence that nursery care itself causes SUDI.