Safe sleep: Birth to 11 months

Safe sleep 1


How big a problem is it?

It is a significant problem. So much so that a dedicated service addresses it. Sudden unexpected deaths in infants (SUDI) is a leading cause of death in NZ for babies one month to one year. SUDI can happen for no apparent reason or it can be caused by a baby’s sleeping environment, or a medical condition.

Who does it affect?

The biggest risk for SUDI is in this first year, from birth to around one year. The death rates from suffocation have increased in the years since 2000, most likely because it is become recognised as a contributing factor in many cases of SUDI.

Approximately 60,000 babies are born each year in Aotearoa New Zealand and the SUDI rate among them is approximately 0.7 in every 1,000 babies born. Most of these deaths are preventable and most occur among Māori and Pacific babies. What follows are our Top Tips for creating a safer sleeping environment for your baby.

This information reflects what the national team at Hapai Te Ora provide. We leave the detail about SUDI to them. So what follows touches on SUDI and but also offers advice on the other risks that need to be addressed.

Top Tips

  • Use a 'safe sleep' bed: wahakura, Pēpi-Pods®, baby boxes, bassinets, cots, cribs or portacots.

  • Always place your baby on their back to sleep, not on their stomach or side and use a firm mattress. Once your baby starts to roll over, it's fine for them to remain in the sleep position they choose.

  • SUDI prevention in detail: Safe Sleep For P.E.P.E

Other risks
  • Toys, pillows, blankets, unfitted sheets, comforters, sheepskins and bumper pads are suffocation risks so keep them out of your baby’s bed.

  • Make sure your baby is dressed right for the room temperature, to avoid overheating. If they look like they are sweating or feeling hot to touch you may have overdressed them.

  • Smoking has been shown to increase the risk of SUDI so keep your baby away from second-hand smoke.

  • Babies love to reach out and grab and once your baby starts to sit and crawl, they will start to look around for things to touch and put in their mouths. Check for anything near their cot they can reach from a sitting or standing position and avoid items with cords, ties, or ribbons that can wrap around their neck.

  • Your baby will fall asleep almost anywhere and it’s tempting not to disturb them. But being left to sleep in a baby swing, or on a sofa, chair, or soft surface increases their risk of SIDS, so always make sure you transfer them to their cot to keep them safe.

  • Remember the A.B.C. for safe sleep:
    A: alone
    B: on their backs
    C: in a cot every time.

  • Breastfeeding can protect your baby from SUDI; it’s also free, readily available and strengthens the bond between you both.

First Aid

If the baby is unconscious, call for help or ask someone to call for you if you are not alone and start CPR immediately. See CPR Instructions for babies and toddlers. Do not stop performing CPR until medical help arrives and takes over.

Link to Safekids' resources

Download SUDI reference card

Reference Card Sources

Link to other organisations’ resources

Hapai SUDI Prevention Coordination Service (National SUDI Prevention Coordination Service)

NZ Health Quality and Safety Commission SUDI protection advice

NZ National Safe Sleep Device Quality Specification Guidelines

Keep Your Baby Safe During Sleep pamphlet

PEPE Safe Sleep Videos




Ministry of Health Safe Sleep pages

Acknowledgement: This page includes a link to the KidsHealth website page containing the Basic Life Support Flow Chart. The Basic Life Support Flow Chart is developed by the New Zealand Resuscitation Council and Australian Resuscitation Council. For more information see New Zealand Resuscitation Council