Preventing Shaken Baby Syndrome:A Guide for Health Depts. & Community-Based Organiations

7/31/2019 Preventing Shaken Baby Syndrome:A Guide for Health Depts. & Community-Based Organiations

http://slidepdf.com/reader/full/preventing-shaken-baby-syndromea-guide-for-health-depts-community-based 1/61

Preventing Shaken

BaBy Syndrome

A Guide for Health Departments and

Community-Based Organizations A part of CDC’s “Heads Up” Series

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention



“Preventing Shaken Baby Syndrome: A Guide for Health Departments and Community-Based Organizations” is a publication of the

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. See www.cdc.gov/injury.



Tl CTT

Summary: Shaken Baby Syndrome is a Preventable Public Health Problem 1

The Facts: What You Need to Know About Shaken Baby Syndrome 3

Focusing on Prevention 4

Understanding the Consequences 4

Learning What to Look For 6

Getting Started: Working Towards Success 9

Building a Framework for Prevention 9

Learning About and from Existing Programs 10

Getting the Message Out: The Right Message, Right Person, Right Time 15Creating Eective Messages 15

Working with the Media 19

Strength in Numbers: Building Partnerships to Prevent SBS 21

Collaborating with other Organizations and the Business Community 21

Initiating Partnerships 21

Working Together: Roles of Health Departments and Community-Based Organizations 23

Identifying Potential Partners 26

Taking Public Health Solutions to the Next Level: Impacting Policy 29Policy is an Eective Public Health Intervention 29

Your Agency/Organization’s Role in Impacting Policy 31

Resources 35

Appendix A: State Initiatives on SBS 43

Appendix B: Prevention Tips for Parents and Caregivers 50

Appendix C: A Partnership Planning Tool 52

Appendix D: Educational Resources 54



1

Shaken Baby Syndrome is a

Preventable Public Health Problem

haken aby yndrome () is often seen as a crime, but it is aso a preventabe pubic

heath probem. tate and oca heath departments and community-based organizations(Cs) have ties to broader resources and programs, and strong connections in

communities. oth heath departments and Cs can take a eading roe in reframing

the issue and engaging a members of a community to take part in the prevention of .

The purpose of this guide from the Centers for Disease Contro and Prevention (CDC) is

to hep your organization identify your roe and to take action to protect infants from .

It outines steps to impement evidence-based intervention strategies, to integrate specic

education messages into existing programs for new parents, caregivers, professionas,

and the genera pubic, and to engage in activities that impact poicy deveopment that are

eective in preventing .

Together with oca and nationa partners, your organization can make a dierence in

preventing , so that a chidren can have safe, stabe, and nurturing reationships and

a better chance to ive to their fu potentia.

S u m m a r y



P r e v e n t i n g S h a k e n B a b y S y n d r o m e

2



T h e F a c t s

3

THE FACTS:

What You eed to Know

about haken aby yndrome

Understanding the facts heps buid awareness, and utimatey aects how we take action.

Using your contact with parents and other community members to promote the facts, risk

factors and triggers, and ways to prevent is the rst step in addressing it as a pubic heath

probem that can be prevented, and not just a crime to be punished.

, a form of abusive head trauma (HT) and inicted traumatic

brain injury (ITI), is a preventabe and severe form of physica

chid abuse. It resuts from vioenty shaking an infant by the

shouders, arms, or egs. may resut from both shaking aone

or from impact (with or without shaking).1 The resuting whipash

eect can cause beeding within the brain or the eyes.2

The merican cademy of Pediatrics (P) and the Centers

for Disease Contro and Prevention (CDC) report that

matreatment causes a high rate of injury and death among

infants.4,5 can cause death, menta retardation or

deveopmenta deays, cerebra pasy, severe motor

dysfunction, bindness, and/or seizures.

asics3:

■ is a eading cause of chid abuse

deaths in the United tates. eary a

victims of suer serious heath

consequences and at east one of every

four babies who are vioenty shakendies from this form of chid matreatment.

■ abies (newborn to 4 months) are at

greatest risk of injury from shaking.

■ Inconsoabe crying is a primary

trigger for shaking a baby.

1Carbaugh . Understanding shaken baby syndrome. dv eonata Care 2004;4(2):105–16.

2Centers for Disease Contro and Prevention, ationa Center for Injury Prevention and Contro, Division of Vioence Prevention. haken aby yndrome Tip heet [onine]. [cited 2010

March 1.] vaiabe from URl: http://www.cdc.gov/heathmarketing/entertainment_education/tips/shaken_baby.htm.


4Centers for Disease Contro and Prevention. onfata Matreatment of Infants [onine]. [cited 2010 March 1.] vaiabe from URl: www.cdc.gov/mmwr/preview/mmwrhtm/mm5713a2.htm.

