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Best Crib Mattress in 2021

Best safest crib mattress 2021

What is the best crib mattress in 2021?

Your baby will spend over 70% of their first year sleeping in their crib.  Therefore, finding the best crib mattress in 2021 is an important decision. 

Additionally, baby’s good health starts with good sleep.  Thus, creating an ideal sleeping setting starts with choosing the best crib mattress in 2021.

In this article we explore the following:

  • Federal Regulations Mattresses Must Meet
  • CPSC and FDA Guidelines
  • Using AAP Safe Sleep Guidelines to Choose the Best Crib Mattress 
  • Types of Crib Mattresses – Pros and Cons of Each
  • Types of Breathable Crib Mattress – Pro and Cons of Each

Federal Regulations Mattresses Must Meet

Flammability Testing:

Crib mattress makers must conform to two basic regulations.  The first is Federal Standard 16 CFR 1633.   This law is also known as, “Flammability” or  “Open Flame” test.  All mattress sets must pass this test, including crib mattresses.  As an act of Congress, with the control of the Consumer Products Safety Commission (CPSC), this law has been in effect since July 1, 2007. 

Federal Standard 16 CFR 1633 requires mattress manufacturers to put their mattress design through a 30-minute flammability test. This test, which follows a very strict plan, is conducted over an open flame. Hence, the name “Open Flame” test.  If the mattress design passes the test, then it has approval for selling.  However, if it fails the test, then the manufacturer cannot legally create the mattress before making changes that allow it to pass the test.

Testing of Flame Retardant Chemicals/Methods:

Currently, there are no required tests to tell if the flame retardants manufacturers use contain harmful chemicals.  Consequently, a crib mattress that do not use flame retardants is the best crib mattress in 2021.

Proper Size Requirements:

The other regulation crib mattresses must meet is proper sizing.   For example, a mattress for use in a standard-size crib must be at least 27 1/4 inches wide x 51 1/4 inches long.  Further, the crib mattress height cannot be more than six inches in height.  Length and width limits are set for preventing wedging and suffocation between the mattress and crib sides.  The height limit prevents an infant from falling out of the crib while standing.

Other suggested requirements, such as proper labeling of fiber content, are voluntary.

CPSC and FDA Guidelines

The American Academy of Pediatrics (AAP), Consumer Products Safety Commission (CPSC) and the Food and Drug Administration (FDA) regularly update guidelines and recommendations to promote infant safe sleep.  In particular, these guidelines and recommendations are useful in helping parents make safe product choices. 

Retrospective Studies:

Recommendations and guidelines given by safety organizations are based on retrospective analysis of infants who have been injured or died while sleeping. By definition, a retrospective study is an observational study that looks at death and injury cases that already happened before the study begins.  In other words, retrospective studies look backwards and study causes of suspected risk or safety conditions with similarities to a result that is set at the start of the study.

CPSC Crib Sheet Recommendations:

The CPSC was the first to suggest all crib mattresses requiring sheets, use sheets that are “tight fitting.”  In 2001, the CPCS issued a warning to parents to avoid using loose-fitting crib mattress sheets.  This recommendation is based on retrospective studies showing 17 babies, most under 12 months old, who suffocated or strangled.  These infants became entangled in sheets in their cribs.  Most notably, two of these deaths were the result of tight-fitting sheets coming off a crib mattress and strangling the infants.  

Based on this warnings, a crib mattress that does not use a sheet is the best crib mattress for your baby in 2021.

FDA Sleep Positioner Warning:

The FDA makes similar recommendations to parents which includes avoiding the use of sleep positioners and bumper pads.  And most recently, they warn against using an inclined sleeper or putting an infant in an inclined sleep position.

Using AAP Guidelines to Choose the Best Crib Mattress

AAP crib mattress recommendations focus on eliminating the following:

After a careful study of peer-reviewed published data used by the AAP to create their safe sleep guidelines, we list the top ten things to consider when choosing the best crib mattress in 2021 for your sleeping baby.

Peer-reviewed published studies require looking for the following when choosing the safest and best crib mattress in 2021:

 1.  Firmness: 

Most crib mattress makers want parents to believe a firm crib mattress is recommended to support an infant’s growing bones.  This is not accurate (“The Truth About Firm Crib Mattresses”).  In fact, there is a large increase in plagiocephaly  (flat head syndrome) and hip dysplasia in young infants.   Known as an unintended consequence of the back-to-sleep campaign, flat head syndrome was virtually unknown until the popularity of the back-to-sleep campaign which includes back sleeping on firm mattresses.

The reality is, the AAP states, “Soft bedding can increase the risk of suffocation.”  The fact is, a soft mattress allows a baby’s face to compress into the mattress surface and block the infant’s nose and mouth.  In contrast, firm mattresses don’t allow face compression.  The nose and mouth will not be blocked.

Consequently, the best crib mattress in 2021 is firm,

2.  Tight fit in crib: 

The mattress should fit tight against the sides of the crib and the crib mattress.  To test for a tight fit, place two fingers down the side of mattress close to the inside walls of the crib.  Make sure no extra space exists. Additionally, the same rule applies for all infant mattresses and pads. A tight fit helps avoid entrapment of baby’s head and tiny arms and legs

In conclusion, the best crib mattress in 2021 fits tight in the crib.

3.  No Vinyl, padded, or quilted covering/topper:

Vinyl covers, and padded or quilted toppers can trap heat.  If heat is trapped, it causes an infant’s core body temperature to rise.  According to the AAP, it is important to avoid overheating with infant’s.  Moreover, the AAP warns against use of padded toppers.  The fact is, padded  toppers are know to trap harmful carbon dioxide.

Additionally, the materials used in vinyl crib mattress covers off-gas phthalates.  Phthalates are considered harmful chemicals.  

Therefore, the best crib mattress in 2021 has no vinyl, padded or quilted covering/topper.

4.  Air Permeability: 

Science proves infants thrive both physically and emotionally in an oxygen rich environment. In 2011, the AAP recommends air permeable sides in play yards and bassinets.  This recommendation is based on infants  found non-responsive with their face wedged against side of the bassinet or play yard. In 2016, the AAP recognizes air-permeable mattresses as being safer than air-impermeable mattresses for infants who roll.  

