ABUSIVE HEAD TRAUMA PREVENTION PROJECT
KARYN M. PATNO, MDCHILD PROTECTION PROGRAM OF VT
CLINICAL DIRECTOR
LAURA MURPHY, MDPROJECT INSTRUCTOR
KAY SHANGRAW, RNPREVENT CHILD ABUSE VERMONTSBS PREVENTION COORDINATOR
COLLABORATORS
Prevent Child Abuse- VT American Academy of Pediatrics- VT Chapter Department for Children and Families Vermont Department of Health Vermont Child Health Improvement Program
ABUSIVE HEAD TRAUMA IN VT
Since the fall of 2007 there has been a dramatic increase in the incidence of abusive head trauma; also known as “Shaken Baby Syndrome”
There have been 22 cases; 7 of these fatal
The cause for the increase is unclear, but may include the economy, job loss, social stress
OBJECTIVES
TO IMPACT THE INCIDENCE OF ABUSIVE HEAD TRAUMA through:
Educating new parents around issues of infant crying and dangers of shaking
Educating primary care providers on the risk factors for AHT; also known as “Shaken Baby Syndrome”
Strengthening primary care providers in anticipatory guidance around the issue of infant crying
RECOGNIZING RISK FACTORS
Risk Factor assessment should start in the prenatal period when possible
Risk Factor assessment continues in the newborn period and at each well child visit
Review known risk factors prior to each well child visit
RISK FACTORS
Parent with a previous, “Termination of Parental Rights” (TPR)
Parent with a child currently in DCF custody Teen Parent(s); especially when there is poor
extended family support Parent(s) with drug/alcohol abuse history Maternal Depression Parent(s) with history of ADHD
RISK FACTORS
Unwanted pregnancy; unwanted child Non-biological father figure in household, e.g.,
boyfriend, step-father Note: Having a grandfather as the “father
figure” is not a risk factor Special Needs Child (premature, congenital
defects) Twins Infant with fussy or irritable temperament
ANTICIPATORY GUIDANCE
Newborn Visit First Week Visit 2-4 Week Visit 2 Month Visit 4 Month Visit 6 Month Visit
NEWBORN VISITBF pg. 276
Review and identify risk factors Talk about coping with the “newness” of the
baby Discuss sleep deprivation and the need to take
care of maternal needs Reassure parents that it is NORMAL to feel
stressed and frustrated with the baby Introduce the topic of infant crying and let
parents know that crying is normal
NEWBORN VISITcontinued
Remind parents that crying is how their baby communicates to them.
Sometimes babies cry “for no apparent reason”; this is also NORMAL.
Review strategies: Check that basic needs are met, hold and rock the baby, sing or talk softly
When nothing seems to work: Put the baby down, take a break, ask for help
FIRST WEEK VISITBF pg. 294
Review/Update risk factors Assess for postpartum depression Discuss Infant Crying: Is your baby fussy?
What do you do to calm him? Have you ever been unable to calm him? What did you do, or what would you do, if you were unable to calm him?
Discuss newborn brains and their delicacy. Talk about the danger of shaking or hitting.
FIRST WEEK VISITcontinued
Discuss strategies: Check baby's needs: hungry? Needs to burp?
Needs diaper change? Over-tired? Sick? Hold infant and talk or sing to him Rock infant Go outside for a walk or drive in the car
Talk about getting “to the end of your rope” Realize that everyone's rope is a different length.
Moms tend to be longer than dads.
FIRST WEEK VISITcontinued
If dad is not at visit, encourage mom to talk to him about infant crying and about these strategies
Ask how mom thinks dad is coping with the new baby
PEARL OF WISDOM: No baby has ever hurt himself by crying. Babies get hurt when parents get to the end of their rope and shake or hit them.
ONE MONTH VISITBF pg. 310
Review Risk Factors: Assess for domestic violence
Talk about infant crying: Do you feel your baby's crying is excessive? What do you do to calm your baby? Do you ever get frustrated or stressed by your baby's crying?
Crying peaks around age 1-2 months Remind parents that crying is normal and that it
is not a sign of bad parenting.
ONE MONTH VISITcontinued
All babies cry. Good parents are those that recognize when they are getting to the “end of their rope” and take precautions not to shake their infant.
Review Interventions: The 5 S's
Swaddle Side position Shushing Swinging Sucking
When nothing seems to work:
Put the baby on her back in her crib/bassinet and walk away!!!
The 5 “S’s”The 5 “S’s”1 1. SwaddlingA Feeling of Pure “Wrap”tureTight swaddling is the cornerstone ofcalming, the essential first step in soothing your fussy baby and keeping him soothed. Wrapping makes your baby feel magically returned to the womb and satisfies his longing for the continuous touching and snugness he enjoyed there. Swaddling also protects your baby from accidentally flipping onto the stomach. Always check sure your baby is not overheated and do not allow him to sleep in bed with loose blankets.
2. Side/StomachYour Baby’s Feel –Good PositionThe side/stomach positions soothe your fussy newborn by instantly shutting off the Moro Reflex (the panicky feeling of falling). That’s why these are perfect feel-good positions for unhappy babies.When you put your infant to sleep, however, the back is the only, safe position.
3. ShhhhingYour Baby’s Favorite Soothing SoundA loud, harsh shushing sound is music to your baby’s ears. Shhhing comforts him by mimicking the whooshing noiseyour blood made as it flowed through the arteries of the placenta. And, the louder your baby cries, the louder the Shhhing has to be in order to calm him.
4. SwingingRock-a Bye BabyTo your baby, fresh out of the womb -lying on a soft, motionless bed is disorienting and unnatural. Newborns are like sailors who come to dry land after nine months at sea; the sudden stillness can drive them bananas. That’s why rhythmic, monotonous, jjggly movement - what we call swinging - is one of the most common methods parents have always used to calm their babies. To get your baby to stop crying, the swinging should be like a shiver (fast, tiny movements) . Then, once he is settling down you can use a slower, broader rocking motion to keep him calm.
Few impulses are as powerful as a parent’s desire to calm her crying baby. Although this instinct is as Ancient as parenting itself, Calming a baby is a skill that takes some practice. Vigor is the Essential Tip for calming Baby. The fastest way to succeed in stopping your baby’s cycle of crying is to meet his level of intensity. This need for vigor often seems odd to first-time parents, but after your screaming baby pauses for a few moments can you gradually slow your motion, soften your shushing, and guide him down from his frenzy to a soft landing.
5. Sucking The Icing on the Cake
One of the most perfect ways to soothe your cranky baby is to let her suckle.
Sucking takes a baby who is beginning to quiet and lulls her into a deep and profound state of tranquility. Sucking
triggers your baby’s calming reflex and leads to a rich and satisfying
Level of relaxation.
The Happiest Babyon the block .
2 MONTH VISITBF pg. 328
Review/Update Risk Factors Discuss Infant Crying: Remind parents that this
is the age where crying is peaking. Crying tends to decrease between 3-4 months.
Ask how they are coping with the infants crying. What works to calm their baby?
Review infant brain fragility and the dangers of shaking: Permanent brain damage or death
Review strategies again
4 MONTH VISITBF pg. 343
Review/Update Risk Factors Discuss infant crying: Is your baby crying more
or less then the last visit? How are you and the father coping with your baby's crying?
Have you or the father ever felt like you were at the end of your rope? What did you do when this happened?
Are you and the father comfortable putting the baby down and taking a break?
4 MONTH VISITcontinued
Who else takes care of the baby? Have you talked to them about your baby's crying and what works to calm him?
Have you used baby sitters yet? Don't forget to talk to them about what to do when your baby cries.
Remind other people who take care of your baby to never shake, hit or yell.
6 MONTH VISITBF pg. 359
Review/Update Risk Factors Are parents still together? If not, is there a
new “father figure” in the picture. How is he adjusting to the baby?
Discuss Infant Crying: Even though the infant is 6 months old, he may still have crying spells where you cannot calm him. Remember, it is ok to put him in his crib and let him “work it out”. Have you ever had to do this?
Review day care issues, baby sitters
