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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.

Breathable Baby Mattress or Air Permeable?

Breathable Baby Mattress

Is the preferred crib mattress, a breathable baby mattress or an air permeable crib mattress?

About Breathable:

Many crib mattress companies are beginning to market their fiber filled or plastic filled baby mattress as being “breathable.”  So what is the definition of breathable?  When it comes to fiber and fabrics, the definition of breathable is admitting air to the skin and allowing sweat to evaporate.

Air Permeable:

The definition of air permeable when it comes to fibers and fabric is the rate of airflow passing perpendicularly through a known area under a prescribed air pressure differential between two surfaces of a material.  

Many parents believe a breathable baby mattress is the same as an air permeable crib mattress.  There are some similarities between a breathable baby mattress and an air permeable crib mattress; both admit air to the skin and both allow sweat to evaporate.  However, the air permeable crib mattress is the only crib mattress  that is recognized by medical professionals and safe sleep experts as addressing the risk factors associated with infant sleep related deaths and a breathable crib mattress is not.

AIR PERMEABLE CRIB MATTRESSES AND THE AAP

In fact, the SafeSleep® Breathe-Through Crib Mattress created by Safe Sleep Technologies, (formerly Secure Beginnings) is the only air permeable crib mattress on the market today that is approved and endorsed by leading American Academy of Pediatric (AAP) physicians as addressing the multiple risk factors associated with infant sleep related deaths (SIDS/SUID).

In 2011, Dr. Margie Andreae and her sister Julie – the creator of the first commercially viable air permeable/breathe-through crib mattress – began to challenge the AAP’s Safe Sleep Task Force to include relevant test data proving the SafeSleep® air permeable crib mattress does reduce the many risk factors associated with infant health and safe sleep.

The pair used scientific literature supported rationale for to convince the Task Force to recognize the safety and health benefits of air permeable crib mattresses.

The AAP’s Task Force on Sudden Infant Death Syndrome technical report was originally published online October 17, 2011 in Pediatrics.

Dr Rachel Moon, the Chair of the Task Force, maintains that there was no data to support the use of breathable crib mattresses or air permeable crib mattresses to prevent SIDS/Suffocation at that time. 

RELEVANT SCIENTIFIC TEST DATA

Relevant scientific test data shows the air permeable mattress by Safe Sleep Technologies: 

  • Reduces the risk of CO2 rebreathing compared to a fiberfill  mattress,
  • Eliminates the use of a crib sheet and potential for entanglement, and
  • Reduces Staph aureus colonization by eliminating the fiber fill or plastic core.     

CO2 RETENTION AND RISK OF REBREATHING

Prior to the publication of the AAP Task Force report, studies were available that clearly demonstrated that the risk of rebreathing of exhaled air (CO2) was lowest on air permeable crib mattresses and surfaces (Kemp 2000, Bar-Yishay 2011).   In addition, Dr. Moon was provided with test data from Intertek, a CPSC accredited and recommended lab, showing significantly low risk hazard of rebreathing of an air permeable crib mattress (lower than the firm fiber fill crib mattress with tight fitting sheet). These data demonstrate that the air permeable crib mattress has significantly lower CO2 retention.  All three reports used similar test methods and had similar results.  

While the studies do not demonstrate a direct prevention of SIDS or suffocation, they rely on the hypothesis of rebreathing of CO2 as a potential contributor for these unexpected infant deaths.  Indeed no studies have substantiated this hypothesis; however, this is the same hypothesis used by the AAP Task Force to support many of their recommendations including the following with quotes taken from the AAP Task Force report.

  1. Supine sleep position: “The prone or side sleep position can increase the risk of rebreathing expired gases, resulting in hypercapnia and hypoxia.
  2. 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.”
  3. 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.”
  4. 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.”
  5. 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.”

AIR PERMEABLE SIDES IN BASSINETS

In addition, the Task Force recommends air permeable sides when bassinets are used. This recommendation is based on a retrospective review and analysis of infant deaths occurring in bassinets between June 1990 and November 2004 that were reported to the CPSC (Pike/Moon 2008). The authors identified at least six infants who were found with their “face wedged against the side of the bassinet.” While there was no mention of any bassinets having air permeable sides in the study, the study authors (including R Moon who is on the AAP Task Force) recommend “a bassinet with vertical sides of air-permeable material, such as mesh, may be preferable to one with air-impermeable sides.”  The Task Force makes the recommendation for air permeable sides based on infants with face wedged against side of sleep environment but fails to recommend air permeable crib mattresses as being preferable air impermeable crib mattresses to address infants face-straight- down on firm mattresses despite the continued report of such deaths.

FIBERFILL MATTRESS VS. AIR PERMEABLE MATTRESS 

Further the Task Force’s accompanying policy statement (AAP, 2011) recommends the following sleep surface: “Use a firm sleep surface—A firm crib mattress, covered by a fitted sheet, is the recommended sleeping surface to reduce the risk of SIDS and suffocation.”

Here the authors are stating that the firm crib mattress reduces the risk of SIDS.  Even though they list this recommendation as Level A, they fail to provide the citations that support this recommendation in the policy statement.  In referring back to the technical report, the authors rely on the CPSC recommendations to support their recommendation for the firm crib mattress:

“Cribs should meet safety standards of the CPSC, Juvenile Product Manufacturers Association, and the ASTM International (formerly the American Society for Testing and Materials), including those for slat spacing, snugly fitting and firm mattresses, and no drop sides.121”

This citation [121 US Consumer Product Safety Commission. Crib Safety Tips: Use Your Crib Safely. Washington, DC: US Consumer Product Safety Commission. CPSC document 5030] is a tip sheet written for parents and caregivers.  It is not a well-conducted case-control study, a systematic review, or a meta-analysis.  No other citation is provided.  The citations for this recommendation do not meet the Level A requirements. 

DR. JAMES KEMP AND COLLEAGUES

Dr. James Kemp and colleagues were some of the first to study the potential for various sleep surfaces to prevent infant rebreathing (Kemp 2000).  They found that the firm mattress and four of the five surfaces designed to prevent rebreathing consistently allowed lethal rebreathing of CO2.  Only one product—an air permeable crib mattress—was able to maintain CO2 levels below this threshold.  The authors go on to say that “even firm crib mattresses could pose a rebreathing threat when vulnerable infants sleep prone.” They refer to studies showing that unaccustomed prone sleepers, including infants who are placed supine and roll prone have an increased risk of SIDS (L’Hoir 1998 and Mitchell EA 1999). These studies and others have shown that nearly half of SIDS victims unaccustomed to prone sleep, were discovered in the face-straight-down position. Many of these infants were found on a firm crib mattress. Dr. Kemp’s data supports that if vulnerable infants were placed on an air permeable crib mattress or surface, they would experience less risk of rebreathing should they inadvertently roll prone.  There is no reference to breathable crib mattresses reducing CO2 levels or reducing risks.

