Monthly Archives: September 2020

How to Prevent SIDS

How to Prevent SIDS

How to Prevent SIDS

We want to help parents avoid a tragedy by sharing how to prevent SIDS (Sudden Infant Death Syndrome). Yearly, there are around 3,500 sudden unexpected infant deaths in the U.S. alone.

SIDS is an unfortunate reality that many new parents face. However, there are certain things you can do to reduce the risk of SIDS for your infant.

Read on to find out what sudden infant death syndrome is and what best to do for your baby to prevent SIDS.

What Is Sudden Infant Death Syndrome?

Sudden Infant Death Syndrome (SIDS) is the general term used when a baby suddenly dies for no obvious reason. In order for death to be under SIDS, the infant must be younger than the one-year-old.  If the child is over one year old, it is considered SUDC (Sudden Unexplained Death of a Child).

The cause of death of a baby is typically defined as SIDS after a thorough investigation and no cause of death can be identified. 

SIDS is considered a diagnosis of exclusion.

Why Does Sudden Infant Death Syndrome Happen?

At the time of writing, scientists are not 100% sure what exactly causes SIDS. However, they speculate it is because infants are unable to effectively detect low oxygen or high carbon dioxide levels. Children and adults can wake up to prevent suffocation, but many babies are unable to do so.

There is a triple risk model that’s proposed by scientists:

  1. An undetectable abnormality prevents the infant from responding to low oxygen/high carbon dioxide levels
  2. There’s a triggering event (i.e. sleeping on the stomach, blanket around the face, hand or arm near the face)
  3. The above 2 points happen in a critical development period believed to be a rapid brain growth phase

Some SIDS deaths are not preventable, but most are preventable.  Infants in unsafe sleep conditions are at high risk of SIDS. 

How to Prevent SIDS

Unfortunately, we cannot fully prevent SIDS. The good news, however, is that there are many steps you can take to drastically reduce the risks of SIDS and the chances of it happening. Read on for our tips on how to prevent SIDS.

Preventing SIDS Starts with Get Your Infant Vaccinated

There is a small minority of people who believe vaccinations cause problems, including SIDS. But that’s not true.

In fact, vaccines help protect against SIDS. The evidence suggests vaccinations reduce the risk of SIDS by 50%. 

So, one sure way on how to prevent SIDS is getting your baby vaccinated.

Have Your Baby Sleep on Their Back Helps Prevent SIDS

If your baby is sleeping on their side or stomach, this can lead to one of two scenarios.  Firstly, when the crib mattress is soft, its nose and mouth are buried in the crib mattress, which cuts off its oxygen supply.  The second, when the crib mattress is firm, exhaled air (carbon dioxide) can be inhaled.  When carbon dioxide is continuously inhaled, it leads to death.

Another way to prevent SIDS is to always put your child down to sleep on their back. Back sleep is the safest place for a baby to sleep and is believed to significantly reduce the risk of SIDS.

Risk of SIDS Increases When Co-Sleeping

Co-sleeping is something some parents choose because parents believe it helps them bond with their babies better.

But the fact is insufficient sleep associated with parenthood can prevent adults from getting clues they have rolled over on their infants. As a result, they can unintentionally suffocate their babies. Babies can also easily become entangled in the sheets and blankets.

For breastfeeding mothers, make sure that your infant is safely put in their crib before falling asleep. 

Your baby should have his own crib, which means he should not co-sleep with anyone. This means they should not sleep with you or their siblings. Co-sleeping is one of the biggest risk of SIDS and other infant sleep related deaths.

Keep the Crib in Your Room to Prevent SIDS

For the first three months of your child’s life, you should keep the crib in your room. This allows you to quickly check them and take lifesaving measures if you notice they are not breathing.  It is best to put the crib as close as possible to the bed.

After three months, your baby should eat enough to sleep through the night.

