Changes in Sleep Practices During and After Illness

OBJECTIVES Unsafe sleep practices contribute to sleep-related infant mortality. Recent infant illness is a risk factor for sudden unexplained infant death. This study examined changes to safe sleep practices during and after infant illness. METHODS We performed a prospective cohort survey study of caregivers of infants (aged 0–12 months) presenting to the pediatric emergency department (ED) for illness. Surveys assessed sleep practices before, during, and after illness (2-week and 1-month follow-ups). We assessed adherence to the American Academy of Pediatrics (AAP) safe sleep recommendations at each time point. Differences in adherence were evaluated using mixed-effects logistic regression, whereas Poisson regression was used to evaluate the change in number of safe sleep practices for selected participant characteristics. RESULTS Of 131 enrolled participants, 106 (81%) completed all follow-up surveys. Adherence to AAP recommendations was low (<10%) across all time points but decreased during illness without a significant change following illness. Bed-sharing increased from 57.3% pre-illness to 68.7% during illness (P = .032) and remained elevated at the 1-month follow-up (83.6%). Sleeping in a crib or pack n’ play decreased from 61.8% pre-illness to 48.1% during illness (P = .005) and remained low at follow-up. Caregiver motivations changed during illness, with fewer citing safety (46.6% vs 42.0%) and more being influenced by family recommendations (5.3% vs 15.3%). CONCLUSIONS Caregivers of infants presenting to the ED for low acuity illness report low adherence to safe sleep practices, which worsened during and after illness. Future studies should explore targeted, illness-specific anticipatory guidance to reinforce safe sleep practices during and after illness.