DR. EPHRAIM BAR-YISHAY AND COLLEAGUES

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, two conventional firm crib mattresses and three mattresses with an additional layer or topper designed to improve air flow similar to the toppers on current crib mattresses claiming to be “breathable crib mattresses”. (Bar-Yishay 2011).  The air permeable crib mattress had a significantly faster rate of CO2 elimination and only the air permeable mattress was able to prevent CO2 accumulation with maximal CO2 levels significantly lower than that of the other crib mattresses. They concluded that the air permeable crib mattress exhibited significantly better aeration properties compared to the other five mattresses including the firm crib mattresses.  the crib mattresses with “breathable” toppers to improve airflow – now being marketed as breathable crib mattresses – actually had higher rates of CO2 than the conventional crib mattress with no breathable  cover.

SAFE SLEEP TECHNOLOGIES

Finally a US manufacturer of an air permeable crib mattress contacted the CPSC for recommendations on an accredited independent lab to conduct similar tests on aeration properties on their product.  Intertek was recommended because they use a similar mechanical model and methods as designed by Dr. Kemp.  The lab compared CO2 elimination on four different surfaces—an air permeable mattress, a firm mattress with tight fitting sheet, sheepskin, and a bean bag chair.  The latter two are known high risk hazards for rebreathing (Kemp 1991, Kemp 1993) and have been implicated in a significant number of SIDS fatalities. Just as in the studies by Kemp and Bar-Yishay, the air permeable crib mattress showed significantly less CO2 retention than the firm crib mattress and the high hazard comparators.  Intertek concluded that the air permeable crib mattress represents a significantly lower risk hazard for rebreathing than the firm crib mattress.  They also compared the air permeability of the air permeable 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 air permeable crib mattress has an air permeability rate over 330 times greater than the firm crib mattress.

These two well-designed, well-conducted case controlled studies along with the independent CPSC testing lab results strongly support a recommendation for use of an air permeable crib mattress.  Just as the Task Force’s five Level A recommendations listed above are all based in some  part on risk of rebreathing, it stands to reason that the Task Force would recommend the air permeable crib mattress with its significantly lower risk of rebreathing than the firm crib mattress with tight fitting sheet.

SUFFOCATION/ENTANGLEMENT IN BEDDING: RISK OF CRIB SHEETS

The AAP Task Force concurs with the CPSC that all loose bedding should be removed from the infants sleep environment.  The CPSC and the AAP issued an alert in 2001 warning parents and pediatricians of the “hidden hazard in babies’ cribs” of loose crib mattress sheets based on death reports of infants who suffocated or strangled when they became entangled in their crib mattress sheet. Two of the deaths involved fitted sheets.  The CPSC now requires that all crib mattress sheets carry a warning that the sheet should not be used if it doesn’t fit properly. CPSC pushed the sheet-making industry to improve the fit of crib sheets on mattresses. However deaths from sheet entanglement remain a risk for infants.  In the CDC’s multistate SUID Case Registry, the mechanism most frequently reported for possible and explained suffocation deaths was soft bedding which the registry defines as soft or loose bedding (Shapiro-Mendoza 2014). The loose bedding is not further defined but could be a blanket or fitted sheet that became loose.  

Crib mattress manufacturers are not sheet manufacturers. The CPSC defines the industry requirements for mattress size based on ASTM standards. Their length and width requirements are consistent but their requirement for height is  six inches or making mattress sizes inconsistent.  Because there are no crib sheets made for a given mattress, the crib sheet remains a hazard. The design of the air permeable crib mattress eliminates this risk because no sheet or other bedding is used.  Breathable crib mattresses still use a sheet.

The same data used by the Task Force in its recommendation against the use of soft or loose bedding, also supports a recommendation against the use of a crib mattress sheet when possible.

ROLE OF BACTERIA AND THE RISK OF FIBER FILL

A recent review article attempts to establish bacterial infection as having a major role in the pathophysiology of SIDS (Goldwater 2013).  The authors debunk the respiratory physiology model both as being unproven and inconsistent with the most plausible physiological events that take place during a SIDS death. 

A recent study showed SIDS victims, especially those found prone, are more often colonized with S. aureus than living control subjects (Highet 2014).  Studies have demonstrated colonization of traditional fiber filled crib mattresses with Staph aureus (Sherburn 2007) suggesting a source for acquiring these bacteria.  While no studies are available measuring colonization of air permeable crib mattresses, the surface is designed to be removed and laundered.  The SafeSleep® by Safe Sleep Technologies, recommends regular cleaning of the surface in a conventional washer and dryer.  Breathable crib mattresses still have fiber or other fills that can become contaminated.

Based on the bacterial infection hypothesis, it stands to reason the Task Force should consider recommending regular washing of infant sleep surfaces and removal of fillers from crib mattresses to reduce exposure to these pathogens.

In summary, the 2016 Safe Sleep Technical report now recognizes the safety advantages of air permeable crib mattresses to reduce the risk of unexpected suffocation/entanglement and other hazards that may be associated with SIDS.

The AAP does not recommend the use of “breathable” crib mattresses to reduce the risk of SIDS and other infant sleep related deaths.

For more information on air permeable crib mattress versus breathable crib mattresses please visit Compare to “Breathable” Crib Mattresses

Refrences:

Patrick L. Carolan, MD; William B. Wheeler, MD; James D. Ross, RRT, RCP; and James S. Kemp, MD, (2000), Potential to Prevent Carbon Dioxide Rebreathing of Commercial Products Marketed to Reduce Sudden Infant Death Syndrome Risk, Pediatrics, 105:4 774-779

Bar-Yishay, E., Gaides, M., Goren, A. and Szeinberg, A. (2011), Aeration properties of a new sleeping surface for infants. Pediatr. Pulmonol., 46: 193–198. doi: 10.1002/ppul.21351

L’Hoir MP, Engelberts AC, van Well GTJ, et al.  Risk and preventive factors for cot death in the Netherlands, a low-incidence country.  Eur J Pediatr. 1998;157(8):681– 688

Edwin A. Mitchell, BSc, MBBS, DCh, FRACP, FRCPCH, DSc; Bradley T. Thach, MD; John M. D. Thompson, PhD; Sheila Williams, BSc; for the New Zealand Cot Death Study, Changing Infants’ Sleep Position Increases Risk of Sudden Infant Death Syndrome.  Arch Pediatr Adolesc Med. 1999;153:1136-1141.

Kemp JS, Thach BT. Sudden death in infants sleeping on polystyrene-filled cushions. N Engl J Med. 1991 Jun 27;324(26):1858–1864

Kemp JS, Thach BT. A sleep position–dependent mechanism for infant death on sheepskins. AJDC. 1993;147:642-646.

American Academy of Pediatrics Task Force on Infant Positioning and SIDS.  SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment, Pediatrics; originally published online October 17, 2011; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME DOI: 10.1542/peds.2011-2284

Jodi Pike, MD and Rachel Y. Moon, MD, Bassinet Use and Sudden Unexpected Death in Infancy, J Pediatr. Oct 2008; 153(4): 509-512

McDonell, Emily and Moon, Rachel, Infant Deaths and Injuries Associated with Wearable Blankets, Swaddle Wraps, and Swaddling, Journal of Pediatrics 2014; 164:1152-6

US Consumer Product Safety Commission. CPSC Alerts Caregivers to Hidden Hazard in Babies’ Cribs, Washington, DC: US Consumer Product Safety Commission; MAY 18, 2001; Release Number: 01156

Carrie K. Shapiro-Mendoza, PhD, MPHa, Lena Camperlengo, DrPHa, Rebecca Ludvigsen, MPHb, Carri Cottengim, MAc, Robert N. Anderson, PhDd, Thomas Andrew, MDe, Theresa Covington, MPHf, Fern R. Hauck, MD, MSg, James Kemp, MDh, and Marian MacDorman, PhDd.  Classification System for the Sudden Unexpected Infant Death Case Registry and its Application.  J Pediatr. Jun 2014; DOI: 10.1542/peds.2014-0180

Paul N. Goldwater1,2 and Karl A. Bettelheim. SIDS Risk Factors: Time for New Interpretations.