Keep the Crib as Bare as Possible

If you have a baby, you might want to decorate your crib so it is cute, or you might want them to have soft, comfortable objects with which they can snuggle, like blankets, toys and pillows. However, these items can trap harmful carbon dioxide, which increases the risk of death.  Avoiding rebreathing of carbon dioxide is one of the most important step to prevent SIDS.

Even plain pillows and blankets can significantly increase the risk of SIDS. All you need is a firm mattress, and that’s it. Do not use bumper pads; they have been associated with suffocation, asphyxiation and strangulation deaths of infants.  Some states have even banned selling them.

Make sure you dress your baby warmly and adequately for the weather.  The general rule is to add one more layer than you would have for the bed.  Wearable blankets are best suited to reduce the risk of SIDS.

Get a SafeSleep® Crib Mattress 

If you need a firm mattress, you should get one from SafeSleep ®.

The SafeSleep ® Breathe-Through Crib Mattress has years of research and testing to create a safer, more sanitary sleeping environment for babies. The SafeSleep ® crib mattress is fully and easily washable.  It is also hypoallergenic.

According to leading AAP doctors and policymakers, SafeSleep® breathable crib mattress is a scientific answer to “how to prevent SIDS.”

The SafeSleep ® Breathe-Through Crib Mattress has been scientifically proven to have the lowest risk of suffocation and carbon dioxide rebreathing. So if your baby needs to sleep on their stomach for any reason, you want a SafeSleep ® crib mattress.  It’s the only crib mattress physicians write prescriptions for infants who must tummy sleep for health reasons.

Furthermore, the mattress has a 3D air-permeable topper and no core that leads to position pressure, which can cause skull deformities. Both factors will help keep your infant comfortable throughout the night.

And if the mattress is dirty, you can throw the topper in a washing machine and wipe the base! it’s the only completely washable crib mattress on the market.

Lower the Risk of SIDS

Now you know what sudden infant death syndrome (SIDS) is, why it happens, and how to prevent SIDS, you lower the chances of it happening to your baby.

Thank you for reading our blog on how to prevent SIDS. PLEASE share and pass this along to keep babies safe while sleeping.

Why a Breathable Baby Crib Mattress Should Also Be Air Permeable

Breathable Baby Crib Mattress

Why a Breathable Baby Crib Mattress Should Also be Air Permeable

About Breathable:

Many crib mattress companies are beginning to market their fiber filled or plastic filled baby mattresses as being “breathable.”  So what is the definition of breathable?  When it comes to fiber and fabrics, the definition of breathable is admitting air to the skin and allowing sweat to evaporate.

Air Permeable:

The definition of air permeable when it comes to fibers and fabric is the rate of airflow passing perpendicularly through a known area under a prescribed air pressure differential between two surfaces of a material.  

Many parents believe a breathable baby crib mattress is the same as an air permeable crib mattress.  There are some similarities between a breathable baby crib mattress and an air permeable crib mattress; both admit air to the skin and both allow sweat to evaporate.  However, the air permeable crib mattress is the only crib mattress  that is recognized by medical professionals and safe sleep experts as addressing the risk factors associated with infant sleep related deaths.


In fact, the SafeSleep® Breathe-Through Crib Mattress created by Safe Sleep Technologies, (formerly Secure Beginnings) is the only breathable baby crib mattress that is also air permeable.   The SafeSleep® air permeable crib mattress is the only breathable baby crib mattress on the market today that is approved and endorsed by leading American Academy of Pediatric (AAP) physicians as addressing the multiple risk factors associated with infant sleep related deaths (SIDS/SUID).

In 2011, Dr. Margie Andreae and her sister Julie – the creator of the first commercially viable breathable baby crib mattress that is also air permeable – began to challenge the AAP’s Safe Sleep Task Force to include relevant test data proving the SafeSleep® air permeable crib mattress reduces the many risk factors associated with infant’s health and safe sleep.

The pair used scientific literature supported rationale to convince the Task Force to recognize the safety and health benefits of air permeable crib mattresses.

