Tag Archives: carbon dioxide rebreathing

Are there warning signs of SIDS?

Crib Mattress to Prevent SIDS

Are there warning signs of SIDS?

SIDS (Sudden Infant Death Syndrome) has no symptoms or warning signs. Babies who die of SIDS seem healthy and normal.  They show no signs of struggle. 

Diagnosis of Exclusion

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 of the infant.   SIDS is a diagnosis of exclusion, meaning he cause of death is labeled as SIDS only after all other causes have been excluded.

Carbon Dioxide Rebreathing

While there are no warning signs of SIDS and the cause of SIDS is unknown, many clinicians and researchers believe that SIDS is associated with problems in the ability of the baby to arouse from sleep to detect low levels of fresh oxygen.  Rebreathing carbon dioxide leads to hypoxia, and eventually death. 

SIDS is a big concern of most parents because there are no warning signs of SIDS.

Face Down Sleeping

When babies sleep face down, they can re-breathe exhaled carbon dioxide if sleeping on a fiber filled mattress or pad.  Babies who sleep on their tummy with their hand or arm close to their face can also re-breathe.  Normally, rising carbon dioxide levels activate nerve cells in the brain stem, which stimulate the brain’s respiratory and arousal centers. The baby then wakes up, turns his head, and breathes faster to get more oxygen. SIDS babies fail to rouse to get fresh oxygen.  Rebreathing of carbon dioxide eventually suppresses their need to breathe and they never wake.  SIDS babies simply pass in their sleep with no warning signs.

Triple-Risk Model

The “Triple-Risk Model” for SIDS has been proposed to explain how SIDS occurs, and why there are no warning signs of SIDS. The model holds that SIDS occurs when three conditions exist simultaneously:

  • the infant has an underlying (e.g., brainstem) abnormality that makes him unable to respond to low oxygen or high carbon dioxide blood levels
  • the infant is exposed to a triggering event such as sleeping face down on its tummy
  • these events occur during a vulnerable stage in the infant’s development, i.e., the first 6 months of life

The underlying abnormality is low serotonin levels in the brain stem.  We currently have no way to test infants to find out which ones do or do not have low serotonin levels.  The vulnerable stage in the infant’s development is believed to be a rapid brain growth phase.   Conception to birth is a human’s most rapid growth phase and birth to 1 year is the second.   Infant’s internal organs are growing quickly.  Unfortunately, we have no way to determine when an infant is growing through a rapid brain growth phase, so all infants remain vulnerable.    The Triple Risk Theory helps explain why there are no external warning signs for SIDS.

Risk Reduction

There is currently no way to “prevent” SIDS from occurring; however, you can vastly reduce your baby’s risk of SIDS by:

  • putting your baby to sleep on his back
  • keeping blankets, pillows, stuffed animals, bumpers, and other stuffed objects out of his crib
  • overheating your baby or his room when he sleeps
  • not smoking when you are pregnant and not allowing anyone to smoke around your baby
  • breastfeeding
  • Using an air permeable/breathe-through crib mattress that does not trap carbon dioxide even if your baby is sleeping face down or on their tummy

Over 3,400 infant deaths are classified as SIDS each year in the U.S., and there are no warning signs for these SIDS deaths.  The best a parent can do is make good choices to keep their sleeping baby safe.  The best way to keep your baby safe is to make sure when you put your baby to sleep for nap or night, you do everything possible to make sure there is nothing in your baby’s crib that can cause the build up of carbon dioxide should your baby roll to their tummy.  The creators of the first air permeable/breathe-through crib mattress found out the hard way what can happen when an infant rolls over on while sleeping on a fiber filled crib mattress.


Since there are no warning signs for SIDS, all infants remain at risk.  The SafeSleep® Breathe-Through Crib Mattress  has given over 80,000 parents piece of mind.  Why?  The SafeSleep®”Completely” 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 would be gone before the infant takes their next breath of air – even if face straight down

The hollow frame below the open weave top layer is filled with nothing but constantly circulating, pure organic air, creating the ideal oxygen rich sleep environment for your baby.  Check out all the features and benefits!

Will a Baby Wake if They Can’t Breathe?

Breathable Crib Mattress

Will a baby wake if they can’t breathe?

Most babies will wake if they can’t breathe.  But some will not wake if they can’t breathe.  The issue we face is, we don’t know which babies will wake and which ones will not. 

The two main reasons infants stop breathing is airway obstruction and the other is carbon dioxide rebreathing. 

Airway Obstruction

Airway obstruction occurs most often when an infant’s nose is obstructed.  One example would be an infant sleeping on soft bedding that is blocking his nasal passages.  Infants are obligate nose breathers.  This means they breathe primarily through their nose.  This usually changes at around six-months of age but will differ for all infants. 