The Role of Bacteria. Pediatrics Research International Journal. Aug 2013; Vol. 2013, Article ID 867520; DOI: 10.5171/2013.867520

Amanda R. Highet, Anne M. Berry, Karl A. Bettelheim, Paul N. Goldwater. Gut microbiome in sudden infant death syndrome (SIDS) differs from that in healthy comparison babies and offers an explanation for the risk factor of prone position. International Journal of Medical Microbiology. Jul 2014; Volume 304, Issues 5–6, July 2014, Pages 735–741; DOI: 10.1016/j.ijmm.2014.05.007

Jenkins R.O, Sherburn R.E. Used cot mattresses as potential reservoirs of bacterial infection: nutrient availability within polyurethane foam. J Appl Microbiol. Nov 2007;  Epub 2007

Breathe Easy Baby and SafeSleep®

Best Breathable Crib Mattress

Breathe Easy Baby and SafeSleep®

What are the differences between Breathe Easy Baby and SafeSleep®?  There are more similarities than differences between the Breathe Easy Baby and SafeSleep® Crib Mattress. 

Breathe Easy Baby and  SafeSleep® Comparison Chart

Check out the comparison chart.  We also give you descriptive detail explaining both the similarities and the differences between Breathe Easy Baby and SafeSleep® so you can make an informed decision.  Your baby will spend over 70% of their first year sleeping, so what they sleep on is a very important decision.

Breathe Easy Baby vs SafeSleep Crib Mattress

What is the difference between Breathe Easy Baby and SafeSleep®?

The fact is, there really isn’t much of a difference between Breathe Easy Baby and SafeSleep®.  How do I know?  I am one of the patent authors on the original Breathe Easy Baby design – US Patent Number US8607390B2

The original, and may I add, revolutionary breathe-through crib mattress design was launched in 2010 under the company name Secure Beginnings®.  

Leaving the Past Behind

So now let’s fast forward to 2018.  After irreconcilable differences between the three founders of Secure Beginnings®, two different companies emerged; SafeSleep® and Breathe Easy Baby.  Slight  differences between Breathe Easy Baby and SafeSleep® exist.

The Divorce

Yes, even businesses can end up in divorce.  As with most divorces, we focused on the children.  In this case, our baby!  Our revolutionary crib mattress that addresses all the safety and comfort issues that no other standard crib mattress can.  

The Baby

However, like many divorces, we did not agree on how to best raise “our baby.” Like most divorced couples sharing custody of a child, we took different approaches  to nurturing “our baby.”  We didn’t want to change our perfect baby.  We just had some fundamental differences on how to best raise her!  Hence, the difference between Breathe Easy Baby and SafeSleep® emerged.

Similarities and Differences

What are the similarities and the differences between Breathe Easy Baby and SafeSleep®?:

Let’s start with the similarities: 

Now, the differences:

  • Only SafeSleep® uses Infant friendly water-based paints for the wood sides
  • Breathe Easy Baby’s locking bar mechanism must constantly be tightened or the bars randomly pop open
  • Only SafeSleep’s® new locking system has a secondary latch to ensure the bars cannot pop open
  • SafeSleep’s® fabrics are OEKO-TEX® certified fabrics, ensuring no harmful substances.  Breathe Easy Baby admits to using low-cost polyester fabrics that are not certified
  • Only SafeSleep® uses a lightweight mattress bottom made from virgin plastic with no VOC’s or off-gassing.  Breathe Easy Baby use a heavy solid plastic that is difficult to control tolerances so it  known to pop out of the frame which is problematic for dispelled liquids and cleaning
  •  SafeSleep® believes parents shouldn’t have to wait for weeks or even days for their products, that’s why we ship all our products the day you place your order.

The Most Surprising Difference

The “Most Surprising” difference between the Breathe Easy Baby and SafeSleep® Breathe-Through Crib Mattress is the price!  The SafeSleep® Crib Mattress is $299 and the Breathe Easy Baby Crib Mattress is $399.  Both Breathe Easy Baby and SafeSleep® offer free shipping.  

Check out the SafeSleep® Breathe-Through Crib Mattress here!

If you still want to pay $100 more for the “almost same” crib mattress by the “Other Company” go here!

Over 80 thousand infants have slept safely and comfortably on the SafeSleep® Breathe-Through Crib Mattress with not one single reported incident, injury or death.

Order Your SafeSleep® 100% Breathe-Through Crib Mattress Today!  

 

Will a Breathable Mattress Help Avoid SIDS?

Breathable Crib Mattress to Prevent SIDS

Will a Breathable Mattress Help Your Baby Avoid SIDS?

Over 3,600 seemingly health babies die each year in the U.S.  Will a “breathable” mattress help your baby avoid SIDS (Sudden Infant Death Syndrome)?

In early 2000, the crib mattress buzz word was organic.  Twenty years later, it is now “breathable.”  With so many crib mattress manufacturers claiming to have breathable mattresses, we thought it was time to address the question, “Will a breathable mattress help your baby avoid SIDS?”

What is SIDS

A baby is determined to have died from SIDS if no cause of death can be identified following a death scene investigation, an autopsy, and a review of the clinical history. SIDS as a cause of death is determined only when all other causes have been excluded.

With infant related sleep deaths, the cause of death can be difficult to determine with certainty. Infants who die from sudden death usually pass away while asleep in their cribs. Victims are often found lying face down. There are no signs of trauma. Usually their deaths are not witnessed by another person, which makes it difficult for investigators to piece together how they died.  There are also no clear biological markers.

Slate Magazine

In an August 2016 article published in Slate Magazine under a similar title, Could a Breathable Mattress Help Your Baby Avoid SIDS?, the author believes breathable crib mattresses manufacturers do nothing more than exploit the fears of parents. 

According to the article’s author,

“There was a lot of research in the 1990’s that showed rebreathing is a hazard when babies sleep on soft bedding, like sheepskin, or with a blanket covering their heads. However, there isn’t evidence that sleeping on firm mattresses with a tight-fitting sheets—as is recommended—causes problematic rebreathing in babies, even if they roll onto their tummies. Plus, rebreathing is just one hypothesis for why tummy sleeping might be riskier.”

The fact is, there is scientific data showing that crib mattresses with fiber or other core materials do cause problematic rebreathing in babies.  This is noted in the same pub med resources as the author uses to debunk firm mattresses with a tight fitting sheet as not being problematic.  Logically, if fiberfill mattresses were not problematic, why not suggest infants can tummy sleep? 

The author’s goes on to state,

“More recent research has found that babies sleeping belly-down also have impaired arousability, altered cardiovascular control, and lower blood pressure and cerebral oxygenation, any of which may be important when it comes to SIDS.”

