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Impact of COVID-19 infection on the sleep of infants and toddlers

Zongyuan Liu,Mengyue Li,Jiping Lv,Yajie Wang,Debin Yang,Linan Gao,Yuanzhe Li,Bo Hu

Published 2025 in BMC Pediatrics

ABSTRACT

Following the termination of China’s dynamic zero-COVID policy on December 7, 2022, a substantial rise in COVID-19 infections among infants and toddlers was observed. Clinical practice revealed that many infected infants and toddlers subsequently developed sleep-wake disturbances. However, research on this specific population remains limited. This study aimed to examine the impact of COVID-19 infection on sleep patterns in infants and toddlers to inform clinical practice and management strategies. We conducted a prospective study of children aged 0–35 months, including COVID-19-positive patients from the pediatric respiratory department and age-matched healthy controls from child healthcare department between January 1 and December 31, 2023. Parents completed the Brief Infant Sleep Questionnaire and a demographic questionnaire at baseline, with follow-up assessments conducted over six months. COVID-19 infection significantly affected multiple sleep parameters: nighttime sleep duration, daytime sleep duration, nighttime awakening duration, sleep latency and bedtime. Nighttime awakening duration was the most significantly affected sleep parameter, with persistent disturbances lasting up to 6 months post-COVID infection without returning to baseline levels. Age ≥ 12 months was a protective factor against night waking, sleeping while feeding and screen time ≥ 1 h were independent risk factors for night waking. Our findings demonstrate that COVID-19 infection causes significant and prolonged disruptions to sleep architecture in infants and toddlers, with these effects persisting beyond the acute infection phase and being moderated by specific environmental factors, highlighting the need for routine sleep assessments in pediatric COVID-19 patients, targeted parental education on modifiable risk factors, and the development of interventions to mitigate sleep disturbances during future public health emergencies.

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