Safe sleeping and Sudden Unexpected Death in Infancy (SUDI)

Updates made to this guidance

23 February 2026: this guidance has been updated to cover all tamariki we work with, not just those in care.

Supporting practice

Our practice is supported by our practice framework (encompassing our models and practice standards), our care standards, and tools and resources.

Why SUDI awareness matters

SUDI is the leading cause of preventable death for tamariki aged 28 days to 1 year.

• Most deaths occur between 2 months and 4 months.
• Common causes are suffocation by bedding or accidental smothering during co-sleeping.
• Most cases are preventable with safe sleeping environments.

SUDI surveillance report | Environmental Health Intelligence NZ, Massey University (PDF 366 KB)

Hāpai – SUDI Prevention Coordination Service

Change for our children

How we can help

We need to understand what SUDI is, and its key risk and prevention factors.

Sites can organise training sessions with their local health SUDI specialist.

Sudden unexpected death in infancy (SUDI) | Healthify

Reports of concern may not directly relate to tamariki under 2 years but if a tamaiti under 2 years is in the home, we should check that the whānau or family understand SUDI and safe sleeping practices, and that safe sleep practices are important to prevent death.

We should seek information to understand if we need to advocate for and assist the whānau or family to reduce risk factors.

After experiencing a SUDI, whānau or family have reported that they did not know their tamaiti could die as a result of co-sleeping, or exposure to drugs and alcohol. Tamariki have a right to have well-informed whānau or family and carers. It is important to explain that even one unsafe sleep can result in death.

Risk factors for SUDI

Tamariki under 2 years are more vulnerable to SUDI when certain risk factors are present.

Factors that increase vulnerability that cannot be changed

• Born before 36 weeks.
• Low birth weight (under 2500 grams or 5.5 pounds).
• Health issues.
• Born to a young mother.
• Male.

Environmental risk factors that can be managed

• Co-sleeping with others without the use of wahakura or pēpi-pod®, including other tamariki and rangatahi. There is additional risk if others in the bed have been using drugs and/or alcohol.
• Unsafe sleeping situations, including in an adult bed, on a couch or chair, in a car seat.
• Unsafe bedding, such as loose covers, soft bedding, use of adult-sized blankets, pillows (including U-shaped pillows), stuffed toys in the sleeping space, swaddling with adult clothing.

Other risk factors

• Mother smoked during pregnancy.
• Exposure to drugs or alcohol during pregnancy.
• Late or no prenatal care.

Strengthening our response to unborn and newborn pēpi

Social risk factors

• Homelessness or transience.
• Inadequate, overcrowded or emergency housing.
• Poverty and financial insecurity.
• Addictions or health issues that impair parenting.
• Smoking.
• Parental or caregiver exhaustion.
• Caring for an unwell or unsettled tamaiti can increase the risk of co-sleeping.

If we identify risk factors

We can:

• explore with the parents and whānau or family their knowledge about SUDI
• encourage planning for safe sleep when te tamaiti is unwell or irritable, when parents or caregivers are exhausted, or when travelling
• explore options to maintain a safe sleeping space for te tamaiti, such as a pēpi-pod® or wahakura, which are portable and able to be in the same bed as the parents or caregiver – a danger time for tamariki is when their normal bed is not available
• share facts and risk factors about SUDI clearly, and explain that safe sleep practice can significantly reduce the risk of death
• promote smoke-free environments and explore what people can do to minimise exposing te tamaiti to second-hand and third-hand smoke
• consider cultural advice or refer to a health professional and take a team approach.

We record our analysis and understanding of how the whānau or family are responding to the care needs of their tamaiti.

Māori and Pacific have higher rates of co-sleeping, and caring for te tamaiti can be a shared responsibility with extended whānau or family. Consider how to share SUDI prevention information with everyone in the whānau or family – is there another person who might understand the cultural context better?

Consider holding a hui to identify the needs and supports and to allow the whānau or family and caregivers to make informed decisions about the care of their tamaiti.