Without knowing it, the author is describing effects of rebreathing exhaled air (CO2).  Impaired arousability, altered cardiovascular control, low blood pressure, and lack of cerebral oxygenation, are all signs of rebreathing.  When an individual rebreathes their exhaled air (CO2), it suppresses their need to breathe and eventually leads to hypoxia and then death.

Rebreathing

According to a March 2019 article in Health, research by Dr. Gordon Buchanan, a neurologist and epileptologist at the University of Iowa reveals,

“Babies and adults who die from sudden death syndromes may be born with brains that aren’t good at recognizing rising CO2 levels in their blood. In sudden death cases, it’s thought that the individuals’ airways get blocked somehow while sleeping in bed — such as by a pillow, a toy or tangled bedding. But it wasn’t clear why the person doesn’t simply wake up and fix the problem by repositioning themselves or by crying out for help.

Buchanan thinks that individuals who succumb to sudden death syndromes may have malfunctioning serotonin receptors in their brains. These receptors are part of our brain’s “suffocation alarm system” and help to ensure that blood oxygen and carbon dioxide (CO2) levels are healthy. But Buchanan thinks that a rare neurological difference causes some people’s brains to be bad at detecting when blood CO2 levels get too high — which is a signal to our bodies that we could be suffocating. Instead of waking up like most people would, those with this defect stay asleep and are seemingly powerless against what’s happening to them.

Dr. Hannah Kinney was the first to be credited with discovering the effects of serotonin levels in an infants brain stem and SIDS 

The problem we face, is there is no way to test to find out which babies do, and which babies do not have a compromised “suffocation alarm system,” so all infants remain vulnerable.

Approved Standards

So, can a breathable mattress help your baby avoid SIDS?  In the Slate article previously mentioned, the author correctly states,

One problem with mattresses being marketed as “breathable” is that there aren’t any approved standards for what this should mean.”

She gives one example of the Nook Pebble Pure mattress that uses coconut husk as part of its fill.  According to Dr. James Kemp, a pediatric pulmonologist at St. Louis Children’s Hospital and SIDS expert, called this “exactly the wrong idea,” noting that a porous interior might actually trap carbon dioxide. A mattress filled with tea tree bark made in Australia in the 1980s and ’90s and marketed as breathable turned out to increase the risk of SIDS, and, according to a study by Kemp, allowed more rebreathing.

Some “breathable” crib mattresses with porous interior and cores are actually shown to be more dangerous than a solid fiber fill crib mattress.

Claims of Preventing SIDS

The Slate author states,

 “In designing “breathable” mattresses and claiming that they will inherently keep babies safer, these companies are demonstrating a fundamental lack of understanding of the complexity of SIDS, and, more broadly, of science. “The ‘evidence’ the manufacturers of these crib mattresses provide is not evidence of reduced risk of suffocation or SIDS,” said Dr. Fern Hauck, a member of the AAP’s Task Force on SIDS. “As long as the mattresses meet government safety standards, they can be used, but they should not be marketed as preventing SIDS or suffocation,” she added.”

The reality is none of the “breathable” crib mattress companies mentioned in the article claim to prevent SIDS.  The author uses a very misleading statement.

Since SIDS is a diagnosis of exclusion, there is nothing that can prevent it.  It would be like say you have something that can cure death by natural causes.  The term Sudden Infant Death Syndrome is also misleading, and often confusing, since SIDS is not a syndrome or a diagnosis.  It’s simply a term used if we don’t know what else to classify an infant death as.

Science

No studies exist comparing infants who sleep on various crib mattresses to see which one has fewer SIDS deaths.  This lack of studies includes the recommended firm crib mattress with a tight-fitting sheet. No published studies or valid scientific testing is available that shows if one crib mattress, including the currently recommended firm mattress with a tight-fitting sheet, or sleep surface has a lower/higher SIDS risk.  These gold standard studies do not exist for any of the AAP Task Force recommendations and likely never will; it is not feasible to enroll the number of infants required to get sufficient data.  

We cannot say with scientific certainty if a breathable mattress could help your baby avoid SIDS.  We also cannot say with scientific certainty that a firm crib mattress with a tight-fitting sheet can avoid SIDS.  In fact, we can’t say with scientific certainty that any of the AAP’s safe sleep recommendations will avoid SIDS.  The real question should be, can a breathable crib mattress avoid known SIDS “risks”?  All of the AAP’s safe sleep guidelines focus on risk avoidance.

Risk Avoidance  

Knowing what we now do, the question should be can a breathable crib mattress avoid known SIDS risks? 

Let’s look at the following quotes taken from the AAP’s Safe Sleep Policy Statement ;  

  1. Supine sleep position: “The prone or side sleep position can increase the risk of rebreathing expired gases, resulting in hypercapnia and hypoxia.”
  2. 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.”
  3. 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.”
  4. 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.”
  5. Avoid Overheating and Head Covering in Infants: “It is not known whether the risk associated with head covering is attributable to overheating, hypoxia, or rebreathing.”

While the studies do not demonstrate a direct prevention of SIDS or suffocation, they rely on the hypothesis of rebreathing of CO2 as a potential contributor for these unexpected infant deaths.   A basic pathophysiological principle is the hypothesis that rebreathing C02 is associated with ALTE/SIDS/asphyxia.  Indeed, no studies have substantiated this hypothesis; however, this is the same hypothesis used by the AAP Task Force to support the majority of their recommendations.

Further, the Task Force recommends air permeable sides when bassinets are used. This recommendation is based on a retrospective review and analysis of infant deaths occurring in bassinets between June 1990 and November 2004 that were reported to the CPSC (Pike/Moon 2008). The authors identified at least six infants who were found with their “face wedged against the side of the bassinet.” While there is no mention of any bassinets having air permeable sides in the study, the study authors (including R Moon who is on the AAP Task Force) recommends “a bassinet with vertical sides of air-permeable material, such as mesh, may be preferable to one with air-impermeable sides.”  The Task Force makes the recommendation for air permeable sides based on infants with face wedged against side of sleep environment.   Logic would dictate that air permeable mattresses as being preferable to air impermeable mattresses to address infants face-straight- down on firm mattresses.

Breathable vs. Breathe-Through

Not all breathable crib mattresses are air permeable.  An air permeable crib mattress allows an infant who is face straight down to breathe normally right through the crib mattress without rebreathing their exhaled air.

There is only one mattress on the market today that has been scientifically tested and concludes it significantly reduces the risk of carbon dioxide rebreathing and is completely breathe-through.

The Science of “Breathe-Through”

Safe SleepTechnologies is a company that does understand the complexity of SIDS, and, more broadly, of science.  The four founders all lost a loved one to SIDS.  One of the founders is an AAP member and chairs one of the AAP’s committees.

The SafeSleep®Breathe-Through Crib Mattress was designed with the idea that baby’s do not always arouse when rebreathing harmful carbon dioxide.  Ten years ago, SafeSleep® founders challenged an industry standard by creating a crib mattress with no fill and replaced it with free-flowing air. 

These efforts have been recognized by top medical professionals and even prompted the American Academy of Pediatrics to recognize their crib mattresses with no fill and air permeable surfaces as safer for the infant who rolls in their 2016 Safe Sleep Technical Report.  

