Sleeping safely through sickness: innovative strategies for reducing infant mortality in the pediatric emergency department

The National Institute of Child Health and Human Development awarded The Johns Hopkins University $168,988 on August 24, 2026, under the Child Health and Human Development Extramural Research (CFDA 93.865) program to develop and pilot an illness-specific safe sleep intervention for infants delivered via text message after pediatric emergency department visits.

Dr. Howard, under mentorship of Drs. Rachel Moon and Leticia Ryan, will conduct research addressing sudden unexpected infant death (SUID), the leading cause of post-neonatal mortality in the United States. The project targets a critical gap: intercurrent infant illness increases unsafe sleep practice adoption by caregivers, yet only 5 percent of families receive safe sleep education during pediatric emergency department visits. The work comprises three aims: qualitative identification of safe sleep challenges during infant illness and caregiver education preferences (Aim 1); Delphi consensus development of a tailored intervention with caregivers, clinicians, and public health experts (Aim 2A); and a randomized pilot trial evaluating feasibility, acceptability, and preliminary adherence effects compared with standard care (Aim 2B). The project integrates the PRECEDE-PROCEED health promotion model and RE-AIM framework to create a pragmatic, scalable intervention optimized for real-world deployment.

Performance is located in Baltimore, Maryland. The period of performance extends from August 24, 2026, through July 31, 2030. The assistance type is a Project Grant.

Abstract

Sudden unexpected infant death (suid) is the leading cause of post-neonatal mortality in the united states, accounting for approximately 3,700 deaths annually. The majority of suid cases involve unsafe sleep practices. While national public health campaigns such as "back to sleep" initially reduced suid rates, recent increases highlight the urgent need for novel, targeted prevention strategies. Intercurrent infant illness is a recognized risk for unsafe sleep; DR. Howard's recent K12-funded study found that 21% of caregivers reported adopting unsafe sleep practices during illness, changes that persisted for weeks. Yet, only 5% of these families received safe sleep education during their pediatric emergency department (PED) visit. PED visits for infant illness are, therefore, a missed opportunity for prevention. Under the expert mentorship of DRS. Rachel moon and leticia ryan, DR. Howard will develop and pilot a novel, illness-specific safe sleep intervention delivered via text message after PED visits. Aim 1 will qualitatively identify challenges to safe sleep during infant illness and preferences for education delivery in the PED. Aim 2A will apply delphi consensus methods with caregivers, clinicians, and public health experts to develop a tailored, illness-specific safe sleep intervention. Aim 2B will conduct a randomized pilot trial to evaluate the feasibility, acceptability, and preliminary effect on adherence to american academy of pediatrics safe sleep recommendations compared with the standard of care. Guided by the precede-proceed health promotion model and the RE-aim framework, this project integrates behavioral theory with implementation science to design a pragmatic, scalable intervention optimized for real-world deployment. Its innovations include targeting illness as a critical period of vulnerability, using the PED as an underutilized but high-yield prevention setting, and employing a low-burden, technology- enabled delivery strategy. DR. Howard, a pediatric emergency medicine physician and injury prevention researcher at johns hopkins, has formal training in epidemiology and a focused record in suid prevention. This career development award will provide DR. Howard with training in (1) advanced qualitative and mixed- methods research, (2) dissemination and implementation science, and (3) clinical trial design. The johns hopkins environment provides exceptional research infrastructure, access to diverse and high-risk populations, and strong collaborations across pediatrics, public health, and injury prevention. Her multidisciplinary mentorship team includes national leaders in suid research, injury prevention, qualitative methods, and trial design. The proposed work will yield essential preliminary data for a future multicenter R01 trial and position DR. Howard to become an independent, NIH-funded investigator and national leader in suid prevention.