Is a Breathable Crib Mattress Worth it?

Best Breathable Crib Mattress

Is a Breathable Crib Mattress Worth it?

We are starting to hear a lot more about the benefits of “Breathable Crib Mattress.”  But is a breathable crib mattress worth it?   

Prior to breathable crib mattress which hit the consumer market in early 2000, crib mattresses were made either with polyurethane foam, memory foam or some type of cotton or wool batting or other fiberfill.  These crib mattresses often have a vinyl or waterproof cover to prevent the “fill” from becoming contaminated.

Crib Mattresses and Flame Retardants

In 1975, all crib mattress manufacturers were subject to stringent flammability requirements enforces by the Consumer Product Safety Commission (CPSC).  These standards were put in play after foam crib mattresses were becoming ingulfed in flames during home fires.   This new regulation forced crib mattress manufacturers to use flame retardants such as boric acid and other harmful chemicals in their products to meet these new regulations. 

The Popularity of Organic Crib Mattresses

In the mid 80’s, organic crib mattresses were gaining popularity because of their eco-friendly and natural fiber content that eliminated the need for flame retardants.  These certified organic cotton and wool mattresses still need chemical coatings to protect the fill from becoming contaminated.  These coatings are in the form of sprayed on nano-coatings or silicas.  Nano-coatings are not toxic, but the monomers that are needed to bind the coating, so it adheres to the fabric sleep surface is a known carcinogenic.  Still, parents seem willing to spend more on these hybrid mattresses to prevent their infants from exposure to flame retardant chemicals and the off gassing caused by heat buildup on vinyl covers.

Scientist Begin Studying the Correlation of Crib Mattresses and SIDS

In the early 90’s, scientists began realizing the effects of infant bedding, including crib mattresses, in Sudden Infant Death Syndrome (SIDS) cases.  Do these findings alone help answer the question, is a breathable crib mattress worth it?  Dr. James Kemp and Dr. Brad Thatch were two of the first scientists who began studying the effects of various types of infant sleep surfaces and mattresses.  They quickly realized surfaces that retained high levels of carbon dioxide (or had low carbon dioxide dispersion rates) proved to be significantly more dangerous than surfaces that did not allow carbon dioxide to accumulate.  One such study concludes the dangers of infants sleeping on sheep skin which was a popular surface used in many Scandinavian Countries.  Kemp and Tatch labeled sheepskin as a high-risk hazard in an infant’s sleep environment since it retains high levels of carbon dioxide.  Kemp and Tatch used similar methods to point out the dangers of crib mattresses with porous interiors noting, “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 caused more rebreathing.”

Additional Studies helping to answer the question, “Is a breathable crib mattress worth it?”:

The Year of the Breathable Crib Mattress

Even though breathable crib mattress designers were awarded patents dating back to 1950, it was not until 2000 that the first breathable crib mattresses were readily available for consumer purchase in the U.S.  One of the more notable breathable crib mattresses was known as the Halo Active Airflow Mattress, by Halo® Innovations.  The Halo crib mattress had a solid plastic frame with a hollow core and a fan in it to dispel carbon dioxide.  Unfortunately, the Company discontinued sales of the product in 2011.  The design was bulky making it difficult for consumers to change the bedding and it required constant replacement of the fan’s filters.  The product had merit on the safety aspects but fell short on ease-of-use.  Because of the difficulty in using the product, consumers did not believe a breathable crib mattress worth it?  However, the product did bring about an interest by future manufacturers of breathable crib mattresses to have their products scientifically tested using similar methods to the Halo brand crib mattress.  These studies began proving on a safety front that breathable crib mattresses are worth the higher price.