The AAP’s Task Force on Sudden Infant Death Syndrome technical report was originally published online October 17, 2011 in Pediatrics.

Dr. Rachel Moon, the Chair of the Task Force, maintains that there was no data to support the use of breathable crib mattresses or air permeable crib mattresses to prevent SIDS/Suffocation at that time. 


Relevant scientific test data shows the air permeable crib mattress by Safe Sleep Technologies: 

  • Reduces the risk of CO2 rebreathing compared to a fiberfill  mattress,
  • Eliminates the use of a crib sheet and potential for entanglement, and
  • Reduces Staph aureus colonization by eliminating the fiber fill or plastic core.     


Prior to the publication of the AAP Task Force report, studies were available that clearly demonstrated that the risk of rebreathing of exhaled air (CO2) was lowest on breathable baby crib mattresses that are also air permeable  (Kemp 2000, Bar-Yishay 2011).   In addition, Dr. Moon was provided with test data from Intertek, a CPSC accredited and recommended lab, showing significantly low risk hazard of rebreathing of an air permeable crib mattress (lower than the firm fiber fill crib mattress with tight fitting sheet). The data demonstrates  air permeable crib mattress have significantly lower CO2 retention.  All three reports use similar test methods and have similar results.  

While the studies of the three breathable baby crib mattresses that are also air permeable 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.  Indeed no studies have substantiated the rebreathing hypothesis; however, this is the same hypothesis used by the AAP Task Force to support many of their recommendations including the following with quotes taken from the AAP Task Force report.

  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.”


In addition, 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 unresponsive 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 the Chair of the  AAP Safe Sleep 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 but fails to recommend air permeable crib mattresses as being preferable to air impermeable crib mattresses to address infants face-straight- down on firm mattresses despite the continued report of such deaths.


Further the Task Force’s accompanying policy statement (AAP, 2011) recommends the following sleep surface: “Use a firm sleep surface—A firm crib mattress, covered by a fitted sheet, is the recommended sleeping surface to reduce the risk of SIDS and suffocation.”

Here the authors are stating that the firm crib mattress reduces the risk of SIDS.  Even though they list this recommendation as Level A, they fail to provide the citations that support this recommendation in the policy statement.  In referring back to the technical report, the authors rely on the CPSC recommendations to support their recommendation for the firm crib mattress:

“Cribs should meet safety standards of the CPSC, Juvenile Product Manufacturers Association, and the ASTM International (formerly the American Society for Testing and Materials), including those for slat spacing, snugly fitting and firm mattresses, and no drop sides.121”

This citation [121 US Consumer Product Safety Commission. Crib Safety Tips: Use Your Crib Safely. Washington, DC: US Consumer Product Safety Commission. CPSC document 5030] is a tip sheet written for parents and caregivers.  It is not a well-conducted case-control study, a systematic review, or a meta-analysis.  No other citation is provided.  The citations for this recommendation do not meet the Level A requirements. 


Dr. James Kemp and colleagues were some of the first to study the potential for various sleep surfaces to prevent infant rebreathing (Kemp 2000).  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—a breathable baby crib mattress that is also air permeable—was able to maintain CO2 levels below this threshold.  The authors go on to say that “even firm crib 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 (L’Hoir 1998 and Mitchell EA 1999). These studies and others show 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 crib mattress. Dr. Kemp’s data supports that if vulnerable infants were placed on an air permeable crib mattress or surface, they would experience less risk of rebreathing should they inadvertently roll prone.  There is no reference to breathable crib mattresses that are not air permeable reducing CO2 levels or reducing risks.


