A Promising Model for Shaken Baby Syndrome Prevention

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A Promising Model for Shaken Baby Syndrome
Prevention

• Jane Swenson, CNP

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(No Transcript)
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Preventing SBSWhy 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
• 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 2.21
• 68.5 male - Birth fathers
  37
• Mothers
  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
• - Parents 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),1996

• Important contributing factors to CA
• Family structure and size
• Poverty
• Alcohol substance abuse
• Domestic violence
• Community violence

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Whats Been Done?

• Public Awareness
• Community Education

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Public Awareness

• Brochures
• Billboards
• Buscards
• Transtop 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
• Fathereducation
• Male audiences JDC, Prisons

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Upstate N.Y.SBS Education Project Premises

• Most people know that shaking is bad
• SBS represents a momentary lapse in control,
  likely secondary to frustration
• 75 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 months
• Education 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 childs
  safety
• We want to educate you about the dangers of
  shaking infants
• Please 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 Statement
• All 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 regions live births
• Steadily increasing numbers of returned CS each
  subsequent year
• Currently receiving CS from 80 of live births
• 96 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 parents
• 93 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)
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Upstate N.Y.SBS Education Project Case Analysis
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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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(No Transcript)
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Twin Cities Metro SBS Prevention Program

• task force created 2001
• materials developed and translated
• implementation plan TC Metro
• 15 hospitals, 7 counties
• collaboration with MDH for data

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SBS Visits at Home Visits

• Be direct and clearit is NEVER ok to shake a
  baby
• Educate re normal crying behavior
• Educate re how to cope with crying
• Engage parents as advocates for babys safety
• Include dad/father figure in SBS and ALL education

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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