Implementation of an Emergency Department-Based Educational Intervention to Improve Infant Sleep Practices

Purpose: In the US, about 3,500 infants die each year from sleep-related deaths. The American Academy of Pediatrics (AAP) published safe sleep recommendations, however limited caregiver knowledge and financial constraints are potentially barriers to following these recommendations. With these barriers in mind, educational interventions demonstrated varying degrees of improvement in infant sleep practices, but it is unclear if the emergency department (ED) is an effective location for education. This study aimed to assess current sleep practices of infants in the community, determine caregiver knowledge of safe sleep, and to evaluate the efficacy of a brief ED-based educational intervention. Methods: Caregivers of infants ages 0-6 months being seen in an urban freestanding pediatric ED between 2017 and 2019 for non-life-threatening illnesses were recruited to participate in the study. The initial survey, administered during the ED visit, asked about the infant’s sleep environment, caregiver knowledge, and barriers to safe sleep. Caregivers then watched a ten-minute video demonstrating AAP sleep recommendations. An educational handout, safe sleep book, and sleep sack for their infant were provided to each caregiver. If caregivers reported no appropriate sleep location for their child, a pack-n-play was provided free of charge. A follow up phone survey was completed 2-4 weeks later assessing their infant’s current sleep environment and caregiver knowledge on AAP recommendations for safe sleep. Results: Sixty-eight of the 111 caregivers recruited in the study completed both the pre and post surveys. The majority (87%) of caregivers surveyed were mothers with an average age of 27.5 years (SD 5.5). Infants were 51% male with an average age of 14.75 weeks (SD 8.3). Forty-one percent of infants were breastfed; 32% of caregivers admitted to someone smoking in or outside the home. Ninety-six percent of caregivers reported a nurse or physician had previously discussed infant safe sleep with them, and 35% of caregivers knew a baby who has died of SIDs. Prior to the education, 90% of caregivers were able to identify that infants should sleep in the supine position, but only 65% of infants were sleeping in this position. Following the educational intervention, there was an increase in infants always sleeping in their crib from 40% to 65% (p=0.003), but no significant change in infant sleep position. Ninety percent of caregivers reported the education was helpful, 60% discussed safe sleep with other caregivers, 80% utilized the sleep sack provided, and 91% read the provided safe sleep book. Conclusion: The majority of caregivers identified the educational intervention as helpful and were utilizing the materials provided with a significant improvement in crib utilization for sleep. No similar improvement in infant sleep positioning occurred, indicating barriers to adherence to safe sleep recommendations beyond caregiver knowledge.