Carbon Dioxide Rebreathing

As adults, we have a trigger or a defense mechanism when we sleep that if our carbon dioxide rises, we wake up and turn our head on the side or we roll when we are rebreathing our exhaled air, we will turn your head to get oxygen.  It is believed that some infants do not have this trigger, and these infants will not wake if they can’t breathe.  This is known as the “arousal defect.”

The arousal defect  prevents some infants from waking up even when they’re not getting enough oxygen.  It is believed these infants have low serotonin levels in the brain stem or high levels of serotonin in the blood.  There is currently no way to test babies for these serotonin levels until after death.  Many SIDS infant’s have been shown to have low serotonin levels in the brain stem at death.  Dr. Hannah Kinney was the first to discover these findings.  Her research has helped shed light on why seemingly normal babies do not wake if they can’t breathe.   

It is believed that these vulnerable infants will not wake if they can’t breathe or respond (turn their heads) when they are rebreathing their exhaled air.  If these infants continue to rebreathe their exhaled air, it will eventually suppress their need to breathe leading to hypoxia and eventually death. 

These vulnerable infants do not wake if the are rebreathing, and instead sleep quietly through their last breath.  SIDS is a silent killer.

American Academy of Pediatrics Safe Sleep Task Force Recommendations

In 2011, the American Academy of Pediatrics Task Force on SIDS decided to expand the safe sleep recommendations to include recommendations to reduce the risk of rebreathing and other sleep related infant deaths.  As noted in the policy statement,

“It is unknown whether the nonsupine (tummy) position by itself increases the risk of suffocation, and we have therefore not included suffocation as a rationale for supine sleeping in either the Policy Statement or the Technical Report. Moreover, the similarity noted in risk factors should not be construed as implying that SIDS is caused by suffocation. Indeed, they are two separate entities. Unfortunately, at this time, there is no unique cellular pathology or biological markers that enables medical examiners, coroners, or pathologists to differentiate SIDS from suffocation deaths.  Consequently, a determination of the cause of death must be made in the absence of this information.” 

Current Recommendations and Carbon Dioxide Rebreathing

If you look at the current safe sleep recommendations published by the AAP Safe Sleep Task Force, you will notice most of the recommendations center on eliminating the risk of an infant rebreathing carbon dioxide.  These recommendations are based on years of studying  why some babies don’t wake if they can’t breathe.  These recommendations include:

  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.”

What Can Parent do to Avoid the Buildup of Carbon Dioxide in Their Infant’s Crib?

Dr. James Kemp and colleagues were some of the first to study the potential for various sleep surfaces to prevent infant rebreathing. In one study of five different infant sleep products claiming to reduce the risk of carbon dioxide rebreathing along with a firm crib mattress with a tight fitting sheet – currently recommended by the American Academy of Pediatrics (AAP) for safe infant sleep.  Kemp and colleagues found the firm mattress and four of the five surfaces designed to prevent rebreathing of carbon dioxide consistently allowed lethal rebreathing of carbon dioxide.  According to Kemp, “Only one product—an air-permeable crib mattress—was able to maintain carbon dioxide 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.”

Additional 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 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 (to their tummy).

About Air Permeable/Breathe-Through Crib Mattresses

Until we can identify which babies will wake if they can’t breathe, and which babies will not wake if they can’t breathe, your best defense is an air- permeable/breathe-through crib mattress that does not allow harmful carbon dioxide to accumulate.

SafeSleep® is the first company to design a market successful, air-permeable crib mattress that eliminates carbon dioxide retention in response to infants who don’t wake if they can’t breathe.  The SafeSleep® was developed by professionals, including a leading pediatrician, who were personally impacted by the loss of a loved one who had rolled in the middle of the night. 

The creators of the SafeSleep® created a crib mattress that eliminates carbon dioxide retention at a faster rate than and infant breathes.  An infant takes a breath every 1-2 seconds.  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 will always be present for baby to breathe in.  

Carbon dioxide dissipates in less than half a second on the SafeSleep® Breathe-Through Crib Mattress, meaning the carbon dioxide on the SafeSleep® Breathe-Through mattress is gone before a baby takes their next breath– even if face straight down.

The SafeSleep® breathe-through crib mattress is the only crib mattress physicians write prescriptions for infants who must tummy sleep for health reasons.  The SafeSleep® is considered the safest crib mattress among leading American Academy of Pediatrics Physicians and Committee Members.

