Abstract
Bedding characteristics have been associated with an increased risk of respiratory impairment and sudden infant death. However, the relevant bedding properties and the mechanisms influencing newborn respiration remain poorly understood. Existing evidence is fragmented across epidemiological, clinical, forensic, and regulatory studies, with limited integration of respiratory physiology and engineering-based measurement frameworks. Consequently, current safety guidelines rely largely on qualitative criteria and simplified mechanical tests that may not adequately capture physiologically relevant risks. This review examines the available literature investigating potential mechanisms through which bedding characteristics may influence infant breathing, identifies possible relevant bedding properties, and critically evaluates the testing methods proposed to assess these properties. By synthesizing evidence across disciplines, we highlight key knowledge gaps and misalignments between current testing approaches and the underlying biomechanical and physiological determinants of respiratory compromise. Carefully designed future in-vivo and in-vitro studies are needed to elucidate mechanisms and more precisely identify hazardous bedding characteristics. In particular, stronger interdisciplinary integration and the development of advanced biomechanical in-vitro models that more accurately reproduce infant respiratory function are essential. This integrative framework aims to support evidence-based bedding design and inform future regulatory standards to enhance infant safety.