Sudden unexpected death in infancy (SUDI)

Also known as cot death and includes SIDS

Key points about SUDI

  • 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 Aotearoa New Zealand. Thinking about SUDI can be very frightening for new parents, but there are ways you can greatly reduce your child's risk.
  • 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.
  • There are things you can do to help you keep your baby safe from SUDI, plus resources and people who can support you to keep your baby safe.
Purple waterlily on a pond in Aotearoa New Zealand
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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 below.

Woman putting baby into cot to lie on its back

Image credit: Canva

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.

Video: TAHA - Safe Sleep for Baby

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(TAHA Well Pacific Mother & Infant Service, NZ, 2014)

Here is a way you can have your baby next to your bed but not actually in your bed with you.

Baby sleeping in 3 sided cot next to parents' bedImage credit: Canva


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(external link). Wahakura are hand-woven sleep spaces for pēpē made out of harakeke (flax) and using the tradition of rāranga (Māori weaving practices).

Tips on how to co-sleep with your pēpi

Use a wahakura

A wahakura is a small, flax-woven bed that can be fitted with a mattress that allows parents to have their baby in their bed but contained in a safe space. This helps protect against accidental suffocation caused by a parent or caregiver rolling onto their baby, or the baby being smothered by blankets. Wahakura were piloted in Gisborne in 2006 and Hawke’s Bay in 2007 and later rolled out around other parts of the country.

Use a pepi-pod

Pepi-pods are made from polypropylene plastic that can be fitted with a mattress and bedding. Like the wahakura, they are placed on the parent’s bed but provide a buffer of protection against accidental suffocation.

Put them to sleep on their back

Put your baby to sleep on their back with their feet right at the foot of their sleeping place. This helps to keep their airways clear and stop them burrowing under the blankets. Always put your baby back to sleep in their sleeping place (eg, wahakura or pepi-pod) after feeding so you don’t fall asleep on them.

Provide a smoke-free environment

Having a smoke-free home and car keeps your baby free from second-hand cigarette smoke, which is very harmful to them. Also, ensure the person looking after your baby is free from drugs and alcohol so they can be alert to your baby’s needs.

Breastfeed your baby

If possible, breastfeed only for the first 6 months. It’s advisable to keep breastfeeding until your baby is a year old if you can because breastfeeding helps protect your baby against SUDI.

Uncover their head and face

Make sure your baby’s head and face are free from things that may suffocate them like a pillow, bumper pad or hat. Don’t put any stuffed toys or playthings in your baby’s sleeping place that they could suffocate or choke on, including teething necklaces.

Dress them for the temperature

Your baby needs to be kept at a comfortable temperature so they don’t overheat. Make sure your baby doesn’t have too many clothes or blankets on. Having your baby in one more layer of clothing than you would wear is a good guide.

Use a firm and well-fitting mattress

Having a firm, flat mattress helps keep your baby’s airways open and stops them rolling. Make sure there are no gaps between your baby’s mattress and the side of the wahakura or pepi-pod.


Sands NZ(external link) Support for parents and families who have experienced the death of a baby at any stage during pregnancy, as a baby or infant.
Bittersweet(external link) 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. 


national sudi prevention programme

National SUDI prevention programme

Ministry of Health of NZ, 2019

safe sleep for pepe

Safe sleep for P.E.P.E

Hāpai SUDI Prevention Co-ordination Service, NZ

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Nari Faiers, Workforce Development and Cultural Lead, SUDI Prevention National Coordination Service, Hāpai Te Hauora Māori Public Health

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