Help Your Baby Avoid SIDS

Will a Breathable Mattress Help Avoid SIDS?

Will a Breathable Mattress Help Your Baby Avoid SIDS?

Over 3,600 seemingly health babies die each year in the U.S.  Will a “breathable” mattress help your baby avoid SIDS (Sudden Infant Death Syndrome)?

In early 2000, the crib mattress buzz word was organic.  Twenty years later, it is now “breathable.”  With so many crib mattress manufacturers claiming to have breathable mattresses, we thought it was time to address the question, “Will a breathable mattress help your baby avoid SIDS?”

What is SIDS

A baby is determined to have died from SIDS if no cause of death can be identified following a death scene investigation, an autopsy, and a review of the clinical history. SIDS as a cause of death is determined only when all other causes have been excluded.

With infant related sleep deaths, the cause of death can be difficult to determine with certainty. Infants who die from sudden death usually pass away while asleep in their cribs. Victims are often found lying face down. There are no signs of trauma. Usually their deaths are not witnessed by another person, which makes it difficult for investigators to piece together how they died.  There are also no clear biological markers.

Slate Magazine

In an August 2016 article published in Slate Magazine under a similar title, Could a Breathable Mattress Help Your Baby Avoid SIDS?, the author believes breathable crib mattresses manufacturers do nothing more than exploit the fears of parents. 

According to the article’s author,

“There was a lot of research in the 1990’s that showed rebreathing is a hazard when babies sleep on soft bedding, like sheepskin, or with a blanket covering their heads. However, there isn’t evidence that sleeping on firm mattresses with a tight-fitting sheets—as is recommended—causes problematic rebreathing in babies, even if they roll onto their tummies. Plus, rebreathing is just one hypothesis for why tummy sleeping might be riskier.”

The fact is, there is scientific data showing that crib mattresses with fiber or other core materials do cause problematic rebreathing in babies.  This is noted in the same pub med resources as the author uses to debunk firm mattresses with a tight fitting sheet as not being problematic.  Logically, if fiberfill mattresses were not problematic, why not suggest infants can tummy sleep? 

The author’s goes on to state,

“More recent research has found that babies sleeping belly-down also have impaired arousability, altered cardiovascular control, and lower blood pressure and cerebral oxygenation, any of which may be important when it comes to SIDS.”

Without knowing it, the author is describing effects of rebreathing exhaled air (CO2).  Impaired arousability, altered cardiovascular control, low blood pressure, and lack of cerebral oxygenation, are all signs of rebreathing.  When an individual rebreathes their exhaled air (CO2), it suppresses their need to breathe and eventually leads to hypoxia and then death.

Rebreathing

According to a March 2019 article in Health, research by Dr. Gordon Buchanan, a neurologist and epileptologist at the University of Iowa reveals,

“Babies and adults who die from sudden death syndromes may be born with brains that aren’t good at recognizing rising CO2 levels in their blood. In sudden death cases, it’s thought that the individuals’ airways get blocked somehow while sleeping in bed — such as by a pillow, a toy or tangled bedding. But it wasn’t clear why the person doesn’t simply wake up and fix the problem by repositioning themselves or by crying out for help.

Buchanan thinks that individuals who succumb to sudden death syndromes may have malfunctioning serotonin receptors in their brains. These receptors are part of our brain’s “suffocation alarm system” and help to ensure that blood oxygen and carbon dioxide (CO2) levels are healthy. But Buchanan thinks that a rare neurological difference causes some people’s brains to be bad at detecting when blood CO2 levels get too high — which is a signal to our bodies that we could be suffocating. Instead of waking up like most people would, those with this defect stay asleep and are seemingly powerless against what’s happening to them.

Dr. Hannah Kinney was the first to be credited with discovering the effects of serotonin levels in an infants brain stem and SIDS 

The problem we face, is there is no way to test to find out which babies do, and which babies do not have a compromised “suffocation alarm system,” so all infants remain vulnerable.

Approved Standards

So, can a breathable mattress help your baby avoid SIDS?  In the Slate article previously mentioned, the author correctly states,

One problem with mattresses being marketed as “breathable” is that there aren’t any approved standards for what this should mean.”

She gives one example of the Nook Pebble Pure mattress that uses coconut husk as part of its fill.  According to Dr. James Kemp, a pediatric pulmonologist at St. Louis Children’s Hospital and SIDS expert, called this “exactly the wrong idea,” noting that a porous interior might actually trap carbon dioxide. A mattress filled with tea tree bark made in Australia in the 1980s and ’90s and marketed as breathable turned out to increase the risk of SIDS, and, according to a study by Kemp, allowed more rebreathing.

Some “breathable” crib mattresses with porous interior and cores are actually shown to be more dangerous than a solid fiber fill crib mattress.

