New Frameworks for Understanding Sudden Unexpected Deaths in Infancy (SUDI) in Socially Vulnerable Families.

THEORETICAL PRINCIPLES: Sociological frameworks may enhance understanding of the complex and multidimensional nature of disadvantage, which is prevalent among families who experience Sudden Unexpected Death in Infancy (SUDI).

PHENOMENA ADDRESSED: SUDI is the largest category of postneonatal death and largely associated with the social determinants of health. The highly successful 'Back to Sleep' campaign has resulted in a more than 85% decrease in SUDI. However, social inequalities have accompanied this decrease, and the burden of SUDI now lies with the most disadvantaged and socially vulnerable families. A considerable body of research on the phenomena of SUDI and disadvantage has been published over the last decade, demonstrating the widening social gradient in SUDI, and the importance in recognising structural factors and the multifactorial nature of disadvantage. Gaps in understanding of risk factors and scepticism about the received wisdom of health professionals have emerged as central themes in understanding why socially vulnerable families may adopt unsafe infant care practices. The direct impact of social disadvantage on infant care has also been recognised.

RESEARCH LINKAGES: The translation of epidemiological findings regarding SUDI risk into public health recommendations for health professionals and families alike has to date focused on eliminating individual level risk behaviours. Unfortunately, such a model largely ignores the broader social, cultural, and structural contexts in which such behaviours occur. Translating the new knowledge offered by sociological frameworks and the principles of behavioural economics into evidence based interventions may assist in the reduction of SUDI mortality in our most socially vulnerable families.