The SafeSleep® Breathe-Through Crib Mattress is designed to prevent harmful carbon dioxide from accumulating so that if an infant is face straight down and cannot arouse,  they will not rebreathe their exhaled air.

The SafeSleep® Breathe-Through Crib Mattress has been tested for carbon dioxide retention and has a ten-fold decrease in carbon dioxide retention when compared to a fiberfill mattress with a tight-fitting sheet.  It takes 2 minutes for carbon dioxide to dissipate on a firm crib mattress with a tight sheet; it takes less than 1/2 a second for it to dissipate on the SafeSleep® Crib Mattress.  An infant takes a breath every 1-2 seconds, meaning the carbon dioxide (poisonous gasses) on the SafeSleep® Breathe-Through mattress are gone before the infant takes their next breath of air – even if face straight down and does not arouse.

We can say with scientific certainty that the SafeSleep® Breathe-Through Crib Mattress significantly reduces the risk of carbon dioxide rebreathing even if the infant is face down or tummy sleeping.

 

Keeping Baby’s Items Sanitized

Best Crib Mattress

Keeping Baby’s Items Sanitized, is important during the Covid-19 Pandemic.  To reduce spreading the Virus, keep your baby’s toys, clothes, and bedding  sanitized and free from germs.  Routine cleaning and disinfection of baby’s items, using appropriate disinfection methods, can help keep you and your baby safe. 

Disinfect baby’s items that easily get dirty, such as a baby’s changing table. Sanitize surfaces that your baby often touches, such as his or her crib frame, changing table, toys, bottles, and pacifiers.

Wipe down metal, wooden, and plastic surfaces with a bleach solution to properly disinfect baby’s items.  Battery-operated toys can also be wiped down with a bleach solution.  Once the bleach has dried, it’s OK for little ones to stick the toys in their mouths because the chlorine will have evaporated.

  • Use 5 tablespoons (1/3 cup) bleach per gallon of water or.
  • 4 teaspoons bleach per quart of water.

Plastic toys without batteries can also be washed in the dishwasher to perform routine cleaning and disinfection of baby’s items.

Wash your child’s, clothing, bedding and washable plush toys in the warmest possible setting using your regular laundry detergent to disinfect baby’s items. Dry them completely.  Do not “hug” or shake dirty laundry before washing to avoid spreading the virus or other dirt and bacteria. 

Your SafeSleep Breathe-Through Crib Mattress topper can be washed with a mixture of bleach and detergent to disinfect.  The wood base, plastic bottom section, and metal bars can be conveniently wiped down with a bleach solution without removing it from the crib.

Use soap and hot water or a bleach solution to disinfect Baby’s Items  used in their mouth, such as bottles and pacifiers. If you need to cut grease or remove stubborn dirt, add vinegar and baking soda to the mix.  Keeping Baby’s Items Sanitized can also be accomplished by running these items through the dishwasher.

Wipe down and disinfect other household items your baby may come in contact with such as TV remotes, cell phones, table tops, furniture, and floors.

Current evidence suggests that novel Coronavirus may remain viable for hours to days on surfaces made from a variety of materials. Cleaning of visibly dirty surfaces followed by disinfecting is a best practice measure for prevention of COVID-19 and other viral respiratory illnesses in households.  

For more Covid-19 Cleaning tips, visit https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cleaning-disinfection.html

For information on how long Coronavirus will survive on surfaces visit, https://health.clevelandclinic.org/how-long-will-coronavirus-survive-on-surfaces/

5 Amazing Resources for New Moms

Best Breathable Crib Mattress

These five amazing resources for new moms will be your favorite go-to’s. Becoming a mom is surely life-changing – they say when a baby is a born, so is a mom. I know that I completely changed as a woman after having my son. I felt a new found confidence and a feeling that I could do anything. Having a baby is not easy so once it’s done there’s an immense feeling of pride.

As a new mom I found these five amazing resources to be extremely helpful with tips, stories from moms, and just good reading to make motherhood fun. Let’s face it, even the basics for first-time moms is sometimes a hidden secret.

#1 Red Tricycle

With over a million mom readers each month, Red Tricycle will become one of your favorite basics for first-time moms.  Red Tricycle is an amazing website I love and frequent often.  The websites tagline says it best — “Find the coolest ideas for things to do, eat, see and make with your kids. Our mission is simple, help parents have more fun with their kids.”

I love reading the articles from their contributor network of moms too. Here’s an article that shares how to keep toddlers entertained at restaurants without using technology.

#2 Romper.com

With 82 million readers Romper.com is another guaranteed favorite for first-time moms. Their Instagram bio says it best:  “A new generation figuring out what motherhood means for us.”

They have really fabulous round-up articles like this one:  Winter Gear for Babies to Keep them Warm & Cozy

I also love their heartfelt stories like this article about honoring our little babies on World Preemie Day.

#3 Family Sleep Institute

As first time parents we learned the hard way about not letting our baby learn how to self-soothe back to sleep on his own. Instead he needed mommy to rock him back to sleep. So 16 weeks straight of our baby waking up every one to two hours all night long turned our world upside down.

We tried everything and nothing worked. You can learn more about what saved us and how to get baby to sleep in a crib all night long after JUST ONE NIGHT.

So this is why we chose The Family Sleep Institute (FSI) website as a top resource for new moms. They certify sleep consultants and their program is amazing. So any certified sleep consultant that comes from FSI you know will be amazing.

You can find a certified child sleep consultant anywhere in the US and it’s all done virtually so you do not need to be local to them.

#4 Faust Island

I adore this blogger and her articles are awesome. This website offers a ton of green living and family tips and some fun posts too.

Some of my favorites basics for first-time moms are:

#5 Baby-Chick.com

This is last on the list but certainly not least. It’s one of my favorite resources for first-time moms and most frequented websites.

This site is all about giving moms education, inspiration and a smile. With nearly 500k social media followers and growing fast, bookmark this website too – you won’t be disappointed.

Baby-Chick says it best, “We believe in celebrating this time in a woman’s life and supporting each mother through her parenting journey. Through our website and social media channels, we provide an empowering, educational and uplifting experience to expectant women and mothers by giving them helpful information so that they can make better informed decisions for themselves and their family.”

How awesome is this?!

My favorites (so many to choose from):

How we Potty Trained in One Day

5 Products that Celebrity Moms Love

As moms we are so busy, so it’s great to take time to read an article each day not only to learn from other moms and relate to our fellow mom superheroes.

Hiccups May Help Babies Regulate Breathing

Breathable Crib Mattress

Scientists have discovered hiccups may help babies regulate their breathing.  Baby’s who can regulate their breathing are less likely to get in stressful situations while sleeping.

About the study:

In a study led by University College London (UCL), researchers monitored “13 newborn babies” and “found that hiccuping triggered a large wave of brain signals which could aid their development.” The study’s senior author Lorenzo Fabrizi said the observed brain activity might help babies “learn how to regulate their breathing muscles.” The study, which was published in Clinical Neurophysiology, suggests that hiccups “may play a crucial role in our development – by helping babies regulate their breathing.”

The highlights of the study reveal:

1)  Diaphragm contraction in newborns evoked a sequence of three event-related potentials.

