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Some Baby Sleep-Safety Advice that You’ve Heard Before and Some that You Haven’t

Well, 2020 is behind us, and for the first time in my 40-year career, everyone now understands exactly what I do for a living.  I’m an epidemiologist.  But I don’t work to prevent Covid-19, I work to prevent injuries.  Over many years I’ve tried to find new ways to promote safety.  Usually this has involved plugging the gaps that other people have somehow overlooked.

Each of my journeys seems to start with a question.  Back around 2009 I got interested in three published studies that all pointed to a serious problem with overly soft mattresses.  Babies sleeping on soft surfaces were definitely at greater risk of suffocation.  This finding, I’m sure you will agree, is hardly surprising.  So I naively asked experts around the world to help me understand just how firm is firm enough for mattress safety.

To my amazement (and horror), no one had an answer – not the medical people, nor the engineers, nor the manufacturers, nor even the researchers who had published the articles.  Unfortunately, this is often how it goes in public health.  We tend to note the problem long before we discover the solution, just like with Covid-19.

In trying to define acceptable mattress firmness, I really had no idea how to develop an objective test.  The path to a solution turned out to be a fascinating and unpredictable one, the details of which I will share with you in a future blog post.  For the moment though, it’s more important for me to remind you how to protect your baby from suffocation during the first 12 months of life.  You may have heard some of this before, but it only takes 30 seconds to review it.  And then look out for the bombshell at the bottom!

  • Your baby should not be sharing a sleep surface with anyone else.
  • Babies should be placed on their back to sleep, face up.
  • Babies should be placed horizontal to sleep; you don’t want their head to tip forward.
  • The sleep surface, whether in a crib or pram, should pass my formal firmness test (which is freely available to everyone). You can conduct you own informal firmness test by following the directions here:
  • Keep all objects (pillows, bumpers, toys, etc.) out of the sleep environment.
  • Consider using an infant sleeping bag or sleep suit instead of normal sheets and blankets.
  • Never expose babies to cigarette smoke.
  • Seek expert advice if you have any questions.


If you really want to protect your baby from suffocation, you also need to be aware of false mattress-safety claims.  Of course the most important precaution is to always place your baby face up to sleep.  But babies can roll face down, and that’s when you want the safest possible mattress for them.  Some manufactures claim that their mattress is safer because air can easily pass through their product.  This seems logical, but air permeability is not a guarantee of safety.  In fact, a standard, firm, foam mattress with a tight sheet cover is actually safer than some of the so-called safety products.

HOW CAN THIS BE?   Well, it works like this.  On a standard, firm, foam mattress the baby’s expelled carbon dioxide dissipates, i.e. it drifts away, preventing the baby from rebreathing it.  Rebreathing of carbon dioxide causes suffocation.  With many of the so-called air- permeable mattresses, the carbon dioxide (being heavier than air) sinks into the mattress, where it can then be sucked up by the baby for rebreathing.  In other words, the carbon dioxide does not dissipate.  This has been determined by a special test using a mechanical baby that breaths in and out like a real baby.  If a manufacturer will not show you their results on this kind of test, don’t fall for their safety hype.  Other types of testing, which simply confirm air permeability, are not a substitute for the mechanical baby test.

ABOUT THE AUTHOR – Dr Ron Somers is the inventor of the mattress safety test soon to be adopted by the US Government

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