Based on these recommendations, the best crib mattress in 2021 is air permeable.

5.  Carbon Dioxide Retention:  

While there are no scientific studies to demonstrate a direct prevention of SIDS or suffocation, the AAP Safe Sleep Task Force relies on the hypothesis of rebreathing of carbon dioxide as a likely reason for unexpected infant deaths.  A basic pathophysiological principle is the hypothesis that rebreathing carbon dioxide is associated with SIDS and asphyxia.  Crib mattresses that contain fiberfill, loose cores, quilted surfaces, and even crib sheets have all been shown to trap harmful carbon dioxide.  

Therefore, the best crib mattress in 2021 eliminates carbon dioxide rebreathing.

6.  Are  Waterproofing Chemicals Used:

A crib mattress containing any type of fiber fill, needs waterproofing chemicals.  The fact is, fiberfill crib mattresses become contaminated by a baby’s excretion if there is no waterproof barrier. Consequently, crib mattresses with fiber fill, have a waterproof coating. Many times, the waterproofing coating contains harmful chemicals.  Common chemicals include, silica, monomers, or other toxins. 

Consequently, the best crib mattress in 2021 uses no waterproofing chemicals.

7.  Are Fireproofing Chemicals Used:

All crib mattresses must pass flammability testing.  If a crib mattress has fiber fill or a cover made from flammable fabrics; foam, cotton, linen, or other cellulose fibers, fireproofing chemicals are used.  Notably, fireproofing chemicals include boric acid, ammonium polyphosphate, silica, or antimony trioxide.  The fact is, these harmful chemicals are considered carcinogens. 

Therefore, the best crib mattress in 2021 has no fireproofing chemicals.

8.  Washable:

Scientific studies point to the relation of Staphylococcus aureus (Staph) colonization with stomach sleep position.  It is believed, stomach sleep position increases the risk of ingestion/inhalation of bacteria contaminating the sleeping surface.  According to scientific studies, this bacteria risk could account for the increased risk of SIDS in babies who are tummy sleeping.  Consequently, the AAP warns against using second-hand crib mattresses to avoid the risk of bacteria and pathogens in mattresses. 

A completely washable crib mattress eliminates the buildup of pathogens, mold, and other microorganisms.  Consequently, the best crib mattress choice in 2021 is a completely washable.

9.  Positional Pressure: 

A firm mattress is necessary.  However, choosing a firm crib mattress that does not cause positional pressure on an infant’s delicate skull, is also an important consideration. Positional pressure is caused by too much time on a hard flat surface. Firm mattresses with dense cores and fill create direct pressure on the back of an infant’s head while back sleeping.  Additionally, they can cause the same type of pressure on an infant’s hips if lying on their side.

Therefore, the best crib mattress choice in 2021 eliminates positional pressure.

10.  Can Liquids Pool on the Surface:

Infants often spit up in the middle of the night.  Many fiberfill mattresses have waterproofing barriers that cause liquids to pool on the surface.  These water barriers allow parents to wipe clean the spit up.  Additionally, waterproofing barriers are used to make the mattress stain resistant.  However, if an infant is not being supervised, pooled liquids can be dangerous and uncomfortable. 

Finally, the best crib mattress choice in 2021 is one that forces liquids to immediately travel away from baby.

Types of Crib Mattresses – Pros and Pros and Cons of Each

There are many different types of crib mattresses.  Let’s go through the different types so you can choose the best crib mattress in 2021.  Remember, our choice is based on peer-reviewed published studies used by the American Academy of Pediatrics’ Safe Sleep Task Force to create safe sleep guidelines.

Innerspring Crib Mattress:

A standard crib mattress with steel coils with an over layer of various cushioning materials such as foam, wool, polyester, cotton, or other cellulose fibers.  This type of mattress is encased in a fabric or vinyl overlay.  Innerspring mattresses manufacturers differentiate themselves by describing their coil count and the steel gauge thickness of the coils.  The larger the coil count and the thicker the steel, the denser the mattress is.

Pros: 

Innerspring mattresses are firm and create a tight fit in the crib.

Cons:

Innerspring mattresses have some type of vinyl, padded, or quilted topper.  Notably, innerspring mattresses have low rates of air permeability.  Consequently, the have high carbon dioxide retention levels. 

Innerspring mattresses require waterproofing and fireproofing chemicals.  Moreover, innerspring mattresses cannot be washed or disinfected. In addition, a mattress pad is normally used that can also trap additional harmful carbon dioxide.  In fact, the AAP warns against using mattress pads.  Mattress pads trap carbon dioxide, reduce air permeability, and can cause suffocation if an infant is in the tummy position.

Positional pressure cannot be avoided with innerspring mattresses.  Lastly,  liquids pool on this type of crib mattress. 

Best safest crib mattress 2021

Innerspring mattresses require additional bedding such as mattress pads and sheets.  They range in price from $60 on the low end to $350 dollars on the high end.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of an innerspring mattress:

Rating

Good:

  • Firm
  • Tight Fight

Bad:

  • Vinyl Cover or Quilted Topper
  • Low to No Air Permeability
  • High Rate of Carbon Dioxide Retention
  • Use of Waterproofing Chemicals
  • Use of Fire Retardants
  • Cannot be Completely Washed to Disinfect
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface

Foam Crib Mattress:  

Foam mattresses are typically made from polyurethane, a foam resin. There are different densities of foam and different chemical makeup of the foam.  Consequently, some foam mattresses will pass the firmness test, while others will not.  To be sure a foam mattress is firm enough, press your hand on the mattress and see how far it sinks in. It should not sink in more than a 1/4″.

Pros: 

Mattresses made from foam are often lightweight and inexpensive.  Additionally, they generally have a snug fit.

Cons: 

Foam mattresses have vinyl  or waterproof cover to protect the foam from contamination.  Further, they have very low rates of air permeability – if any at all.  Additionally, they retain carbon dioxide for long periods of time. 

