Breathable Crib Mattress – The Ultimate Guide
The medical and safe sleep experts at Safe Sleep Technologies have studied the topic of breathable crib mattresses for over a decade. They have consulted with top SIDS experts, safe sleep policymakers, child safety experts, and leading medical experts on the topic. Most notably, they even influenced changes to the American Academy of Pediatrics safe sleep policies on the topic.
If you are looking for straightforward answers about breathable crib mattresses based on scientific studies, you found the place. The experts at Safe Sleep Technologies answer your questions relating to breathable crib mattresses. Additionally, we help you distinguish fact from fiction on the topic. We also explain the various types. Then, we give you a comprehensive look at each.
We follow up with what to look for when shopping for a breathable crib mattress. And we give you the AAP’s most current recommendation on what type of breathable crib mattress is safest.
We begin with answering common questions parents have about breathable crib mattresses. These questions are:
- What is a breathable crib mattress?
- Can a baby suffocate with a breathable crib mattress?
- Does crib mattress have to be breathable?
- Can babies breathe through their mattress?
- Are breathable crib mattresses safer?
- What makes a crib mattress breathable?
- Can a baby sleep on their stomach on a breathable crib mattress?
- Are breathable crib mattresses necessary?
- Will a breathable crib mattress prevent SIDS?
- Do you put sheets on a breathable mattress?
- Risk Factors of SIDS – Fact and Fiction
After we answer these common questions about breathable crib mattresses, we explain the following:
- Types of breathable crib mattresses
- Identifying and classifying the breathable crib mattresses on the market by design type
- Analysis of each breathable crib mattress design to gain a better understanding of their effectiveness and what their definition of “breathability” means
- What you should look for when buying a breathable crib mattress
- Updated 2022 AAP Safe Sleep Recommendations Technical Report – Breathable Crib Mattresses
Every parent’s worst nightmare is waking up to an unresponsive baby. Sudden Infant Death Syndrome (SIDS) is the leading cause of death of a baby from one month to 12 months. In fact, SIDS claims the lives of over 3,400 seaming healthy infants each year in the U.S. It’s no wonder parents are turning to crib mattresses that claim to reduce the risk of SIDS, Sudden Unexpected Infant Deaths (SUID), and suffocation. These crib mattresses are being marketed as “breathable” crib mattresses.
What is a Breathable Crib Mattress?
One problem with mattresses being marketed as “breathable” is that there aren’t any approved standards. Currently, there is no standard or regulation that defines the “breathability” of a crib mattress. This will become more apparent with our in-depth analysis of breathable crib mattresses later in this article.
By definition, “breathability” denotes the ability of a fabric to allow perspiration, evaporated by the body, to escape (diffuse) to the outside (termed moisture vapor transmission), thereby allowing comfort.
Consequently, a standard foam or innerspring crib mattress with a cotton cover fits the definition of breathable.
I have seen some “breathable crib mattresses” defined as – ” A mattress that typically has a porous surface that your baby can breathe through should they roll over face down.” Other definitions include – ” Allows for air to move between all layers of the mattress.”
Another definition takes it a step further, – “A breathable crib mattress allows for air to move between all layers of the mattress, from cover to core, and out the other side.” Yet another definition defines a breathable crib mattress as – “Providing airflow surrounding the baby with better temperature regulation and better reduction in sweaty backs.”
As you can see, the term “breathable crib mattress” is a term with many definitions. I believe it is safe to say, there are as many definitions of “breathable crib Mattress” as there are breathable crib mattress designs This is a topic we will explore later.
Many will argue that “breathable” is nothing more than an illusory term designed to sell crib mattresses.
I believe we need to dig deeper into the different types of breathable crib mattresses. This will help you determine if the claims made by breathable crib mattress manufacturers are accurate. But first, we answer some more common questions.
Can a Baby Suffocate With a Breathable Crib Mattress?
To answer this question, we must first look at the definitions of suffocation? There are two types of suffocation.
Suffocation in the traditional sense is when oxygen is cut off. This normally happens by the airways being blocked. Suffocation of this type normally has a “panic” response. The oxygen needed to sustain life is being denied. A struggle to breathe ensues.
As long as a crib mattress is firm, it is difficult for an infant to suffocate in the “traditional sense.” Infants are obligate nose breathers. This means they breathe exclusively through their nose. The exception is when they are crying. Further, an infant’s nose does not have the hard cartilage like an adult’s. Consequently, if there is face compression caused by sleeping face down, their nostrils flare open.
If a crib mattress is too soft, it can cause an infant’s nostrils to sink far enough into the mattress that their airway becomes obstructed. This is how babies suffocate on soft mattresses. Obstruction causes suffocation in the traditional sense. This type of suffocation can occur on a traditional or a breathable crib mattress if an infant’s airways become obstructed.
The reasons the American Academy of Pediatrics (AAP) warns parents against using a soft mattress, putting pads, or quilts underneath a sleeping baby.
Another type of suffocation is when there is a build-up of carbon dioxide (CO2) in the tissues and organs. This type of suffocation is caused by “rebreathing.” Rebreathing is when exhaled air is being breathed back in. As humans, when we exhale we exhale CO2 or “bad air.”
When a baby is sleeping on his stomach, CO2 can build up around the baby’s head. So, rather than breathing fresh air, the baby breathes the bad air.
When rebreathing, oxygen levels in the body drop. CO2 rises. Rebreathing CO2 suppresses the need to breathe. Rebreathing eventually leads to hypoxia. It’s basically a “sleepy” death.
For most babies, rebreathing bad air will not cause a problem. Their brain tells them that they are breathing too much CO2. They will cough, cry, turn their head or do something to get themselves out of this bad situation.
However, some infants are believed to have what’s called an “arousal defect.” This defect prevents them from waking up even if they’re not getting enough oxygen.
There is a defense mechanism we have when we sleep that makes us wake up or turn our heads or roll if CO2 rises. Babies with this arousal defect don’t respond. Their brains don’t tell them there is a problem. They continue to breathe the bad air, which can then cause them to die unexpectedly.
