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Positional Asphyxia

Positional asphyxia happens when a person can't get enough air to breathe due to the positioning of his/her body. This happens most often in infants, when an infant dies and is found in a position where his/her mouth and nose is blocked, or where his/her chest may be unable to fully expand. It is felt that the positioning of the infant led to a lack of oxygen and a death by asphyxia (suffocation.) Examples include an infant found wedged between a mattress and the wall, an infant sleeping on a couch with an adult who is found with his face pushed against the cushions of the couch.

Positional asphyxia varies from a death from SIDS in a few important ways. A child is said to die of SIDS (sudden infant death syndrome) if he/she:

  • is less than 1 year of age,
  • died while sleeping and that death remains unexplained after a thorough investigation, including a complete autopsy and review of the circumstances of death and clinical history.

An infant who dies while sleeping in an otherwise safe sleeping environment may still be called a SIDS death even if he/she is found with his mouth/nose in the mattress as long as no other reason for the death can be found.

Why does it happen?

Positional asphyxia occurs when an infant is put to sleep or falls asleep in an unsafe sleeping environment or in an unsafe position. Examples of unsafe sleeping environments can include:

  • Couches
  • Beanbag chairs
  • Infants sharing a bed with others
  • Waterbeds
  • Pillows
  • Cribs with mattresses that don't properly fit
  • Adult beds
  • Cribs with sheepskins, quilts, other soft surfaces

An unsafe position would include:

  • Sleeping face-down
  • Sleeping in an infant carrier with head covered, or face against soft surface (including parent's chest)
  • Side-sleeping


Prevention of positional asphyxia includes many of the same things that help to prevent SIDS:

  • Infants are safest when sleeping in their own crib or bassinet with a firm mattress that fits well and no extra pillows/quilts/soft toys in the area.
  • Infants should be placed on their back to sleep.
  • To promote breastfeeding, the baby should be in the same room as the mother, but while sleeping should be in his/her own crib/bassinet.
  • If a parent chooses to sleep with their babies, the bed should not have any blankets, comforters or pillows and should not be against a wall or have space where the baby could fall between mattress and a side, head or foot board.
  • Parents who sleep with their babies should not use any substance (alcohol, drugs, sleeping pills, narcotic pain medications) that would make it difficult for them to wake up.

Remember these basics:

Back to sleep
Sleep in safe environment - crib or bassinet without loose materials or soft bedding and with a mattress that fits
Sleep alone
If baby falls sleep in your arms, on the couch, on pillows, etc., and you don't have a crib handy and/or you need to leave the area or are falling asleep yourself - put the baby on his/her back on the floor. It is safer than the sofa or chair.
Car seats
If your baby falls asleep in the car seat and you don't have a crib available and won't be watching the baby, make sure he/she is not on a counter or table (or anyplace high) and that he/she is buckled into the seat. Babies can slide down when not buckled and get in a position where their airway is blocked.
Don't cover up your infant so you can't see him/her.
Avoid over-heating your baby. Buy sleepers that can double as a blanket. If you feel you must use a blanket, tuck it in the mattress and make sure the top only reaches the baby's chest. Keep room temperature 70 in winter.