Sleep Space Data Record (2019)

From 2019, the Ministry of Health assumes responsibility for overall monitoring of sleep space services in NZ and DHBs are responsible for all quality processes. To complement this, Change for our Children offers district health boards (DHBs) a data support service for timely and useful feedback at a local level, whatever device is distributed. We will send data quarterly to each DHB service on any data entered here, to support quality implementation by DHBs.

This is a 'one stop shop' for any or all of the reporting options below.

  1. Ministry of Health reporting 
  2. Distribution reporting Are we offering sleep spaces to appropriate infants and implementing the programme with fidelity?
  3. Impact reporting Does infant care at 6-8 weeks reflect appropriate use of sleep spaces and safe sleep principles?

INSTRUCTIONS: For online entry, please enter distribution and impact data at the same time. Use the tab key to move to the next response.                                                                                                                                                      (Revised 1 Jan 2019)


Service details (essential for linking data to your DHB region)

DHB Region:

Distributing Agency 



 (please specify)

1. Ministry of Health Reporting 
  To meet Ministry of Health requirements.
 NHI of mother:   
 NHI of baby:   
Date assessment was made that a safe sleep device is needed:  
 day   month   year 
 Family accepted a safe sleep device:   
  Accepted      Declined
 Type of safe sleep device provided:   
Date safe sleep device was provided  
 day   month   year 
to Distribution Reporting      OR      if finished, to SUBMIT at the end.  
2. Distribution Reporting (data collected when sleep space is issued)
To answer: Are sleep spaces going to more vulnerable babies? 
 Current age of mother:  
 Age of baby at distribution (completed weeks):  
 Any smoking before most recent pregnancy:  

yes   no 

 Any smoking during most recent pregnancy:  
yes   no
 Baby born <37wks or weighing<2500gm):  
yes   no

 Any other concerns:

 (more than one option may be selected)  


regular smoking in baby's household

regular alcohol or drug use in baby's household


mental health concerns  

low maternal support  

infant welfare

 Baby's ethnicity includes: 

(more than one option may be selected)  





Baby has a baby bed  

yes (family has a cot, bassinet ...) 

no (family has no other baby bed

Device offered:  
To answer: Are core components of the programme implemented?
 Was a standard safety briefing completed?  
 Was infant airway protection demonstrated to you, using the tube provided (or a drinking straw or similar)?  
yes   no
 Were you (whanau) encouraged to share your knowledge  with others about protecting babies?  
yes   no
to Impact Reporting      OR      if finished, to SUBMIT at the end.  
3. Impact Reporting  (data collected at follow-up when baby is 6-8 weeks)
 To answer: Are sleep spaces used appropriately? Are safe sleep principles applied?
1. How many people have you spoken with so far about protecting babies?  
2. Since getting the sleep space, has your baby ever shared a bed, mattress or couch with someone who was also asleep?
yes   no
3. If yes, was your baby also in their sleep space at the time?  
4. Do you place your baby on the back for sleeping?  
5. Do you do safe sleep checks and remove hazards from where your baby sleeps, such as: pillows, soft or loose items and toys?  
6. Does your baby sleep in the same room as a main carer at night?  
7. Is your baby currently breastfed?
(use standard definitions for 'feeding in past 48 hours'?
8. Is a main carer receiving support to be smokefree?  
9. Did your baby sleep in their sleep space this past week?  
10. What age is your baby now? (in complete weeks  

11. Please rate how well your sleep space has supported you.

(on a scale of 1(low) to 9 (high))

  a) with better sleep for mother 

b) with breastfeeding  

c) with safety  

d) in other ways   (please specify)

12. Where will your baby usually sleep next, when too big for their sleep space or bassinet?  
 COMMENT: Would you like to comment on your experience using a sleep space?  
      You will know that your form has been submitted successfully when you get an immediate acknowledgement.