Sleep practices during infant illnesses may increase risk of sudden infant death

When a child falls ill, caregivers often change how and where the infant sleeps—wanting to keep them close through the night. But new research from Johns Hopkins Children’s Center suggests that some of these changes—although well-intentioned—contradict proven safe sleep practices for infants, and may do more harm than good.

In interviews with more than 100 caregivers of infants ages birth to 12 months presenting to the emergency department for infant illness, researchers found that unsafe sleep practices became more common during periods of illness—and often persisted even after the illness resolved.

These changes to sleep practices increase an infant’s risk of sudden unexpected infant death (SUID), a broad term that includes sudden infant death syndrome (SIDS). SUID, defined as the unexpected sudden death of a seemingly healthy infant from known and unknown causes, resulted in the deaths of 3,700 infants in 2022, according to federal health statistics.

Numerous studies over past decades have tied unsafe sleep practices to both SIDS and SUID. Findings from the study were published Sept. 18 in Pediatrics, and add to evidence that infant illness is a risk factor for SUID.

Caregivers were asked about the infants’ usual sleep practices, and if they changed when the babies were sick. The caregivers reported that adherence to safe habits, such as putting their infants in a crib or playpen, declined overall from 61.8% before illness to 48.1% during illness.

In addition, the proportion of caregivers reporting their infants sleeping in a bed or on a couch rose from 56.5% before illness to 62.6% during illness, and further increased to 75% at the one-month follow-up. Similarly, bed-sharing rates increased overall from 57.3% before illness to 68.7% during illness, and further increased to 83.6% at the one-month follow-up.

Many caregivers in the study reported shifts away from recommended safe sleep practices, such as placing infants on their backs to sleep, during infant illness. The most common changes included increased bed-sharing, sleeping on non-recommended sleep surfaces, and prone or side positioning, which are not in line with the American Academy of Pediatrics safe sleep recommendations.

The fact that the alterations persisted beyond the illness period highlights the need for targeted interventions to reinforce safe sleep practices during illness, says Mary Beth Howard, M.D., M.Sc., pediatric emergency medicine physician at Johns Hopkins Children’s Center and lead researcher on the study.

“Parents often make these changes because they want to comfort or closely watch their sick baby, but these well-intentioned adjustments actually raise the risks of sudden, unexpected death. Illness is a particularly vulnerable time, making it even more important to stick to safe sleep guidelines,” says Howard.

The Johns Hopkins investigators note that October is Sudden Infant Death Syndrome (SIDS) Awareness Month, a time to encourage safe infant sleep practices. According to the American Academy of Pediatrics, safe sleep practices include placing infants on their backs to sleep, having infants sleep alone without blankets, pillows or stuffed animals, and having babies sleep in a crib or bassinet.

Additional experts who contributed to this research include Leticia Ryan, Kevin Psoter, Barry Solomon, Milind Mutala and Sarah Ehrenberg from Johns Hopkins and Rachel Moon from University of Virginia.