Baby Sleeping Face Down?

Baby Sleeping Face Down

Are you finding your baby sleeping face down? 

Finding your baby sleeping face down is a terrifying feeling.  The founders of SafeSleep® know too well.  They lost loved ones to SIDS / positional asphyxiation.  One was 4 months and the other was 7 1/2 months; two seemingly healthy infants were found face down and unresponsive. 

Consequently, we believe all crib mattresses should be designed to be breathe-through.  Breathe-through crib mattresses do not contain any fill of any kind, and they offer the solution to bridge the safety gap not addressed by the back-to-sleep campaign – what to do when a baby begins to roll.

Babies normally reach the developmental milestone of rolling over when they are around four months.  But some reach it as early as two months.

Since one of the founders is a pediatrician, we used scientific data and turned our tragedy into innovation to successfully answer the question that the Back to Sleep campaign does not!  What can I do if my baby starts to roll in the middle of the night and is sleeping face down?  

Our mission was to create a crib mattress to eliminate all the risk factors associated with SIDS deaths.  A crib mattress that allows an infant to breathe normally should they end up face down on their mattress.  Knowing the dangers of stomach sleeping infants rebreathing carbon dioxide, we made sure carbon dioxide would be gone on our breathe-through crib mattress before a baby takes in their next breath by eliminating any type of fill or core material known to trap carbon dioxide . 

Since sheets and other bedding materials are linked to infant deaths, we eliminated the need for them.  Instead, we made the entire mattress surface machine washable and the mattress frame easy to wipe clean. 

We also addressed multiple other safety issues including, infant overheating, positional pressure on an infant’s delicate skull, eliminating liquids, including spit up, accumulation on the mattress surface, and we made sure there were no toxins or other potentially harmful chemicals.

The AAP has No Clear Guidelines to Address the Situation “When a Baby Begins to Roll”

Current recommendations and guidelines of the American Academy of Pediatrics (AAP) and other sources for infant safety do not address the situation of the infant who rolls over in the middle of the night unsupervised.  Too often, these babies end up in a straight-down position.  Unfortunately, when the baby is sleeping face down, he or she is at a significantly increased risk of SIDS and positional asphyxiation

Infants Rolling Over and Sleeping Face Down

Researchers from New Zealand have shown that more than a quarter of infants who died of SIDS in their study were last placed in a prone (tummy) position (back).²  These researchers suggest an infant’s ability to escape potentially fatal situations during prone sleep may be impaired by inexperience in prone sleep.  Later, their findings are supported by Dr. Moon and colleagues in their review of infant sleep related deaths in child care settings.³ 

Unfortunately, infant inexperience in prone sleep is now a common unintended consequence of the successful back-to-sleeping campaign.  Notably, we have no way of keeping young infants from rolling, and far too often we find them sleeping face down.

Infants Begin to Roll at Four Months

Specifically, parents and caregivers are often concerned about the appropriate strategy for infants to learn to roll over, which usually takes place around four months.  Normally babies roll from back to tummy before they roll from tummy to back.  About six months old, they start rolling in both directions.   

SIDS Risk and Baby Rolling Over

The fact is, infants under six months of age represent about 90 percent of all SIDS-related deaths.  The belief is that SIDS risks is peaking between 1-4 months of age.  Notably, this is the age infants are just beginning to roll over.

In a study on infant sleep, 6% and 12% of 16 to 23-week-old infants placed on their backs or sides are found in a vulnerable (face-down) position.  Additionally, 14% of infants aged 24 weeks or older are in the prone position.  Lastly, 18% of those placed on either their right or left or sides, are found in the prone position.4

Repositioning Baby Who is Sleeping Face Down

Parents are encouraged to move an infant who is sleeping face down back to the supine (back) position.  However, turning a baby back over is unrealistic with several position changes per night.  Furthermore, if a baby sleeps on his tummy, the repositioning of the sleeping baby to the supine (back) position can be disruptive and could completely discourage the use of the supine position. 

According to a study published in the Journal of the American Medical Association, there is insufficient data on specific recommendations on when infants can sleep in a prone position.4

Nothing to Do with Good Head and Neck Control

Parents are often falsely assured when their infant rolls on their own or has good head control, they are no longer at risk of SIDS.   

In contrast, scientific test results tell us differently.  According to SIDS researcher Dr. Bradley T. Thach, “The first times babies who usually sleep on their backs or sides roll or are put on their tummy have a 19-fold increase in the risk of sudden death,” he says. “We wonder if these babies, who find themselves face down, do not turn their heads to breathe easier.  If so, that is because their reflexes haven’t developed far enough or because they simply don’t wake up?  Many parents believe if a baby can lift its head, he or she is okay to sleep on their tummy, but that is a false assurance,” Thach says.5

Carbon Dioxide and Baby Sleeping Face Down

Currently, the AAP recommends a firm crib mattress with a tight-fitting sheet.  However, the firm mattress with tight-fitting sheet has been shown posing a high risk of rebreathing of carbon dioxide.  In fact, according to a 2000 study published in Pediatrics, the findings reveal  firm mattresses can pose a high risk of rebreathing  when infants sleep prone.6   Further, these findings may be of relevance to recent studies showing that unaccustomed prone sleepers, i.e., infants who typically sleep supine but are inadvertently placed or roll prone, have an increased risk of SIDS.   For example, these studies show from 43% to 71% of SIDS victims, unaccustomed to prone sleep, were discovered in the face-straight-down position.” 5

Carbon Dioxide Rebreathing and SIDS

Rebreathing is when an infant lies face-down or near-face-down on his stomach and air is trapped around the baby’s nose or mouth.  Consequently, this trapped exhaled air causes the baby to breathe more carbon dioxide than oxygen.  Specifically, if the baby does not wake up or respond appropriately, it leads to death.7

David Greenblatt, Faculty of Mechanical Engineering, Flow Control Laboratory, demonstrates Infant Suffocation Caused by Rebreathing Carbon Dioxide.