According to Dr. Umakanth Katwa, Attending Pulmonologist and Director of the Sleep Laboratory at Boston Children’s Hospital and professor at Harvard Medical School, “This means even though they are rebreathing their carbon dioxide, what happens is the brain doesn’t wake up. So that means they cannot lift their head, turn on their side, or roll over.”
The problem we face is there is no way to know which babies have an arousal defect. There is no way to test infants to find out if they are vulnerable. This means we must assume all infants have this defect in order to protect them from rebreathing.
It’s important to note that this “arousal defect” is not the cause of SIDS by itself.
Meaning, infants don’t just fail to wake up. There must be an outside stressor such as CO2 or airway obstruction. So if we can remove the outside stressor, the infant remains protected. An infant who sleeps on their back, alone in a crib is protected from carbon dioxide and face covering.
However, we all know infants eventually roll over. In fact, infants who are not used to sleeping on their stomach have a 40% increased risk of SIDS when they roll over for the first time. This is discovered by two different notable studies. One study is conducted in Canada and the other in the United States.
It is believed these infants end up rebreathing their CO2 that becomes trapped inside the fiber fill or top surface of their crib mattress. CO2 will also trap in blankets, quilted toppers, and soft toys, and even the folds of sheets.
Consequently, it is possible for a baby to suffocate by rebreathing their CO2 in certain types of breathable crib mattresses. In fact, some breathable crib mattress designs are actually more dangerous when it comes to CO2 rebreathing than a traditional firm crib mattress.
For a crib mattress to prevent suffocation, it must accomplish two major functions,
- It must not allow for face compression or airway blockage.
- The C02 a baby exhales must be gone before a baby takes in their next breath of air. If C02 remains present for longer than the time it takes a baby to take a breath, it fails this test.
The hidden risk with crib mattresses is the risk of rebreathing. Traditional crib mattresses and soft objects are known risk hazards when it comes to rebreathing. This is why the AAP strongly encourages back sleeping.
Does a Crib Mattress Have to Be Breathable?
A crib mattress does not have to be breathable. However, we know that babies continue to be found on their stomach on crib mattresses. We know their is a risk if a baby sleeps on their stomach on a fiber fill crib mattress.
However, we also know that there are many definitions of “breathable” when it comes to crib mattress.
A crib mattress needs to be safe. It should reduce all the risk possible with infant sleep.
Can Babies Breathe Through Their Mattress?
Most crib mattresses do not allow a baby to safely breathe through them. This is another reason why back sleeping is important. Infants are at a significant increased risk of SIDS when they sleep on their stomach.
However, there is one crib mattress that has been tested to show oxygen rich air while a baby is breathing through it. It is the SafeSleep® Breathe-Through Crib Mattress. The SafeSleep® does not have any fill or core. Instead, it is designed so an infant can breathe “normally” right through it. This crib mattress has earned the recognition of top medical professionals and safe sleep experts because of its comprehensive safety design.
It’s the only crib mattress that pediatricians and respiratory therapists write prescriptions for infants who must sleep on their stomach for health reasons.
In order for babies to breathe through their mattress, there must be nothing obstructing airflow. Most crib mattresses have multiple layers that make it impossible for air to flow unobstructed. Even breathable crib mattresses with plastic cores have multiple layers which can impede airflow. Additionally, these types of crib mattresses have multiple layers of 3D mesh that is quilted together.
Ask yourself this, is it easier to breathe through a quilted comforter or a thin piece of fabric with air holes?
Find out more about why a breathable crib mattress should also be air permeable by reading, Why a Breathable Baby Crib Mattress Should Also Be Air Permeable
Are Breathable Crib Mattresses Safer?
As stated above, back sleeping is safest, but we know infants eventually roll over. Moreover, some infants simply refuse to sleep on their back. Parents want a safe option for their stomach sleeping baby.
Many breathable crib mattresses claim to be safer because they have air-permeable, 3-dimensional mesh covers. They claim these covers increase airflow and improve temperature regulation under a baby. In theory, these covers allow a baby to breathe through the mattress should they become face down.
As we explained earlier, a baby can breathe as long as there is no obstruction to their airways – in particular their nostrils. Try holding a thick, firm block of foam to your face. Press your face hard against the foam and you will see what we mean. You can still breathe.
The issue is, many breathable crib mattress companies are not measuring the true risk. This risk is rebreathing.
Using the same example with the block of foam, if you hold the foam long enough to your face, you will find that your breathing will eventually become compromised. This is because you are beginning to rebreathe the CO2 that is accumulating in the foam.
Dr. Ron Somers warns parents about false mattress-safety claims. Somers has spent over three decades in the field of child safety,
“You need to be aware of false mattress-safety claims. Some manufacturers claim that their mattress is safer because air can easily pass through their product. This seems logical, but air flowing through the surface is not a guarantee of safety. In fact, a standard, firm, foam mattress with a tight sheet cover is actually safer than some of the so-called “breathable” products.
HOW CAN THIS BE? With many of the so-called “breathable” mattresses, the CO2 (being heavier than air) sinks into the mattress, and it is then sucked up by the baby for rebreathing.
In other words, the CO2 does not dissipate. This has been determined by a special test using a mechanical baby that breathes in and out like a real baby. If a manufacturer will not show you their results on this kind of test, don’t fall for their safety hype.”
For a breathable crib mattress to be safer, CO2 must be gone before a baby takes in their next breath of air. A baby takes a breath every 1 to 2 seconds.
Consequently, you want to make sure the breathable crib mattress you are using has a CO2 dissipation rate of less than 1 second. This means the CO2 is gone before your baby takes in their next breath of air.
Testing is available for crib mattress manufacturers. As Dr. Somers state, make sure the breathable crib mattress you buy has been tested to show a CO2 dissipation rate of less than 1 second.