If you want to learn more about the scientific test data on the SafeSleep® crib mattress, visit safesleeptech.com

See how the SafeSleep® crib mattress test data influenced changes to the 2016 Safe Sleep Policy here

Sleep Products for Infants; is yours safe?

Best Crib Mattress

Are your infant’s sleep products safe?  Most parents believe if a product makes its way to the shelves of big box retailers and etailers, it must be safe.  The grim reality is many are not.  We have seen one recent example, the Fisher Price Rock and Play and other inclined sleep products causing hundreds of infant deaths.

As a SIDS and Safe Sleep content expert, I have been privileged to the juvenile product industry standard’s flaws when it come to safety of infant sleep products.


The Consumer Product Safety Commission (CPSC), who works closely with the ASTM (formerly known as American Society for Testing and Materials), has a  sub committee on infant sleep products.  The issue is, this committee is made up predominately of sleep product manufacturers.  And the ASTM physician on the committee, wants thousands of well documented deaths before “risking” making product mandates for infant sleep products.


Over ten-years-ago, I challenged an industry standard and made drastic changes to the traditional crib mattress design.  I was fortunate; I had a pediatrician (who is also a mother of four) acting as a free consultant while I was in the design phase of my air permeable/breathe-through crib mattress.  She  offered me both professional and practical advice and introduced me to many prominent players in the medical community.  She has many professional connections through her decades of service as a Committee Chair Member of one of the American Academy of Pediatrics (AAP) sub committees. 

We both lost a loved one to positional asphyxiation, classified as a SIDS death.  Product safety and testing for my design was paramount.  Without her connections, I believe finding the proper testing methods and scientific data to create a product that we could prove is safe, would have proven difficult. 

Testing requirements

The sad reality is infant sleep products do not require much testing at all.  Infant sleep products must meet flammability requirements which often results in adding harmful chemicals to fiber and foam filled products.  And if you want to call yourself a “standard size crib mattress,” you must conform to size requirements, and that’s it.  The CPSC asks that you use proper labeling of your fiber content, but it’s not mandatory.

The lack of standards and available testing methods makes it difficult for manufacturers to know if their sleep products are truly safe, let alone consumers.  So, who is responsible for unsafe infant sleep products making their way into the homes of unsuspecting consumers?

Infant’s spend 70% of their first year sleeping.  The safest thing all parents should own is a sleep product.

No easy task

It was no easy task, but we were determined to keep safety and testing as our two main criteria for our new design.  Once we identified all the risks associated with conventional crib mattresses and infant sleep products, we had to search for medical professionals willing to test our product.  Some tests didn’t even exist.  We had to convince a few medical professionals to develop testing.   

We needed to make sure our infant sleep product not only conformed to the few current regulations in play, we needed to make sure it conformed to the AAP’s Safe Sleep Policy Recommendations.  This was no easy task finding testing available to make this possible.  The AAP was just about to publish their 2011 Safe Sleep Policy, so we found out as much as we could about updated recommendations.  There were no new updates for crib mattresses.  The AAP continues to recommend a firm crib mattress with a tight-fitting sheet even though there is no test data to support a firm crib mattress with a tight-fitting sheet as being safe. 

Testing versus retrospective analysis

When I say there is no test data, I mean there is no gold standard testing where babies are placed on different types of crib mattresses to see which ones will survive on a certain type of crib mattress and which ones will not.  As you can see, this type of testing would be unethical.   The closest testing of this type was done by Dr. James Kemp who used baby bunnies.  The AAP Safe Sleep Task Force members must go by what is called retrospective analysis.  This means, the best data they have is to sift through thousands of infant death reports and find correlations of infants in a certain age group, gender, weight, etc.. and try to determine why some infants lived and others died.  For example, let’s take the “back-to-sleep” recommendation.  These scientists found that infants fitting similar profiles were more likely to die if they were on their tummy while sleeping than on their back.  The recommendation for a firm crib mattress is based on infants dying on soft mattresses.

Inherent flaws

Retrospective analysis data can often be flawed, and it is subject to interpretation by the scientists.  Death scene investigations are not always standardized.  There is a significant effort in this direction, but we are not there yet.  It is up to the medical examiner or pathologist to determine the cause of death and take notes on the series of events and the scene.  You can have two examiners look at the same scene, and there is a high probability one examiner will include certain data and exclude data the other examiner would not.

Firmness testing

Even though the AAP recommends a “firm” crib mattress or sleep surface based on death scene investigations, no standard for firmness in the US exists.  More importantly, there is no available firmness testing.  There is also no testing available to determine if a sheet is safe or not.  According the most recent AAP safe sleep recommendations, a sheet that is designed for the mattress you are using is recommended.  The issue is, crib mattress manufacturers are not the ones manufacturing sheets.  There are no clear guidelines for consumers to ensure they are buying the proper sheets for their particular mattress.

