Baby nests and pods - what are the safety worries?

The risk of SIDS

Please remember, although SIDS (Sudden Infant Death Syndrome) is very worrying it’s also very rare. There were 198 cases of SIDS in England and Wales in 2018 (the latest available figures) - that’s 0.03% of the 656,379 live births in England and Wales. Cases of SIDS have been reducing since 1991.

The single most important and effective action that parents can do is to place your baby on their back to sleep at night and for day time naps. Dramatic reductions in SIDS have been seen across the world since this advice was introduced - in the UK SIDS fell by 58% in 1991 following a campaign by FSID (now known as The Lullaby Trust) to always place your baby on their back to sleep.

Why are The Lullaby Trust saying baby nests and pods do not meet safer sleep guidelines?

The Trust has based its advice on a comprehensive collection of nearly 200 scientific papers, which it last updated in June 2019. The Trust told us that their warning is based on this research, not any specific cases of baby deaths or injuries.

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In its latest 2019 report, The Lullaby Trust states:

"Some products marketed for infant sleep, such as hammocks and nests or pods, are not firm and flat and so are not recommended for use by The Lullaby Trust, although their relationship to SIDS has not yet been established"

As of 2020, we haven’t been able to find any evidence of reported cases across the world of babies’ deaths specifically involving a sleeping pod or nest used outside of a parent's bed. We found 7 non-UK cases where a baby had died while co-sleeping in their parents' bed when sleeping in a pod or nest. Medical reports suggested the deaths were linked to bed sharing rather than the nest itself.

We did find one case of a baby suffocation death in Australia in 2016 linked to a portable sleeping space - but this was a padded portable crib rather than a pod or nest. We will update as soon as we hear of any incidents involving these products.

To make its advice as clear as possible, The Lullaby Trust has created a simple rule: babies should sleep on a firm, completely flat, waterproof surface. It’s this rule that it warns sleeping pods and nests don’t meet. We’ve looked at each of these and the research behind them.

Firm mattress

How do pods and nests not comply? Some, but not all, have soft mattresses – eg, the base part that your baby sleeps on.

Risk 1: Soft mattresses may increase the risk of SIDS or suffocation, particularly if your baby rolls over on to their front (or is placed to sleep on their front).

Evidence: There’s strong evidence that a soft mattress increases the risk of SIDS or suffocation, most significantly if a baby sleeps on their front or rolls onto their front. One study found a soft mattress increased SIDS risk by 5 times.

Risk 2: The Lullaby Trust states that “soft surfaces can make it harder for babies to lose body heat and maintain a safe temperature”.

Evidence: This is not so clear-cut as overheating has been linked with SIDS when heavy bedding has been used or the room temperature has been too high, rather than a soft mattress.

What's the definition of a non-firm (ie soft) mattress? Unfortunately, it’s not easy to find a consensus of opinion on this. The Lullaby Trust states that a soft mattress is one that lets your baby’s head sink in further than a few millimetres. Meanwhile, the study that showed the 5 times risk defined a soft sleep surface as one that let a baby’s head sink 25mm (1 inch) or more. In the US, a firm mattress is defined as maintaining its shape when your baby is placed on it. Memory foam mattresses are advised against.

What you should do: Avoid pods or nests that have a soft mattress due to the risk of SIDS or suffocation. Always place a pod or nest on a flat, firm surface.

Flat mattress

How do pods and nests not comply? Although most baby nests have flat mattresses, they have padded, raised bumper sides, which are close to your baby’s head, and so are not entirely flat. However, many moses baskets and carry cots also have padded solid sides at the same distance to your baby's head (sometimes even closer) as a baby nest. Moses baskets and carry cots are currently deemed safe by The Lullaby Trust.

Risk 1: Padded bumpers may increase the risk of SIDS or suffocation if your baby rolls over or turns their face to the side so that they’re breathing into the bumper.

