Safe Sleep Will a Baby Wake if They Can't Breathe

Will a Baby Wake if They Can’t Breathe?

Will a baby wake if they can’t breathe?

Most babies will wake if they can’t breathe.  But some will not wake if they can’t breathe.  The issue we face is, we don’t know which ones will and which ones will not. 

There are two main causes for infants to stop breathing.  One is obvious – airway obstruction.  The other is not as obvious – carbon dioxide rebreathing.

Airway Obstruction

Airway obstruction occurs most often when an infant’s nose is obstructed.  One example would be sleeping in soft bedding that is blocking their nasal passages.  Infants are obligate nose breathers.  This means they breathe primarily through their nose.  This usually changes at around six-months of age but will differ for all infants. 

Carbon Dioxide Rebreathing

As adults we have a trigger when we are sleeping to turn our heads to get fresh air if we are rebreathing our exhaled air.  It is believed that some infants do not have this trigger until later and these infants will not wake if they can’t breathe.  It is believed these infants have low serotonin levels in the brain stem and high levels of serotonin in the blood.  There is currently no way to test babies for these serotonin levels until after death.  Many SIDS infant’s have been shown to have low serotonin levels in the brain stem at death.  Dr. Hannah Kinney was the first to discover these findings.  Her research has helped shed light on why seemingly normal babies do not wake if they can’t breathe.    

It is believed that these infants will not wake if they can’t breathe or respond (turn their heads) when they are rebreathing their exhaled air.  If these infants continue to rebreathe their exhaled air, it will eventually suppress their need to breathe and it becomes lethal.  These vulnerable infants will not wake if they can’t breathe and they sleep quietly through it.

American Academy of Pediatrics Safe Sleep Task Force Recommendations

In 2011, the American Academy of Pediatrics Task Force on SIDS decided to expand the safe sleep recommendations to include recommendations to reduce the risk of rebreathing and other sleep related infant deaths.  As noted in the policy,

“It is unknown whether the nonsupine (tummy) position by itself increases the risk of suffocation, and we have therefore not included suffocation as a rationale for supine sleeping in either the Policy Statement or the Technical Report. Moreover, the similarity noted in risk factors should not be construed as implying that SIDS is caused by suffocation. Indeed, they are 2 separate entities. Unfortunately, at this time there is no unique cellular pathology that enables medical examiners, coroners, or pathologists to differentiate SIDS from suffocation, and thus a determination of the cause of death must be made in the absence of this information.” 

Current Recommendations and Carbon Dioxide Rebreathing

If you look at the current safe sleep recommendations published by the AAP Safe Sleep Task Force, you will notice most of the recommendations center on eliminating the risk of an infant rebreathing.  These recommendations are based on years of studying  why baby some babies don’t wake if they can’t breathe.  These recommendations include:

  1. Supine sleep position: “The prone or side sleep position can increase the risk of rebreathing expired gases, resulting in hypercapnia and hypoxia.”
  2. Room-Sharing Without Bed-Sharing Is Recommended: “Bed-sharing might increase the risk of overheating, rebreathing or airway obstruction, head covering, and exposure to tobacco smoke, which are all risk factors for SIDS.”
  3. It Is Prudent to Provide Separate Sleep Areas and Avoid Cobedding for Twins and Higher-Order Multiples in the Hospital and at Home: “Furthermore, there is increased potential for overheating and rebreathing while cobedding, and size discordance might increase the risk of accidental suffocation.”
  4. Pillows, Quilts, Comforters, Sheepskins, and Other Soft Surfaces Are Hazardous When Placed Under the Infant or Loose in the Sleep Environment: “However, such soft bedding can increase the potential of suffocation and rebreathing.”
  5. Avoid Overheating and Head Covering in Infants: “It is not known whether the risk associated with head covering is attributable to overheating, hypoxia, or rebreathing.”

What Can Parent do to Avoid the Buildup of Carbon Dioxide in Their Infant’s Crib?

Dr James Kemp and colleagues were some of the first to study the potential for various sleep surfaces to prevent infant rebreathing. They found that the firm mattress and four of the five surfaces designed to prevent rebreathing consistently allowed lethal rebreathing of CO2.  Only one product—an air permeable crib mattress—was able to maintain CO2 levels below this threshold.  The authors go on to say that “even firm mattresses could pose a rebreathing threat when vulnerable infants sleep prone.”

They refer to studies showing that unaccustomed prone sleepers, including infants who are placed supine and roll prone have an increased risk of SIDS (O’Hoir 1998 and Mitchell EA 1999).  These studies and others have shown that nearly half of SIDS victims unaccustomed to prone sleep, were discovered in the face-straight-down position.  Many of these infants were found on a firm mattress.  Dr Kemp’s data supports that if vulnerable infants were placed on an air permeable surface, they would experience less risk of rebreathing should they inadvertently roll prone (to their tummy).

About Air Permeable/Breathe-Through Crib Mattresses

Until we can identify which babies will wake if they can’t breathe, and which babies will not wake if they can’t breathe, your best defense is an air permeable/breathe-through crib mattress that does not allow harmful carbon dioxide to accumulate.

SafeSleep® is the first company to define a market successful design to eliminate carbon dioxide retention in response to infants who don’t wake if they can’t breathe.  We were founded by people who had been personally impacted by the loss of an infant upon sleep surfaces sold as “safe” for infants but not designed with ensuring unobstructed breathing.  We fixed what was an “obvious” shortcoming in industry standards after losing a loved one.

We want to make sure every baby, regardless of if they do or if they do not wake if they can’t breathe remains safe while sleeping.

Want to learn more about SafeSleep®?  Visit us at

See how we influenced changes to the 2016 safe sleep policy here

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