Since foam is a petroleum-based product, foam crib mattresses contain a fire retardant.  Specifically, petroleum-based product are highly flammable.  If a foam mattress does not have a vinyl cover, it will have some type of waterproofing chemical.  The fact is, there has to be a water barrier between the surface material and the foam.  Otherwise, the foam will become contaminated. 

The vinyl surface of a foam mattress is washable.  However, there is no way to wash or sanitize the foam interior. 

Some foam mattresses will cause positional pressure while others will not.  Positional pressure is contingent on the density of the foam.  For example, the denser the foam, the more positional pressure it will cause on an infant’s head. Notably, the vinyl or waterproof coating causes pooling of liquids.

Best safest crib mattress 2021

Popular Foam Crib Mattresses

Foam mattresses also require extra bedding.  Mattresses made of foam range in price from $39 to $200.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a foam mattress:

Rating

Good:

  • Firm
  • Tight Fight

Bad:

  • Vinyl Cover or Quilted Topper
  • Low to No Air Permeability
  • High Rate of Carbon Dioxide Retention
  • Use of Waterproofing Chemicals
  • Use of Fire Retardants
  • Cannot be Completely Washed to Disinfect
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface

Latex Crib Mattress: 

Latex mattresses are similar in construction to foam crib mattresses.  Additionally, they also share many of the same features.  There are different densities of latex mattresses.  In spite of popular belief, pure latex will not cause allergic reactions. 

Most latex mattresses pass the firmness test since they are normally denser than foam.  Latex mattresses are much heavier than foam.  As a result, if you have to change sheets, it can be difficult to lift the mattress.

Pros: 

Mattresses made with latex are firm and create a nice snug fit in the crib.  Furthermore, they help keep baby’s core temperature stable by eliminating the buildup of heat, 

Cons: 

Latex mattresses have minimal air permeability.  In addition, carbon dioxide retain rates depend on the density of the latex.  Most latex crib mattresses contain a fire retardant.  Otherwise, they have a wool overlay.  Notably, wool creates a natural fire retardant. 

Moreover, Mattresses made with latex have some type of waterproofing chemical to act as a water barrier. Because the surface of latex mattresses is usually fabric,  they are not washable.  Further, most require a mattress pad.  Additionally, there is no way to wash or sanitize the latex core. 

Because of their density, latex mattresses cause positional pressure .  How much positional pressure is contingent on the density of the latex.  Additionally, liquids will also pool on the surface of a latex crib mattress.

Best safest crib mattress 2021

Popular Latex Crib Mattresses

Latex mattresses also require extra bedding.  The mattresses range in price from $350 to $800.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a latex mattress:

Rating

Good:

  • Firm
  • Tight Fight
  • Some Air Permeability

Bad:

  • Vinyl Cover or Quilted Topper
  • High Rate of Carbon Dioxide Retention
  • Use of Waterproofing Chemicals
  • Use of Fire Retardants
  • Cannot be Completely Washed to Disinfect
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface

Plant Based Fiber Crib Mattress:  

Coconut choir is the most common type of plant-based fiber used in crib mattresses.  Normally, Coconut choir is used in combination with a foam or cotton layer overlay.   Surprisingly, coconut choir is heavier than foam. 

Pros:   

Coconut choir is very firm and dense.  It creates a tight fit in the crib.  Notably, coconut choir is moisture resistant.  However, it does not do well if it gets saturated.  Consequently,  it needs some type of water barrier.  This plant based fiber has a high level of air permeability if not mixed with other materials.  Unfortunately, we could not find a crib mattress of this type that did not contain a mixture of other materials.  

Cons: 

Coconut choir crib mattresses retain high levels of carbon dioxide.  Additionally, they require some type of vinyl covering or waterproofing chemicals.  If there is no waterproofing chemicals, the choir will become contaminated if saturated.  And, fire retardant chemicals must be used for compliance with CPSC regulations. 

Moreover, there is no way to sanitize coconut choir without ruining its structure.  Since the mattress requires either a vinyl cover or waterproofing chemicals, liquids will pool on the surface of a coconut choir filled crib mattress   In addition, coconut choir is dense; therefore,  it does create positional pressure on baby’s skull.

Best safest crib mattress 2021

Popular Plant-Based Crib Mattresses

Plant-base crib mattress range in price from $260 to $1,250 dollars.  Some models we identified need extra bedding while some do not.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a plant-based mattress:

Rating

Good:

  • Firm
  • Tight Fight
  • Some Air Permeability

Bad:

  • Vinyl Cover or Quilted Topper
  • High Rate of Carbon Dioxide Retention
  • Use of Waterproofing Chemicals
  • Use of Fire Retardants
  • Cannot be Completely Washed to Disinfect
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface

 

Types of Breathable Crib Mattresses – Pros and Cons of Each

The idea behind a breathable crib mattress is that air can flow through the surface of the mattress.  However, there are many types of breathable crib mattresses, so we will explore each type:

  • Open Celled Covers and Traditional Foam or Fiberfill

  • Hollow Cut-Outs or “Air Channels”

  • Spongy, Food-Grade Polymer Core

  • No Fill or Core

Breathable Mattresses with Open-Celled Covers and Traditional Foam or Fiberfill: 

Breathable crib mattress of this type is either a foam filled or Innerspring mattress that has an open channel, spacer fabric cover.  The cover is often removable.  However, removing it from the crib is necessary to remove the cover.

Pros: 

Breathable crib mattresses with open-celled covers and traditional fiberfill are firm and provide a tight fit in the crib.  Additionally, the covers are not vinyl or thick.  Instead this mattress type has an air permeable cover. 

Cons: 

Since breathable crib mattresses with open-celled covers and traditional foam or fiberfill use traditional foam or fiberfill, they can trap high levels of carbon dioxide. Even though the cover does not have waterproofing or flame-retardant chemicals, the same cannot be said for the core. 

Additionally, foam and fiberfill mattress can cause positional pressure.  The open-celled cover is washable, but the core is not.  Consequently, the mattress cannot be completely disinfected.  Liquids will still pool below the open-celled cover.