Evidence: There’s strong evidence of SIDS or suffocation deaths linked to sleep positioners or cot bumpers, where the baby’s head has been found close to a padded side. We could find no published studies or evidence yet specifically for pods and nests.

What if the padded bumpers are breathable? Some sleep pods and nests, such as Sleepyhead, are made of breathable and permeable materials. However, we’ve not found SIDS research that’s been carried out on these materials. The official safe sleep advice from the American Academy of Pediatrics (AAP) states that breathable sleep surfaces have yet to show scientifically that they offer a decreased risk of SIDS.

Risk 2: The Lullaby Trust told us it’s concerned that padded bumpers may increase the risk of overheating (which may increase the risk of SIDS), because they’re so close to your baby’s head, where most heat is lost.

Evidence: We couldn’t find any scientific evidence of an overheating risk from side bumpers. There is evidence that links over-heating to an increased risk of SIDS. However, these have been linked to the use of heavy bedding, coverings that go over a baby’s head or a hot room, rather than the close proximity of padded bumpers.

The bottom line: To reduce the risk of SIDS or suffocation, do not use any blankets or loose coverings when placing your baby to sleep. Baby nests/pods have nowhere to tuck in blankets, so you must not use any coverings. Ensure your baby's room temperature is the right temperature (16-20°C) and if you're using a sleeping bag, this is the correct tog/thickness. Check on your baby occasionally to ensure they are not overheating or have their head positioned closely facing one of the sides.

Waterproof mattresses

How do pods and nests not comply? Most don’t come with waterproof mattresses and may not have a separate mattress that can be fitted with a tight, waterproof covering.

Risk: Mattresses can harbour bacteria that have been linked to illnesses that may increase the risk of SIDS. The Lullaby Trust states in its Safer Sleep Product Guide that waterproof mattresses help to stop bacteria building up inside the mattress. It also states in its research document, “A mattress with a waterproof cover will help parents to keep it clean and dry.”

Evidence: There’s clear evidence that certain bacterial-based illness, particularly upper-respiratory conditions, may increase the risk of SIDS.

However, the theory that the risk of SIDS is increased by bacteria harbouring in mattresses has yet to be definitely proved.

Studies have shown that second-hand mattresses are linked to a higher risk of SIDS, however despite several research projects, scientists have not been able to explain the reason for this increased risk, and whether this is directly linked to bacteria.

One Scottish study from 1995 showed that when old mattresses were covered in PVC, the SIDS risk was no longer increased. Further studies have looked at how PVC coverings may affect the growth or dispersal of bacteria, with mixed results.

In the US and Australia, the official safe sleeping advice is a firm, flat mattress covered by a fitted sheet, without mention of it being waterproof.

What if the mattress is anti-bacterial? We are asking The Lullaby Trust if having an anti-bacterial mattress would replace the need for waterproofing, and will post their reply.

Should you buy a waterproof covering? There’s some concern that a waterproof covering can prevent a mattress being breathable or may raise the temperature making your baby sweat more. The Trust states that if you make sure your baby doesn’t get too hot, then “breathability and temperature regulation of a sleep surface does not need to be a consideration”.

This emphasises the importance of being vigilant about avoiding your baby getting too hot or too cold when they sleep.

If you do buy a waterproof covering for your mattress, the key thing is to avoid loose bedding, so only use a waterproof cover that fits tightly and ensure there are no gaps between the mattress and the sides where your baby could become wedged.

The bottom line: Never use a secondhand baby pod or nest due to the risk of SIDS. More evidence is needed with regard to the link between SIDS and waterproof mattresses, but keep your mattress clean and bedding regularly washed.

Is the warning just about pods and nests?

No, although the statement focuses on pods and nests, it also warns that all of the following sleep products don’t conform to their safer sleep guidelines:

Cushioned sleeping pods and nests
Baby hammocks
Cot bumpers, pillows and duvets
Sleep positioners (anything that wedges or straps a baby in place)

However, the Trust is particularly concerned about sleeping pods and nests because they have become so widely used by parents. “As a SIDS charity, we have watched with concern as products that go against safer sleep advice gain popularity,” explains Francine Bates, the Trust’s Chief Executive.