Claims of Preventing SIDS

The Slate author states,

 “In designing “breathable” mattresses and claiming that they will inherently keep babies safer, these companies are demonstrating a fundamental lack of understanding of the complexity of SIDS, and, more broadly, of science. “The ‘evidence’ the manufacturers of these crib mattresses provide is not evidence of reduced risk of suffocation or SIDS,” said Dr. Fern Hauck, a member of the AAP’s Task Force on SIDS. “As long as the mattresses meet government safety standards, they can be used, but they should not be marketed as preventing SIDS or suffocation,” she added.”

The reality is none of the “breathable” crib mattress companies mentioned in the article claim to prevent SIDS.  The author uses a very misleading statement.

Since SIDS is a diagnosis of exclusion, there is nothing that can prevent it.  It would be like say you have something that can cure death by natural causes.  The term Sudden Infant Death Syndrome is also misleading, and often confusing, since SIDS is not a syndrome or a diagnosis.  It’s simply a term used if we don’t know what else to classify an infant death as.

Science

No studies exist comparing infants who sleep on various crib mattresses to see which one has fewer SIDS deaths.  This lack of studies includes the recommended firm crib mattress with a tight-fitting sheet. No published studies or valid scientific testing is available that shows if one crib mattress, including the currently recommended firm mattress with a tight-fitting sheet, or sleep surface has a lower/higher SIDS 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.  

We cannot say with scientific certainty if a breathable mattress could help your baby avoid SIDS.  We also cannot say with scientific certainty that a firm crib mattress with a tight-fitting sheet can avoid SIDS.  In fact, we can’t say with scientific certainty that any of the AAP’s safe sleep recommendations will avoid SIDS.  The real question should be, can a breathable crib mattress avoid known SIDS “risks”?  All of the AAP’s safe sleep guidelines focus on risk avoidance.

Risk Avoidance  

Knowing what we now do, the question should be can a breathable crib mattress avoid known SIDS risks? 

Let’s look at the following quotes taken from the AAP’s Safe Sleep Policy Statement ;  

  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.”

While the studies do not demonstrate a direct prevention of SIDS or suffocation, they rely on the hypothesis of rebreathing of CO2 as a potential contributor for these unexpected infant deaths.   A basic pathophysiological principle is the hypothesis that rebreathing C02 is associated with ALTE/SIDS/asphyxia.  Indeed, no studies have substantiated this hypothesis; however, this is the same hypothesis used by the AAP Task Force to support the majority of their recommendations.

Further, the Task Force recommends air permeable sides when bassinets are used. This recommendation is based on a retrospective review and analysis of infant deaths occurring in bassinets between June 1990 and November 2004 that were reported to the CPSC (Pike/Moon 2008). The authors identified at least six infants who were found with their “face wedged against the side of the bassinet.” While there is no mention of any bassinets having air permeable sides in the study, the study authors (including R Moon who is on the AAP Task Force) recommends “a bassinet with vertical sides of air-permeable material, such as mesh, may be preferable to one with air-impermeable sides.”  The Task Force makes the recommendation for air permeable sides based on infants with face wedged against side of sleep environment.   Logic would dictate that air permeable mattresses as being preferable to air impermeable mattresses to address infants face-straight- down on firm mattresses.

Breathable vs. Breathe-Through

Not all breathable crib mattresses are air permeable.  An air permeable crib mattress allows an infant who is face straight down to breathe normally right through the crib mattress without rebreathing their exhaled air.

There is only one mattress on the market today that has been scientifically tested and concludes it significantly reduces the risk of carbon dioxide rebreathing and is completely breathe-through.

The Science of “Breathe-Through”

SafeSleep is a company that does understand the complexity of SIDS, and, more broadly, of science.  The four founders all lost a loved one to SIDS.  One of the founders is an AAP member and chairs one of the AAP’s committees.

The SafeSleep Breathe-Through Crib Mattress was designed with the idea that baby’s do not always arouse when rebreathing harmful carbon dioxide.  Ten years ago, SafeSleep founders challenged an industry standard by creating a crib mattress with no fill and replaced it with free-flowing air. 

These efforts have been recognized by top medical professionals and even prompted the American Academy of Pediatrics to recognize their crib mattresses with no fill and air permeable surfaces as safer for the infant who rolls in their 2016 Safe Sleep Technical Report.  

The SafeSleep Breathe-Through Crib Mattress is designed to prevent harmful carbon dioxide from accumulating so that if an infant is face straight down and cannot arouse,  they will not rebreathe their exhaled air.

The SafeSleep Breathe-Through 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.  An infant takes a breath every 1-2 seconds, meaning the carbon dioxide (poisonous gasses) on the SafeSleep Breathe-Through mattress are gone before the infant takes their next breath of air – even if face straight down and does not arouse.

We can say with scientific certainty that the SafeSleep Breathe-Through Crib Mattress significantly reduces the risk of carbon dioxide rebreathing even if the infant is face down or tummy sleeping.

 

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