Baby Sleeping Face Down – What To Do

Baby sleeping face down

Baby sleeping face down?  

Finding your baby sleeping face down is a scary feeling.  The founders of SafeSlee know too well.  Sadly, they lost a loved ones who rolled in the middle of the night.  

Fast forward, the founders set out to stop this from happening to other infants.  So don’t worry.  There is a solution. 

It’s true, most infants turn their heads when their not getting fresh oxygen.  For example when a baby is sleeping on their side and close to a bumper pad.  Or, when your baby is a stomach sleeper and they are face down.  But unfortunately, some will not.  We don’t know which ones will or will not.  Consequently, we need to remove the risk.

Unfortunately, there are over 3600 sudden unexpected infant deaths each year in the U.S.

The AAP has No Clear Guidelines –   “When a Baby Begins Rolling Over or Baby is Sleeping Face Down”

In 1944, a pathologist who studied infant deaths noticed that over 65% of infants who died from SIDS during the night were found face down.  However, it was not until the 1990’s when SIDS researchers and medical professionals launched the back-to-sleep campaign.  

Currently, the American Academy of Pediatrics (AAP) does not give parents clear directions on what to do when a baby begins rolling over.  I have seen newborns rolling to their side to sleep. Trust me, this is very risky in the middle of the night.  

Too often, these babies end up face down. Unfortunately, babies sleeping face down are at a greater risk of SIDS

Baby Rolling and Sleeping Face Down

 

Baby Sleeping Face Down?

We know the answer to the question, “should babies sleep on their back?”  

Finally, we can easily answer the question that the Back-to-Sleep campaign does not!  What do I do when my baby begins rolling over in sleep? 

Impressively, the answer is a totally breathe-through crib mattress.  The mattress is designed by a leading Pediatrician.  Specifically, a baby can breathe normally while sleeping face down.  As a result, it is called the SafeSleep® Breathe-Through Crib Mattress.  

It’s unique design is tested and shows 100% oxygen rich air while breathing through the mattress.  Breathable crib mattresses don’t offer this feature.  

It’s no wonder, the SafeSleep® is the number one pediatrician recommended crib mattress.  In fact, it is the only crib mattress pediatricians and respiratory therapists write prescriptions for infants who must tummy sleep for health reasons.

Shop the SafeSleep® Breathe-Through Crib Mattress

Baby Sleeping Face Down

So Why Trust Us?

I never thought of becoming a crib mattress designer.  In fact, I am running my own successful design firm when a friend showed me a photo of a breathe-through crib mattress.  He is aware of my design skills.  Consequently, he asks me to develop it. 

As you can imagine, it is no easy decision.  However, I am sure of one thing.  A crib mattress of this type will save a lot of young lives.  Consequently, it is something I can’t ignore.  

Safer Crib Mattress Design For a Baby Sleeping Face Down

Immediately, I shows the idea to my sister.  She is a leading pediatrician.  Specifically, she serves on many national committees.  Additionally, she is the author of many peer-reviewed publications that advance the health of children. 

She and I both know the idea is brilliant.  For this reason, we know it is a project too important for infant safe sleep to overlook.

Research of Crib Mattresses

First, we begin by researching crib mattresses of all types.  Specifically, we are looking at the many issues relating to their safety.  However, we are also looking at their use in aiding an infant’s health and development.  Additionally, we don’t ignore sanitary and comfort issues. 

Over time, our research includes a lot of peer-reviewed published studies to find out what the best and safest crib mattress should look and feel like. 

These studies include:

  • crib mattresses.
  • play yards.
  • SIDS and other infant sleep related deaths.
  • Flat Head Syndrome.
  • Off-gassing & toxins used in mattresses
  • Mold, pathogens and other bacteria in crib mattresses.