Unfortunately, conventional crib mattresses with fiber fill, vinyl covers, and quilted toppers can cause carbon dioxide to accumulate.  According to Dr. James Kemp and Dr. Brad Thach, these bedding materials act to retard the dispersal of exhaled gasses (carbon dioxide), retaining the gasses near a face down infant’s nose and mouth.  With each subsequent breath, the infant takes in an air mixture which is progressively less adequate to sustain life. Further, the more conducive an item is to rebreathing (retaining carbon dioxide), the more hazardous the item is.8

Based on multiple peer-reviewed studies, SIDS experts agree, infants sleeping on their tummy 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. 

The Consumer Products Safety Commission warns against placing babies to sleep on couches and chairs.  They also warn parents about the dangers of putting a pillow under a sleeping baby.  All these items are proven to trap carbon dioxide and can lead to rebreathing if a baby is in the neutral stomach position.  

A Real Solution for a Real Problem

Developed by People with Real KnowledgeOur Story!

SafeSleep ® is the safest crib mattress and only crib mattress with no fibre fill or core. We designed our breathable crib mattress to have a hollow center, side openings and a firm, air-permeable topper to create an oxygen-rich environment, even if an infant is face down all night.  We also made our crib mattress recyclable, non-toxic, completely washable and super comfortable to remove the use of crib mattress sheets.

The SafeSleep® eliminates the risk of an infant rebreathing carbon dioxide.  See how the SafeSleep® crib mattress works!

Scientific Data on Air-Permeable Crib Mattresses

Scientific evidence shows that some air permeable mattresses have a “significant” reduced risk of rebreathing of carbon dioxide.9,10  For instance, the SafeSleep® Breathe-Through Crib Mattress has been tested for carbon dioxide retention and has a tenfold decrease in carbon dioxide retention compared to a fiberfill mattress with a tight-fitting sheet.  For example, it takes 120 seconds for carbon dioxide to dissipate on a firm crib mattress with a tight sheet.  However, it takes less than 1/2 a second for it to dissipate on the SafeSleep® Crib Mattress.10

In conclusion, an infant takes a breath 40-60 times per minute or every 1-2 seconds, which means the carbon dioxide (poisonous gases) on the SafeSleep® Breathe-Through mattress disappears before the infant takes his next breath of air – even if their face is straight down.

An infant takes a breath every 1-2 seconds

Mattresses with Foam, Padding, or Encased Fill

  • It takes 160 seconds for carbon dioxide to dissipate into a firm crib mattress.
  • Carbon dioxide is accumulating when a baby is face down on a firm crib mattress.

SafeSleep® Breathable Crib Mattress

  • It takes less than 1/2 a second for carbon dioxide to dissipate into the SafeSleep® breathable crib mattress. 
  • Carbon dioxide on the SafeSleep® breathable crib mattress leaves before your baby takes their next breath of air—even if your baby is sleeping face down.

Is your baby sleeping face down?  Learn more about breathe-through crib mattresses at    

Study References:

  1. Carleton, James N.,  Donoghue, Ann M.,  Porter, Warren K. Mechanical model testing of rebreathing potentialin infant bedding materials.  Arch Dis Child 1998;78:323–328
  2. Mitchell EA, Thach B, Thompson J, Williams S. Changing infants’ sleep position increases risk of sudden infant death syndrome. Arch Pediatr Adolesc Med. 1999;153:1136–1141
  3. Rachel Y. Moon, Kantilal M. Patel and Sarah J. McDermott Shaefer. Sudden Infant Death Syndrome in Child Care Settings. Pediatrics 2000;106;295
  4. Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA. 1998
  5. Paluszynska DA, Harris KA, Thach BT. Influence of sleep position experience on ability of prone sleeping infants to escape from asphyxiating microenvironments by changing head position. Pediatrics, Dec. 1, 2004.
  6. Patrick L. Carolan, William B. Wheeler, James D. Ross and RCP*; and James S.Kemp, Potential to Prevent Carbon Dioxide Rebreathing of Commercial Products Marketed to Reduce Sudden Infant Death Syndrome Risk, Pediatrics 2000 105;774
  7. Patel, Aloka L., Harris, Kathy, Thack, Bradley T. Inspired CO2 and O2 in sleeping infants rebreathingfrom bedding: relevance for sudden infant death
  8. Kemp, James S., Nelson, Verna E., Thach, Bradley T.,  Physical Properties of Bedding That May Increase Risk of Sudden Infant Death Syndrome in Prone-Sleeping Infants.  Journal of Pediatrics,July,1994,Vol.36,no.S1
  9. 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
  10. William W. Fox, MD and Thomas H. Shaffer, Carbon Dioxide Rebreathing Assessment of SafeSleep® Crib Mattress Sample.  Intertek., wouso7330