The main reason behind wanting to elevate the crib mattress in your baby’s crib is to combat reflux. The parallel here is drawn between inclined sleeping positions reducing reflux in adults and, theoretically, the same being true for babies.
The idea is that various fluids are encouraged to drain down towards the stomach and thorax and away from the mouth and upper airways. This should, in theory, enable the infant to breathe more easily and presumably prevent mucus or bile buildup which could cause suffocation or aspiration.
This approach is true for adults at least and is used in a variety of conditions from sinus problems and common colds to acid reflux issues, but since infants are much more restricted in their ability to move freely, the safety of it is much more dubious.
For example, even devices in which the baby is seated are absolutely advised against by the AAP. The reason behind this is that infants lack the capacity to freely move their head because their neck muscles are not yet fully developed, therefore sleeping in a seated position might cause their heads to droop forward, restricting airways and causing rebreathing (which is dangerous because of reduced oxygenation of the brain) and potentially aspiration (which might cause asphyxiation).
As you can imagine from this example, the same concerns apply to anything that is aimed at adjusting the sleeping position of the infant in the crib. The agreement between professionals seems to be that less is more and bare is better. A flat, firm mattress and sleeping on the back are almost universally recommended (you can check the best mattresses here).
It should be kept in mind that no empirical evidence that elevating the infant’s head helps prevent reflux exists, and it is only recommended in very specific circumstances that will be discussed in detail below. They include upper airway disorders that have to do with the infant’s ability to breathe properly in situations where they haven’t gone through operative procedures to remove them.
If those conditions are met, you will want to find a safe way to elevate your baby’s head while they are asleep. However, since a baby can’t safely use a pillow, the solution is found in elevating one end of the crib mattress.
At this point, it is advisable to consider a few facts.
The American Academy of Pediatrics states that there is no evidence that putting your baby to sleep in an inclined position reduces reflux. It also warns that inclined mattresses pose a risk of causing SIDS (Sudden Infant Death Syndrome). Their main concern with elevated mattresses is that the baby might slide down the incline to the foot of the crib, coming into a dangerous position that could hamper its breathing and movement.
If, for whatever reason, you still think that your child might profit from sleeping on an elevated mattress: consult your family doctor or pediatrician first. There are certain conditions in which your doctor or pediatrician might prescribe an elevated mattress for sleep, but they are limited to very specific cases.
Here is a quote from the relevant section from the 2016 AAP publication on sleep safety for infants and prevention of SIDS:
“The supine sleep position does not increase the risk of choking and aspiration in infants, even those with gastroesophageal reflux, because infants have airway anatomy and mechanisms that protect against aspiration. The American Academy of Pediatrics (AAP) concurs with the North American Society for Pediatric Gastroenterology and Nutrition that “the risk of SIDS outweighs the benefit of prone or lateral sleep position on GER [gastroesophageal reflux]; therefore, in most infants from birth to 12 months of age, supine positioning during sleep is recommended. …Therefore, prone positioning is acceptable if the infant is observed and awake, particularly in the postprandial period, but prone positioning during sleep can only be considered in infants with certain upper airway disorders in which the risk of death from GERD [gastroesophageal reflux disease] may outweigh the risk of SIDS.”
Examples of such upper airway disorders are those in which airway-protective mechanisms are impaired, including infants with anatomic abnormalities, such as type 3 or 4 laryngeal clefts, who have not undergone anti-reflux surgery. There is no evidence to suggest that infants receiving nasogastric or orogastric feeds are at an increased risk of aspiration if placed in the supine position.
Elevating the head of the infant’s crib is ineffective in reducing gastroesophageal reflux and is not recommended; also, elevating the head of the crib may result in the infant sliding to the foot of the crib into a position that may compromise respiration.”
The rest of this article should be considered in conjunction with these guidelines. For more information on safe sleep practices that don’t have to do with the elevation of the mattress, you can visit the AAP publications website, while the quoted content may be found specifically here.