If a breathable crib mattress does not have a CO2 dissipation rate of less than 1 second, the breathable crib mattress is not considered “safer.” Make sure to check for this testing when looking at breathable crib mattresses.
One breathable crib mattress that been tested for CO2 dissipation is the SafeSleep® Breathe-Through Crib Mattress. The testing on the SafeSleep® shows a CO2 dissipation rate of 1/2 of a second. This is well below the 1 second threshold.
As we mentioned above, a baby takes a breath every 1 to 2 seconds. The SafeSleep® has a CO2 dissipation rate of only ½ a second. This means that CO2 is gone from the SafeSleep® crib mattress before a baby takes in their next breath of air.
It takes less than 1/2 second for CO2 to dissipate from the SafeSleep® Breathe-Through Crib Mattress. A baby takes a breathe every 1 to 2 seconds. CO2 is gone on the SafeSleep® before a baby takes in their next breathe of air. It takes over 2 seconds for it to dissipate from a fiber fill crib mattress.
Can a Baby Sleep on Their Stomach on a Breathable Crib Mattress?
Again, back sleeping is your safest option. However, some infants must sleep on their tummy for health reasons.
Currently, there is only one breathable crib mattress that pediatricians and respiratory therapists write prescriptions for infants who must sleep on their tummy for health reasons. This breathable crib mattress is the SafeSleep®.
The SafeSleep® was created by a leading pediatrician and a safe sleep expert. It is scientifically tested to show oxygen-rich air while a baby is breathing through it.
There is no core or fill material inside the SafeSleep® crib mattress. Instead, the 3D mesh surface is suspended over an open box. There are vented sides and ends on this design. The design of the SafeSleep® promotes constant, uninterrupted, passive airflow.
If a crib mattress has fiber filling or a center core, air flow is going to be interrupted. This interrupted airflow can cause CO2 to accumulate. The more porous the core or filling materials are, the longer it takes for CO2 to evaporate. Exhaled air gets into the core and stays trapped. Remember, CO2 is heavier than air.
Scientific studies on crib mattresses marketed as “breathable” in Australia in the 1980s and ‘90s, turned out to be anything but breathable. According to SIDS researchers, these crib mattresses with porous interiors actually trap carbon dioxide. The mattress marketed as breathable in Australia turned out to increase the risk of SIDS. And, it allowed more rebreathing.
Before letting your baby sleep on their tummy on a breathable crib mattress, make sure the mattress does not trap CO2. And test it to make sure it won’t cause face compression. Simply press on it to see if it sinks down.
Remember, the CO2 dissipation rate needs to be below 1 second.
Are Breathable Crib Mattresses Necessary?
Unlike infant car seats, crib mattresses have very little government regulations. We can say conclusively that if you want to put your infant in a car, a car seat is necessary.
The fact there are no approved standards for breathable crib mattresses, it is not a mandated necessity. Further, the fact is the exact mechanism of SIDS — what causes so many babies to die in their sleep — remains unclear.
However, the leading theory is rebreathing. As mentioned prior, rebreathing is when a baby repeatedly inhales the CO2 they’re exhaling. This deprives them of oxygen. And, causes CO2 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, Harrison Distinguished Teaching Professor of Pediatrics and Division Head at the University of Virginia School of Medicine and chair of the American Academy of Pediatrics Safe Sleep Task Force.
In fact, rebreathing is the basis for the majority of the AAP’s safe sleep recommendations. These recommendations, quoted from the 2016 Safe Sleep Policy Statement and included in the 2022 technical report:
- 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…”
- 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.”
We cannot say conclusively that any of the safe sleep recommendations provided by the AAP will prevent SIDS. Unethical studies would have to be conducted to have scientific certainty.
Consequently, scientists are left with making recommendations based on comparing infants who have died to those with similar characteristics who did not. This is called retrospective analysis.
For example, we cannot say with scientific certainty or have definitive evidence that back sleeping will prevent SIDS. But when comparing infants who died of SIDS to those who did not, the majority of SIDS deaths involved an infant found sleeping on their stomach.
Safe sleep recommendations are designed to reduce the risk of SIDS. So if we believe rebreathing CO2 can cause SIDS, it makes sense to use a crib mattress that eliminates this risk. After all, you would never consider not using a car seat for your baby. Because we know a car seat reduces the risk of a baby being injured or dying during a car accident.
Will a Breathable Crib Mattress Prevent SIDS?
This is a simple answer – No.
By definition, SIDS is a diagnosis of exclusion. This means that after a complete investigation, there is no scientific explanation as to the direct cause of death. These deaths are labeled as SIDS.
SIDS is a subcategory of SUID (Sudden Unexpected Infant Death). SUID includes all unexpected deaths. Deaths without a clear cause are labeled as SIDS. Those from a known cause, such as suffocation or strangulation are labeled as SUID. One-half of all SUID cases are SIDS. Since SIDS often happens when an infant is asleep with no witnesses, it’s difficult to identify – scientifically – a cause of death.
To say something can prevent SIDS is like saying something can prevent death by natural causes.
Most manufacturers realize they cannot make direct claims that their products reduce or eliminate SIDS. The Food and Drug Administration (FDA) warns manufacturers about making such claims. And they impose strict penalties to those who do. Consequently, companies that make such claims are in violation of the Federal Food, Drug and Cosmetic Act.
Further, if a company claims that its product prevents SIDS, then it is by definition a medical device and needs FDA approval. It would require scientific studies to prove that the product prevents SIDS. As we mentioned before, this would require unethical testing to determine which infants survive and which ones do not. Obviously, this is not a realistic option.
If a company is going to make unsubstantiated claims that their products prevent SIDS or SIDS risk without having scientific evidence to back it up, you should be cautious of these companies and their products.
None of the AAP’s safe sleep recommendations claim to “prevent or reduce” SIDS. Their recommendations claim to prevent risk. For example, back sleeping does not “prevent” SIDS. However, it prevents a risk associated with SIDS deaths.
