Is a Breathable Crib Mattress Worth it?

Is a breathable crib mattress worth it

Is a Breathable Crib Mattress Worth it?

Is a breathable crib mattress worth it?  They range in price from $249 up to $600.  We are hearing a lot more about the benefits of “Breathable Crib Mattress.”  But is a breathable crib mattress worth the added cost?   

Breathable crib mattresses hit the consumer market in early 2000.  Prior to breathable mattresses, crib mattresses were made with a core material with a fabric overlay.  Popular core materials include polyurethane foam, memory foam, cotton, wool batting or other plant based fibers.  Also, they have a vinyl or waterproof cover to prevent the “fill” from becoming contaminated.

Crib Mattresses and Flame Retardants

In 1975, all crib mattress manufacturers are subject to stringent flammability requirements enforced by the Consumer Product Safety Commission (CPSC).  Flammability standards are put in play after foam crib mattresses become engulfed in flames during house fires.  Consequently, new regulations force crib mattress manufacturers to use flame retardants such as boric acid and other harmful chemicals. 

The Popularity of Organic Crib Mattresses

In the mid 80’s, organic crib mattresses are gaining popularity based of their eco-friendly and natural fiber content.  Moreover, organic mattresses eliminate the need for flame retardants.  However, certified organic cotton and wool crib mattresses still need chemical coatings to protect the fill from contamination.  Popular coatings include, sprayed on nano-coatings or silicas.  Nano-coatings are not toxic, but the monomers binding the coating are.  Monomers are a known carcinogenic.  Still, parents are willing to spend more on these hybrid crib mattresses for two basic reasons.  The first reason is preventing their infants from exposure to flame retardant chemicals, and the second reason is avoiding off gassing caused by heat buildup on vinyl covers.

Scientist Begin Studying the Connection Between Crib Mattresses and SIDS

The early 90’s, scientists are noticing the effects of infant bedding, including crib mattresses, in Sudden Infant Death Syndrome (SIDS) cases.  Should these findings alone answer the question, is a breathable crib mattress worth it? 

Carbon dioxide risk discovered

During the late 70’s, Dr. James Kemp and Dr. Brad Thatch are the first scientists studying the effects of various types of infant sleep surfaces and mattresses.  They quickly realize surfaces retaining high levels of carbon dioxide (or low carbon dioxide dispersion rates) prove to be significantly more dangerous than surfaces that do not allow carbon dioxide to accumulate.  Additionally, one such study concludes the dangers of infants sleeping on sheep skin.  Sheep skin was a popular infant sleep surface used in many Scandinavian Countries. 

Known high-risk hazards

Kemp and Tatch label sheep skin as a high-risk hazard in an infant’s sleep space.  It is a hazard because of to the high levels of carbon dioxide it retains.  The scientists use similar methods to point out the dangers of crib mattresses with porous interiors.  Notably, Kemp states, “Mattress filled with tea tree bark made in Australia in the 1980s and ’90s and marketed as breathable crib mattresses turned out to increase the risk of SIDS and caused more rebreathing of carbon dioxide.”

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

The Year of the Breathable Crib Mattress

First breathable crib mattress

Breathable crib mattress designers are awarded patents dating back to 1950.  However, it  is not until 2000 the first breathable crib mattresses are readily available for consumer purchase in the U.S.  One of the more notable breathable crib mattresses is the Halo® Active Airflow Mattress by Halo® Innovations. 

About the Halo® breathable crib mattress

The Halo® crib mattress is a solid plastic frame with a hollow core and a fan in it to get rid of carbon dioxide.  Unfortunately, the Company discontinues sales of the product in 2011.  Notably, the design is bulky making it difficult for consumers to change the bedding.  Additionally, it requires constant replacement of the fan’s filters.  The product has a lot of merit on the safety front.  However, it  falls short on ease-of-use. 

The first breathable crib mattress doesn’t meet expectations

Because of the difficulty in using the product, consumers do not believe the Halo® breathable crib mattress is worth it?  However, the product does bring about an interest by future manufacturers of breathable crib mattresses to have their products scientifically tested

Testing of breathable crib mattresses

Similar testing methods used by the Halo® brand breathable crib mattress, are used by other breathable crib mattress makers.  Ultimately, these studies scientifically prove a breathable crib mattresses is significantly safer than a traditional or organic baby mattress.