Dr. Ephraim Bar-Yishay and colleagues provided the second study on CO2 accumulation and rebreathing on six infant sleep surfaces—a breathable baby crib mattress that is also air permeable, two conventional firm crib mattresses and three mattresses with an additional layer or topper designed to improve air flow similar to the toppers on current crib mattresses claiming to be “breathable crib mattresses”. (Bar-Yishay 2011).  The breathable baby crib mattress that is also air permeable had a significantly faster rate of CO2 elimination and only the breathable baby crib mattress that is also air permeable was able to prevent CO2 accumulation with maximal CO2 levels significantly lower than that of the other crib mattresses. They concluded that the breathable baby crib matress that is also air permeable exhibited significantly better aeration properties compared to the other five mattresses including the firm crib mattresses.  the crib mattresses with “breathable” toppers to improve airflow – now being marketed as breathable crib mattresses – actually had higher rates of CO2 than the conventional crib mattress with no breathable  cover.


Finally a US manufacturer of a breathable baby crib mattress that is also air permeable contacted the CPSC for recommendations on an accredited independent lab to conduct similar tests on aeration properties on their product.  Intertek was recommended because they use a similar mechanical model and methods as designed by Dr. Kemp.  The lab compared CO2 elimination on four different surfaces—the breathable baby crib mattress that is also air permeable, a firm mattress with tight fitting sheet, sheepskin, and a bean bag chair.  The latter two are known high risk hazards for rebreathing (Kemp 1991, Kemp 1993) and have been implicated in a significant number of SIDS fatalities. Just as in the studies by Kemp and Bar-Yishay, the breathable baby crib mattress that is also air permeable showed significantly less CO2 retention than the firm crib mattress and the high hazard comparators.  Intertek concluded that the breathable baby crib mattress that is also air permeable represents a significantly lower risk hazard for rebreathing than the firm crib mattress.  They also compared the air permeability of the breathable crib mattress that is also air permeable to a firm crib mattress using the ASTM-D737-04 standard test method of air permeability of textiles. Based on the test data, the breathable baby crib mattress that is also air permeable has an air permeability rate over 330 times greater than the firm crib mattress.

These two well-designed, well-conducted case controlled studies along with the independent CPSC testing lab results strongly support a recommendation for use of a breathable baby crib mattress that is also air permeable.  Just as the Task Force’s five Level A recommendations listed above are all based in some  part on risk of rebreathing, it stands to reason that the Task Force would recommend the breathable baby crib mattress that is also air permeable with its significantly lower risk of rebreathing than the firm crib mattress with tight fitting sheet.


The AAP Task Force concurs with the CPSC that all loose bedding should be removed from the infants sleep environment.  The CPSC and the AAP issued an alert in 2001 warning parents and pediatricians of the “hidden hazard in babies’ cribs” of loose crib mattress sheets based on death reports of infants who suffocated or strangled when they became entangled in their crib mattress sheet. Two of the deaths involved fitted sheets.  The CPSC now requires that all crib mattress sheets carry a warning that the sheet should not be used if it doesn’t fit properly. CPSC pushed the sheet-making industry to improve the fit of sheets on crib mattresses. However deaths from sheet entanglement remain a risk for infants.  In the CDC’s multistate SUID Case Registry, the mechanism most frequently reported for possible and unexplained suffocation deaths was soft bedding which the registry defines as soft or loose bedding (Shapiro-Mendoza 2014). The loose bedding is not further defined but could be a blanket or fitted sheet that became loose.  

Crib mattress manufacturers are not sheet manufacturers. The CPSC defines the industry requirements for mattress size based on ASTM standards. Their length and width requirements are consistent but their requirement for height is  six inches or less, making mattress sizes inconsistent.  Because there are no crib sheets made for a given mattress, the crib sheet remains a hazard. The design of the breathable crib mattress that is also air permeable eliminates this risk because no sheet or other bedding is used.  Breathable crib mattresses that are not air permeable, still use a sheet.

The same data used by the AAP Safe Sleep Task Force in its recommendation against the use of soft or loose bedding, also supports a recommendation against the use of a crib mattress sheet when possible.


A recent peer-reviewed article attempts to establish bacterial infection as having a major role in the pathophysiology of SIDS (Goldwater 2013).  The authors debunk the respiratory physiology model both as being unproven and inconsistent with the most plausible physiological events that take place during a SIDS death. 