Best safest crib mattress 2021

Open Celled Covers and Traditional Foam or Fiberfill

 

Breathable crib mattresses with open-celled covers and traditional foam or fiberfill range in price  from $200 to $350.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a breathable crib mattresses with open-celled covers and traditional foam or fiberfill:

Rating

Good:

  • Firm
  • Tight Fight
  • Some Air Permeability
  • No Vinyl Cover or Quilted Topper

Bad:

  • High Rate of Carbon Dioxide Retention
  • Use of Waterproofing Chemicals
  • Use of Fire Retardants
  • Cannot be Completely Washed to Disinfect
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface Below 3D Cover

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

This type of breathable crib mattress is a foam crib mattress with large cut-out areas in the interior center of the foam.  In theory,  air pockets form in the center of the mattress.

Pros: 

Breathable crib mattresses with hollow cut-outs or “air channels” are firm and provide a tight fit in the crib.  However, the covers are made from either synthetic or natural fibers.   These covers impede airflow.

Cons:  

Since the air channels are on the interior, breathable crib mattresses with hollow cut-outs or “air channels” offer limited passive airflow on the surface. For this reason, these mattresses can actually trap harmful carbon dioxide.  Most notably, these mattresses offer no advantage in reducing carbon dioxide levels. 

Moreover, breathable crib mattresses with hollow cut-outs or “air channels” use waterproofing chemicals by admission.  So that, the foam interior is not contaminated.  Further, fire retardant chemicals are also used. 

Additionally, the risk of positional pressure exists since the mattress is comprised mostly of foam,   The cover is washable, but the interior core is not washable.  By design, liquids pool on the surface.

Best safest crib mattress 2021

Hollow Cut-Outs or “Air Channels” in the Mattress

 

Breathable crib mattresses with hollow cut-outs or “air channels” range in price from $199 to $299.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a breathable crib mattresses with hollow cut-outs or air channels:

Rating

Good:

  • Firm
  • Tight Fight

Bad:

  • Vinyl Cover or Quilted Topper
  • Low to No Air Permeability
  • High Rate of Carbon Dioxide Retention
  • Use of Waterproofing Chemicals
  • Use of Fire Retardants
  • Cannot be Completely Washed to Disinfect
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface

Breathable Crib Mattresses with Spongy, Food-Grade Polymer Core: 

This type of hybrid mattress creates a firm surface and 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 trap carbon dioxide.

Pros

Firm, tight fit, high air permeability rate, and completely washable.  One of the three mattresses listed uses waterproofing chemicals and the two others do not.  Additionally, liquids will not pool on the surface.  However, one of the products claims to have a “waterproof” cover.  In this instance, waterproofing chemicals are used.

Cons: 

Breathable Crib Mattresses with Spongy, Food-Grade Polymer have a firm core that may cause positional pressure.  The topper is removable for laundering. However, the core is cumbersome to wash or disinfect.  For example, the manufacturers recommend soaking the core in a bathtub or shower.  For this reason, the mattress is susceptible to further contamination from bathroom pathogens. 

In reference to fire retardants, Newton® recently switched from using a phosphorus-based flame retardant chemical on their plastic core to a flame-resistant viscose (wood pulp based) barrier fabric that fits over the plastic core.  Viscose is a man-made cellulose fiber which is flame retardant by incorporating “phosphorous” in the viscose matrix. The phosphorous flame retardant is incorporated at the fiber spinning stage. Halo® uses flame retardants.

Liquids will not pool on the surface.  On the contrary, liquids flow into the spongy, polymer core.  Consequently, requiring a cumbersome and risky cleaning process.

Best safest crib mattress 2021

Spongy, Food-Grade Polymer Core

 

Breathable crib mattresses with spongy, food-grade polymer range in price from $250 to $350.  Some models have a waterproof covers and some do not.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a breathable crib mattresses with spongy, food-grade polymer:

Rating

Good:

  • Firm
  • Tight Fight
  • Air Permeability
  • Lower Rates of Carbon Dioxide Retention
  • Can Be Completely Washed and Disinfected

Bad:

  • Quilted Topper
  • Use of Waterproofing Chemicals 
  • Use of Fire Retardants
  • Can Cause Positional Pressure
  • Allows Liquids to Pool on Surface of Waterproof Models
  • The Core Must be Removed and Washed in a Bathtub or Shower Making it Highly Susceptible to Bathroom Pathogens

Breathe-Through Crib Mattresses with No Fill or Core: 

The two-part crib mattress system consists of an open frame with side openings.  Additionally, there is an open-celled, air permeable top (topper) surface creating passive airflow.  Oxygen rich air circulates in and harmful carbon dioxide circulates out.

Pros: 

Firm, tight fit, very high air permeability rates promoting an oxygen rich environment.  In addition, the mattress is completely washable without the hassle of having a core to bathe or shower.  For example, the mattress topper slides off easily and is machine washable.  Next, wipe the open frame section with a disinfectant to sterilize.  Since there is no fiber fill or core, there is no reason for waterproofing.  No waterproofing; no waterproofing chemicals!  

Similarly, with no fill or core, there is no need for fire retardants.  Additionally, the absence of fill or a core, eliminates the risk of positional pressure on an infant’s delicate skull.

Cons: 

With all the scientific testing on the two-part breathable crib mattresses with no fill or core, we did not find any cons based on our criteria.  In fact, breathable crib mattresses with no fill or core are 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.

Best safest crib mattress 2021

No Fiberfill or Core

 

Breathable Crib Mattresses with no fill or core range in price from from $300 to $400.

Using the AAP’s Safe Sleep Guidelines, here is a summary of the pros and cons of a breathable crib mattresses with no fill or core:

Rating

Good:

  • Firm
  • Tight Fight
  • No Vinyl or Quilted Topper
  • Significantly High Rate of Air Permeability
  • Significantly Low Rate of Carbon Dioxide Retention
  • No Waterproofing Chemicals 
  • No Use of Fire Retardants
  • Can be Completely Washed and Disinfected
  • No Positional Pressure
  • Liquids do not Pool on Surface

Additionally, the test data on breathable crib mattresses with no fill or core is impressive!

Conclusion:

A good night’s sleep really sets the tone for any day, especially for babies. With the risk of SIDS and other fears while a baby sleeps, you can now rest assured you will make the safest and best crib mattress choice in 2021.