There are various methods to elevate the crib mattress. The cheapest method is using a rolled-up blanket, a pillow or something similar, which you would then put beneath the head-end of the mattress. There are a few important things to pay attention to when doing this.
First, make sure the pillow or blanket you are using is secured beneath the mattress. No part of it should stick out from underneath the mattress, as it might be strangulation or choking hazard to your child.
The second concern is getting a fitting angle. This can be achieved by removing the mattress and marking the point to which you would have to elevate one end to get the desired angle. Then you would adjust the blanket or pillow height to match the marked point on the crib railing.
Since elevation is generally not recommended by the AAP, there is no exact number to aim for. The standard angle seems to be around 15° and up to 30°. Again, please consult your family doctor or pediatrician first. Too sharp of an angle could pose a dramatic risk for your baby.
You could potentially secure the blanket or pillow beneath the mattress with some sort of Velcro tape or regular tape, but again, there is no guarantee that either of those things will hold, and neither are they completely safe themselves, so it is best to stay away from them completely.
Another option to elevate the crib mattress is to use a so-called crib wedge. This is a device that looks like a regular piece of mattress shaped in the form of a wedge and is supposed to be wedged beneath the mattress. Since these things are made in the same width as a crib mattress, there is less danger from it sticking out and posing strangulation or choking hazard when compared to the first method.
The emphasis here is on less dangerous. They aren’t completely safe. If your doctor has not recommended their use you would be best advised to stay away from them. They don’t seem to be produced at angles higher than 16° either, which should tell you that the manufacturers have their concerns about the safety of your child and wouldn’t risk putting them to sleep on a 30° angle inclined mattress.
The third and final option is to elevate the whole crib rather than to elevate the mattress. There are devices made especially for this purpose that you can buy, called bed risers or furniture risers, which appear to be fairly sturdy and uniform. The cheaper option, of course, is sticking a bunch of books or other similar items directly beneath the posts of the crib to achieve elevation, although I can’t imagine why you would go to such a risk in any circumstance.
Something to mention about raising the whole crib instead of elevating the mattress is that you can’t achieve as sharp of an angle with bed raisers as you would when you elevate the mattress, since the effective length of the crib is larger than the mattress, you can expect smaller angles achieved.
There is also a product that might help prevent the sliding down of infants on elevated mattresses called sleep positioner swaddles or anti-rollover blankets. It’s a sort of blanket made with Velcro lining that is meant to keep your baby fixed on their backs.
In theory, this would be in concordance with the AAP guideline of ensuring that your baby always sleeps on their back, but keep in mind that many pediatricians don’t recommend swaddling babies when they sleep at all, and many more don’t recommend the use of gadgets that could pose additional hazards.
Therefore, as before, please consult your pediatrician or family doctor before you buy anything. They will know best whether your infant needs any of these things in the first place, and they are sure to provide you with the best and safest method to do it.
What it boils down to is that you shouldn’t decide without consulting a trained professional and even when they give you the recommendation you should monitor your baby for the first few nights to make sure that they aren’t sliding down the elevated mattress.
This is an extremely serious issue and must not be taken lightly. Approximately 3500 infants die annually from sleep-related issues in the US alone. We don’t mean to frighten you with the information provided, but you must be properly informed and fully aware of preventable dangers concerning your child.
In addition to the already mentioned AAP recommendations, there are standards set by the Consumer Product Safety Commission which review various products including those related to infant bedding and you should look for products certified by them to ensure your child’s safety.
Their official website offer an option to subscribe to email updates on recalled products which will alert you about any updates to safety standards that might not be fulfilled by items you already own.
It’s also a great website with a wealth of information on recalled products that you should check out before making any purchases. They also have a page with crib safety regulations and recommendations here.
We hope that this short overview has provided you with the necessary know-how and some pointers on where to further your knowledge about the topic and that you are now fully equipped to tackle this issue and find the best option for you. Stay aware of the dangers, keep your baby safe, and most importantly: talk to a doctor or pediatrician before making a decision you might regret.