There is no shortage of crib mattress manufacturers selling the idea to parents that a breathable crib mattress reduces suffocating and SIDS risks should an infant end up on their stomach while sleeping. Just make sure the company is transparent about their scientific testing.
Find out more on the topic of breathable crib mattresses and the prevention of SIDS by reading, Will a Breathable Mattress Help Avoid SIDS?
SIDS vs. Suffocation
Sleep-related causes of infant deaths (SUID) are those linked to how or where a baby sleeps. These deaths are due to accidental causes, such as suffocation, entrapment, or strangulation. Entrapment is when the baby gets trapped between two objects, such as a mattress and a wall, and can’t breathe. Strangulation is when something presses on or wraps around the baby’s neck, blocking the baby’s airway. These deaths are not SIDS.
Currently, we do not know what causes infants to die while sleeping (SIDS). As stated prior, the leading theory is rebreathing CO2. The idea is that babies end up with an object covering their face. They are on their stomach. Or, they are on a loose sheet that is creating a pocket of air. These conditions force an infant to repeatedly inhale the CO2 they’re exhaling. This deprives them of oxygen and causes CO2 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 AAP’s safe sleep task force.
Rebreathing CO2 is the leading theory behind SIDS. Consequently, rebreathing CO2 is the theory SIDS and Safe Safe Sleep policy makers rely on when making recommendations.
With SIDS, there are no clear biological markers to determine if a baby fell victim to rebreathing. In other words, we cannot say with scientific certainty. Unethical testing would have to be performed on infants for this to be a “known” cause.
Instead, SIDS researchers and safe sleep policy makers rely on retrospective analysis to create policy. Retrospective studies include looking at the death scene investigations of SIDS victims. They are then compared to healthy infants in the same age group and other similar characteristics. Currently, the AAP recommends the following pertaining to crib mattresses:
- Avoid second-hand if possible: Because of the dangers associated with mold and bacteria
- Make sure the mattress is firm. A firm mattress helps prevent both suffocation risk and the risk of rebreathing CO2
- Do not use an inclined mattress or devise to make a crib mattress inclined. The surface should be flat. An inclined surface has been linked to many suffocation and rebreathing deaths.
- Keep the crib empty. The only thing that should be in the crib is a properly dressed baby. This recommendation is based on reducing rebreathing, suffocation, and overheating.
- Place your baby to sleep on their back for every sleep. This recommendation is also based on reducing rebreathing, suffocation, and overheating.
- Make sure the crib mattress fits tightly in the crib. If a gap of over 1” exists on any side, your baby is at risk of getting wedged between the side of the mattress and the crib. This recommendation is based on reducing suffocation, and strangulation
- Use a tight fitted sheet. This recommendation is based on reducing rebreathing, suffocation, and strangulation.
Do You Put Sheets on a Breathable Mattress?
Many breathable crib mattresses require the use of a sheet. Others have removeable covers that are machine washable. Sheets are designed to create a sanitary sleep environment. They are removable for machine washing.
However, crib sheets can pose a danger In the crib. In 1984, the CPSC issued a warning to parents after learning of 17 babies who died. Most of them were under 12 months old. The cause of death was suffocation or strangulation. These infants became entangled in sheets in their cribs or beds. Some of these sheets were fitted crib sheets.
One breathable crib mattress design eliminates the use of a crib sheet – the SafeSleep®. A crib sheet cannot be used with this breathble crib mattress design. Instead, the surface of the mattress is easily removed for machine washing. This design is intentional. It eliminates the risks associated with crib sheets.
Risk Factors of SIDS – Fact, and Fiction
Sleeping on tummy
Infants who sleep on their tummy, especially those who are face down, run the risk of rebreathing CO2. They are also prone to overheating. In fact, infants who sleep on their stomach are 2x more likely to succumb to SIDS than those sleeping on their back. Additionally, infants who are not accustomed to sleeping on their back are 4x more likely to die of SIDS the first time they roll over.
Lack of oxygen rich air
It is important for an infant to have oxygen rich air while sleeping. This is not only important for their safety, but also for their health and wellbeing. There has been some research on using a fan in an infant room to protect them from SIDS. However, there is no conclusive data. If you are going to use a fan that is freestanding, make sure your baby cannot get near the fan or the electrical cord.
Blankets, bumper pads, and other objects can obstruct an infant’s airways. It can also them to rebreathe exhaled CO2. Many crib mattresses can also block an infant’s airways or cause them to rebreathe should they end up in a face down position.
Off gassing from crib mattresses causes SIDS
It all started in 1989 when someone claimed that he had figured out the cause of SIDS. They claimed it is chemicals (fire retardants) used in crib mattresses, interacting with a fungus that released toxic gasses. No substantial studies exist to confirm this theory. Frankly, medical experts wish this rumor would stop.
The idea behind this theory is that the fire barrier chemicals used in many crib mattresses would interact with a fungus. Heat from the baby’s body would heat up the deadly mixture. Then, toxic gasses would be released in the air. These gasses would then be inhaled by a sleeping baby.
Studies found that the fungus associated with this theory were almost never actually present in any mattress. Additionally, infants who died of SIDS in countries that don’t use flame-retardant chemicals in their mattresses, were no lower in countries that do.
SIDS is not caused by immunizations. It’s important for your baby to get their scheduled immunizations. There is a lot of research behind the proper time, amount, and type of immunizations your child needs. Some parents believe immunizations cause SIDS. There is no research to substantiate this claim.
The fact is, SIDS rates peak around 4 months. Your baby will receive two sets of shots during this time. Consequently, some parents try to link the two. There are no scientific studies that link vaccinations to SIDS.
Recent Discoveries in SIDS Research
Recent discoveries in SIDS research point to an infant’s inability to arouse when they are in a compromised position. This means some infants simply do not turn their head if their airway is obstructed. Or, when they are rebreathing CO2. This is what makes the idea of a breathable crib mattress so appealing.
According to. Dr. Umakanth Katwa, Attending Pulmonologist and Director of the Sleep Laboratory at Boston Children’s Hospital and professor at Harvard Medical School.