2)  Hiccups can be encoded by the brain as early as ten weeks prior to average time of birth.

3)  Hiccups – frequent in newborns – provide afferent input to the developing brain

Ectroencephalogram (EEG) activity

The CNN Health Study tested whether diaphragm contraction provides afferent input to the developing brain, as following limb muscle contraction. In 13 infants on the neonatal ward (30–42 weeks corrected gestational age), ectroencephalogram (EEG) activity were analyzed.  EEG is a test that detects electrical activity in the brain.   All bouts of hiccups of the infants occurred during wakefulness or active sleep.

Why Hiccups May Help babies regulate breathing:

The study confirms, Involuntary isolated body movements are prominent in pre-term and full-term infants.  Hiccups are involuntary contractions of respiratory muscles, primarily the diaphragm.  Hiccups, observed in newborns, provides nerve impulses to the brain to the developing sensory cortices in pre-term and full-term infants – helping babies regulate breathing

Further, Hiccups are frequent throughout the human perinatal period during active phases of the infant. The perinatal period starts at the 20th to 28th week of gestation and ends 1 to 4 weeks after birth.  Involuntary contraction of the diaphragm can be encoded by the brain from as early as ten weeks prior to the average time of birth.

The study’s senior author Lorenzo Fabrizi states, “When we are born, the circuits which process body sensations are not fully developed, so the establishment of such networks is a crucial developmental milestone for newborns.”  This leads to our theory that hiccups may help regulate breathing in babies.

See the full study on why hiccups may help babies regulate their breathing here 

Helping babies regulate their breathing is an important safeguard for infant safe sleep.

 

 

Safe Sleep Holiday Travel Reminder

Safest Crib Mattress

With the Holiday season fast approaching, many families will be traveling over the coming months to celebrate the holidays with friends and family. Make sure your baby has a safe place to sleep, for nap time and nighttime while away from home this Holiday Season.

Make sure to communicate Safe Sleep Protocol with the friends and family members who may be assisting with your baby’s care during travel.  You want to make sure everyone understands the safest place for you baby to sleep is in a crib, or bassinet.  Make sure the sleep surface is firm.  Remember to keep soft bedding and items out of the sleep area; this includes stuffed toys, mattress pads, bumper pads, and blankets.  These items have been found to cause strangulation deaths, and they are known to trap carbon dioxide. 

A Breathe-Through Crib Mattress or play yard is always your safest option since they protect your baby from rebreathing carbon dioxide.  Rebreathing carbon dioxide is believed to be the biggest risk factor in infant sleep related deaths and SIDS/SUDI.  The SafeSleep Breathe-Through products are the only products in the U.S. to pass the Australia/New Zealand firmness standard making them the perfect sleep environment to keep your baby safe.

Arrange for a safe sleep space at hotels and at your final destination. The Consumer Product Safety Commission has a Safe to Sleep® Crib Information Center, which explains that federal crib standards.  Steer clear of inflatable air mattresses, as they pose a deadly danger.

For information on crib safety, contact the CPSC at 1-800-638-2772 or www.cpsc.gov.

Keep Baby & Toddler Safe at Home

Best baby crib mattress

Keeping baby and toddler safe at home can sometimes produce high anxiety.  We try to watch our kids every moment and be there to catch them for every tumble.  Unfortunately we cannot be there 100% of the time. It’s very important that we prevent injuries to our little ones as best as possible.One way is to identify and know hidden hazards around the home.

#1 Hidden Hazards in the Crib 

Many parents are unaware of the risks that a traditional crib mattress poses. Fiber-fill crib mattresses trap carbon dioxide.  If baby rolls over and breathes face down, or even has an arm or hand up near their face, there is a high risk of trapping and rebreathing carbon dioxide.  Rebreathing carbon dioxide leads to hypoxia, a form of suffocation.  In many instances, rebreathing deaths are coded as SIDS. 

One way of keeping your baby and toddler safe from this hidden danger while sleeping, is to use a Breathe-Through Crib Mattress.  The Safe Sleep Breathe-Through Crib Mattress is the only crib mattress where babies can breathe normally even if face down all night. There’s no crib sheet, or fiber fill to cause the hidden danger of carbon dioxide rebreathing.  Instead, the air permeable topper sits over a hollowed airspace producing constant airflow.  Baby’s face down can breathe normally right through the mattress without trapping carbon dioxide. BONUS: it’s made from recycled and eco-friendly products!

#2 Door Hinges

My son had a play date with his friend from school, and his mom had to cancel because he had a horrific injury happen. His middle finger was in the door hinge when someone closed the door and it cut the tip of the finger right off!

It is so sad to see our little friend sitting in the hospital with his cast.

After this happened. I was determined to prevent this hidden hazard.
I found some great solutions. They have many different door shield guards that are easy to install and protect against pinched fingers available on many e-commerce sites.

#3 Small Coins & Button Batteries can be Lethal Hidden Hazards

Always keep coins and button batteries far out of reach and tucked away where babies and toddlers cannot get to. According to poison control, “swallowed batteries burn through a child’s esophagus in just 2 hours, leading to surgery, months with feeding and breathing tubes, and even death.” SOURCE

If your child begins vomiting consistently for no apparent reason, chances are they swallowed  something that is lodged in the throat.  Many parents mistake this reaction as a food allergy.  Be sure to insist on a chest X-ray in the ER.  A chest X-ray can determine if your child did swallow something.

#4 Dressers, Bookshelves & TVs 

“In the U.S., a child dies every two weeks from furniture tipping over, and 42 percent of those fatalities occur in the bedroom.” (SOURCE)

We all probably remember that big IKEA recall due to the death of six children, but it’s not just IKEA furniture that poses a risk.

By securing all dressers, shelves, and TVs to the walls so if a child tries to climb up it, you can easily prevent this hidden danger.

#4 Things in the Crib

We have come a long way educating parents on safe sleep for babies, but we still have a ways to go because we see photos of babies sleeping in cribs packed full of stuff like pillows, blankets, bumpers, toys, and stuffed animals. NO. NO. NO. Please never have anything in the crib with your baby.These items all pose a hidden danger to your sleeping baby.

A SafeSleep Crib Mattress, the best breathe-through crib mattress for babies, and a wearable blanket on baby is all that should be in the crib EVER.

Get in the habit of not putting anything in the crib even during awake times. The crib is for sleeping and, babies can become confused if they play in the crib with toys.

#5 Crib Rail Covers

When babies start to teethe they chew on everything including the rails of the crib. Ingesting toxic chemicals and paint is a hidden hazard for baby, but there’s a simple solution.

KidKusion invented these amazing gummi crib rail covers that stick right on. Babies can now safely chew on their rails and get relief from the unique texture, but without ingesting anything toxic.

#6 Corners

When my little onestarted cruising around (holding onto furniture to “walk” around) anytime he was near a corner I would dash over to protect him. Kid Kusion has these awesome furniture edge and corner cushions to protect babies and toddlers from falling on sharp furniture.

#7 Eco Cleaners

Most parents lock up their cupboards so babies cannot get into cleaning products, but cleaning with toxic chemicals still harms your children.  Instead, make a swap for green cleaning products so that you and your family don’t have to be exposed to the hidden hazards in chemicals.