A recent study showed SIDS victims, especially those found prone, are more often colonized with S. aureus than living control subjects (Highet 2014).  Studies demonstrate colonization of traditional fiber filled crib mattresses with Staph aureus (Sherburn 2007) suggesting a source for acquiring these bacteria.  While no studies are available measuring colonization of breathable baby crib mattresses that are also air permeable, the surface is designed to be removed and laundered.  The SafeSleep® by Safe Sleep Technologies, recommends regular cleaning of the surface in a conventional washer and dryer.  Breathable baby crib mattresses that are not air permeable have fiber or other fills that can become contaminated.

Based on the bacterial infection hypothesis, it stands to reason the AAP Safe Sleep Task Force should consider recommending regular washing of infant sleep surfaces and removal of fillers from crib mattresses to reduce exposure to these pathogens.

After a long evidentiary process, the 2016 Safe Sleep Technical report now recognizes the safety advantages of breathable crib mattresses that are also air permeable crib in reducing the risk of unexpected suffocation/entanglement and other hazards that may be associated with SIDS.

The AAP does not recommend the use of breathable crib mattresses that are not also air permeable to reduce the risk of SIDS and other infant sleep related deaths.

For more information on breathable baby crib mattresses that are also air permeable please visit

Breathable Crib Mattress


Patrick L. Carolan, MD; William B. Wheeler, MD; James D. Ross, RRT, RCP; and James S. Kemp, MD, (2000), Potential to Prevent Carbon Dioxide Rebreathing of Commercial Products Marketed to Reduce Sudden Infant Death Syndrome Risk, Pediatrics, 105:4 774-779

Bar-Yishay, E., Gaides, M., Goren, A. and Szeinberg, A. (2011), Aeration properties of a new sleeping surface for infants. Pediatr. Pulmonol., 46: 193–198. doi: 10.1002/ppul.21351

L’Hoir MP, Engelberts AC, van Well GTJ, et al.  Risk and preventive factors for cot death in the Netherlands, a low-incidence country.  Eur J Pediatr. 1998;157(8):681– 688

Edwin A. Mitchell, BSc, MBBS, DCh, FRACP, FRCPCH, DSc; Bradley T. Thach, MD; John M. D. Thompson, PhD; Sheila Williams, BSc; for the New Zealand Cot Death Study, Changing Infants’ Sleep Position Increases Risk of Sudden Infant Death Syndrome.  Arch Pediatr Adolesc Med. 1999;153:1136-1141.

Kemp JS, Thach BT. Sudden death in infants sleeping on polystyrene-filled cushions. N Engl J Med. 1991 Jun 27;324(26):1858–1864

Kemp JS, Thach BT. A sleep position–dependent mechanism for infant death on sheepskins. AJDC. 1993;147:642-646.

American Academy of Pediatrics Task Force on Infant Positioning and SIDS.  SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment, Pediatrics; originally published online October 17, 2011; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME DOI: 10.1542/peds.2011-2284

Jodi Pike, MD and Rachel Y. Moon, MD, Bassinet Use and Sudden Unexpected Death in Infancy, J Pediatr. Oct 2008; 153(4): 509-512

McDonell, Emily and Moon, Rachel, Infant Deaths and Injuries Associated with Wearable Blankets, Swaddle Wraps, and Swaddling, Journal of Pediatrics 2014; 164:1152-6

US Consumer Product Safety Commission. CPSC Alerts Caregivers to Hidden Hazard in Babies’ Cribs, Washington, DC: US Consumer Product Safety Commission; MAY 18, 2001; Release Number: 01156

Carrie K. Shapiro-Mendoza, PhD, MPHa, Lena Camperlengo, DrPHa, Rebecca Ludvigsen, MPHb, Carri Cottengim, MAc, Robert N. Anderson, PhDd, Thomas Andrew, MDe, Theresa Covington, MPHf, Fern R. Hauck, MD, MSg, James Kemp, MDh, and Marian MacDorman, PhDd.  Classification System for the Sudden Unexpected Infant Death Case Registry and its Application.  J Pediatr. Jun 2014; DOI: 10.1542/peds.2014-0180

Paul N. Goldwater1,2 and Karl A. Bettelheim. SIDS Risk Factors: Time for New Interpretations.