” Theoretically, a crib mattress that prevents a baby from rebreathing CO2 – disperses carbon dioxide more quickly – makes sense.”
Katwa, points to simulations done by mattress companies that show some mattresses can disperse carbon dioxide more quickly. He points to testing conducted on the SafeSleep® crib mattress.
“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.” Katwa explains the importance of this by saying, “Babies who die in these kinds of situations tend to have what’s called an “arousal defect” which prevents them from waking up even when they’re not getting enough oxygen.”
“There is a defense mechanism when we sleep that if your carbon dioxide rises, you wake up and you turn your head to the side or you roll,” Katwa says. “Babies with SIDS not only need to suffocate, but they need to have an 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 their head, turn on the side, or roll over.”
The alluring appeal of the SafeSleep® Breathe-Through Crib Mattress is that CO2 is gone before a baby takes in their next beath of air. So if a baby does have an arousal defect, the CO2 is gone so they cannot rebreathe.
The most recent SIDS related discovery was made in May of 2022 by a SIDS researcher in Australia. This discovery links the low levels of the enzyme butyrylcholinesterase (BChE) in infants’ blood tests to SIDS. It was overzealously reported that a cure for SIDS will soon be available.
The grim reality is the lack of this enzyme is a beginning to identifying biological markers at best.
As mentioned earlier, there are no current biological markers to conclude a clear cause of death in many infant sleep related deaths. Finding a biological marker is just the beginning to a long process. If we can somehow identify infants who are at risk. These are infants who do not arouse when their airway is obstructed or they are rebreathing. We will be on our way to a cure.
But the question becomes, what can we do for these infants? There is no way to inject a vulnerable infant with the enzyme that is deficient. And if we did, what would the overall effects be?
Perhaps these infants would be directed to sleep on crib mattresses that eliminate airway obstruction and rebreathing CO2. Crib mattresses like the SafeSleep®.
As you can see, we are still left with taking risk prevention measures to keep fresh oxygen flowing to a baby while they are sleeping. This helps explain the allure of breathable crib mattresses.
The problem is, not all breathable crib mattresses keep fresh oxygen flowing to your sleeping baby. In fact, some so-called breathable crib mattresses may be more hazardous than a traditional firm crib mattress.
Types of Breathable Crib Mattresses
There are 5 types of breathable crib mattresses:
- Traditional foam or innerspring crib mattresses with a 3D mesh, removable cover
- Hollow cut-outs or “air channels.”
- Hybrids with multiple layers
- Spongy, food-grade polymer core with covers made from multiple layers of 3D mesh quilted together
- No fill or core with single layer 3D mesh, suspended cover
Traditional Foam or Innerspring Crib Mattresses with a 3D Mesh, Removable Cover
Breathable crib mattresses of this type are either a traditional, foam filled or Innerspring mattress. The only difference is, it has a removable cover. This cover is made from a 3D mesh fabric cover.
I like to refer to this breathable model as the “wolf in sheep’s clothing.”
Hollow Cut-Outs or “Air Channels.”
Next is the breathable crib mattress with hollow cut-outs. This type of breathable crib mattress is a foam crib mattress. The difference is, it has large cut-out areas in the interior center of the foam. In theory, air pockets form in the center of the mattress. However, there is very little passive air flow.
Hybrids with Multiple Layers
These types of breathable crib mattresses have several layers of inner core materials encased in a fabric outer layer. Most often, the layers consist of foam along with other martials such as coconut choir. Some of these hybrids don’t divulge what their core material is made up of. Instead, they use made up words like ” eco-friendly Bundle Fiber™.”
Spongy, Food-Grade Plastic Core with a Multiple Layers of a 3D Mesh Surface Quilted Together
This type of hybrid mattress creates a relatively firm surface. It usually has a tight fit in the crib. However, the quilted topper is questionable. The AAP warns against the use of quilted toppers and pads. In particular, they can trap CO2.
No Fill or Core with 3D “Single Layer” Mesh Surface
This two-part mattress system consists of an open frame with side openings. Additionally, there is a single layer, 3D mesh surface that allows passive airflow. The surface is suspended over the hollow base using a unique locking bar system.
Oxygen rich air travels in the base and up through the 3D mesh surface. Harmful CO2 travels back out through the 3D mesh surface. And then out the sides of the hollow base. .
This breathable crib mattress has a patented design.
Identifying and classifying the breathable crib mattresses on the market by design type
Next, we list the crib mattresses on the market that claim to be breathable. We place them in the correct category. These categories are based on the types of breathable crib mattresses we listed above.
Traditional Foam or Innerspring Crib Mattresses with a 3D Mesh, Removable Cover
- Naturpedic® – Breathable – List Price $399.00
- Naturpedic® – Breathable Ultra – List Price $499
- Dream On Me®, Breathable Crib mattress – List Price $77.99
- Lullaby Earth® Breathe Safe Breathable Crib Mattress – List Price $279
- Bundle of Dreams® Classic 100% Breathable Crib Mattress – List Price $229.99
- Bundle of Drams® EcozyKids® 100% Breathable Dual Firm Crib and Toddler Mattress – List Price $129.99
- Bundle of Dreams® 100% breathable Orion Crib Mattress – List Price $199.99
- Beadgear Air-X Performance Crib and Toddler Mattress – List Price $299.99
- Eclipse Baby Breathable Crib Mattress – List Price $179.00
List of breathable crib mattresses with hollow cut-outs or “air channels”
- Sleep Ovation Baby Breathable Crib Mattress – List Price $499.00
- Colgate Good Night Owl Breathable Crib Mattress – List Price $269.99
Hybrids breathable crib mattresses with multiple layers
- Nook Pure Organic Crib Mattress – List Price $419.00
- Nook Air Lightweight Crib Mattress – List Price $199.00
- Colgate PureCuddles™ Breathable Crib Mattress (Made exclusively for Target) – List Price $174.99
- Bloom Retro Breathe Crib Mattress – List Price $275.00
- Oeuf® Pure and Simple Natural Dual Firm Crib mattress – $290.00
- Avacado Green Eco Organic Crib Mattress – List Price $299.00
- Avacado Green Organic Crib Mattress – List Price $399
Spongy, Food-Grade Plastic Core with a Multiple Layers of a 3D Mesh Surface Quilted Together
- HALO® Dreamweave Breathable Crib Mattress – List Price $249.00
- Ducky Airnest™ Crib Mattress – List Price $299.00
- EcoAir™ Waterproof Baby Crib Mattress by Brentwood Homes – List Price $299.00
- Newton Baby® Essential Breathable Crib Mattress – List Price $249.00
- Newton Baby® Original Breathable Crib Mattress – List Price $299.99
- Newton Baby® Waterproof Breathable Crib Mattress – List Price $349.99
No Fill or Core with 3D “Single Layer” Mesh Surface
The SafeSleep® is the only crib mattress we could find that has no fill or core of any kind. Consequently, it is in a class of its own.