Favorite all time cleaners:

Let’s protect our little ones and make sure these hazards are not hidden anymore in your home. What other safety tips do you have?

 

Crib Mattresses and SIDS

Crib Mattress that Prevents SIDS

 

Crib Mattresses and SIDS; cases continue to be reported of infants placed supine (on back) and found prone (on tummy) on firm crib mattresses with evidence of suffocation/positional asphyxiation (rebreathing) and others becoming entangled and suffocating in sheets. 

 Crib Mattresses and SIDS – The Science

“The first few times babies who usually sleep on their backs or sides shift to the prone (lying face down) position, they have a 19-fold increased risk of sudden death,” says senior author Bradley T. Thach, M.D., a Washington University pediatrician at St. Louis Children’s Hospital. “We wondered if these babies, finding themselves face down, fail to turn their heads to breathe easier. If so, is that because their reflexes haven’t developed far enough or because they just don’t wake up?” The findings also indicate that good head-lifting ability while lying prone may not be sufficient to protect a baby from SIDS. “Many parents think that if a baby can lift its head, he or she is okay to sleep prone, but that is a false assurance,” Thach says (Paluszynska 2004) 

Crib Mattress and SIDS – The Prone Position

Research on infants who are novice at prone sleep has demonstrated they are less likely to respond effectively to CO2 accumulation making them especially vulnerable (Paluszynska 2004). Researchers out of New Zealand have shown that over one quarter of the infants who died of SIDS in the prone position in their study were last placed non-prone (on their back). These researchers suggested that an infant’s competence in escaping from potentially lethal situations during prone sleep may be impaired by inexperience in prone sleeping (Thatch1999). Their findings were later supported by Dr. Moon and colleagues in their review of infant sleep related deaths in child care settings (Moon 2000). Unfortunately this infant inexperience in prone sleep is now a common unintended consequence of the successful back to sleep campaign.

Babies who never sleep on their stomachs don’t learn behaviors that may lessen their risk of SIDS, researchers at Washington University School of Medicine in St. Louis have found. Even so, the researchers caution that infants should always be placed on their backs to sleep. 

Crib Mattresses and SiDS – The Introduction of Air Permeable/Breathable Crib Mattresses

Air permeable/breathe-through crib mattresses are the best defense for a baby that rolls in the middle of the night and ends up sleeping face down. This is the most successful approach to preventing the tragedies we see relating to crib mattresses and SIDS.  A breathe-through crib mattress is designed to prevent the  accidental suffocation/positional asphyxiation (rebreathing) when baby rolls in the middle of the night. 

Crib Mattresses and SIDS – Published Relevant Scientific Case Controlled Studies Supporting the Recommended Use of Air Permeable Crib Mattresses:

Dr. James Kemp and colleagues were some of the first to study the potential for various sleep surfaces to prevent infant rebreathing. They found that the firm crib mattress and four of the five surfaces designed to prevent rebreathing consistently allowed lethal rebreathing of CO2. Only one product—an air permeable crib mattress—was able to maintain CO2 levels below this threshold. The authors go on to say that “even firm crib mattresses could pose a rebreathing threat when vulnerable infants sleep prone.”

Crib Mattress and SIDS – The Novice Tummy Sleeper

Studies show that unaccustomed prone sleepers, including infants who are placed supine and roll prone have an increased risk of SIDS (O’Hoir 1998 and Mitchell EA 1999). These studies and others have shown that nearly half of SIDS victims unaccustomed to prone sleep, were discovered in the face-straight-down position. Many of these infants were found on a firm crib mattress. Dr. Kemp’s data supports that if vulnerable infants were placed on an air permeable surface, they would experience less risk of rebreathing should they inadvertently roll prone.

Crib Mattress and SIDS – Breathe-Through Crib Mattress Testing

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, two conventional firm crib mattresses and three mattresses with an additional layer or topper designed to improve air flow (Bar-Yishay 2011). The breathe-through crib mattress had a significantly faster rate of CO2 elimination and only the air permeable mattress was able to prevent CO2 accumulation with maximal CO2 levels significantly lower than that of the other mattresses. They concluded that the breathe-through crib mattress exhibited significantly better aeration properties compared to the other five mattresses including the firm mattresses with tight sheet. 

A representative of SafeSleep®, a U.S. manufacturer of a breathe-through crib mattress, contacted the CPSC for recommendations on an accredited independent lab to conduct similar tests on aeration properties on their product. Intertek was recommended because they use a similar mechanical model and methods as designed by Dr. Kemp. The lab compared CO2 elimination on four different surfaces—our air permeable crib mattress, a firm mattress with tight fitting sheet, sheepskin, and a bean bag chair. The latter two are known high risk hazards for rebreathing (Kemp 1991, Kemp 1993) and have been implicated in a significant number of SIDS fatalities. Just as in the studies by Kemp and Bar-Yishay, showed significantly less CO2 retention than the firm crib mattress and the high hazard comparators. Intertek concluded that the the breathe-through crib mattress represents a significantly lower risk hazard for rebreathing than the firm crib mattress. Intertek also compared the air permeability of the 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 air permeable crib mattress has an air permeability rate over 330 times greater than the firm crib mattress with tight sheet.

These two well-designed, well-conducted case controlled studies along with the independent CPSC testing lab results strongly support a recommendation for the use of air permeable/breathe-through crib mattresses.

Crib Mattress and SIDS – CO2 Retention and Risk of Rebreathing

The studies outlined above clearly demonstrated that the risk of rebreathing of exhaled air (CO2) is lowest on air permeable surfaces (Kemp 2000, Bar-Yishay 2011). And data from Intertek, a CPSC accredited and recommended lab, shows significantly low risk hazard of rebreathing of an air permeable mattress (lower than the firm mattress with tight fitting sheet). These data demonstrate that the breathe-through crib mattress has significantly lower CO2 retention. All three reports use similar test methods and have similar results.

Crib Mattress and SIDS – Direct Prevention of SIDS and CO2 Hypothesis by AAP

While the studies do not demonstrate a direct prevention of SIDS or suffocation, they rely on the hypothesis of rebreathing of CO2 as a potential contributor for these unexpected infant deaths. A basic pathophysiological principle is the hypothesis that rebreathing C02 is associated with ALTE/SIDS/asphyxia. Indeed no studies have substantiated this hypothesis; however, this is the same hypothesis used by the AAP Task Force to support the majority of their recommendations including the following with quotes taken from the AAP Task Force report (AAP 2011):

1. Supine sleep position: “The prone or side sleep position can increase the risk of rebreathing expired gases, resulting in hypercapnia and hypoxia.”
2. 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.” 
3. 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.”
4. 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.”
5. 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.”

Crib Mattress and SIDS – AAP Recommends Air Permeable Sides in Bassinets and Play Yards

Further, the Task Force recommends air permeable sides when bassinets are used. This recommendation is based on a retrospective review and analysis of infant deaths occurring in bassinets between June 1990 and November 2004 that were reported to the CPSC (Pike/Moon 2008). The authors identified at least six infants who were found with their “face wedged against the side of the bassinet.” While there is no mention of any bassinets having air permeable sides in the study, the study authors (including R Moon who is on the AAP Task Force) recommends “a bassinet with vertical sides of air-permeable material, such as mesh, may be preferable to one with air-impermeable sides.” The Task Force makes the recommendation for air permeable sides based on infants with face wedged against side of sleep environment. Logic would dictate that air permeable/breathe-through crib mattresses as being preferable to air impermeable mattresses to address infants face-straight-down on firm crib mattresses.

