Knowledge and Barriers to Safe Sleep Counseling Among Pediatric Emergency Department Clinicians and Trainees

To assess knowledge of the American Academy of Pediatrics (AAP) safe sleep recommendations, identify barriers to education, and explore strategies to improve education delivery in the acute care setting among pediatric emergency department (ED) clinicians and trainees.

We conducted a cross-sectional survey of pediatric ED clinicians and trainees at a tertiary care children's hospital. The survey assessed knowledge of AAP safe sleep recommendations, current counseling practices, perceived barriers, and suggested interventions. Descriptive statistics and stratified analyses were performed.

Of 226 eligible clinicians and trainees, 182 responded (80.5%). Most were pediatric residents (47.5%) or nurses (33.9%). Knowledge was high (mean score: 5.5/6, standard deviation: 0.7), with no significant differences across roles or experience levels. Major barriers to counseling included time constraints (86.3%) and competing clinical priorities (77.6%), followed by language or cultural barriers (38.3%). Although 71.0% provided education when observing unsafe sleep practices, only 29.5% documented counseling. Clinician and trainees endorsed system-level supports such as multilingual resources (65.0%), provision of cribs or sleep sacks (56.3%), electronic medical record prompts (53.0%), and referral pathways for safe sleep resources (53.6%).

Although pediatric ED clinicians and trainees demonstrate strong knowledge of AAP recommendations, system-level barriers limit consistent counseling. Addressing these barriers represents a critical opportunity to reduce the heightened risk of sleep-related infant death during illness. Embedding safe sleep education into ED workflows may strengthen sudden unexpected infant death prevention efforts and reduce infant mortality.