The Role of Bacteria. Pediatrics Research International Journal. Aug 2013; Vol. 2013, Article ID 867520; DOI: 10.5171/2013.867520

Amanda R. Highet, Anne M. Berry, Karl A. Bettelheim, Paul N. Goldwater. Gut microbiome in sudden infant death syndrome (SIDS) differs from that in healthy comparison babies and offers an explanation for the risk factor of prone position. International Journal of Medical Microbiology. Jul 2014; Volume 304, Issues 5–6, July 2014, Pages 735–741; DOI: 10.1016/j.ijmm.2014.05.007

Jenkins R.O, Sherburn R.E. Used cot mattresses as potential reservoirs of bacterial infection: nutrient availability within polyurethane foam. J Appl Microbiol. Nov 2007;  Epub 2007

When Will My Baby Roll Over?

Safest Crib Mattress when a baby begins to roll

Many new parents ponder the question, “when will my baby roll over?”  If you ask a group of parents when their baby first rolled over, you will likely get a variety of answers. This is because there is no exact age that babies will rollover. On average most babies are able to roll by 4-6 months of age. Others roll as early as two months of age. Rolling over takes strength and coordination.

Will my baby roll over from their back to their tummy or tummy to back first?

Most babies learn to roll from their tummy to their back first. Babies need time and practice to build up the muscles in their back, arms, and neck. This is why tummy time is crucial to helping your baby learn to roll over. Rolling from back to tummy is typically later because this takes significantly more strength in the neck and back.

How can I help my baby learn how to roll over?

When in tummy time, encourage your baby to lift their head up off of the surface and turn to one side by talking to them and having them try to follow your voice. This motion of lifting the head and turning is fundamental to eventual rolling over. Once they have mastered this, help your baby raise their head and chest up off the surface by placing their arms in front of them under their shoulders so they can easily push up using their arms. 

Do I need to worry about my baby rolling over in their sleep?

It can be exciting when your baby does begin to roll over, but it can also cause anxiety. Many parents worry about their baby rolling over in their sleep.  The American Academy of Pediatrics and the Centers for Disease Control instruct parents to place their babies to sleep on their backs to reduce the risk of Sudden Infant Death Syndrome (SIDS). According to the CDC, about 3,600 babies die from SIDS in the United States every year. Prone or face-down sleeping increases the risk of infants re-breathing carbon dioxide that they exhale into their sleep surface. A high level of carbon dioxide can suppress the infant’s breathing center. 

Is there anything I can do to keep my baby safe if my baby rolls over in their sleep?

Babies should always be placed on their back in their crib, but your baby will roll over during the night eventually. And when this happens using a SafeSleep® Breathe-Through Crib Mattress can give parents peace of mind knowing that their baby can breathe even when face down. Traditional crib mattresses with vinyl covers, cores, quilted toppers, and even loose-fitting sheets have been known to trap carbon dioxide; this is especially concerning when your baby rolls over. The SafeSleep® Breathe-Through Crib Mattress significantly reduces the risk of carbon dioxide rebreathing even if the infant is face down or tummy sleeping.

Are there other precautions I need to take to keep my baby safe once my baby can roll over?

One of the leading causes of injuries to infants is a fall from an elevated surface such as a parent’s bed or a changing table.  This often occurs in a split second when a parent sets their baby down and the baby unexpectedly rolls for the first time.  Unfortunately, the roll may be right off of the bed or changing table onto the floor.  To prevent this type of injury always keep one hand on your baby when they are on an elevated surface without protective baby-safe side rails or netting regardless of their age.