Crib Mattress and SIDS – Suffocation/Entanglement in Bedding and Crib Sheets

The AAP Task Force concurs with the CPSC that all loose bedding should be removed from the infant’s sleep environment. The CPSC and the AAP issued an alert in 2001 warning parents and pediatricians of the “hidden hazard in babies’ cribs” of loose sheets based on death reports of infants who suffocated or strangled when they became entangled in their crib sheet. Two of the deaths involved fitted sheets (CPSC 2001). The CPSC now requires that all crib sheets carry a warning that the sheet should not be used if it doesn’t fit properly. CPSC pushed the sheet-making industry to improve the fit of crib sheets on mattresses. However deaths from sheet entanglement remain a risk for infants. In the CDC’s multistate SUID Case Registry, the mechanism most frequently reported for possible and explained suffocation deaths was soft bedding which the registry defines as soft or loose bedding (Shapiro-Mendoza 2014). The loose bedding is not further defined but could be a blanket or fitted sheet that became loose. 

Crib mattress manufacturers are not sheet manufacturers. The CPSC defines the industry requirements for mattress size based on ASTM standards. Their length and width requirements are consistent but their requirement for height is “less than six inches” making mattress sizes inconsistent. Because there are no crib sheets made for a given mattress, the crib sheet remains a hazard. The design of the air permeable crib mattress eliminates this risk because no sheet or other bedding is used.

The same data used by the AAP Task Force in its recommendation against the use of soft or loose bedding, also supports a recommendation against the use of a crib mattress sheet when possible.

Crib Mattress and SIDS – Role of Bacteria in Crib Mattresses

A recent review article attempts to establish bacterial infection as having a major role in the pathophysiology of SIDS (Goldwater 2013). The authors debunk the respiratory physiology model both as being unproven and inconsistent with the most plausible physiological events that take place during a SIDS death.

A recent study showed SIDS victims, especially those found prone, are more often colonized with Staphylococcus aureus than living control subjects (Highet 2014). Studies have demonstrated colonization of traditional fiber-filled crib mattresses with Staph aureus (Jenkins 2007) suggesting a source for acquiring these bacteria. While no studies are available measuring colonization of air permeable crib mattresses, the surface is designed to be removed and laundered. The U.S. made model recommends regular cleaning of the surface in a conventional washer and dryer.

Based on the bacterial infection hypothesis, it stands to reason that breathe-through crib mattresses that allow for regular washing of infant sleeping surfaces and removal of fiber-fill from the mattress reducing exposure to these pathogens should be recommended.

Crib Mattress and SIDS – Summary

In summary, scientific data supports the recommendation for use of air permeable/breathe-through crib mattresses to reduce the risk of unexpected suffocation/entanglement and other hazards that may be associated with SIDS/SUID.

Learn more: safesleeptech.com 
#SIDS #safesleep 

Refrences:

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.

Mitchell EA, Thach B, Thompson J, Williams S. Changing infants’ sleep position increases risk of sudden infant death syndrome. Arch Pediatr Adolesc Med. 1999

Rachel Y. Moon, Kantilal M. Patel and Sarah J. McDermott Shaefer. Sudden Infant Death Syndrome in Child Care Settings. Pediatrics 2000

Patrick L. Carolan, MD; William B. Wheeler, MD; James D. Ross, RRT, RCP; and James S. Kemp, MD, (2000), Potential to Prevent Carbon Dioxide Rebreathing of Commercial Products Marketed to Reduce Sudden Infant Death Syndrome Risk, Pediatrics, 105:4 774-779

Bar-Yishay, E., Gaides, M., Goren, A. and Szeinberg, A. (2011), Aeration properties of a new sleeping surface for infants. Pediatr. Pulmonol., 46: 193–198. doi: 10.1002/ppul.21351

L’Hoir MP, Engelberts AC, van Well GTJ, et al. Risk and preventive factors for cot death in the Netherlands, a low-incidence country. Eur J Pediatr. 1998;157(8):681– 688

Edwin A. Mitchell, BSc, MBBS, DCh, FRACP, FRCPCH, DSc; Bradley T. Thach, MD; John M. D. Thompson, PhD; Sheila Williams, BSc; for the New Zealand Cot Death Study, Changing Infants’ Sleep Position Increases Risk of Sudden Infant Death Syndrome. Arch Pediatr Adolesc Med. 1999;153:1136-1141

Kemp JS, Thach BT. Sudden death in infants sleeping on polystyrene-filled cushions. N Engl J Med. 1991 Jun 27;324(26):1858–1864

Kemp JS, Thach BT. A sleep position–dependent mechanism for infant death on sheepskins. AJDC. 1993;147:642-646

American Academy of Pediatrics Task Force on Infant Positioning and SIDS. SIDS and Other Sleep-Related Infant Deaths: Expansion of Recommendations for a Safe Infant Sleeping Environment, Pediatrics; originally published online October 17, 2011; TASK FORCE ON SUDDEN INFANT DEATH SYNDROME DOI: 10.1542/peds.2011-2284

Jodi Pike, MD and Rachel Y. Moon, MD, Bassinet Use and Sudden Unexpected Death in Infancy, J Pediatr. Oct 2008; 153(4): 509-512

US Consumer Product Safety Commission. CPSC Alerts Caregivers to Hidden Hazard in Babies’ Cribs, Washington, DC: US Consumer Product Safety Commission; MAY 18, 2001; Release Number: 01156

Carrie K. Shapiro-Mendoza, PhD, MPHa, Lena Camperlengo, DrPHa, Rebecca Ludvigsen, MPHb, Carri Cottengim, MAc, Robert N. Anderson, PhDd, Thomas Andrew, MDe, Theresa Covington, MPHf, Fern R. Hauck, MD, MSg, James Kemp, MDh, and Marian MacDorman, PhDd. Classification System for the Sudden Unexpected Infant Death Case Registry and its Application. J Pediatr. Jun 2014; DOI: 10.1542/peds.2014-0180

Paul N. Goldwater1,2 and Karl A. Bettelheim. SIDS Risk Factors: Time for New Interpretations. The Role of Bacteria. Pediatrics Research International Journal. Aug 2013; Vol. 2013, Article ID 867520; DOI: 10.5171/2013.867520

Amanda R. Highet, Anne M. Berry, Karl A. Bettelheim, Paul N. Goldwater. Gut microbiome in sudden infant death syndrome (SIDS) differs from that in healthy comparison babies and offers an explanation for the risk factor of prone position. International Journal of Medical Microbiology. Jul 2014; Volume 304, Issues 5–6, July 2014, Pages 735–741; DOI: 10.1016/j.ijmm.2014.05.007

Jenkins R.O, Sherburn R.E. Used cot mattresses as potential reservoirs of bacterial infection: nutrient availability within polyurethane foam. J Appl Microbiol. Nov 2007; Epub 2007