Our Top Pick:

SafeSleep® is our top crib mattress choice in 2021.  The SafeSleep® addresses every safety and comfort concern:

  • Firmness
  • Tight fit
  • No vinyl, padded, or quilted topper
  • Air permeability rate of over 330x of fiberfill mattresses
  • Significantly low carbon dioxide retention to prevent rebreathing
  • No need for waterproofing chemicals since there is no fill to contaminate
  • No need for fireproofing chemicals
  •  Easy to wash and sanitize
  • No positional pressure on infants skull
  • Liquids are wick away and prevents liquids from pooling

The SafeSleep® allows an infant who is face down to breathe-normally.  The open sides and open celled topper eliminates the buildup of carbon dioxide.  Carbon dioxide is a known risk factor in infant sleep related deaths. The Company uses natural and organic components. 

The SafeSleep® is a crib mattress you can use for many children.  It is completely and easily washable to prevent mold and bacteria growth.  We love the fact it is non-toxic and even recyclable.  Above all, it is the only crib mattress recognized by leading AAP policy makers as significantly reducing SIDS and other infant sleep related risks.  

The ultimate goal is your baby’s safety and comfort.  Moreover, when your baby sleeps better, you sleep better.  Therefore, sleep comfortably with the piece of mind you have chosen the safest and most comfortable crib mattress for your baby. 

Make sure to follow these additional safe sleep recommendations to keep your sleeping baby safe:

Avoid Second-Hand if Possible:

Because of the dangers associated with mold and bacteria, it’s best to avoid a used mattress, especially if you don’t know the history of the product. Reusing one from another one of your children? Make sure there aren’t any openings in the waterproof cover where mold could’ve taken root. 

However, breathable crib mattresses with no core are reusable since they have no fill or core where mold or bacteria can accumulate.

Keep the Crib Empty:

Although they look lovely, pillows, bumpers, stuffed animals and blankets shouldn’t be in a baby’s crib. That’s because they can wind up covering your baby’s face and be a suffocation or rebreathing hazard. In addition, crib sheets have been associated with infant sleep related deaths, so don’t use them if you don’t need to.

Breathable crib mattresses with no core do not use sheets or other bedding.  The topper is easily removed for washing.

Place Baby on Back:

The safest sleeping position for your baby is on their back.  However, if your baby should roll in the middle of the night, have the peace of mind they can breathe normally if they are on a mattress they can breathe right through.

Now that you know what the best crib mattress is in 2021, please share with other parents so we can keep babies safe while sleeping.   From tragedy to innovation, check out the story behind the safest breathable crib mattress! 

Is a Breathable Crib Mattress Worth it?

Is a Breathable Crib Mattress Worth it

Is a Breathable Crib Mattress Worth it?

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

Breathable crib mattresses hit the consumer market in early 2000.  Prior to breathable crib mattresses, crib mattresses all 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 much safer than a traditional or organic crib 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 crib mattresses.  In conclusion, the breathe-through crib 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.

Additionally, the lab also compares 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.   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 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® and 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 crib 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 crib mattress 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 crib mattresses has 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 crib 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.

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, 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 is always be 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, It 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 over $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.  Consequently, 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 the 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 lb 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 crib mattresses that are marketed.

Baby Sleeping Face Down?

Baby Sleeping Face Down

Are you finding your baby sleeping face down? 

The founders of SafeSleep® lost their loved one to SIDS / positional asphyxiation.  One was 4 months and the other was 7 1/2 months; two seemingly healthy infants were found face down and unresponsive. 

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

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

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

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

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

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

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

Infants Rolling Over and Sleeping Face Down

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

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

Infants Begin to Roll at Four Months

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

SIDS Risk and Baby Rolling Over

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

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

Repositioning Baby Who is Sleeping Face Down

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

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

Nothing to Do with Good Head and Neck Control

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

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

Carbon Dioxide and Baby Sleeping Face Down

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

Carbon Dioxide Rebreathing and SIDS

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

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

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

Based on multiple peer-reviewed studies, SIDS experts agree, infants sleeping on their tummy on fiberfill crib mattresses, quilted surfaces, soft surfaces, pillow-like surfaces, vinyl pads, mattresses filled with tea tree bark and other natural fibers, and even surfaces that claim to be breathable, show increased risk of rebreathing of carbon dioxide. 

A Real Solution for a Real Problem

Developed by People with Real KnowledgeOur Story!

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

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

Scientific Data on Air-Permeable Crib Mattresses

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

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

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

Study References:

  1. Carleton, James N.,  Donoghue, Ann M.,  Porter, Warren K. Mechanical model testing of rebreathing potentialin infant bedding materials.  Arch Dis Child 1998;78:323–328
  2. Mitchell EA, Thach B, Thompson J, Williams S. Changing infants’ sleep position increases risk of sudden infant death syndrome. Arch Pediatr Adolesc Med. 1999;153:1136–1141
  3. Rachel Y. Moon, Kantilal M. Patel and Sarah J. McDermott Shaefer. Sudden Infant Death Syndrome in Child Care Settings. Pediatrics 2000;106;295
  4. Willinger M, Hoffman HJ, Wu KT, et al. Factors associated with the transition to nonprone sleep positions of infants in the United States: the National Infant Sleep Position Study. JAMA. 1998
  5. Paluszynska DA, Harris KA, Thach BT. Influence of sleep position experience on ability of prone sleeping infants to escape from asphyxiating microenvironments by changing head position. Pediatrics, Dec. 1, 2004.
  6. Patrick L. Carolan, William B. Wheeler, James D. Ross and RCP*; and James S.Kemp, Potential to Prevent Carbon Dioxide Rebreathing of Commercial Products Marketed to Reduce Sudden Infant Death Syndrome Risk, Pediatrics 2000 105;774
  7. Patel, Aloka L., Harris, Kathy, Thack, Bradley T. Inspired CO2 and O2 in sleeping infants rebreathingfrom bedding: relevance for sudden infant death Journals.Physiology.org/doi/pdf/10.1152/jappl.2001.91.6.2537
  8. Kemp, James S., Nelson, Verna E., Thach, Bradley T.,  Physical Properties of Bedding That May Increase Risk of Sudden Infant Death Syndrome in Prone-Sleeping Infants.  Journal of Pediatrics,July,1994,Vol.36,no.S1
  9. Bar-Yishay E, Gaides M, Goren A, Szeinberg A. Aeration properties of a new sleeping surface for infants. Pediatr Pulmonol. 2011;46(2):193–198 342. Colditz PB, Joy
  10. William W. Fox, MD and Thomas H. Shaffer, Carbon Dioxide Rebreathing Assessment of SafeSleep® Crib Mattress Sample.  Intertek., wouso7330

When Can a Baby Sleep on Their Stomach?