Some of the more notable studies include:

Sources for Our Crib Mattress Research

Additionally, in our research of creating the safest and best crib mattress, we use the following:

  • Scientific testing
  • American Academy of Pediatrics (AAP) safe sleep guidelines
  • Consumer Products Safety Commissions (CPSC) findings
  • The National Institute of Health (NIH) safe sleep guidelines
  • Interviews with SIDS experts, AAP experts, child safety experts, pediatric lung specialists, and parents who lost an infant while sleeping.

Our Crib Mattress Research

We are familiar with AAP’s data on safe sleep.  So much so, we challenge the Safe Sleep Task Force in 2015.  The result is an update to information on the benefits of breathe-through crib mattresses

As mentioned prior, breathe-through crib mattresses allow a baby who is sleeping face down to breathe normally through his mattress.  This feature eliminates the risk of suffocation.  Equally important, it eliminates the risk of rebreathing.

AAP Safe Sleep Task Force (SSTF)

I spoke with many of the SSTF Members.  In fact, the Chair, Dr. Rachelle Moon and I wereboth expert witnesses in the same trial.  The trial involved the death of a 7 ½ month old baby.  Consequently, I was able to discuss with her the many issues the SSTF faces while creating safe sleep guidelines. 

AAP Committee – Fetus and Newborns

Additionally, we spoke with members of the AAP’s Committee of Fetus and Newborns (COFN). COFN over sees the AAP’s SSTF’s policies and guidelines.

In particular, COFN studies issues and current advances in fetal and neonatal care.  Moreover, they make recommendations regarding neonatal practices.  Also, they work with the American College of Obstetricians and Gynecologists (ACOG) to consider fetal issues.  This bridges the gap between obstetrics and pediatrics in regards to fetus care.

Leading SIDs Researchers Who Did Studies on Baby Sleeping Face Down

In addition, we met with both Dr. James Kemp, Pediatric Pulmonologist.  Also present is  Dr. Brad Thatch, a neonatologist.  Both work at St. Louis Children’s Hospital. 

Markedly, both Kemp and Thatch are known as top SIDS researchers.  Kemp is consistently on “The Best Doctors in America” list. 

Equally impressive, thatch received the Anaheim Award for Sleep and Breathing Research in Infancy in 2000.  Also, he is a long-term board member of First Candle SIDS Alliance. 

Significantly, both Doctors are are known for their SIDS research.  Notably, they identified “rebreathing” as the most likely cause of many infant sleep related deaths. 

To elaborate, rebreathing is when an infant continues to rebreathe their exhaled air (CO2).  It’s important to remember, rebreathing is the leading theory behind SIDS deaths. Eliminating rebreathing risk is used for the most of the Safe Sleep Task Forces’ safe sleep guidelines.

New Legislation Pertaining to Crib Safety

In particular,  their is new legislative action outlawing the sale of bumper pads in the U.S.  Part of this law is based on newborns rolling on their side to sleep with their faces wedged up against or near bumper pads.  This position can cause a baby to rebreathe his exhaled air.

We must ask ourselves, if a bumper pad is causing rebreathing when a baby rolls to their side while sleeping, what is the danger of a baby sleeping face down? Obviously, most crib mattresses have more padding than a bumper pad.  If a bumper pad is a danger for a baby sleeping on their side.  We have to conclude a crib mattress with fiber fill is equally as dangerous to a baby sleeping face down.

Epidemiologist

I met Dr. Ron Somers, an epidemiologist, on an infant list service.  Dr. Somers is the creator of the Australia standard for crib mattress firmness.  This standard is listed as AS/NZS 8811.1:2013. 

The SafeSleep® Crib Mattress is the only mattress in the U.S. to pass his crib mattress firmness test. Even more impressive, Dr. Somers gives our product an unsolicited endorsement.

The firmness standard is also known as “method 1: Crib Mattress – Test for firmness.  It is the only test to address the issue of minimum safe firmness for crib mattresses. 