We were not concerned about sheet testing since our products do not use them.  We knew they have been linked to many strangulation deaths, so they were out for our design.

However, we were interested in making sure our products met firmness standards.  I happened to e-meet a doctor on a SIDS infant list serve who is a child product safety expert in Australia, Dr. Ron Somers.  Dr. Somers developed a test to measure crib mattress firmness and established a standard in Australia and New Zealand.  Not only did he test our mattress free of charge, he helped get them into multiple child-care facilities in Australia.  He also gave our product an unsolicited endorsement

The point is the firmness test was not available in the US.  We had to ship our product to Australia to have it tested. 

Asphyxiation – airway blockage & rebreathing

Our next big safety concern with conventionally designed crib mattresses was the risk of asphyxiation.  Asphyxiation is two-fold in reference to crib mattresses and other sleep products. 

First, there is asphyxia, commonly know as suffocation, when airways are blocked.  A soft fiber-filled mattress or a quilt would be perfect examples of how an infant’s airways could become blocked if face into them.

Second, asphyxiation can occur if an individual continues to rebreathe their exhaled air (carbon dioxide). SIDS experts believe carbon dioxide rebreathing is a common risk factor associated with infant sleep related deaths. It’s believed some infants do not respond by turning their heads when rebreathing their exhaled air.  If an infant rebreathes their carbon dioxide without responding, the carbon dioxide eventually suppresses their need to breathe, making it lethal.  To reduce the risk of carbon dioxide rebreathing, the American Academy of Pediatrics recommends a firm crib mattress, placing baby on their back, no bumper pads, no quilts or blankets, no mattress pads, no sleeping on couches, or sleeping with others, and not allowing a baby to sleep on you.  Some of these recommendations have multiple risks.  For example, co-sleeping is a risk for carbon dioxide rebreathing and overlay/suffocation.    

New products being targeted

We are currently seeing another product being sold in the infant sleep product category that seems to be causing concern with many medical professionals, the Dock-a-Tot.  One pediatrician mommy blog site that warns parents against the product is PediMom.com.  In a recent Facebook (FB) post by PediMom she states,

“I have coded and lost infants due to this contraption. We advocate for no bumpers, right? This is like several big fluffy bumpers placed even closer to your child’s face which increases their risk of suffocation and death.” 

She goes on to say,

“Don’t come at me with, “I only let my baby lounge in it, not sleep in it”. Infants fall asleep in the blink of an eye and NO PARENT can have their eyeballs on their child 100% of the time. It’s impossible and if you’re honest you’ll admit that.”

Another FB pediatrician I follow is Dr. Diane Arnaout.  I love her no-nonsense approach.  Here is her FB message to her followers regarding the Dock-a-Tot,

“I know. I know. You guys love them. You put your baby in bed with you. You feel like they have their own sleep space. The baby feels nestled and cozy. Yay sleep. All is well.  Until your baby turns his sweet little head to the side. Maybe even his body nestles to the side. Maybe his face presses into the “breathable” material. Maybe he breathes comfortably here for awhile.  The air in that little space by his face is breathed in, and out. Oxygen goes in, carbon dioxide goes out. Slowly, there is more exhaled carbon dioxide in that little space than there is oxygen.  What most parents (and even medical professionals) don’t realize is that CARBON DIOXIDE REBREATHING is something researchers believe contributes heavily to sudden infant death. “

She continues on to say,

“The U.S. Food and Drug Administration (FDA)  has begged parents not to use them and manufacturers to stop making them since 2010: https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm227575.htm

From a manufacturer

As a manufacturer, I understand that you can create and produce just about anything for infant sleep and it requires virtually no oversight or testing.   I also understand many manufacturers are more interested in the bottom line than they are in safety.  Until stricter regulations, structured testing, and accessible testing methods are available, we will continue to lose innocent lives to eventually prove an infant sleep product is unsafe and should never have been sold to consumers.

Safe Sleep Technologies is our manufacturing company, and our mission is not only to deliver safer, healthier, more sanitary crib mattresses to families, it is also to lobby for change in safety regulation and testing.  We hope to one day see both carbon dioxide dissipation testing and firmness testing mandated for all infant sleep products.  If you would like to learn more about our Company and story, please visit https://safesleeptech.com

You may also be interested in our successful efforts in influencing changes to the 2016 AAP Safe Sleep Policy and technical report.  https://www.globenewswire.com/news-release/2016/11/14/889732/0/en/Two-Michigan-Women-Influence-Changes-to-the-2016-Safe-Sleep-Policy.html