The average price of a breathable crib mattress is $300. Find out why a breathable crib mattress is worth it.
Analysis of Each Breathable Crib Mattress Design to Gain a Better Understanding of Their Effectiveness and What Their Definition of “Breathable” Means
Before we begin our analysis, we want to remind you about the warning issued by Dr. Ron Somers. Somers is the Former Director of Epidemiology, SA Health. He is the author of the only crib mattress firmness standard (This testing is known as AS/NZS 8811.1:2013).
BEWARE OF FALSE MATTRESS-SAFETY CLAIMS
by Dr Ron Somers, Former Director of Epidemiology, SA Health
“If you really want to protect your baby from suffocation, you need to be aware of false mattress-safety claims. The most important precaution is to always place your baby face up to sleep. But babies can roll face down, and that’s when you want the safest possible mattress for them. Some manufacturers claim that their mattress is safer because air can easily pass through their product. This seems logical, but air permeability is not a guarantee of safety. In fact, a standard, firm, foam mattress with a tight sheet cover is actually safer than some of the so-called safety products.HOW CAN THIS BE? Well, it works like this. On a standard, firm, foam mattress the baby’s expelled carbon dioxide dissipates, i.e. it drifts away, preventing the baby from rebreathing it. Rebreathing of carbon dioxide causes suffocation. With many of the so-called air-permeable mattresses, the carbon dioxide (being heavier than air) sinks into the mattress, and it is then sucked up by the baby for rebreathing. In other words, the carbon dioxide does not dissipate. This has been determined by a special test using a mechanical baby that breathes in and out like a real baby. If a manufacturer will not show you their results on this kind of test, don’t fall for their safety hype. Other types of testing, which simply confirm air permeability, are not a substitute for the mechanical baby test.”
We also want to remind you there is no current standard for “breathable” when it comes to a crib mattress. So let’s list the things we do and don’t know about crib mattresses and SIDS. This is based on scientific research.
What We Do Not Know About SIDS
- What causes SIDS. SIDS is a diagnosis of exclusion when no cause of death can be scientifically determined (2).
- Which infants are more likely to rebreathe CO2. Most infants will turn their head to avoid “rebreathing” but some do not. We have no way of testing to find out which infants are “vulnerable.” So, all infants remain at risk (10).
- The CO2 retention level of all crib mattresses and sleep surfaces that claim to be “breathable.” Scientific studies show, some breathable crib mattresses and sleep surfaces that have porous cores, actually retain higher levels of carbon dioxide than thick fiberfill materials (5-8).
- No studies exist comparing infants who sleep on various crib mattresses to see which one has fewer SIDS deaths. No published studies or valid scientific testing is available that shows if one crib mattress 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, they likely never will. It is not feasible to enroll the number of infants required to get sufficient data. To perform suffocation and rebreathing testing, unethical testing would have to be performed on infants to find out the “suffocation threshold” (4).
What we do know about crib mattresses and SIDS based on scientific research
- Prone sleep is a known risk factor for SIDS. Sleeping face-down increases this risk further (1).
- Even after a thorough investigation, it can be hard to tell SIDS apart from other sleep-related infant deaths. These deaths include overlay or suffocation. Most often, these deaths are unwitnessed. There are no tests to tell SIDS apart from suffocation. To complicate matters, people who investigate SIDS deaths may report the cause of death in different ways. Some may not include enough information about the circumstances of the event from the death scene (3).
- Infants in the face down position 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 CO2 which leads to hypoxia. Hypoxia is a condition associated with SIDS (5-9). According to Dr. James Kemp and Dr. Brad Thach, some bedding materials may act to retard the dispersal of exhaled gasses (CO2). These gasses are retained near a face down infant’s mouth. With each subsequent breath, the infant takes in an air mixture which is progressively less adequate to sustain life. The more conducive an item is to rebreathing CO2, the more hazardous the item would be (8).
- It is important to keep fresh oxygen flowing to a sleeping baby. It’s also important to avoid anything in the crib that can cause the build-up of CO2 and heat.
- Scientific evidence shows some air permeable mattresses provide a “significant” decreased risk of rebreathing of CO2 (5,6,7,8,9,11). The SafeSleep® Breathe-Through Crib Mattress has been tested for CO2 retention. CO2 takes 2 minutes to dissipate from a firm crib mattress with a tight sheet. It takes less than 1/2 a second for it to dissipate on the SafeSleep® mattress (11). An infant takes a breath every 1-2 seconds. This means the CO2 (poisonous gasses) on the SafeSleep® Breathe-Through mattress is gone before the infant takes their next breath of air – even if face straight down (12).
The SafeSleep® Breathe-Through Crib Mattress is the only crib mattress on our list we could find scientific testing showing carbon dioxide levels below the desired 1 second level. Also, we did not do any actual testing on other breathable crib mattress designs. We relied solely on published data on products with the same or similar designs.
