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A Promising Model for Shaken Baby Syndrome Prevention

Jane Swenson, CNP

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Preventing SBS:Why Bother?

Second most common cause of death due to trauma in children

1/3 die of their injuries, 1/2 of remainder suffer permanent neurological and visual sequelae

Responsible for > 95% of serious head injuries in children < 1 y/o

1400 deaths from SBS in U.S. annually

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Jacy Showers, Ed.; 1982,1983,1987, 1990,1992

Inadequate knowledge about the dangers of shaking

24-50% of parents/adults did not know shaking was dangerous

Pre and post test scores indicate adults can be educated about dangers of shaking young children

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Starling SP, Holden JR, Jenny C.; 1995

127 infants with AHT and perpetrator identification:

Male/female perpetrators = 2.2:1 68.5% male - Birth fathers 37% Mother’s boyfriends 20.5% Stepfathers 3.1% Male babysitters 3.9%

31.5% female - Female babysitters 17.3% Birth mothers 12.6%

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Gray JD, Cutler CA, Dean JG and Kempe CH; 1979

Kempe family stress index:

- Parent’s childhood history

- Potential for violence

- Stressors/concerns

- Perception of infant

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Gray JD, Cutler CA, Dean JG and Kempe CH; 1979 (cont.)

- Substance abuse

- Discipline issues

- Unrealistic expectations?

- Support systems

- CPS involvement?

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Milner, J, 1991; Coody D, Et Al, 1994

Risk factors for child abuse:

- Childhood history of CA

- Isolation

- Unrealistic expectations

- Substance abuse history

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Milner, J, 1991; Coody D, Et Al, 1994 (cont.)

- Violence history

- Lack of family/social support

- Impulsive behavior

- Depression

- Relationship problems

- Financial difficulties

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National Incidence Study of Child Abuse & Neglect (NIS-3),1996Important contributing factors to CA:

– Family structure and size – Poverty– Alcohol & substance abuse– Domestic violence– Community violence

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What’s Been Done?

Public Awareness Community Education

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Public Awareness

BrochuresBillboardsBuscardsTranstop posters

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Community Education

Portrait of Promise video Young babysitter curriculum Daycare provider licensure requirement Prenatal education Early childhood education classes Parenting classes “Father”education Male audiences; JDC, Prisons

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Upstate N.Y.SBS Education Project : Premises

Most people know that shaking is badSBS represents a momentary lapse in

control, likely secondary to frustration75% of perpetrators are parents, and 60%

are fathers or father figures (stepfathers, boyfriends)

Therefore any educational effort needs to target parents, and especially fathers/father figures

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Upstate N.Y.SBS Education Project : Premises

Average age of victims is 5-9 monthsEducation needs to remind both parents

at the correct time – on the birth of the child, when they:– Are a captive audience– Are focused on their infant– Will soon be exposed to the

frustrations of parenting

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Upstate N.Y.SBS Education Project : Premises

Parents can be advocates by disseminating information to other caregivers

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Upstate N.Y.SBS Education Project : Approach

Congratulations on your new baby!You are the best advocates for your

child’s safetyWe want to educate you about the

dangers of shaking infantsPlease help us ‘spread the news’ to

everyone who cares for your child!

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Upstate N.Y.SBS Education Project : Protocol

All parents (mothers and fathers) asked to review both written and video materials:– video, brochure on SBS, information on

coping with crying,Commitment StatementAll materials provided in English and

Spanish

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Upstate N.Y.SBS Education Project : Protocol

Both parents asked to voluntarily sign a commitment statement (CS)– Signed by both parents whenever possible– Asks a few simple demographic questions for

tracking– Witnessed by nurse/educator

• Identifying information expunged if parents refuse

– Copies sent monthly by participating hospitals to the study coordinators for tracking

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Upstate N.Y.SBS Education Project : Goals

1) Educate every parent of every child

2) Confirm receipt of information– Track number of returned

commitment statements

3) Monitor regional cases of abusive head injury

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Upstate N.Y.SBS Education Project : Results (1998-2002)

CS recorded from 37,136 families– Represents 61% of the region’s live births– Steadily increasing numbers of returned

CS each subsequent year– Currently receiving CS from > 80% of live

births96% of CS signed by mothers, and 75%

by fathers or father figures

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Upstate N.Y.SBS Education Project : Results (1998-2002)

Information was very well received - of people returning CS:– 92% think information is helpful– 95% recommend information for all

parents93% already know that shaking an

infant is dangerous~ 10% contributed positive

comments, few negative comments

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Upstate N.Y.SBS Education Project : Results (1998-2002)

18.3/100,000

3.2

45

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Study

49% (< 0.05)

35.5/100,000

Annualized Incidence

54% (< 0.05)7.0Cases/Year

72Time Period (months)

42# of Cases

% ReductionControl

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Upstate N.Y.SBS Education Project : Case Analysis

2Born at participating hospital, CS returned

3Born at participating hospital, no CS

5Born at non-participating hospital

2Born before program

Number of cases

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Upstate N.Y.SBS Education Project : Results (1998-2002)

Results appear to be specific– No change in the frequency of other

regional abuse referrals in WNY– No comparable decline reported in other

US metropolitan areas (SIGCA listserve query)

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SBS Prevention: Conclusions

A coordinated and comprehensive program of hospital based parent education may be significantly effective in reducing the incidence of abusive infant head trauma

These results need to be verified and expanded upon in larger trials

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Twin Cities Metro SBS Prevention Program

task force created 2001materials developed and translatedimplementation plan: TC Metro

– 15 hospitals, 7 countiescollaboration with MDH for data

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SBS Visits at Home Visits

Be direct and clear…it is NEVER ok to shake a baby

Educate re: normal crying behaviorEducate re: how to cope with cryingEngage parents as advocates for

baby’s safetyInclude dad/father figure in SBS and

ALL education

“It is clear that even though the media, politicians, and the public would like to believe that quick fixes can be found, the nature of child maltreatment, the depth to which it is ingrained in our society and the complexity of the problem all defy simple solutions.”

Krugman, 1997