Scientific Studies Begin on Crib Mattresses Marketed to be Breathable

  • 2000 Dr. Kemp and Colleagues

  • 2011 Ephraim Bar-Yishay and Colleagues

  • 2012 Dr. William W. Fox and Dr. Thomas H. Shaffer

2000 Dr. Kemp and Colleagues

In 2000, the Halo Active Airflow Mattress was one of five products marketed in the US to prevent rebreathing of carbon dioxide.  Dr. Kemp and colleagues studied all five products along with a firm crib mattress with a tight-fitting sheet.  An infant mannequin with its nares connected via tubing to an 100-mL reservoir filled with 5% CO(2) was used. The mannequin was positioned prone face-down or near-face-down. The sleep surfaces were studied with the covering sheet taut, covering sheet wrinkled, and with the mannequin arm positioned up, near the face.

 According to Kemp, “We measured the fall in percentage end-tidal CO(2) as the reservoir was ventilated with the piston pump. The half-time for CO(2) dispersal (t(1/2)) is an index of the ability to cause or prevent rebreathing. Compared with the face-to-side control, 5 of 6 surfaces allowed a significant increase in t(1/2) in all 3 prone scenarios. The firm mattress and 4 of the 5 surfaces designed to prevent rebreathing consistently allowed t(1/2) above thresholds for the onset of CO(2) retention and lethal rebreathing in an animal model (J Appl Physiol. 1995;78:740).”  This means, 4 of the 5 products tested along with the firm crib mattress with a tight- fitting sheet posed a hazard for an infant placed or rolling to the prone (tummy) position. 

Kemp states, “With very few exceptions, infants should be placed supine (back) for sleep. For  infants placed prone or rolling to the prone position, significant rebreathing of exhaled air would be likely on all surfaces studied, except one – the Halo Active Airflow Crib Mattress.   The four other products tested; Bumpa Bed, Breathe Easy, Kid Safe/Baby Air, and Sleep Guardian never achieved any commercial success.

2011 Dr. Ephraim Bar-Yishay and Colleagues

In 2011, Dr. Ephraim Bar-Yishay and colleagues provided the second study on CO2 accumulation and rebreathing on six infant sleep surfaces—an air permeable crib mattress marketed in Isreal, two conventional firm crib mattresses and three mattresses with an additional layer or topper (mattress pad) designed to improve air flow (Bar-Yishay 2011). The breathe-through crib mattress had a significantly faster rate of CO2 elimination and only the air permeable mattress was able to prevent CO2 accumulation with maximal CO2 levels significantly lower than that of the other mattresses. They concluded that the breathe-through crib mattress exhibited significantly better aeration properties compared to the other five mattresses including the firm mattresses with tight sheet.  

2012 Dr. William W. Fox and Dr. Thomas H. Shaffer

SafeSleep®, a U.S. manufacturer of a breathe-through crib mattress, opted to use a CPSC accredited lab to conduct similar tests on aeration properties on their product.  The test methods were designed by Dr. William W. Fox and Dr. Thomas H. Shaffer.  Their test method use a similar mechanical model and methods as  designed by Dr. Kemp. The lab compared CO2 elimination on four different surfaces—the SafeSleep® air permeable crib mattress, 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 SafeSleep® breathable crib mattress showed significantly less CO2 retention than the firm crib mattress and the high hazard comparators. The lab concluded that the SafeSleep® breathe-through crib mattress represents a significantly lower risk hazard for rebreathing than the firm crib mattress. Intertek also compared the air permeability of the SafeSleep® breathe-through crib mattress to a firm crib mattress using the ASTM-D737-04 standard test method of air permeability of textiles.  Based on the test data, the SafeSleep® air permeable crib mattress has an air permeability rate over 330 times greater than the firm crib mattress with tight sheet.

These well-designed, well-conducted case controlled studies strongly support a recommendation for the use of air permeable/breathable crib mattresses in reducing the risk of SIDS and suffocation.  So is a breathable crib mattress worth it?

Safe Sleep Policy and Carbon Dioxide Rebreathing

Today SIDS experts and Safe Sleep Advocates believe many SIDS deaths are caused by infants rebreathing their exhaled air, carbon dioxide.   This is evidenced in the American Academy of Pediatrics (AAP) 2016 safe sleep policy

This report provides the evidence used to support the AAP’s “Recommendations for a Safe Infant Sleeping Environment” which is used by all safe sleep advocates.