Analysis of Traditional Foam or Innerspring Crib Mattresses with 3D Mesh, Removable Covers
When we look at the breathable crib mattress design with a traditional foam or innerspring crib mattress with a 3D mesh, removable cover, we have to wonder if this is the type of crib mattress Dr. Somers is alluding to.
The idea behind this breathable mattress design is that you can add a 3D mesh cover over a standard crib mattress to give it “breathability.” However, you still have a block of foam or batting under it. Ideally, air would flow through the mesh layer but it comes in contact with the dense core.
So you have to wonder, if CO2 is heavier than air, wouldn’t CO2 get trapped in the layers?
One study published in the Journal of Pediatrics in 2000, compares five different infant products that claim to reduce rebreathing. Three of the products claim to prevent the accumulation of CO2 by the passive conductance of exhaled air through mesh netting, foam channels, or foam undersurfaces.
These products proved to actually accumulate more CO2 because there was nothing to actively disperse exhaled air.
Standard Foam or Fiberfill Crib Mattress with 3D Mesh Cover
Analysis of Breathable Crib Mattress Design with Hollow Cut-Outs or “Air Channels”
This type of breathable crib mattress design consists of a foam block that has air channels. One design has a cover that is not removable and the other design offers a zippered removable top and bottom cover.
The issue with this design is the foam channels. With CO2 being heavier than air, it seems CO2 will sink and trap in these deep foam channels.
In fact, the AAP’s, Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment, states “Soft mattresses, including those with adjustable firmness or those made from memory foam, could create a pocket (or indentation) and increase the chance of rebreathing or suffocation if the infant is placed or rolls over to the prone position.”
Another issue is the fact the mattress has a cover that is water resistant. Water-resistant fabrics will shed water and dry quickly, but they’re not entirely waterproof. If liquids seep into foam, the foam can become contaminated.
Breathable Crib Mattresses with Hollow Cut-Outs or Air Channels
Analysis of Hybrid Breathable Crib Mattress Design with Multiple Layers
This breathable crib mattress design consists of several layers of materials. Some of these materials include foam, wool, coconut coir, and latex. The more layers air needs to travel through, the longer it take good air to flow to your baby and bad air flow away from your baby.
SIDS researchers show a ‘breathable’ tea tree bark-filled mattress marketed in Australia in the 1980’s and ‘90’s actually increased re-breathing of CO2 and was associated with an increased risk of SIDS. It turns out, these breathable mattresses actually caused more SIDS deaths. The study indicates that a more porous material, such as coconut coir, may actually trap carbon dioxide rather than help disperse it.
Breathable Crib Mattresses with Multiple Layers
Analysis of Breathable Crib Mattress Design with Plastic Cores and Multiple Layers of 3D Mesh, Quilted Together
These breathable crib mattresses have a food-grade polymer plastic core that resembles a block of ramen noodles. The cover is multiple layers of 3D mesh, quilted together. The cover is removable for machine washing.
Additionally, the plastic core is also washable. However, it must be washed in a bathtub, shower, or with a garden hose. Two of the manufacturers of this mattress design state it takes between 2-6 hours for the core to dry in a well ventilated area.
We have also seen complaints by consumers of “discovering what looks like mold inside one of their breathable crib mattresses”
In the newly released, Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment, the AAP warns against mattress toppers designed to make the sleep surface softer for infants under 1-year-old.
Since some of these crib mattresses with plastic cores use a surface that resembles a traditional crib mattress topper. And some claim they add the extra layers and quilting to make it softer. Make sure these toppers meet the specifications put forward by the AAP if your baby is under one-year-old.
Breathable Crib Mattress with Plastic Core and a Cover Made of Multiple Layers of 3D Mesh Layers Quilted Together
Analysis of Breathable or Breathe-Through Crib Mattress Design with No Fill or Core and a Single Layer of 3D Mesh
This breathable crib mattress design is a one-of-a-kind. It is designed by a leading pediatrician which gives it high marks. It’s the only crib mattress on our list that has no fill or core material of any kind. Additionally, it registers 100% oxygen rich air when a baby is breathing through it while face down.
You are probably wondering how this is even possible. The design consists of four pieces connected together creating an open-box frame. There is a bottom piece that fits into four recessed slots on the bottom of this open-box frame. The pieces that make up the open-box frame have cut-outs that allow air to flow freely through all four sides.
On the top of this open frame are hinges with a unique locking bar system. This system is made out of rolled and stainless steel.
A single layer, 3D mesh surface slides over the locking bar system. This system stretches the top surface very taut over the open-box frame. It then locks in place. The single, 3D mesh topper allows air to travel up and down through the surface quickly and with no interruption.
Fresh air is constantly circulating through the openings on the open-box frame. It then travels up and down through the 3D mesh surface. There is no core or fill to obstruct or impede airflow.
This constant, uninterrupted airflow also helps keep a baby’s core body temperature stable. Since there is no fill or core, there is nothing to raise a baby’s body temperature. Consequently, babies seem to sleep longer, and better on this breathable crib mattress design.
Breathe-Through Crib Mattress Design with No fill or Core with a single layer 3D mesh surface
No need for waterproofing
There are no waterproofing layers on this breathable crib mattress design. In fact, water is wicked away quickly. It settles on the bottom of the open-box frame far below a sleeping baby. This gives this breathable design an added safety benefit. No liquids can pool on the surface. This feature eliminates the risk of a baby re-inhaling their spit up.
The unique locking bar system that creates a firm flat surface, also creates an easy removal process for washing the 3D mesh surface. Additionally, the open-box frame section is easily wiped clean while still in the crib.
You don’t have to worry about mold, pathogens, or other microbials developing in this breathable crib mattress design. There is no fill or core to become contaminated.
The design of the SafeSleep® crib mattress is the only truly breathe-through crib mattress.
Compare the SafeSleep® design to breathable crib mattresses with plastic cores in our side-by-side comparison, breathable crib mattress plastic core or no core.
