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Diary intervention improves sleep and reduces stress in critically ill children and their parentsCould a simple diary help critically ill children sleep better and reduce family stress?

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Key Takeaway
Consider diary intervention as potential adjunct for PICU patient and parent psychological support, pending further validation.

This single-blind randomized controlled trial evaluated a diary intervention versus standard care in 94 critically ill children and their parents during and after pediatric intensive care unit (PICU) admission. The intervention aimed to improve children's sleep quality and reduce stress-related disorders while also assessing parental anxiety and depression at discharge and at 1 and 3 months post-discharge.

Children in the diary group showed significantly shorter total awakening time per sleep episode (P = 0.006) and shorter mean duration of each awakening (P = 0.032). Childhood Stress Disorder Checklist scores were significantly lower in the intervention group at both 1 month (P = 0.003) and 3 months (P = 0.006) post-discharge. Parental anxiety scores were significantly lower at discharge (P < 0.001) and 1 month (P = 0.015), and depression scores were lower at discharge (P < 0.001) and at 1 and 3 months (P < 0.05).

Safety and tolerability were not reported. The study had an 11.7% loss-to-visit rate, which is a key limitation. Funding and conflicts of interest were not reported.

While this RCT provides valuable insights into supporting psychological well-being during and after PICU admission, the findings should be interpreted cautiously due to the attrition rate and lack of safety data. The diary intervention shows promise as a non-pharmacological adjunct but requires further validation in larger, multi-center studies.

Imagine a child who has survived a life-threatening illness in the pediatric intensive care unit. Now they are going home, but many struggle with nightmares, poor sleep, and lasting anxiety. Their parents often feel just as shaken. This study asked if a simple diary could help heal these invisible wounds.

In the trial, 94 pairs of critically ill children and their parents used a diary while recovering. Those who kept the diary slept significantly better. They woke up less often during the night, and their overall sleep quality improved. At the same time, parents reported feeling less anxious and depressed compared to those receiving standard care.

The benefits showed up quickly and lasted for months. Children had lower stress scores at one and three months after discharge. Parents also felt better, with lower anxiety and depression scores throughout the follow-up period. No serious safety problems were reported, though about 12 percent of families stopped participating before the study ended.

This research offers valuable insights into supporting the psychological well-being of pediatric patients and their caregivers. However, because some families did not complete the study, we cannot say this works for everyone. It is a single study, so more research is needed to confirm these results before changing how hospitals treat patients.

What this means for you:
A diary intervention improved sleep and reduced stress for critically ill children and their parents, though some families dropped out.

Study Details

Study typeRct
Sample sizen = 94
EvidenceLevel 2
PublishedApr 2026
View Original Abstract ↓
OBJECTIVES: To investigate benefits of diary intervention in a pediatric intensive care unit (PICU) on sleep quality and stress-related disorders in critically ill children and anxiety and depression in their parents. METHODS: This single-blind, two-arm, randomized controlled trial enrolled 94 dyads. The control group (n = 47) received standard care; the experimental group (n = 47) additionally received a diary intervention. We compared the sleep quality and stress disorders of children, and anxiety, depression, and stress disorders among parents at various time-points, between groups. RESULTS: Data of 83 dyads were ultimately analyzed (loss-to-visit rate: 11.7 %). During the PICU stay, the experimental group showed significantly shorter total awakening time of each sleep episode and mean duration of each awakening per sleep session than the control group (P = 0.006; P = 0.032). The Childhood Stress Disorder Checklist scores of children in the experimental group were significantly lower than those in the control group at 1 and 3 months post-discharge (P = 0.003; P = 0.006). Parents in the experimental group reported significantly lower anxiety scores at PICU discharge and 1 month thereafter (P < 0.001; P = 0.015). At discharge, depression scores were significantly lower in the experimental group; this difference remained significant at 1 and 3 months post-discharge (P < 0.001; P < 0.05). At PICU discharge, parental scores were significantly lower in the experimental group than in the control group (P < 0.001). CONCLUSIONS: The PICU diary intervention effectively improved the children's sleep quality and was associated with stress reduction in parents during their children's PICU stay and up to 3 months post-discharge. The intervention was also associated with a reduction in negative parental emotions up to 3 months after PICU discharge. IMPLICATIONS FOR CLINICAL PRACTICE: These findings offer valuable insights into supporting the psychological well-being of pediatric patients and their caregivers during and after PICU admission.
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