SUDI for healthcare providers

Key points about sudden unexplained death in infants (SUDI)

  • This page contains information about SUDI for healthcare providers.
  • Find information on guidelines & recommendations, management and CPD.


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National SUDI prevention programme – needs assessment and care planning guide(external link) Ministry of Health, NZ, 2019

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.

See also: National SUDI prevention programme national – safe sleep device quality specification guidelines(external link) Ministry of Health, NZ, 2019


  1. Use the first antenatal consult and 6-week baby check to discuss the PEPE message and identify risks.
  2. Use the safe sleep calculator(external link) to determine SUDI risk. Document the score.
  3. Identify maternal smoking, drug, and alcohol use. Maternal antenatal smoking is the greatest contributor to SUDI risk.


  1. Discuss the PEPE message and address modifiable risk factors.
  2. 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(external link) , local safe sleep coordinator, or through a WINZ special needs grant(external link).
  3. Encourage engagement with smoking cessation support and Community Alcohol and Drug Service.


NZ SUDI Nationwide Case-Control Study(external link)

This research has identified the following:

  • 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.

Learn more:

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(external link). NZ Med J; 2017 June 2;130(1456):52–64.
Sudden unexpected death in infancy (SUDI) – special report(external link) Child and Youth Mortality Review Committee, NZ, 2017


Sudden unexpected death in infancy (SUDI)(external link) Goodfellow Podcast, NZ, 2019

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.


SUDI Free Online Workshop(external link) Conectus Learning

  • Suitable for all those who currently work in the community to improve the health of families, especially with Māori.
  • An initial step to help you develop the skills needed to work with whānau and make positive behaviour changes to reduce the risk of SUDI.

SUDI eLearning Toolkit(external link) WellChild Health, Ministry of Health, 2012

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.

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

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