Preventing sudden unexpected death in infancy (SUDI)

Also known as cot death and includes SIDS

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

  1. SUDI stands for sudden unexpected death in infancy. Between 40 and 60 babies will die of SUDI in Aotearoa New Zealand each year. 
  2. Knowing the risk factors means you can take steps to lower the risk of SUDI for your pēpē (baby).
  3. The 3 main risk factors are smoking while pregnant, bed-sharing and the position of your baby when sleeping.
  4. The 4 key steps to follow to help you keep your baby safe from SUDI spell PEPE:
    1. Place baby in their own baby bed.
    2. Eliminate smoking in pregnancy.
    3. Position baby flat on their back to sleep.
    4. Encourage and support breastfeeding.
  5. 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
  • bed-sharing
  • 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.
PEPE step  What to do
Place baby in a baby-safe bed

Make sure:

  • 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. 

Eliminate smoking

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. 

Read more about being smokefree for your kids.

Position baby on their back

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.

Encourage breastfeeding

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).

Learn more about how to co-sleep safely with your pēpē.


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. 

Learn more

Safe sleep Ministry of Health, NZ
Keep your baby safe during sleep Well Child Tamariki Ora, NZ
Sudden unexpected death of an infant (SUDI) Plunket, NZ
SUDI prevention co-ordination service Hāpai, NZ
Sudden unexpected death in infancy (SUDI) prevention Northland DHB, NZ


  1. Mitchell EA, Thompson J, Zuccollo J, MacFarlane M, Taylor Barry et al. The combination of bed sharing and maternal smoking leads to a greatly increased risk of sudden unexpected death in infancy – the NZ SUDI Nationwide Case Control Study. NZ Med J; 2017 June 2;130(1456):52–64.
  2. Sudden unexpected death in infancy (SUDI) – special report Child and Youth Mortality Review Committee, NZ, 2017.
  3. Upfront – Sudden unexpected death in infancy – where are we now? BPAC 2013

Reviewed by

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