When Can Babies Sleep on Their Tummy?

When Can a Baby Sleep on Their Stomach?

Are you finding your baby sleeping on his stomach?  A panic feeling that comes over you when you find your baby has rolled in the middle of the night and is now sleeping on his stomach.  The panic feeling is worse when you find them face down. 

So, when can a baby sleep on their stomach so both of you can sleep better?  

We all hear the safe sleep warnings against placing babies on their stomach.  There is an abundance of research supporting placing an infant on his back to reduce the risk of Sudden Infant Death Syndrome (SIDS). 

What isn’t Clear, is When Can a Baby to Sleep on Their Stomach?

Unfortunately, parents are falsely assured from many sources, including pediatricians, that once their baby is strong enough to roll over, it is safe for their baby to sleep on their stomach. 

Using research-based evidence and compelling insight into the following topics, we navigate facts from fiction to determine when it is safe for your baby to sleep on their stomach.

Why Back Sleeping is Best

We know back sleeping is safest, but you may not know why.  According to the AAP Safe Sleep Task Force, “asphyxia is long been considered the primary cause of death in many instances of SIDS.  Frequent autopsy findings of pulmonary edema, often identified with asphyxia, are found with many SIDS deaths.  The practice of back sleep is known to protect against SIDS.   

Rebreathing

Infants sleeping in a prone position or lying on or near a soft blanket or other soft bedding can rebreathe exhaled carbon dioxide.  Rebreathing leads to hypercarbia and hypoxia.  Hence, if the environment of infants does not change or infants are unable to escape the dangerous situation, they will ultimately die of asphyxia. (JAMA Pediatrics February 2017 Volume 171, Number 2)

Asphyxia

Asphyxia occurs when oxygen is insufficient in the human body.  When an infant begins to rebreathe his exhaled air, he slowly deprives himself of oxygen.  Eventually, the constant re-breathing of carbon dioxide suppresses the infant’s breathing needs, leading to hypercarbia.

Hypercarbia

Hypercarbia is a condition of abnormally elevated carbon dioxide levels in the blood. Carbon dioxide is a gaseous product of the body’s metabolism and is usually expelled through the lungs.  Therefore, when carbon dioxide accumulates in the body, it leads to hypoxia.

Hypoxia

Hypoxia is insufficient oxygen in the tissues to maintain physical function.

The belief is infants who;

  • sleep on their stomach,
  • sleep on soft bedding,
  • use a blanket,
  • have stuffed toys in their crib,
  • have bumper pads attached to their crib,
  • sleep with others,
  • have anything close to their face (including their hands and arms),

Are at increased risk of SIDS since these sleeping situations can trap harmful carbon dioxide.

Back sleeping and rebreathing

When infants sleep on their back without a blanket, there is a much lower risk anything can trap carbon dioxide.  Consequently, making it unlikely for an infant to constantly rebreathe his exhaled air.

In order for infants to safely sleep on their stomach, we must eliminate the risk of trapping carbon dioxide.  If we eliminate trapped carbon dioxide, infants cannot rebreathe it. 

Unfortunately, most crib mattresses trap carbon dioxide.  Traditional crib mattress designs contain fillers, vinyl coatings, quilted tops or solid coverings to prevent contamination. These fabrics and fillers all trap deadly carbon dioxide.

What is Rebreathing?

Rebreathing is when an infant lies face-down or near-face-down on his stomach, air is trapped around the baby’s nose or mouth. This causes the baby to breathe more CO2 than oxygen. If the baby does not wake up or react appropriately, it can lead to death.

Watch Professor David Greenblatt video for a visual on rebreathing.

After our analysis, we will introduce you to one crib mattress scientifically tested to eliminate the risk of rebreathing carbon dioxide even if  an infant is in a face-down position.  

Why Some Infants Who Sleep on Their Stomach are at Higher Risk

Most of us know the frightening feeling of a heavy blanket or pillow over our faces.  This feeling forces a natural trigger to remove the object blocking oxygen.  In addition, we do not worry about sleeping on our big fluffy pillows, pillow-top mattresses with our down quilts.  Why?  Because we have an innate sense to turn our head, even in deep sleep, when our breathing is compromised by the accumulation of carbon dioxide. 

Like adults, most infants turn their heads or fight to get something off their faces when carbon dioxide begins to cause breathing difficulties.  But unfortunately, some infants do not!  

A crib mattress eliminating the buildup of carbon dioxide saves lives.

Serotonin and rebreathing

In 2010, a group of scientists discovered the first direct correlation between SIDS / SUID deaths and serotonin levels.  This finding was discoverd by studying the brain stems of infants who died suddenly and unexpectedly.   

Serotonin is a brain chemical that conveys messages between cells and plays a crucial role in regulating breathing, heart rate and sleep.  Researchers theorize serotonin abnormalities reduce an infant’s “ability to respond to breathing difficulties, including low oxygen levels or high carbon dioxide levels. The leading scientist suggests SIDS is the result of infants rebreathing carbon dioxide accumulation in thier bedding and on their mattresses while sleeping on thier stomach. 

Dr. Hannah Kinney, “Babies who died of SIDS had abnormalities in serotonin in reigns of the brain stem that control breathing heart rate and blood pressure during sleep.”  When a baby is put face down in a bed, it begins to rebreathe carbon dioxide, which is toxic.

Several studies have followed, linking high serotonin levels in the blood of SIDS infants and deficiencies in serotonin receptors. These studies report a common result: reflex apnea and arousal reactions that lead to an infant’s inability to respond to rebreathing of carbon dioxide. In brief, some infants simply do not respond when they are in danger of rebreathing of their exhaled air!