Scientific Studies on Crib Mattresses Marketed to be Breathable

  • Dr. Kemp and Colleagues – 2000

  • Ephraim Bar-Yishay and Colleagues – 2011

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

2000 Dr. Kemp and Colleagues

Test procedure

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

Products tested

 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 crib mattress and 4 of the 5 surfaces designed to prevent rebreathing consistently allow 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 pose a hazard for an infant placed or rolling to the prone (tummy) position. 

Test results

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 is 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 achieve commercial success.

2011 Dr. Ephraim Bar-Yishay and Colleagues

2nd test study

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 Israel, two conventional firm crib mattresses and three mattresses with an additional layer or topper (mattress pad) designed to improve air flow (Bar-Yishay 2011).

Test results 

The breathe-through crib mattress has a significantly faster rate of CO2 elimination.  Moreover, the air permeable mattress is able to prevent CO2 accumulation with maximal CO2 levels significantly lower than that of the other baby mattresses.  In conclusion, the breathe-through mattress exhibits 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

3rd test study

SafeSleep®, a U.S. manufacturer of a breathe-through crib mattress, chooses to use a CPSC accredited lab to conduct similar tests on aeration properties on their product.  The test methods are designed by Dr. William W. Fox and Dr. Thomas H. Shaffer.  Notable, the testing uses a similar mechanical model and methods as designed by Dr. Kemp.

Products tested

The lab compares CO2 elimination on four different surfaces—the SafeSleep® air permeable crib mattress, a firm crib mattress with tight fitting sheet, sheepskin, and a bean bag chair. Sheepskin and bean bag chairs are known high-risk hazards for rebreathing (kemp 1991, Kemp 1993) and have been implicated in a significant number of SIDS fatalities.

Test results

Just as in the studies by Kemp and Bar-Yishay, the SafeSleep® breathable crib mattress showes significantly less CO2 retention than the firm crib mattress and the high hazard comparators. The lab concludes the SafeSleep® breathe-through crib mattress is a much lower risk hazard for rebreathing than the firm crib mattress.

Breathable Crib Mattress

Additionally, the lab also compares the air permeability of the SafeSleep® breathe-through crib mattress to a firm baby 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 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.   In fact, this is noted in the American Academy of Pediatrics (AAP) 2016 safe sleep policy.  The AAP Safe Sleep Policy titled,  “Recommendations for a Safe Infant Sleeping Environment” is used by all safe sleep organizations and advocates.

Looking at the following quotes taken from the AAP’s Safe Sleep Policy Statement, do you think a breathable crib mattress is 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.”

There are no studies that demonstrate a direct prevention of SIDS or suffocation by the avoidance of rebreathing carbon dioxide.  However, this is the hypothesis the AAP Safe Sleep Task Force uses to make the majority of their safe sleep recommendations.  For example, back sleeping and using a firm crib mattress with a tight-fitting sheet.

Lack of gold standard studies

Some will argue, there is no evidence a breathable mattresses is safer or will make any difference.  If this is the case, the same has to be said about a firm crib mattress, back sleeping, co-sleeping, and the majority of the other safe sleep recommendations.  The fact is, no gold standard studies exist in reference to SIDS prevention.  Unfortunately, in order to have this type of scientific evidence, unethical testing would have to be done. 

How rebreathing occurs

The risk of rebreathing exists when a baby has an object covering their face, they are positioned face down, or they have their arm or hand near their face when tummy sleeping.  Rebreathing occurs when, they repeatedly inhale the carbon dioxide they’re exhaling.  This is depriving them of oxygen and causing carbon dioxide to build up in their 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.

Flow Control Laboratory, Faculty of Mechanical Engineering, in Israel demonstrates how rebreathing occurs on a fiberfill crib mattress

If a breathable crib mattress eliminates the risk of 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.  In fact, most infants will respond.  These infants have the same natural instinct as an adult to move their head or roll over if their oxygen becomes compromised.  However, babies who die from rebreathing are believed to have an “arousal defect.”  The arousal defect prevents them from waking up even when they’re not getting enough oxygen.

Arousal defect and rebreathing

 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.  Thus, 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.”

