“Is this a pressure relief mattress?” – I hear this question often. The names sound similar, both are for children who spend a lot of time lying down, and in medical supply shops they sit side by side. But they do different jobs. It’s worth knowing the difference before choosing one.
Pressure relief mattress – protects the skin
Its main job is to reduce and redistribute pressure on the skin, to lower the risk of pressure sores.
The most common types are:
- static mattresses – made of foam with specific properties that moulds to the body and spreads pressure over a larger area
- alternating pressure mattresses – with air cells that inflate and deflate in cycles, shifting the points of pressure
This kind of mattress doesn’t hold a child in a particular position. Quite the opposite – a soft or moving surface lets the body sink in, and in a child with spasticity this makes asymmetrical positioning more likely.
Positioning mattress – holds alignment
Its main job is to keep the body in a planned position: legs, pelvis and trunk. The aim is that a child who can’t change position on their own doesn’t spend the night in an asymmetrical posture that encourages hip displacement and deformity.
A custom-made positioning mattress contours around the child’s body and supports it over a large area. However, it isn’t a pressure relief mattress and doesn’t replace assessment of pressure sore risk.
I write more about why night-time position matters for the hips in the article on windswept hips, and about what the research says in the article on night-time positioning.
And an “orthopaedic mattress”?
This term is very common, but it usually just means a firmer mattress with particular foam or spring properties. It doesn’t position the body and isn’t a pressure relief mattress in the medical sense. For a child with high muscle tone and a risk of hip displacement, it’s usually not enough.
The key differences
- purpose – pressure relief protects the skin, positioning maintains body alignment
- how it works – pressure relief spreads or shifts pressure, positioning supports the body and limits sliding
- fit – pressure relief mattresses are usually standard, a positioning mattress can be custom-made
- who it’s for – pressure relief for people at high risk of pressure sores, positioning for children at risk of asymmetry and hip displacement
Which one is needed
It depends on what the main problem is for the individual child.
- the main problem is the skin – e.g. the child already has pressure sores or a very high risk of them – skin protection comes first
- the main problem is alignment – a child with high muscle tone who spends the whole night in one asymmetrical position, is at risk of hip displacement or has had hip surgery – positioning comes first
- both at once – e.g. a child with impaired sensation and a risk of hip displacement. Then the solution needs to be chosen especially carefully, together with the doctor, physiotherapist and nurse
In children with impaired sensation, e.g. with spina bifida, the skin needs particular attention whatever the mattress. More in the article on hips beyond CP.
Whatever the mattress
International guidelines on pressure ulcer prevention (EPUAP, NPIAP and PPPIA, 2019) emphasise that regular repositioning and daily skin checks are the foundation. No mattress replaces them.
In practice, this means:
- change your child’s position regularly – a child who can’t turn over on their own needs help. Clinical guidance suggests a child shouldn’t stay in one position for more than eight hours (Paleg and Livingstone, 2022)
- check the skin every day – especially the sacrum, heels, hips and knees when side-lying
- act on redness – redness that doesn’t fade once pressure is relieved should be reported
- keep things dry and not too warm – moisture and overheating increase the risk of skin damage
I write more about practical sleep positioning in the article on positioning a child with high muscle tone.
Key points
- a pressure relief mattress protects the skin, a positioning mattress maintains body alignment
- a soft pressure relief surface doesn’t hold position, and a positioning mattress doesn’t replace pressure sore risk assessment
- an “orthopaedic mattress” is usually neither
- the choice depends on the main problem for the individual child
- regular repositioning and skin checks are always needed, whatever the mattress
This article is for educational purposes only and does not replace consultation with a doctor, nurse or physiotherapist. The choice of sleep surface is made individually, based on a full clinical assessment of the child.
References
- European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. EPUAP/NPIAP/PPPIA; 2019.
- Paleg G, Livingstone R. Evidence-informed clinical perspectives on postural management for hip health in children and adults with non-ambulant cerebral palsy. Journal of Pediatric Rehabilitation Medicine. 2022;15(1):39-48.