Although the link between serotonin and SIDS / SIDS / SUID is a major finding in 2010.   More than ten years later, we still have no way of testing live infants to determine their serotonin levels, serotonin abnormalities, reflex apnea or arousal reactions. Consequently, all infants are at risk of rebreathing lethal carbon dioxide if they sleep on their stomach on a mattress that does not allow carbon dioxide to dissipate, or if they are in an unsafe sleep environment.

A crib mattress that eliminates carbon dioxide before an infant takes in their subsequent breath, was created by two individuals who experienced a similar tragedy.  One is a pediatrician.

Hypothalamus and rebreathing

Subsequent studies focus on how deficits in the hypothalamus region of the brain can cause infants insufficient responses to carbon dioxide rebreathing

The brainstem and hypothalamus are two regions in which nuclei play an important role in stress responses and arousal mechanisms.

As deaths attributed to SIDS occur during sleep, failure to arouse in a stressful situation is a component of the proposed death mechanism. The hypothalamus is a small but complex part of the brain with important roles in the homeostasis of energy balance, circadian rhythms and stress responses, as well as growth and reproductive behavior. As a regulatory center for so many functions, it receives input and transmits output to various other brain regions. Therefore, since the hypothalamus controls many physiological functions and is highly interconnected with other brain regions, it is an excellent candidate for abnormalities that contribute to the pathogenesis of SIDS.

The reduction of carbon dioxide remains a major concern for safe infant sleep, as it leads to:

  • Asphyxia
  • Hypercarbia
  • Hypoxia

Dangerous Advice

Recommendations from medical professionals and popular pregnancy resources appear to have a common theme: Once your baby can roll over, they are safe to sleep on their stomach.

Community Baby Center, a credible baby forum sponsored by Johnson & Johnson, states, “If your baby is strong enough to roll from back to stomach and stomach to back alone, you don’t have to worry about him rolling and sleeping on his stomach”. In addition, Parents Magazine says, “If your baby can flip himself on his stomach while sleeping, it’s okay to leave him that way.”

Unfortunately, this is dangerous advice!

Current research

New Zealand researchers report: “Parents and caregivers are often concerned about the appropriate strategy for infants who have learned to roll over, which usually takes place at four to six months of age.  As infants mature, they are more likely to roll.  In a study, 6% and 12% of 16 to 23-week-old infants placed on their backs or sides were in the prone position; among infants aged 24 weeks or older, 14% of those placed on their backs and 18% of those placed on their sides in the prone position. 

Repositioning a sleeping infant to the supine (back) position can be disruptive.  Consequently, this could discourage the supine position. 

Data to produce specific recommendations as to when can a baby sleep on their stomach, is lacking.

Infants placed on their back who roll

Further, research shows  more than a quarter of infants who died of SIDS while sleeping on their tummy were last put on their back. These researchers suggest an infant’s ability to escape potentially lethal situations during stomach sleep may be impaired by inexperience in prone sleep.  Dr. Moon later supported their findings (Head of the AAP Safe Sleep Task Force) and colleagues in their review of infant sleep deaths in childcare centers.   

Unintended consequences

Unfortunately, infant inexperience with stomach sleep is now a common, unintended consequence of the successful back-to-sleep campaign.  Babies who roll and are not used to sleeping on their stomach are at greater risk of SIDS. 

According to researchers at Washington University School of Medicine in St. Louis, babies who never sleep on their stomachs do not learn behaviors that can reduce their risk of SIDS.  Consequently, the researchers warn infants should always be put on their backs to sleep.

In 2016, these same researchers recognized the safety benefits of air-permeable crib mattresses that do not allow carbon dioxide to accumulate on the mattress.

Babies who roll

“The first time babies who usually sleep on their backs or sides roll or are placed on their tummy have a 19-fold increase in the risk of sudden death,  We wonder if these babies, who find themselves face down, do not turn their heads to breathe because their reflexes haven’t developed far enough, or because they simply don’t wake up?” says SIDS researcher Bradley T. Thach, MD.

Additionally,  scientific studies indicate an ample head-lifting ability when lying on the stomach may not be sufficient to protect a baby from SIDS. “Many parents think if a baby can lift its head, it is okay to sleep on its tummy, but that is a false assurance,” Thach says. 

It’s starting to make sense why a crib mattress that eliminates the risk of an infant rebreathing their carbon dioxide is protective against SID!

About Dr. Thach

Dr. Brad Thach, now retired, spent most of his career as a SIDS researcher.  His research is still considered relevant.  He and Dr. James Kemp are credited with finding the link between rebreathing carbon dioxide and SIDS.

About Safe Sleep Policy Makers

Who are AAP policy-makers?  The Committee of the American Academy of Pediatrics (AAP) on Fetus and Newborn established the AAP Safe Sleep Task Force in the 1990s and currently monitors their work.  The members of the AAP Safe Sleep Task Force write the AAP Safe Sleep Policies and Guidelines.  The Task Force consists of five physicians who volunteer their time and expertise to make sense of the available data. Unfortunately, these scientists are not without their bias.  For example, before the updated policy in 2016, a new doctor was added specializing in breastfeeding.  There is a new heightened awareness of the importance of breastfeeding to reduce the risk of SIDS.  Eventhoug, there are no gold standard scientific studies to support breastfeeding to prevent SIDS / SUID.

The AAP (including the Safe Sleep Task Force) does not endorse, certify or recommend certain products.  In addition, the AAP restricts interactions with manufacturers, making it difficult for manufacturers to ensure that their products are safe for consumers. 

Randomized Case Controlled Studies vs. Retrospective Analysis

AAP safe sleep policies are based on a retrospective analysis of infant deaths.  These investigations may be flawed.  Actual scientific tests are not carried out to prove SIDS theories, as unethical tests would be required.  Dr. James Kemp, who used baby bunnies, carried out the closest test showing rebreathing of carbon dioxide as a probable cause of SUID / SIDS. 