Crib mattress showing carbon dioxide dispersion rates

Dr. Katwa, states in an article published in Fatherly points to simulations done by mattress companies that show some mattresses disperse carbon dioxide more quickly.  According to Katawa, “Theoretically, this increases 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 a 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

  •  Open Celled Covers and Traditional Fiberfill

  • Hollow Cut-Outs or “Air Channels”

  • Spongy, Food-Grade Polymer

  • No Fill or Core

Breathable Crib Mattresses with Open Celled Covers and Traditional Fiberfill

There are many crib mattress companies using the word “breathable” as loosely as manufacturers use the word “organic” to market their products.  A few examples are Lullaby Earth® , Avocado® Green, Bundle of Dreams®, Serta®, and Naturpedic® .  In reality, most crib mattress claiming to be breathable, are using 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 baby mattress companies don’t reveal any scientific test data on carbon dioxide retention or dispersal rates.

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

Nook®’s breathable crib mattress features hollow cut-outs within what they call “air channels.”  The Company 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, a porous interior might actually trap carbon dioxide. As noted prior, a study conducted by Kemp on mattresses filled with tea tree bark made in Australia in the 1980s and ’90s and marketed as a breathable turned out to increase the risk of SIDS, and 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.”  According to the FDA, Food grade does not mean the plastic is edible. Additionally, it 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.

Suffocation testing

Newton® claims its breathable mattresses have the lowest suffocation rate based on independent testing.  The Company compares their breathable crib mattress to three other crib mattresses.  Two of the crib mattresses are designed with  open celled covers with traditional fiberfill.  These two mattresses are marketed as breathable crib mattresses.  The third mattress is a foam filled mattress with a vinyl cover.  Using a simulated six-month-old mannequin, the suffocation-risk test measures the blockage of the infant’s airway when face-down. 

Test results

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 compresses into the surface and blocks the infant’s nose.  In contrast, if the crib mattress is firm, the infant’s nose is not be blocked.  According to Newton®’s test data, all the crib mattresses tested passed the suffocation test.  The traditional vinyl encased mattress scored lowest, but still passed.

The reality

In reality, all firm crib mattresses will pass this test–even crib mattresses with vinyl or plastic covers, unless the vinyl or plastic cover is loose fitting.  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.  Obviously, if liquids cannot pass through it, than air is also impeded.

Breathable Crib Mattresses with No Fill or Core

The SafeSleep® breathe-through crib mattress is the only breathable baby mattress that does not contain any type of fill or core material.  Therefore, there is nothing  interfering with passive air flow.  Fresh air flows up and down through the open celled topper.  The topper is firmly suspended over a frame with side openings that facilitate constant air flow.

Best Breathable Baby Mattress

From Tragedy to Innovation, the SafeSleep® Breathe-Through Crib Mattress is Designed for Maximum Breathability, Safety, and Comfort.


Recognized by AAP policy makers

SafeSleep® is a revolutionary two-part system allowing an infant who is face straight down to breathe normally right through the mattress.  It is 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

Scientific testing reveals carbon dioxide dissipates in less than half a second on the SafeSleep® breathable crib mattress.  An infant takes a breath every 1-2 seconds, meaning the carbon dioxide on the SafeSleep® breathable crib mattress is gone before a baby takes their next breath– even if face straight down. It takes, on average, 160 seconds for carbon dioxide to dissipate on most crib mattresses.  For some crib mattresses that claim to be “breathable,” it takes as long as 180 seconds, meaning carbon dioxide is always present for baby to breathe in if in the prone position.

Additionally, there is no fill to become contaminated.  Consequently, there is no waterproof cover or coating.  And for the same reason, there are no fire retardants.  By design, SafeSleep® is the only completely non-toxic crib mattress.

With all its features and benefits, the SafeSleep® breathable 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® breathable crib mattress uses no sheets or mattress pads.  On average, this is a cost savings of  $70.  SafeSleep® has a removable topper.  The topper is both easy to remove and wash in a conventional washing machine.  A damp cloth with liquid soap is used to sanitize the base; there is need to remove the base from the crib.  Additionally, there is no cumbersome core to bathe or shower.

Crib mattresses and pathogens

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

Breathable crib mattress for infants and toddlers

The SafeSleep® also transitions for use in a toddler bed with no additional cost.   SafeSleep® hold the weight of an 80 pound child.  With no core to wash, it is ideal during potty training and bed-wetting phases.

Your baby spends 70% of their first year-of-life in their crib, so your baby’s crib mattress is an important decision.   The SafeSleep® breathable crib mattress brand is offering babies scientifically tested, safer, better, longer sleep™ and offering parents complete peace of mind since 2010.

So is a breathable crib mattress worth it?  Yes, but be sure to choose a breathe-through crib mattress which is a lot different than the breathable baby mattresses that are marketed.