Red Nose recommends babies sleep on the back and on a firm, clean, well-fitting mattress that is in good condition.
To Reduce the Risk of Sudden Unexpected Deaths in Infancy (SUDI), including SIDS and Fatal Sleep Accidents
1. Sleep baby on the back from birth, not on the tummy or side
2. Sleep baby with head and face uncovered
3. Keep baby smoke free before birth and after
4. Provide a safe sleeping environment night and day
5. Sleep baby in their own safe sleeping place in the same room as an adult care-giver for the first six to twelve months
6. Breastfeed baby
The term Sudden Unexpected Death in Infancy (SUDI) is now used as this term refers to all cases of sudden and unexpected death in infancy and includes deaths from Sudden Infant Death Syndrome (SIDS) and fatal sleeping accidents. Safe sleeping recommendations target known risk factors associated with SUDI. Where studies specifically define the population as SIDS, this specific term will be used to describe the study findings.
- Red Nose has reviewed the research to date and found there is no evidence to show an increased risk of SUDI for babies who sleep on their back on a firm, clean, well-fitting mattress that is in good condition.
- Sleep baby on a cot mattress that is the right size for the cot, is firm and clean and in good condition with no signs of damage. A soft mattress can increase the risk of SUDI if baby rolls over onto the tummy.
- Make sure there is no more than a 20mm gap between the mattress, the cot sides and the ends of the cot as a baby or toddler can become trapped between a poor fitting mattress and the cot sides. This is especially dangerous if their face is trapped and covered, or their neck is restricted in any way.
- Check the cot is well constructed with a good base. This includes portable cots. The base should not sag as this may form a trough particularly with a soft foam mattress into which a baby on its tummy may roll.1
- Any previously used mattress should have been well stored, firm and clean. If the mattress is damp, torn or mouldy or there is any doubt about its safety, including fit, it should not be used.
- Remove plastic packaging from mattress before use. Always make sure any waterproof mattress protector is strong and a tight fit.
- Never put soft bedding (including lambswool) under or on top of the bottom sheet as this makes the sleeping surface too soft.
- A pillow or cushion is not a safe sleep surface.
Summary of the background research of this information statement
The most recent evidence states that there is no detectable increase in risk using a second hand mattress that is clean, not torn and well fitting.2
Previously, a study by Tappin et al. had found an association between use of a second hand mattress and an increased risk of SIDS, particularly if the mattress was from another home. Unfortunately this paper did not provide details of the condition of the mattresses used in the study (i.e. if the surface was torn, dirty, no longer firm, or fit the cot base snugly, which may be important if it was from another home and not meant for the cot used.) This study also did not indicate the quality of the cot or indicate if there were bumpers or other objects in the cot.3
No association has been found between SIDS cases and the presence of common organisms (Stapylococcus Aureus or Bordetella pertussis) in cot mattresses.4
It was previously suggested that the increased risk of SIDS was associated with bacterial growth in second hand mattresses including S. aureus. S. aureus is a common organism that normally lives on the skin and in the nose and throats of healthy babies. It is therefore not surprising that S. aureus has been found in the foam of cot mattresses, particularly if the foam is exposed and the mattress previously used by other babies. Studies have shown no significant association between levels of dust mite and allergens in polyurethane foam in second hand mattresses and the established cot mattress risk factors for SIDS. However there is possibly an increased risk of minor ailments particularly if the mattress is not well cleaned.5
Comment and Summary
There is no evidence to show that the risk of SUDI increases for babies who sleep on their back and on a firm, clean, well-fitting mattress that is in good condition. There is some evidence to show that there might be higher incidence of SUDI when using some second hand mattresses. However, the condition of these mattresses was not known, nor the fit in the cot, or the sleeping position of the babies.
In Australia, between 1990 and 2015 approximately 5,000 babies died suddenly and unexpectedly. Baby deaths attributed to SUDI have fallen by 85% and it is estimated that 9,967 infant lives have been saved as a result of the infant safe sleeping campaigns.
The Safe Sleeping program is based on strong scientific evidence, has been developed in consultation with major health authorities, SUDI researchers and paediatric experts in Australia and overseas, and meets the National Health & Medical Research Council rules for strong evidence.
For further information visit the Red Nose website at www.rednose.org.au or phone Red Nose on 1300 998 698.
View the references for this article here.
Red Nose National Scientific Advisory Group (NSAG). 2016. Information Statement: Second hand mattresses. Melbourne, Red Nose. This information statement was first posted in October, 2005. Most recently updated February 2017
Last modified: 27/2/18