Sudden unexpected death in infancy (SUDI) is when a baby dies in a way that is unexpected and initially unexplained. Sadly, 60 to 70 babies die suddenly in their sleep every year in New Zealand. Thinking about SUDI can be very frightening for new parents, but there are ways you can greatly reduce your child's risk.
Key points about SUDI
SUDI stands for sudden unexpected death in infancy. Between 40 and 60 babies will die of SUDI in Aotearoa New Zealand each year.
Knowing the risk factors means you can take steps to lower the risk of SUDI for your pēpē (baby).
The 3 main risk factors are smoking while pregnant, bed-sharing and the position of your baby when sleeping.
The 4 key steps to follow to help you keep your baby safe from SUDI spell PEPE:
Place baby in their own baby bed.
Eliminate smoking in pregnancy.
Position baby flat on their back to sleep.
Encourage and support breastfeeding.
There are resources and people who can support you to keep your baby safe.
What increases my baby's risk of SUDI?
There are 3 risk factors that increase a baby's risk of SUDI. The more of these factors a baby has, the greater their risk of SUDI. These are:
infants sleeping on their side or front rather than on their back
the mother smoking in pregnancy.
Of these, the combination of the mother smoking in pregnancy and bed-sharing with their baby is riskiest for babies. Learn more about how to co-sleep safely with your pēpē.
How can I protect my baby from SUDI?
The best way to protect your baby is to follow the PEPE steps:
Place baby in their own baby bed in the same room as their parent or caregiver.
Eliminate smoking in pregnancy and protect baby with a smokefree whānau (family), whare (home) and waka (car).
Position baby flat on their back to sleep – with their face clear of bedding.
Encourage and support breastfeeding and gentle handling of baby.
What to do
Place baby in a baby-safe bed
the mattress is firm and there are no gaps between the mattress and the sides of the baby bed
the blankets and sheets do not cover your baby’s face
your baby cannot become wedged under or in between anything
there are no toys or pillows in your baby's bed
there is nothing that can block your baby’s airway.
Your baby is safest sleeping in the same room as you when you are sleeping.
To keep your baby safe, avoid smoking in pregnancy and make your home smokefree.
Babies from smokefree pregnancies have stronger lungs and more drive to breathe than babies who have been exposed to cigarette smoke.
Being a smokefree whānau helps baby’s breathing and allows them to sleep safely.
Babies are 14 times safer sleeping on their backs than sleeping on their tummies.
When you place your baby to sleep on their back, you are helping them to breathe.
Do not use pillows or anything else that can flex the neck as this can block the airway.
If your baby is coughing up or spilling often or you have concerns about your baby sleeping on their back, seek the advice of a health professional.
If possible, breastfeed your baby. If you are not the mother, encourage and support her to be able to breastfeed the baby. Breastfeeding baby helps to protect them from SUDI.
Breastfeeding strengthens baby, which helps him or her to sleep safely through the night.
Breast milk provides nutrients and antibodies to protect your baby.
Breastfeeding also strengthens the bond between mother and baby. Read more about breastfeeding.
(TAHA Well Pacific Mother & Infant Service, NZ, 2014)
How can I co-sleep with my baby?
If you want to share a bed or sleeping space with your baby, you must have a separate bed for your baby that can be placed in your bed.
There is a range of baby beds you can choose that allow your baby to share your bed while sleeping in their own space, such as a wahakura or pepi pod. Wahakura are hand-woven sleep spaces for pēpē made out of harakeke (flax) and using the tradition of rāranga (Māori weaving practices).
Sands NZ Support for parents and families who have experienced the death of a baby at any stage during pregnancy, as a baby or infant. Bittersweet A support group of parents of a child who has died at any age for any reason. It is Australian-based but is open to bereaved New Zealand parents.
Nari Faiers (Te Arawa, Ngāpuhi) is the Workforce Development and Cultural Lead for the National SUDI Prevention Coordination Service at Hāpai Te Hauora. She brings with her a wealth of knowledge in Māori development and practice and is passionate about reducing inequities within the child health sector. She is a mother of two and grandmother of one.
Credits: Health Navigator Editorial Team. Reviewed By: Nari Faiers, Workforce Development and Cultural Lead, SUDI Prevention National Coordination Service, Hāpai Te Hauora Māori Public Health
Last reviewed: 27 Jul 2018
Information for healthcare providers on SUDI
The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.
This guide offers conversations, questions, advice and care options before, during and after birth. It has been framed around PEPE – the top 4 ways of preventing SUDI.
Place baby in his or her own baby bed in the same room as their parent or caregiver.
Eliminate smoking in pregnancy and protect baby with a smoke-free whānau (family), whare (home), and waka (car).
Position baby flat on their back to sleep, face clear of bedding.
Encourage and support exclusive breastfeeding and gentle handling of baby.
The PEPE framework provides consistency in national messaging and a context for delivering best practice. However, health professionals also need to consider a combination of other factors that can contribute to SUDI at the same time.
Of particular concern are premature birth, a baby that is small for gestational age, multiple birth, age of baby (peak incidence occurs at one to two months of age), previous experience of SUDI, gender (more likely in boys), postnatal depression, age of mother, no antenatal education and late engagement with a midwife.
When using this guide, it is important to use appropriate conversation skills that are mana enhancing and non-judgemental as well as establishing a good rapport with māmā (mother) and families and whānau. Likewise, health professionals must take into account the strengths, wishes, beliefs, practices and needs of families and whānau.
Identify maternal smoking, drug, and alcohol use. Maternal antenatal smoking is the greatest contributor to SUDI risk.
Discuss the PEPE message and address modifiable risk factors.
Encourage parents to use a suitable baby bed. A suitable bed is the best way to reduce SUDI risk. If the family has no suitable baby bed, urgently support to find a suitable baby bed (e.g., Pregnancy Help , local safe sleep coordinator, or through a WINZ special needs grant.
Encourage engagement with smoking cessation support and Community Alcohol and Drug Service.
In New Zealand, the main risk factors for SUDI deaths are prone (front) sleeping, and bed sharing where the mother smoked in pregnancy.
Breastfeeding helps to protect the baby against SIDS.
Populations most at risk of experiencing a SUDI death are Māori and Pasifika mothers, mothers under 25 years of age, and mothers who smoke.
Younger infants are at the highest risk of SUDI, with the peak in deaths at one month of age. Fifty-five per cent of deaths occur in infants under three months of age, 80 per cent occur before five months of age.
The 3 main risk factors for SUDI are smoking while pregnant, bed sharing and the position of your baby when sleeping. Of these 3, the combination of smoking while pregnant and bed sharing are the riskiest for baby, leading to a 32-fold increased risk of SUDI compared with babies not exposed to either risk factor.
Dr Christine McIntosh talks about sudden unexpected death in infancy (SUDI). Christine is a general practitioner working as GP liaison in children’s health at CMDHB and is a senior lecturer at the University of Auckland. Christine is passionate about SUDI prevention and has been researching this topic for over 16 years.
The resource has four specific modules which include describing what SUDI is, the specific vulnerability factors, how to engage effectively with Maori and Pacific Peoples on this health concern and what prevention models can be applied.
Regional HealthPathways NZ
Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: