Educating Parents About Shaken Baby Syndrome

Children's Hospitals Today, Spring 2007
By Karen Seaver Hill
Director, Child Advocacy
NACHRI

Shaken babies are a small but significant portion of the estimated 900,000 victims of child abuse and neglect every year. Of the estimated 1,500 children killed annually by abuse, one in four is a victim of shaken baby syndrome (SBS). For every casualty of SBS, three other babies are shaken severely enough to require medical treatment and will have lifelong complications including seizures, blindness and paralysis. No one knows how many thousands of other less severe cases of shaking are never brought to a physician’s attention and go undiagnosed.

Most SBS cases occur when a parent or other caregiver becomes frustrated with an infant who won’t stop crying. Severe shaking of a baby results in brain injury and swelling that usually stops the crying. The cause (crying baby) and effect (quiet baby) of shaking provide behavioral reinforcement for the abusive caregiver, who may not realize the long-term damage being done.

Despite the devastating outcomes of child abuse, there are interventions that can significantly reduce the incidence of SBS. Specifically, a hospital-based parent education program spearheaded by Mark Dias, M.D., has been replicated in hospitals nationwide and inspired a growing number of state legislative efforts.

Buenos Dias

In 1997, Dias, a neurosurgeon, was employed at Women and Children’s Hospital of Buffalo in New York. Working at a Level I trauma center confined by a combination of jurisdictional and geographic boundaries, the team at Children’s Buffalo were confident that they received all of the most severe shaken baby cases in the western New York region. This exclusivity drove the team to partner with surrounding birthing hospitals to implement an educational program for parents of every newborn in Western New York. The partnership created a simple and cost effective program that for an average $10 per child includes:

• A video, “The Portrait of Promise”
• Information that normalizes crying and offers parents coping mechanisms
• A commitment that parents are asked to sign and return, affirming their understanding of the materials

The results of Dias’ model were published in the April 2005 issue of Pediatrics, where he demonstrates a 54 percent decrease in SBS cases. Over the last few years, the program has expanded with 27 hospitals from Western New York and the Finger Lakes region participating. The SBS program procures signed commitment forms from parents representing 91 percent of live births at participating hospitals.

Now approaching 10 years of sustainability, expansion and success, the Upstate New York SBS Education Program has been one catalyst for 10 states to legislate statewide SBS education initiatives.

Hospital Models

The hospital-based parent education program has been adopted and adapted by a series of children’s hospitals. Dias brought the model with him to Penn State Children’s Hospital/Milton S. Hershey Medical Center in Hershey, PA. He and his team were a driving force in the statewide legislative mandate for SBS education to new parents and serve as hub for the 122 birthing and children’s hospitals participating across Pennsylvania.

Connecticut Children’s Medical Center in Hartford is implementing a staged rollout of the education program. Beginning first with its neonatal intensive care population, the program will ultimately include all infants in the newborn nursery. Connecticut Children’s is adding a domestic violence module to the program, educating nurses to screen and refer families appropriately.

Staff at Loma Linda University Children’s Hospital in California have used the model as a foundation for the “Choices” program crafted to respond to the perpetrator profile in that community. In Choices, the primary SBS message implores mothers to be highly selective in whom they choose to care for their infants.

Hospitals modeling after the Upstate New York SBS Education Program are demonstrating similar parent familiarity and incidence reduction. Primary Children’s Medical Center in Salt Lake City has documented a decrease in SBS cases over a period of three years. The results of a four-year research project at Helen DeVos Children’s Hospital in Grand Rapids, MI, are promising as cases involving shaking appear to have declined. In the past four years, the program has reached 18,000 parents of newborns.

“Preventing Shaken Baby Syndrome and Child Abuse and Neglect” is the ninth in a series of NACHRI case studies on child abuse and neglect.

State Initiatives on Shaken Baby Syndrome 2000 – New York requires every hospital and birth center to ask all new parents to view an SBS video and sign a form indicating they have viewed or refused to watch the video. The requirements also mandate training for child care providers on the identification, diagnosis and prevention of SBS. 2000 – Texas requires licensed daycare facilities to receive education on the identification and prevention of SBS. 2000 – Utah requires all daycare centers to receive training on preventing SBS, preventing sudden infant death syndrome (SIDS), coping with crying babies and understanding brain development. 2002 – Florida requires hospitals and birthing facilities to provide new parents with SBS brochures. 2002 – Pennsylvania mandates hospitals to provide parents with free educational materials on SBS, including a voluntary commitment statement. 2005 – Minnesota mandates distribution of SBS information to new parents at hospitals and training for child care providers. 2005 – Missouri stipulates that every hospital and birthing center will offer to all new parents a viewing of an SBS video prior to discharge. 2005 – Wisconsin stipulates that all new parents prior to discharge receive information and watch a videotape on the dangers of SBS. School districts are required to educate grades five, eight and 11 on SBS. Licensed child care providers are trained regarding SBS, and at-risk families receive SBS education through the Department of Health and Human Services. 2006 – Illinois establishes an SBS program to educate parents and primary caregivers about SBS and provide commitment statements. 2006 – Massachusetts creates a hospital-based program for parents of newborns; education and training programs for parents, caregivers and professionals; support for victims of shaken baby syndrome and their families; and a surveillance and data collection program to measure the incidence of SBS.