Maternity and specialist support services must engage more with fathers to help prevent vulnerable babies being seriously injured or killed, a child safeguarding review has found.

Insufficient attention to men from midwives, health visitors and social workers means support for them “to be active and engaged fathers is limited”, according to a report by the Child Safeguarding Practice Review Panel.

It said the country is in the “unacceptable” position of knowing the least about those who pose the biggest risk to babies’ lives.

The independent panel reviews serious safeguarding cases – when a child dies or suffers serious harm, and abuse or neglect is known or suspected.

Since it was formed in July 2018, it has considered 257 rapid review cases of babies seriously harmed or killed through non-accidental injury in England.

Fathers and stepfathers were a “significantly” greater source of physical abuse to these babies than mothers, it said.

However, men were described as too often being “hidden” or “invisible” to safeguarding agencies.

For its latest report, the panel examined the cases of 23 babies who were known or suspected to have been seriously harmed or killed by their father, stepfather or male carer.

The review engaged more than 300 practitioners during fieldwork visits to 19 local areas, and a clinical psychologist interviewed eight men who have been convicted of either killing or causing serious harm to a baby and are currently serving a prison sentence.

It said there is evidence that universal maternity services do not “regularly, significantly and substantially” involve fathers, a pattern which is replicated throughout targeted, child protection services.

The opportunities to offer men support in their role as fathers are therefore “not maximised”.

It is calling for services to work with men to address significant risk factors, such as domestic abuse, substance misuse, and mental health problems, before the additional stressor of a baby’s birth.

It also recommends more research into male perpetrators of abuse against babies, and greater investment to improve how social care services work with men in high-risk families.

Panel chairwoman Annie Hudson said: “This report makes clear that these men must be held to account for this abuse but there is an equally strong imperative for everyone involved in safeguarding children to ‘see’ and know more about these men, their complex histories, the impact of substance abuse and of mental health issues.

“This report indicates that there are systemic weaknesses in how services operate so that, too often, fathers remain hidden, unassessed and unengaged.”

President of the Association of Directors of Children’s Services Charlotte Ramsden said: “Babies and very young children cannot tell us how they feel or what is happening to them, and disrupted access to the formal and informal networks families rely on, from health visitors to grandparents, further heightens the risk of harm as the rise in serious incident notifications shows.

“This review highlights some longer-term challenges in both policy and practice that require urgent action. This includes the involvement of, and focus on, men, both before the birth of a baby and the weeks and months following.

“Our collective focus is almost exclusively on mother and child and this is crucial, but we must make space for fathers and other male figures in both assessments and offers of parenting support.”

Dr Jeremy Davies, of the Fatherhood Institute, who led the literature review, said: “There is a real lack of attention to fathers and father-figures, both in the data and research underpinning our understandings of the risks posed to babies, and in the design, delivery and evaluation of services that might better protect against these rare but tragic cases.

“Our findings suggest that if services routinely found out about, met and supported dads – and worked actively to identify and reduce the risks a small proportion of them pose – more lives could be saved.”

A Government spokeswoman said: “Supporting vulnerable families is a priority for this Government, and we are investing significant funding to improve safeguarding for vulnerable babies, to help councils with high demand for children’s social care, and championing Family Hubs to transform the support available for families.

“We welcome this important review which notes the work already under way to help address some of the findings.

“We continue to work with local authorities and the Child Safeguarding Practice Review Panel to strengthen both the national and local approach to protecting every child from harm.”