Let’s look at the following quotes taken from the AAP’s Safe Sleep Policy Statement keeping in mind the question, “Is a breathable crib mattress worth it?”; 

  • Supine sleep position: “The prone or side sleep position can increase the risk of rebreathing expired gases, resulting in hypercapnia and hypoxia.”
  • 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.”
  • 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.”
  • 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.”
  • 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 there are no studies that demonstrate a direct prevention of SIDS or suffocation by the avoidance of rebreathing carbon dioxide, this is the hypothesis the AAP Safe Sleep Task Force uses to make the majority of their safe sleep recommendations including back sleeping and using a firm crib mattress with a tight-fitting sheet.

Some will argue that there is no evidence that breathable mattresses are safer or will make any difference, the same would have to be said about a firm crib mattress, back sleeping, co-sleeping, and the majority of the other safe sleep recommendations provided by the AAP’s Safe Sleep Task Force Members.  The fact is, we have no gold standard studies when it comes to SIDS prevention.  In order to have this type of scientific evidence, unethical testing would have to be done. 

The idea is that babies end up with an object covering their face, creating a pocket of air, forcing them to repeatedly inhale the carbon dioxide they’re exhaling, depriving them of oxygen and causing carbon dioxide to build up in the body. “There hasn’t been any definitive evidence that that’s what’s going on, but it seems to make sense,” says Dr. Rachel Moon,  Chair of the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome.  

So if a crib mattress can eliminate the risk of an infant rebreathing carbon dioxide, is a breathable crib mattress worth it?

The Arousal Defect

Most SIDS and Safe Sleep Experts believe some infants do not respond when they are rebreathing their carbon dioxide.  Most infants will respond.  They have the same natural instinct to move their head or roll over if their oxygen becomes compromised.  Babies who die from rebreathing are believed to have what’s called an “arousal defect” which prevents them from waking up even when they’re not getting enough oxygen.  Dr. Umakanth Katwa, Attending Pulmonologist and Director of the Sleep Laboratory at Boston Children’s Hospital and professor at Harvard Medical School states, “Babies with SIDS not only need to suffocate, but they need to have the abnormal arousal response. That means even though they are rebreathing their carbon dioxide, what happens is the brain doesn’t wake up.  So that means they cannot lift the head, turn on the side, or roll over.”

Dr. Katwa, in an article published in Fatherly points to simulations done by mattress companies that show some mattresses can disperse carbon dioxide more quickly.  According to Katawa, “Theoretically, this would increase the amount of time it takes for carbon dioxide levels to become lethal, giving babies more time to wake up and move… This is what makes the idea of more breathable mattress so appealing and makes sense.”  In reality, crib mattresses that do not allow carbon dioxide to accumulate faster than the rate of an infant’s breathing, would prevent the baby from rebreathing lethal levels of carbon dioxide even if still asleep

Since we have no way to tell which infants will or will not have an abnormal arousal response, is a breathable crib mattress worth it?

Not All Breathable Crib Mattresses are Created or Scientifically Tested Equally

  • Breathable Crib Mattresses with Open Celled Covers and Traditional Fiberfill

  • Breathable Crib Mattresses with Hollow Cut-Outs or “Air Channels”

  • Breathable Crib Mattresses with Spongy, Food-Grade Polymer

  • Breathable Crib Mattresses with No Fill or Core

Breathable Crib Mattresses with Open Celled Covers and Traditional Fiberfill

There are some crib using the word “breathable” as loosely as manufacturers use the word “organic” to market their products.  A few examples are Lullaby Earth® and Avocado® Green.  Many crib mattress companies simply use an open-celled or 3D fabric over top of a fiberfill mattress.   In reality, these crib mattresses are shown to trap carbon dioxide.  It is no wonder these breathable crib mattress companies don’t reveal any scientific test data on carbon dioxide retention levels of their products.