Safe sleep guidelines for tamariki under 2 years of age

The following prevention measures are recommended for all tamariki under 2 years and are required for tamariki in care.

Resources | SUDI Prevention Coordination Service

Sleep environment

• Keep te tamaiti close to carers at night for the first 6 months.
• In their own bed for every sleep.

Sleep space

A safe bed for te tamaiti has:

• a firm and flat mattress to keep their airways open
• no gaps between the bed frame and the mattress that could trap or wedge te tamaiti
• cot bars that are around 50mm apart (the gap should be no more than 95mm).

Avoid adult beds, couches, chairs, beanbags and waterbeds.

Tamariki shouldn’t be left to sleep in car seats because their head can tip forward and block their airway.

Avoid soft or loose bedding, soft mattresses, pillows, sheepskins, bumper pads and stuffed toys.

If co-sleeping, te tamaiti sleeps in their own sleep device (pēpipod®, wahakura) beside the carer.

Pēpi-Pod® sleep space programme

While portacots are considered safe sleep spaces, they are only safe when they are assembled correctly, remain in good condition and safe sleep principles are followed. Because portacots fold, they may wear faster. Check that the base isn’t sagging, the locks engage every time, the fabric isn’t torn, the frame hasn’t warped, and the mattress fits the cot (that is, it is the correct mattress for that portacot).

Sleeping position

Face up

• Te tamaiti should sleep face up (on their back) as this will keep their airways clear. Tamariki have a built-in alarm that reminds them to breathe, and strong gag and swallow reflexes that protect their airway if they vomit. Where tamariki have been exposed to smoking, drugs and/or alcohol, this alarm is very vulnerable and in cases of SUDI does not wake them up as their airways have been affected.
• Their head should be turned left or right to protect their head shape.

A doctor may recommend a different sleep position for a tamaiti with special needs. It is important that we build our understanding of the reasons for sleep position before we advise whānau or family to change.

Face clear

• Keeping their face clear helps te tamaiti breathe freely and not get too hot.
• Te tamaiti should be placed with their feet close to the end of the bed so they can’t burrow under the blankets.

Other preventive actions

Smokefree environment

• No smoking during pregnancy or around te tamaiti.
  Secondhand smoke | Smokefree.org.nz
  Quitting while pregnant | Smokefree.org.nz
• Homes and cars must be smokefree.
  Keep you baby safe during sleep | HealthEd
• We should discuss with carers and other adults in the home who smoke or vape how to get support and advice to stop.
  Quitline

Tamariki in care are required to have a smoke and vape free environment.

Policy: Smoking and vaping

Vaping is not yet proven to directly increase SUDI risk, but it is not safe for tamariki as it exposes them to nicotine and harmful chemicals, some of which can impact lung development.

Breastfeeding

Breastfeeding is encouraged and supported as it is linked to reduced SUDI risk.

Breastfeeding should not be encouraged where there is methamphetamine use by the mother. Where a mother is using alcohol and breastfeeding, we should encourage them to discuss their use with their health professional.

Breastfeeding – caring for and nurturing a pēpi

Methamphetamine

Avoiding te tamaiti overheating

Ways to avoid overheating:

• not wearing too many layers
• using clothing and bedding made from natural fibres
• keeping the room temperature around 20°C.

Check the temperature of te tamaiti by feeling the back of their neck or their tummy (under the clothes) – they should feel warm, but not hot or cold.

Feedback from whānau or family who have experienced SUDI is that they swaddle in adult clothing and full-sized mink blankets because the house is cold. We need to make sure they have appropriate bedding, clothing and heating for te tamaiti.

Other ways to help protect pēpi from SUDI

Remove amber beads and ‘teething’ necklaces while te tamaiti is sleeping.

Return te tamaiti back in their own bed after feeding.

Keep your baby safe during sleep | HealthEd

Safe beds and bedrooms | Whānau Āwhina Plunket

Policy: Smoking and vaping

Whānau-led safe sleep framework aims to reduce SUDI deaths in Aotearoa | Te Ao Māori News