Sudden Unexpected Death in Infants (SUDI) remains associated with several modifiable risk factors, and practical guidance is needed for families who choose to co-sleep despite current safe sleep recommendations. This Evidence Check examined research published between 2020 and 2025 on modifiable SUDI risk factors, effective interventions and harm-minimisation strategies for co-sleeping. Thirteen sources were included. Identified risk factors were consistent with current NSW guidance and included infants sleeping in a separate room from their caregiver, non-supine sleep positioning, soft bedding or other items in the sleep area, shared sleep surfaces, and prenatal or postnatal exposure to smoking, illicit drugs or other chemicals. Combined interventions were more effective than single strategies, particularly those providing safe sleeping equipment alongside education, culturally appropriate support and follow-up. Hospital and health service quality-improvement initiatives also improved safe sleep knowledge and practices, while digital messaging alone had poor or mixed results. The evidence was varied in quality, and many intervention studies relied on self-reported practices, had limited follow-up or did not link outcomes to SUDI rates. The findings support practical, individualised approaches that address barriers to safe sleep and combine education with access to a safe sleep surface, particularly for families at higher risk.

Citation

Neylon, K, Fereday J, Peters MDJ, Yates R. Safe sleeping practices for babies including a review of co-sleeping: an Evidence Check rapid review brokered by the Sax Institute (www.saxinstitute.org.au) for the NSW Ministry of Health, 2025. DOI: 10.57022//ODSV9398

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