Abstract / Summary
Objective: Admission to the pediatric intensive care unit (PICU) frequently leads to significant sleep disturbances due to the combined effects of continuous monitoring alarms, artificial lighting, repeated bedside procedures, and nighttime care-related interruptions. Non-pharmacological interventions have gained increasing attention as practical, low-cost approaches to address these disruptions. This narrative review was conducted to synthesize current evidence on the effectiveness, feasibility, and clinical implications of non-pharmacological sleep interventions in the PICU.Methods: Studies published between 2016 and 2026 were searched in the PubMed, Web of Science, and Scopus databases. A total of 20 studies addressing non-pharmacological sleep interventions and sleep-related outcomes in PICU populations, together with complementary evidence from other clinically relevant populations, were included in the narrative synthesis.Results: The median number of nocturnal awakenings in children admitted to the PICU was nine. In a mixed pediatric inpatient study, PICU stay was associated with approximately 258 minutes less nighttime sleep than general pediatric unit stay. Available evidence suggests that care clustering and environmental modifications may help reduce sleep disruption, although direct evidence of clinical effectiveness remains limited. Music-based interventions appeared feasible in PICU populations, with no intervention-related adverse events reported in the available small studies, while favorable effects on subjective sleep quality were reported primarily in broader critically ill and surgical populations. Evidence supporting eye masks and earplugs was derived mainly from adult and broader ICU populations, where favorable sleep outcomes were reported. Massage and reflexology were associated with favorable sleep outcomes primarily in neonatal intensive care units and other pediatric inpatient populations. A structured PICU diary intervention was associated with shorter awakening times during PICU hospitalization and lower stress-related symptoms after discharge. Overall, the available evidence suggests that these interventions are generally feasible, although the certainty and directness of evidence vary across intervention modalities.Conclusions: Non-pharmacological sleep promotion interventions may support sleep in critically ill children. However, current evidence is insufficient to determine whether improving sleep reduces the risk of delirium, Pediatric Post-Intensive Care Syndrome, or other long-term outcomes. As PICU-related sleep difficulties may persist for months after discharge, sleep promotion strategies should not be limited to the hospitalization period. Multicenter randomized controlled trials specifically designed for PICU populations and employing validated sleep outcome measures are needed to advance this field toward evidence-based clinical protocols.