Breathable Crib Mattresses with Hollow Cut-Outs or “Air Channels”

Nook®’s breathable crib mattress features hollow cut-outs within that they call “air channels.”  Nook® fills their Pebble Pure mattress with coconut husk. Dr. James Kemp, pediatric pulmonologist at St. Louis Children’s Hospital and SIDS researcher, called this “exactly the wrong idea,” in an email to a reporter at Slate Magazine, noting that a porous interior might actually trap carbon dioxide. As noted prior, 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.

Breathable Crib Mattresses with Spongy, Food-Grade Polymer

Newton® makes their breathable crib mattresses out of a spongy, food-grade polymer that they say is “90% air by volume.”  Food grade does not mean that the plastic is edible. It also is different from environmentally friendly, sustainable, or biodegradable. Food grade means the plastic can come in direct contact with the food we consume as part of the harvesting, processing, or packaging of the food.

Newton® claims its breathable crib mattresses have the lowest suffocation rate based on independent testing.  Newton® used three crib mattress comparators in their testing.  The three comparators were all traditional fiber filled crib mattresses.  Using a simulated six-month-old mannequin, the suffocation-risk test measures the blockage of the infant’s airway when face-down.  The mannequin is placed on the mattress being tested and pressure is applied to the back of the mannequin’s head. If the mattress is soft, the head will compress into the surface and block the infant’s nose; if the mattress is firm, the infant’s nose will not be blocked.  According to Newton’s unpublished test data, all the mattresses they had tested passed the suffocation test.

In reality, all firm crib mattresses will pass this test–even crib mattresses with plastic covers!  Imagine breathing for any extended period of time when your head is face down on a plastic surface and you understand why this test is not reassuring.  It’s not measuring the right risk

The Company also offers a waterproof topper.  A crib mattress with a waterproof topper cannot be air permeable.  

Breathable Crib Mattresses with No Fill or Core

The SafeSleep® breathe-through crib mattress is the only breathable crib mattress does not contain any type of fill or core material.  With no fill or core, there is nothing to become contaminated, and no reason to have a waterproof cover or coating.  It is the only breathable crib mattress to have a patented design.  The revolutionary two-part system allows an infant who is face straight down to breathe normally right through the mattress.  It is also the only crib mattresses recognized by American Academy of Pediatric Policy Makers as reducing the risks associated with SIDS and other infant sleep related deaths. 

Scientific testing reveals carbon dioxide dissipates in less than half a second on the SafeSleep® Breathe-Through Crib Mattress.  An infant takes a breath every 1-2 seconds, meaning the carbon dioxide on the SafeSleep® Breathe-Through mattress is gone before your baby takes their next breath– even if face straight down. It takes, on average, two minutes for carbon dioxide to dissipate on most crib mattresses.  For some crib mattresses that claim to be “breathable,” it takes as long as three minutes, meaning carbon dioxide will always be present for baby to breathe in. 

We believe from a safety standpoint, the SafeSleep® breathe-through crib mattress is a logical choice.  But with a $299 price tag…is the SafeSleep® breathable crib mattress worth it?

Compare the Cost

The SafeSleep® crib mattress uses no sheets or mattress pads.  On average, this is a cost savings of over $70.  The SafeSleep® mattress has a removable topper making it easy to clean in a conventional washing machine.

The American Academy of Pediatrics warns parents against the use of second-hand mattresses since the fill can be contaminated with pathogens and micro-organisms.  Since the SafeSleep® has no core or fill that can become contaminated, it can be used for additional children, making the SafeSleep® the same price as a bargain crib mattress if you use it for two children, and a cost savings if used for more. 

The SafeSleep® also transitions for use as a toddler bed with no additional cost.  The SafeSleep® crib mattress hold the weight of an 80lb child.  With no core to wash, it ideal during potty training and bedwetting phases.

Your baby will spend 70% of their first year-of-life on their crib mattress, so your baby’s crib mattress should be an important decision.   The SafeSleep® brand has been offering babies scientifically tested, safer, longer, better sleep since 2010.

Over 80,000 think it’s worth it!  Check it out here:

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