Key points to remember

• every year, about 60 babies die suddenly in their sleep
• most deaths are preventable
• safe sleep means face up, face clear, smokefree every time and place a baby sleeps
• sleeping face up (on the back) protects babies through a critical stage of development
• a clear face protects babies from suffocation
• a smokefree start to life makes babies strong

Message to parents

• precious new baby?
• advice from everyone?
• how do you decide what is essential and what is not?

This fact sheet offers you essential up-to-date information to help keep your baby safe every time and every place they sleep.

What is SUDI?

SUDI stands for sudden, unexpected death in infancy. Some SUDI deaths can be explained (for example, asphyxia or suffocation). Others cannot be (for example, SIDS or cot death). Most happen in the first six months of life when a baby is asleep.

How does SUDI happen?

Babies have a natural drive to breathe. This fails for SUDI babies. They stop breathing in their sleep. Their breathing may stop because of:

• things in their sleeping environment
• things that weaken a baby's drive to breathe

Who is at risk of SUDI?

SUDI risks comes from a set of things that act together:

• some babies have a weaker drive to breath than others (for example, due to smoking in pregnancy, a low birth weight, being born prematurely or being bottle fed or unwell)
• some sleeping situations have more hazards than others (for example, from pillows, unsafe positioning, people in the bed, loose covers, soft bedding or unsafe swaddling)

How can we protect babies from SUDI?

All babies, all places, every sleep

All babies need protecting from SUDI, in all the places they may sleep, and every time they sleep.

Safe sleep = face up + face clear + smokefree

See the Safe sleep cot card (at right).

Sudden unexpected death is extremely rare for babies protected by this safety formula.

Face up
Your baby was designed to sleep face up (on their back). Their drive to breath works best in this position and their airway is also safer. A built-in alarm reminds them to breath, and strong gag and swallow reflexes protect their airway if they spill.

Face clear
Your baby was designed to sleep with a clear face. This helps them breathe freely and not get too hot. Your baby may fall asleep with their face clear, but will it stay clear? This will depend on how they lie, where they sleep, and how you make it safe.

Smoke free
Your baby was designed to grow and develop smokefree. All smoking harms babies, especially in pregnancy. Smoking takes oxygen and weakens vital systems (such as breathing) as babies develop. When born, such babies need extra protection.

Other ways to protect your baby from SUDI

Your baby was also designed:

• to need you close by (in the same room as you when you sleep)
• to be breastfed (this strengthens their drive to breathe)
• to be handled gently (to protect their brain) (see Preventing shaken baby syndrome on this website)

This is essential care for all babies.

See Change for our Children's Six principles for protecting a baby's life (below). It's available in 20 languages (scroll down past the English version).

Focus on the face

Sleeping babies need to breathe. Placing babies in unsafe sleeping positions, especially if also propped on pillows, swaddled or wrapped, is dangerous. They may suffocate.

What can happen?
Too many SUDI babies were placed for sleep on the tummy, or on the side (but rolled forward) or on the back (but propped on pillows). Sadly, many were then found pressed into pillows, underneath bedding, wedged into gaps, with covers over their heads and faces, or under people.

Safe sleep check

Young babies nap and sleep in many places. This safety check is a way to be confident that every sleep is as safe as possible for your baby.

Young babies nap and sleep in many places. This safety check is a way to be confident that every sleep is as safe as possible for your baby.

1. From the very start, make your baby as strong as possible (less vulnerable)

• smokefree in pregnancy?
• born after 36 weeks?
• weighed more than 2500 gm at birth?
• breastfed?

Essential: More vulnerable babies need the extra protection of their very own ‘baby bed' (a bed designed for babies) every time they sleep.

2. For every sleep, make it as easy as possible for your baby to breathe

• placed for sleep face up (on the back)?
• plenty of space around your baby's face?
• in a safe space (no chance of getting onto the tummy, under covers, near pillows or into gaps)?
• breathes only smoke free air?

3. In every place your baby sleeps, make it as safe as possible.

• close by you (same room as you when you sleep)?
• in own ‘baby bed' or own safe space?
• all possible hazards noticed and removed or avoided?
• a sober person with your baby if there is alcohol, drugs or partying?

Atawhaitia ahau I roto moemoea

From my earliest beginnings, pursue protection so that I may dream.

What about tummy time?

Remember the key messages:

• back for sleep
• front for play
• upright for cuddles and hugs

This will help gravity protect your baby's head shape. (See Positional head-flattening in babies on this website).

What is the SUDI evidence?

Information about SUDI changes as more deaths are explained. Some findings from research are stronger than others. This fact sheet is based on major findings agreed by researchers around the world, and is supported by the findings of coroners.

Where to go for more information

HealthEd (NZ Ministry of Health) www.healthed.govt.nz

• Safe sleep essentials leaflet (see leaflet thumbnail image under the acknowledgements section below)
• Safe sleep cot card (at right)

Acknowledgements

Starship Foundation and the Paediatric Society of New Zealand acknowledge the co-operation of Change for our Children  in making this information available for families. The above fact sheet reproduces the content of the Safe sleep essentials leaflet (October 2009), at left, produced by Change for our Children and endorsed by the The Child and Youth Mortality Review Committee, The NZ Ministry of Health and The Office of the Chief Coroner.

Main reference:
Carpenter, R.G. et al. Lancet 2004; 363:185-91.

Special copyright notice for this page

The copyright notice at the bottom of this page (and all kidshealth pages) does not apply to this fact sheet. Change for our Children holds copyright for all the content of this page. Any requests to reproduce any of the content above need to be made to that organisation.