So is this new advice from The Lullaby Trust?

No, The Lullaby Trust released this warning as part of Safe Sleeping Week in March 2018. It’s the same advice that they gave to us when concern came out in the press in October 2017 about sleep positioners.

So what does this mean for parents using pods or nests?

Firstly please don’t panic. The Lullaby Trust has raised some valid safety concerns based on scientific evidence regarding mattresses, padded bumpers and temperature. Frustratingly, there is no current research relating directly to sleeping pods and nests.

We’re calling for more research to be done, specifically with regards to sleeping pods and nests. However, until we have this, a review of the evidence suggests the following:

Avoid pods or nests that have soft mattresses
If you do use your pod or nest, check regularly to make sure your baby isn’t overheating or sleeping with their head turned into the padded sides
Don't use a secondhand pod or nest - the risk is higher if it comes from outside your home

This is particularly important if your baby is premature (born before 37 weeks), was born weighing under 5.5lb (2.5kg), has an upper respiratory infection or you or your partner is a smoker.

If you do use a pod or nest, always follow these guidelines:

Always follow the instructions when using a pod or nest
Never use loose bedding or let anything cover your baby's face
Don't let your baby sleep in a pod or nest unsupervised. That means only using them for daytime naps when your baby is with you and you can regularly monitor them
Always place a pod or nest on a flat, firm and stable surface. Don't tilt or raise any part of it
Keep your baby in the same room as you
Regularly check that your baby has not moved their face into the side padding and is not overheating
If your baby needs more warmth than their sleepsuit/clothes, use a lightweight baby sleeping bag
Position your baby with their feet at the foot of the pod or nest, giving as much space as possible between your baby's head and the padded sides
And, of course, always put your baby to sleep on their back

It’s all about risks… not certainty

Ultimately, safer sleep guidelines are all about reducing risks. When weighing up the risks, remember the number of SIDS and sleeping-suffocation cases are very small, but a small risk is still a risk.

It's impossible to remove all the risks of SIDS as the cause of SIDS is still not known, but there are things you can do to significantly reduce them.

ALWAYS place your baby on their back to sleep. This is the key safe sleeping rule - the Back To Sleep campaign which launched in 1991 reduced the rate of SIDS by an incredible 81%
Don’t sleep with your baby on a sofa or chair - it can increase the risk of SIDS or accidental suffocation by 50 times
Avoid smoking in pregnancy and after your baby is born – it can increase the risk by 2 to 8 times, depending on how many cigarettes you smoke
Never let your baby’s head be covered, even with a hat
Keep your cot completely clear - don’t use loose bedding, duvets, pillows, sleep positioners, cot bumpers or toys in the cot
Keep your sleeping baby in the same room as you during their first 6 months
Breastfeed your baby if you can
Position your baby ‘feet to foot’ – with your baby’s feet at the foot of the cot or sleeping place
Don’t share your bed with your baby if you or your partner has been drinking, is a smoker, has been taking drugs or is extremely tired

Again, these are even more important if your baby is premature (born before 37 weeks), was born weighing under 5.5lb (2.5kg) or has an upper respiratory infection.

Full disclosure: We feature independent reviews of sleeping pods, nests and other sleeping products, for which we receive no payment. Like most parenting sites and publishers, we sometimes earn revenue through affiliate (click to buy) links. However, we do not allow this to influence our coverage. We have also worked with Sleepyhead to run a paid product test on the Deluxe and Grand on our chat forum - all the testers' feedback was genuine and unedited - and with Purflo to promote an independent review of the Sleep Tight Baby Bed, which was written before the Purflo campaign and over which Purflo had no influence or input.

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Susie BooneEditorial Director, MadeForMums