SIDS and Crib Mattresses
Many mattresses, sleep pads, and surfaces claim to be breathable. Some companies go as far as saying their products reduce and/or decrease the risk of SIDS and/or suffocation. Unfortunately, there is no scientific data to prove if one mattress or surface has a lower rate of SIDS or suffocation deaths over another.
What We’ve Known
- Prone sleep is a known risk factor for SIDS, and face-down sleep increases this risk further (1).
- Even after a thorough investigation, it can be hard to tell SIDS apart from other sleep-related infant deaths such as overlay or suffocation. These deaths are often unwitnessed and there are no tests to tell SIDS apart from suffocation. To complicate matters, people who investigat SIDS Deaths may report the cause of death in different ways and may not include enough information about the circumstances of the event from the death scene (3).
- Infants in the face down position on fiberfill crib mattresses, quilted surfaces, soft surfaces, pillow-like surfaces, vinyl pads, mattresses filled with tea tree bark and other natural fibers, and even surfaces that claim to be breathable, show increased risk of rebreathing of carbon dioxide which leads to hypoxia, a condition associated with SIDS (5-9). According to Dr. James Kemp and Dr. Brad Thach, some bedding materials may act to retard the dispersal of exhaled gasses (carbon dioxide), retaining the gasses near a face down infant’s mouth. With each subsequent breath, the infant takes in an air mixture which is progressively less adequate to sustain life. The more conducive an item is to rebreathing (retaining carbon dioxide), the more hazardous the item would be (8).
- It is important to keep fresh oxygen flowing to a sleeping baby and avoid anything in the crib that can cause the build-up of carbon dioxide and heat.
What We Still Do Not Know
- What causes SIDS. SIDS is a diagnosis of exclusion when no cause of death can be scientifically determined (2).
- No studies exist comparing infants who sleep on various crib mattresses to see which one has fewer SIDS deaths. No published studies or valid scientific testing is available that shows if one crib mattress or sleep surface has a lower/higher suffocation risk. These gold standard studies do not exist for any of the AAP Task Force recommendations and likely never will; it is not feasible to enroll the number of infants required to get sufficient data. To perform suffocation testing, unethical testing would have to be performed on infants to find out the “suffocation threshold” (4).
- Which infants are more likely to rebreathe carbon dioxide. Most infants will turn their head to avoid “rebreathing” but some do not. We have no way of testing to find out which infants are “vulnerable” so all infants remain at risk (10).
- The carbon dioxide retention level of all crib mattresses and sleep surfaces that claim to be “Breathable.” As scientific studies show, some air permeable crib mattresses and sleep surfaces that have porous cores, actually retained higher levels of carbon dioxide than thick fiberfill materials (5-8).
What We Now Know:
Scientific evidence shows some air permeable mattresses provide a “significant” decreased risk of rebreathing of carbon dioxide (5,6,7,8,9,11). The SafeSleep Crib Mattress has been tested for carbon dioxide retention and has a ten-fold decrease in carbon dioxide retention when compared to a fiberfill mattress with a tight-fitting sheet. It takes 2 minutes for carbon dioxide to dissipate on a firm crib mattress with a tight sheet; it takes less than 1/2 a second for it to dissipate on the SafeSleep Crib Mattress (11). An infant takes a breath every 1-2 seconds, meaning the carbon dioxide (poisonous gasses) on this mattress would be gone before the infant takes their next breath of air – even if face straight down (12).
- L’Hoir MP, Engelberts AC, van Well GTJ, et al. Risk and preventative factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr. 1998;157:681–688
- Thach, Brad. Tragic and sudden death. Potential and proven mechanisms causing sudden infant death syndrome. Science and SocietyViewpoint. EMBO Rep. 2008 Feb; 9(2): 114–118
- CDC, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, October 3, 2016 (https://www.cdc.gov/sids/aboutsuidandsids.htm).
- Bar-Yishay E, Gaides M, Goren A, Szeinberg A. Aeration properties of a new sleeping surface for infants. Pediatr Pulmonol. 2011;46(2):193–198 342. Colditz PB, Joy GJ, Dunster KR. Rebreathing potential of infant mattresses and bedcovers. J Paediatr Child Health. 2002;38(2):192–195 343.
- Carolan PL, Wheeler WB, Ross JD, Kemp RJ. Potential to prevent carbon dioxide rebreathing of commercial products marketed to reduce sudden infant death syndrome risk. Pediatrics 2000;105;774
- Colditz PB, Joy GJ, Dunster KR. Rebreathing potential of infant mattresses and bedcovers. J Paediatr Child Health. 2002;38(2):192–195 343.
- James N Carleton, Ann M Donoghue, Warren K Porter. Mechanical model testing of rebreathing potential in infant bedding materials. Arch Dis Child 1998;78:323–328
- James S. Kemp, Rose M. Kowalski, RN, Phillip M. Burch, MD, Michael A. Graham, MD, Bradley T. Thach, MD. Unintentional suffocation by rebreathing: A death scene and physiologic investigation of a possible cause of sudden infant death. J Paediatr. June 1993Volume 122, Issue 6, Pages 874–880.