The AAP Safe Sleep Task Force use retrospective analyses to determine safe sleep recommendations.  Meaning, the best data they have is  filtering through thousands of infant death reports.  Next, they attempt to find correlations between infants in a particular age group, gender, weight, etc., to determine why some infants lived and others died.  Take, for example, the “back-to-sleep” recommendation.  These scientists found infants with similar profiles were more likely to die when they slept on their stomach than on their back.

Unfortunately, retrospective analysis data can be flawed and is subject to scientific interpretation.  SIDS death scene investigations are not currently standardized.  There are considerable efforts in this direction, but we are still not there.  It is up to the medical examiner or pathologist to determine the cause of death.  These individuals  take note of the series of events and the scene.  However, some will be appropriate and complex in their findings and others will not.  Consequently, there is a high probability that one examiner will include data  that the other examiner will not.  Often examiners label a death as SIDS on the single fact the infant was sleeping during the incident.

Limitations of Safe Sleep Policy Makers

The absence of Randomized Case Controlled (Gold Standard) means recommendations are based on retrospective analyses.   For example, it is recommended not to use blankets for infants.  Instead, it is recommended to use wearable blankets.  There is no scientific study to conclude whether a wearable blanket prevents SIDS deaths.  However, many death scene investigations show infants who died compared to infants in a similar environment who did not have loose blankets in their cribs.  This suggests loose blankets in the crib are an increased SIDS risk. 

The same applies to back sleep.  No gold standard scientific study has been carried out to show whether an infant is at increased risk of dying on his or her stomach. However, retrospective data shows infants who were on their back were much less likely to die during sleep, suggesting back sleep reduces the risk for SIDS.

Retrospective analysis suggests air-permeable sides and surfaces are preferable to air-impermeable sides and surfaces to protect against SIDS.  Science that dictates high air-permeability in crib mattresses is preferable.

SIDS and Crib Mattresses

Most of us know the importance of keeping fresh oxygen flowing to a sleeping baby.  Additionally, we now know the importance of avoiding anything in the crib that can block fresh oxygen or cause carbon dioxide to accumulate.  

Unfortunately, conventional crib mattresses with fiber fill, vinyl covers, quilted toppers, and loose sheets all impede fresh oxygen flow, Further, they cause causing carbon dioxide to accumulate.

According to Dr. James Kemp and Dr. Brad Thach, “These bedding materials prevent the dispersion of exhaled gases (carbon dioxide) and keep the gases near a face down infant’s mouth. With each subsequent breath, the infant takes in an air mixture gradually less appropriate to maintain life. The more conducive an object is to rebreathing (to preserve carbon dioxide), the more dangerous the object would be.”

SIDS experts agree infants sleeping on their  stomach 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 an increased risk of rebreathing carbon dioxide.  

Imagine a crib mattress with no fill, no quilted topper, no need for sheets. A crib mattress with side opening and an open celled, firm topper that allows continuous air flow.

Safe Infant Sleeping in the Prone (Face-Down) Position

In the 2011 AAP Safe Sleep Policy and Technical Report, it states, “play yards and bassinets with vertical sides of air-permeable material may be preferable to those with air-impermeable sides.” The recommendation to include air-permeable sides in play yards and bassinets is based on retrospective studies by the AAP Chairperson of Task Force Safe Sleep, Dr. Rachel Moon and her colleague Dr. Jody Pike.

According to Moon and Pike, “We have carried out a retrospective review and analysis of deaths in bassinets between June 1990 and November 2004 reported to the CPSC.” Moon and Pike noted several infants who died were discovered with their faces near or pressed against the side of the bassinet or play yard that had no air-permeable sides.

In 2010, a pediatrician and her sister, a SIDS content expert,  began challenging members of the AAP Safe Sleep Task Force to include published studies confirming the safety benefits of air-permeable crib mattresses with no fill materials for infants who end up in a face-down position.  After all, they recommend air-permeable sides in bassinets and play yards.

Finally, in 2016, the AAP Safe Sleep Task Force states, “Crib mattresses were designed with air-permeable materials to reduce the rebreathing of expired gasses (carbon dioxide), in the event that an infant rolls to a prone position.  These crib mattresses may be preferable to those with air-impermeable materials.”

So, When Can a Baby Sleep on Their Tummy? 

After reviewing the following topics:

  • Why back sleeping is the best if your infant is sleeping on a traditional crib mattress with fiber fill or quilted surfaces.
  • We currently have no way to determine which infants who tummy sleep or roll over are at higher risk.
  • If your baby can roll over on their own from back to tummy and tummy to back, they are “safe” to tummy sleep – which is not only poor advice it could prove fatal.
  • Who our safe sleep policymakers are and the scientific limitations they face.
  • The issues with conventional crib mattresses that contribute to unsafe sleep conditions.
  • The safety benefits of air-permeability.

We can safely say there is no clear age or milestone to determine when it is safe for a baby to sleep on their stomach. However, there is an “air-permeable” alternative to conventional crib mattresses, recognized by AAP policymakers as preferable for infants who end up on their stomach while sleeping.

Air-permeable crib mattress

The test results of the SafeSleep® breathe-through crib mattress are included in the scientific studies reviewed by the AAP.  The SafeSleep® crib mattress is made of air-permeable materials and has no fill or core. Specifically, the design of the SafeSleep® air-permeable mattress eliminates the risk of rebreathing of expired gases (carbon dioxide) in the event that an infant is in a prone position during sleep.

SafeSleep ® does not have any fiber fill or core.  Instead, it has a hollow center with side openings and a firm, air-permeable topper to create an oxygen-rich environment.  

Scientific testing shows exhaled carbon dioxide is gone before a baby takes in their next breath, eliminating the risk of carbon dioxide rebreathing.

When can babies sleep on their stomach
When Can a Baby Sleep on Their Stomach

Back sleep is safest, but if your baby insists on sleeping on his stomach, make sure he sleeps on an air-permeable crib mattress. If you want to learn more about the air-permeable crib mattress allowing an infant to breathe normally, even if face down, check out SafeSleep®’s fully breathe-through crib mattress.

We have no clear answer for when can a baby sleep on their stomach, but there is a clear answer for what a baby should sleep on if they are sleeping on their stomach!