Dr. Somers is the former director of Epidemiology in Australia.  

baby-is-sleeping-face-down-in-mattress

 

Pediatric Lung Specialist

Additionally, I met with Dr. Thomas H. Shaffer, Department of Biomedical Research, Alfred I. duPont Hospital for Children.  He is the Director of the Center for Pediatric Lung Research.  In particular, Dr. Schaffer helped create and over sees the testing used to determine CO2 evaporation levels on crib mattresses.  Currently, his testing and methods are used by certified test labs. 

Warning from Dr. Ron Somers Regarding Breathable Crib Mattresses

In 2020, an article written by Dr. Somers is published in Infant & Nursery Products Alliance of Australia (INPAA).  INPAA is similar to the CPSC in the U.S.  But more specifically, INPAA’s key goal is preventing injuries of children. 

In the article Somers states, “If you really want to protect your baby from suffocation, you need to be aware of false mattress-safety claims.”

Somers explains, “Rebreathing of CO2 causes suffocation. With many of the so-called breathable crib mattresses, the CO2 (being heavier than air) sinks into the mattress.  It is then sucked up by the baby for rebreathing. In other words, the carbon dioxide does not dissipate.

This is determined by a special test using a mechanical baby.  The mechanical baby breaths in and out like a real baby. If a manufacturer doesn’t show you their results on this kind of test, don’t fall for their safety hype.”

SafeSleep® provides this test data and all their test data on their website.

Ironically, Somers is referring to the testing and methods created in part by Dr. Shaffer.

CPSC and SIDS Organizations

We spoke with representatives at the CPSC.  Moreover, we used their data base to find reviews and recalls of infant sleep products.  We also spoke with many SIDS organizations.  And, we also spoke with many parents who lost a baby to SIDS.  

We are parents too

Even though we are both professionals, we are also parents.  We know it can be hard to change crib sheets.  Crib mattress messes are not strange to us.  And, we have our share of fussy sleepers. 

Additionally, we know the value of good sleep for both infants and parents.  Consequently, comfort is also a priority. 

Further, we also know the importance of offering quality at a fair price.  Believe it or not, we even considered the aesthetics.  Parents shouldn’t have to choose between safety and a cute nursery.

The effects chemicals in mattresses have on young children are known.  Consequently, we don’t use any!

Research on Infants Who Rolled Over

In a study conducted in New Zealand, researchers found that 3/4 of the infants who died of SIDS were placed on their backs.  The infants were found on their stomach.  This means, the infants rolled to a stomach position.²  These researchers suggest, an infant’s ability to escape a fatal situations during tummy sleep may be impaired by their lack of experience sleeping on their stomach. 

Later, their findings are supported by Dr. Moon and colleagues in their review of infant sleep related deaths in child care settings.³ 

Unfortunately, infants who don’t sleep on their stomach, but roll over are at higher risk of SIDS.  This is now a common unintended consequence of the back-to-sleeping campaign. 

Unfortunately, keeping a baby from rolling over is impossible. 

Learn more about your baby’s first milestone – baby rolling over.  The medical professionals at SafeSleep® tell you everything you need to know when it comes to your baby rolling over.

SIDS Risk 

The fact is, infants under six months of age represent 90% of all SIDS-related deaths.  SIDS risks is peaking between 1-4 months of age.  

In a study on infant sleep, overall, 24% of infants are found sleeping on their stomach.  Of this 24%, 12% of 16 to 23-week-old infants placed on their backs or sides are found sleeping face down.  Additionally,  4% of infants aged 24 weeks or older rolled on their stomach.  Lastly, 18% of those placed on either their right or left sides, are found on their stomach.4

Nothing to Do with Good Head and Neck Control

Parents are often falsely assured that when their infant rolls side to side on their own, they are no longer at risk of SIDS.  Many parents believe if their baby has good neck and head control, they are safe even if they are a face roller.  Specifically, they believe a baby will turn their head to avoid a possible dangerous situation.

In stark contrast, scientific studies tell us differently. 