What You Should Look For When Buying a Breathable Crib Mattress
You should now have a better understanding of breathable crib mattresses. Clearly, the term “breathable” has multiple meanings when it comes to crib mattresses. Consequently, it’s hard to determine if a breathable crib mattress is actually safe.
To help make things easier, we compiled a list. Here are the things you should consider and check for when shopping for a breathable crib mattress;
- Make sure the mattress is firm and flat. A crib mattress should not be inclined.
- Ask to see the CO2 dissipation rate and make sure it is below 1 second.
- Check to see how easy it is to breathe through the mattress. You can place your hand under the mattress surface and blow into the mattress. You should be able to feel your breath on your hand.
- The size of the crib mattress should be check to ensure proper fit in your crib. You don’t want a gap of larger than 1″ between the outside of the crib mattress and the inside of the crib sides.
- Check for certifications to ensure there are no harmful chemicals. These certifications include OEKO-TEX® certified or GREENGUARD certified for mattresses with no fill or core or plastic cores. CertiPUR-US certified if there is any foam used in the mattress, and Global Organic Textile Standard (GOTS) if there are any core materials. GOTS ensures the fiberfill or core material is pure.
- Make sure the product does not have any bad odors. Some breathable crib mattresses – especially those with plastic cores – have been reported to have bad odors. You certainly don’t want your baby breathing these bad smells in.
- Find out if the mattress is completely washable. Remember, some breathable crib mattresses are easier and faster to wash than others.
- Check to make sure there are no waterproof covers that can artificially elevate your baby’s body core temperature. Air should be able to flow freely under your sleeping baby to prevent them from overheating.
- Be sure there is no way expelled liquids like urine, spit up, or feces can penetrate the mattress and cause it to become contaminated, or trap pathogens, mold, other fungi, or dust mites if it has a mattress core that is not washable.
Your baby will spend a significant amount of time in their crib. This is the one place your baby will be unattended for long periods of time. Make sure it is a safe place with a safe crib mattress.
Medical professionals tell us free flowing air is extremely important not just for the comfort of your baby, but for his or her health, too. So, the better the airflow, the better, safer and longer sleep for your baby. And when your baby sleeps longer, you get to sleep longer.
Read our guide on what to look for when buying a mattress for your baby crib.
Updated 2022 AAP Safe Sleep Recommendations Technical Report – Breathable Crib Mattresses
According to the recently updated 2022 AAP Safe Sleep Technical Report,
“There are commercially available special crib mattresses and sleep surfaces that claim to reduce the chance of rebreathing CO2 when the infant is in the prone position that have been introduced.
Although there are no apparent disadvantages of using these mattresses if they meet the safety standards as described previously, no studies have demonstrated decreased risk of death.”
There are no studies to demonstrate that a firm crib mattress, or a tight fitting sheet decreases risk or death. The AAP goes on to state that some of these “special crib mattresses” are shown to reduce risk of CO2 rebreathing and overheating.
“Certain crib mattresses have been designed with air-permeable materials to reduce rebreathing of expired gases, in the event that an infant ends up in the prone position during sleep, and these may be preferable to those with air-impermeable materials.
With the use of a head box model, Bar-Yishay et al found that a permeable sleeping surface exhibited significantly better aeration properties in dispersing carbon dioxide and in preventing its accumulation. They also found the measured temperature within the head box to be substantially lower with the more permeable mattress, concluding that it was due to faster heat dissipation. This finding could be potentially protective against overheating, which has been identified as a risk factor for SIDS.”
“Colditz et al also performed studies both in vitro and in vivo, showing better diffusion and less accumulation of carbon dioxide with a mesh mattress”
The creators of the SafeSleep® Breathe-Through Crib Mattress challenged the AAP Safe Sleep Task Force to include these findings about breathe-through crib mattresses that significantly reduce CO2 accumulation and overheating.
The scientific data was finally recognized in 2016 and remains part of the AAP’s 2022 updated recommendations.
“However, Carolan et al found that even porous surfaces are associated with CO2 accumulation and rebreathing thresholds, unless there is an active CO2 dispersal system.”
Based on scientific research, it is clear that crib mattresses with a single 3D mesh layer with no type of porous core or fiber fill is the safest breathble crib mattress for your sleeping baby.
Find out why the SafeSleep® is the #1 recommended crib mattress by pediatricians and safe sleep experts, Best Crib Mattress – The Science Speaks
Not only is it the safest breathable crib mattress design, it is also the easiest to wash and sanitize.
If you want more information about crib mattresses check out Crib Mattress Facts and Information
SIDS and Crib Mattresses – Resources and References
(1) L’Hoir MP, Engelberts AC, van Well GTJ, et al. Risk and preventative factors for cot death in The Netherlands, a low-incidence country. Eur J Pediatr. 1998;157:681–688
(2) Thach, Brad. Tragic and sudden death. Potential and proven mechanisms causing sudden infant death syndrome. Science and SocietyViewpoint. EMBO Rep. 2008 Feb; 9(2): 114–118
(3) CDC, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, October 3, 2016 (https://www.cdc.gov/sids/aboutsuidandsids.htm).
(5) 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
(6) Carolan PL, Wheeler WB, Ross JD, Kemp RJ. Potential to prevent carbon dioxide rebreathing of commercial products marketed to reduce sudden infant death syndrome risk. Pediatrics 2000;105;774
(7) Colditz PB, Joy GJ, Dunster KR. Rebreathing potential of infant mattresses and bedcovers. J Paediatr Child Health. 2002;38(2):192–195 343.
(8) James N Carleton, Ann M Donoghue, Warren K Porter. Mechanical model testing of rebreathing potential in infant bedding materials. Arch Dis Child 1998;78:323–328
(9) James S. Kemp, Rose M. Kowalski, RN, Phillip M. Burch, MD, Michael A. Graham, MD, Bradley T. Thach, MD. Unintentional suffocation by rebreathing: A death scene and physiologic investigation of a possible cause of sudden infant death. J Paediatr. June 1993Volume 122, Issue 6, Pages 874–880.