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Changes in Sleep Practices During and After Illness

Mary Beth Howard1,2, Leticia M Ryan1,2, Kevin J Psoter3

  • 1Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland.

Pediatrics
|September 17, 2025
PubMed

Insights

Caregiver adherence to safe infant sleep practices declines during and after illness, increasing risks. Illness-related changes in caregiver motivations and sleep arrangements require targeted guidance to ensure infant safety.

Area of Science:

  • Pediatric Health
  • Infant Sleep Safety
  • Public Health

Background:

  • Unsafe infant sleep practices are a significant factor in sleep-related infant mortality.
  • Infant illness is a known risk factor for sudden unexplained infant death.
  • Understanding caregiver adherence to safe sleep recommendations during and after infant illness is crucial.

Purpose of the Study:

  • To examine changes in caregiver adherence to safe sleep practices during and after infant illness.
  • To identify shifts in caregiver motivations influencing sleep arrangements.
  • To assess the duration of these changes post-illness.

Main Methods:

  • Prospective cohort survey study of caregivers of infants (0-12 months) presenting to a pediatric emergency department for illness.
  • Sleep practices assessed before, during, and after illness (2-week and 1-month follow-ups).
  • Adherence to American Academy of Pediatrics (AAP) safe sleep recommendations evaluated using mixed-effects logistic and Poisson regression.

Main Results:

  • Low adherence (<10%) to AAP safe sleep recommendations was observed across all time points.
  • Adherence decreased during illness, with bed-sharing increasing and safe sleep environments (cribs) decreasing.
  • These unsafe practices remained elevated post-illness, with caregiver motivations shifting from safety to family recommendations.

Conclusions:

  • Caregivers exhibit poor adherence to safe sleep practices, which deteriorates during and after infant illness.
  • Illness-related changes in sleep practices and caregiver motivations persist post-recovery.
  • Targeted, illness-specific anticipatory guidance is needed to reinforce safe sleep practices during and after infant illness.
Abstract

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