According to SIDS  expert Dr. Thach, “The first times babies who usually sleep on their backs or sleep on their sides roll or are put on their tummy, they have a 19-fold increase in the risk of SIDS.”  The percentage increases to 40-fold if an infant is swaddled.

Find our when you should stop swaddling your baby and how to properly transition them.  

Thatch goes on to say, “We wonder if these babies, who find themselves face down, do not turn their heads to breathe easier.  If so, is it because their reflexes haven’t developed far enough.  Or, because they simply don’t wake up?  Many parents believe that if a baby can lift his head, he is okay to sleep on his tummy. That is a false assurance.5

Repositioning Baby Who is Sleeping Face Down

Some physicians tell parents to move an infant who is sleeping on their stomach to their back.  However, turning a baby back over is unrealistic.  Babies have several position changes per night.  Furthermore, we know repositioning a sleeping baby is disruptive.  This makes choosing the safest crib mattress a must.

In short, parents do not have the time or energy to watch their baby all night.  Parents need sleep too.

CO2 and Baby Sleeping Face Down

Currently, the AAP recommends a firm crib mattress. However, a firm crib mattress poses a high risk of rebreathing of CO2.  This is confirmed in several studies.  And let’s not forget that bumper pads are now banned for sale in the U.S. based on infants who have died.

In fact, according to a 2000 study published in Pediatrics, the findings show a firm mattress poses a high risk of rebreathing while an infant sleeps on their stomach.6  There is no mention of the infants sleeping face down. Further, these findings are of relevance to more recent studies.

More recent studies show that babies who do no normally sleep on their back and roll or are placed on their stomach, have an increase risk of SIDS.  According to the studies,  71% of SIDS victims unaccustomed to stomach sleep, are discovered sleeping face down” 5

CO2 Rebreathing and SIDS

Rebreathing CO2 is when a baby rebreathes their exhaled air.  This normally occurs when a baby is sleeping on his stomach and exhaled air is trapped around the baby’s nose or mouth. 

The result, trapped exhaled air causes the baby to breathe in more CO2 than oxygen.  Specifically, if the baby does not wake up or respond appropriately death occurs.7

Example of what is happening when a baby is sleeping face down 

Demonstration of Infant Suffocation Caused by Rebreathing CO2

*Source David Greenblatt Faculty of Mechanical Engineering, Flow Control Laboratory

We know conventional crib mattresses with fiber fill can cause CO2 to accumulate.  Additionally, vinyl covers, and quilted toppers can cause even higher levels of CO2 accumulation.  Even the folds of sheets causes CO2 to accumulate.

According to Dr. Kemp and Dr. Thach, these bedding materials act to slow the dispersal of exhaled gasses (carbon dioxide), keeping the gasses near a face down infant’s nose and mouth

As a result, with each breath, the infant takes in an air mixture which is progressively less adequate to sustain life. Further, the more prone an item is to rebreathing (retaining CO2), the more hazardous the item is.8

Peer-Reviewed Studies on Crib Mattresses

SIDS experts agree, infants sleeping on the following surfaces show increased risk of suffocation and rebreathing CO2

  • fiberfill crib mattresses 
  • quilted surfaces
  • soft surfaces
  • pillow-like surfaces
  • vinyl pads
  • folds of sheets
  • mattresses filled with tea tree bark and other natural and artificial loose fibers

Eliminating Suffocation and Rebreathing Risks

As mentioned above, rebreathing CO2 is a known danger of infants sleeping on their stomach.  Another danger is suffocation.  Rebreathing CO2 is actually a form of suffocation.  Unlike airway obstruction, rebreathing leads to hypoxia.  Hypoxia is a lack of oxygen to human organs.    

Crib mattresses with fiber fill  trap CO2.  They also cause suffocation if they allow for airway obstruction.  The design of the SafeSleep® eliminates both suffocation risk and the risk of rebreathing. 

No Fiberfill or Core

To protect babies from suffocation risk, it’s important they can breathe normally when face down.  In order to accomplish this, a crib mattress must be completely breathe-through.  To be completely breathe through, a crib mattress cannot have any fiberfill or core material to block air flow or trap harmful CO2.   

Fiberfill and other core materials interfere with air flow.  Additionally, they are known to retain higher levels of CO2. 

SafeSleep® has no core or fill material of any kind.  Instead, the base of the mattress is a hollow box with side openings.  This design allows air to circulate uninterrupted.

Air-Permeable, Breathe-Through Surface

In order to be effective, the surface has to be air-permeable.  It’s important that the surface a baby is sleeping face down on be completely breathe-through. This means the surface must be open celled.  An open-celled surface allows air to travel up and down quickly with no obstruction. 

Remarkably, the SafeSleep® is tested showing 100% oxygen-rich air while a baby is breathing through the SafeSleep® mattress.  The surface is a medical grade spacer fabric.  This fabric allows air to pass up and down without obstruction.  Not to mention, testing shows a significantly high rate of airflow

In fact, the SafeSleep® has an air-permeability rate of over 330 times other crib mattresses tested.  That’s a lot of good, healthy, air-flow!

A Real Solution for a Real Problem

Developed by People with Real KnowledgeA Pediatrician and Safe Sleep Expert

The SafeSleep® breathable crib mattress is designed to keep a baby who is sleeping on his side, his stomach, or sleeping face down safe. 

  • There is no fiberfill or core to trap CO2.
  • SafeSleep® breathable crib mattress has a hollow center and side openings.
  • The surface is made from an open-cell fabric that allows air to flow up and down with no interruption. 
  • No crib sheets are used.
  • The surface is 100% machine washable.  
  • No fire retardants or waterproofing chemicals are used.
  • No bathtub or shower is needed for cleaning.

This revolutionary design creates an oxygen-rich environment, even when an infant is face down all night.  The design also creates a user-friendly and easy to clean crib mattress for parents.

 

 

Scientific Data on Air-Permeable Crib Mattresses

Scientific data shows some air-permeable mattresses have a “significantly” reduced risk of rebreathing of CO2.9,10  Specifically, the SafeSleep® Breatthe-Through Crib Mattress is tested for CO2 retention.  It has a whopping tenfold decrease in CO2 retention when compared to a fiberfill mattress. 

To illustrate, it takes 120 seconds for CO2 to evaporate from a firm fiberfill crib mattress.  However, it takes less than .5 (1/2 a second) for it to evaporate from the SafeSleep® Crib Mattress.10

Fact, an infant takes a breath every 1-2 seconds.  This means, CO2 on the SafeSleep® crib mattress is gone before your baby takes his next breath of air – even if their face is straight down.

Conclusion

We cannot stand watch over our babies all night.  Sleep is important for parents too. Finding your baby sleeping face down is a very scary feeling. 

The problem is, we can’t keep them from rolling.  And we cannot keep turning them back over.  It’s unrealistic since infants assume many position changes nightly. Not to mention, flipping them over is disruptive. 

Sadly, we know the horrible outcome of a baby simply rolling in the middle of the night.  But with that being said, we don’t expect parents to simply take our word for it. 

Most importantly, the science provides the proof the SafeSleep® Breathe-Through Crib Mattress is the safest choice for a baby sleeping face down or on their stomach. 

A lot of research went into creating the SafeSleep® Breathe-Though Crib Mattress.  We are proud we are contributing to the progress of keeping sleeping babies safe.

Additionally, we are honored to be recognized by many top medical professionals as bridging the safety gap not addressed by the back-to-sleep campaign – What to do when an infant rolls over.

Is your baby sleeping face down?  SafeSleep® is more than a breathable crib mattress.  It is completely breathe-through. 

Want information on baby sleeping on stomach?  Read our article, When Can Baby Sleep on Their Stomach

Study References:

  1. Carleton, James N.,  Donoghue, Ann M.,  Porter, Warren K. Mechanical model testing of rebreathing potential 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

 

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