5merican cademy of Pediatrics Committee on Chid buse and egect. haken baby syndrome: Rotationa crania injuries—technica report. Pediatrics 2001; 108(1):206–10 [onine].

[cited 2010 March 1.] vaiabe from URl: aappoicy.aappubications.org/cgi/reprint/pediatrics;108/1/206.pdf.




4

CUIG PRVTI

Research shows that shaking most often occurs in response to a baby crying or other factors that can

trigger the person caring for the baby to become frustrated or angry.

The fact is that crying—incuding ong bouts of inconsoabe crying—is norma deveopmenta behavior

in infants. The probem is not the crying, it’s how caregivers respond to it. Picking up a baby and

shaking, throwing, hitting, or hurting him or her is never an appropriate response.

veryone, from caregivers to bystanders, can do something to prevent . Giving parents and

caregivers toos that can hep them cope if they nd themseves becoming frustrated whie caring

for a baby are important components of any prevention program (see ppendix : Prevention Tips

for Parents and Caregivers).

s a pubic heath professiona, you pay a key roe in reinforcing prevention through heping peope

understand the dangers of vioenty shaking a baby, the risk factors and the triggers for it, and ways

to essen the oad on stressed-out parents and

caregivers, a of which may hep to reduce the

number of cases of .

UDRTDIG TH CQUCIt is important to understand that is the resut

of vioent shaking that eads to a brain injury, which

is much ike an adut may sustain in repeated car

crashes. The forcefu shaking that causes is

chid abuse; it does not happen in norma pay.

Caims of perpetrators that the highy traumatic

interna injuries characterized by resuted from

“paying with the baby” are fase. Whie jogging an infant on your knee or tossing him or her in the aircan be very risky, the injuries that resut from are not caused by these types of activities.



5

T h e F a c t s

T h e F a c t s

pproximatey one in four victims die, but there

is a high risk of serious and ong-term heath

consequences for those who ive. can

potentiay resut in the foowing consequences:

■ Death,

■ indness,

■ Menta retardation or deveopmenta deays

(any signicant ags in a chid’s physica,

cognitive, behaviora, emotiona, or socia

deveopment, in comparison with norms) and

earning disabiities,■ Cerebra pasy,

■ evere motor dysfunction (musce weakness

or paraysis),

■ pasticity (a condition in which certain musces

are continuousy contracted—this contraction

causes stiness or tightness of the musces

and may interfere with movement, speech,

and manner of waking), and■ eizures.




6

lRIG WHT T lK R

SBS Signs and Symptoms

abies, newborn to one year (especiay babies ages 2 to 4 months) are at greatest risk

of injury from shaking.6 injuries are not aways visibe. However, babies with may

dispay some outward signs.7,8 Parents, famiy members, caregivers, or others in cose and

reguar contact with an infant shoud seek medica attention right away if they notice any

of the signs and symptoms isted beow.

■ ignicant changes in seeping patterns or inabiity to be awakened,

■ Vomiting (more than usua),

■ Convusions or seizures,

■ Increasing irritabiity,

■ Uncontroabe crying,

■ Inabiity to be consoed, and

■ Inabiity to nurse or eat.

In more severe cases, babies may be:

■ Unresponsive

■ Unconscious

abies shoud be taken to the emergency department immediatey if they are experiencing

any of these severe signs and symptoms of isted above.


7Mieh J. haken baby syndrome. J orensic urs 2005;1(3):111–7.

8Carbaugh . Understanding shaken baby syndrome. dv eonata Care 2004:4(2): 105–16.



7

T h e F a c t s

Factors that Put an Infant at Risk

The foowing factors increase an infant’s risk of being shaken,9,10,11 particuary when combined with a

parent or caregiver who’s not prepared to cope with caring for a baby:

■ eing ess than 1 year of age,

• abies ess than 1 year of age are at the greatest risk, but has been reported in chidren

up to 5 years of age.

• abies (especiay babies ages 2 to 4 months) are particuary at risk of injury from shaking,

because they are sma in reation to the size of aduts who may pick them up and shake them,

and they tend to cry more frequenty and onger than oder babies.

■ Infant prematurity or disabiity,

■ eing one of a mutipe birth,

■ Inconsoabe and/or frequent crying,

■ Prior physica abuse or prior shaking, and

■ Most victims are mae.

Factors that Can Increase Parents’ or Caregivers’ Risk for Harming a Baby

Most perpetrators are parents and their partners, with the majority of the perpetrators being the

mae parent or partner. The foowing factors increase a parent’s or caregiver’s risk of shaking a baby,

particuary when combined with not being prepared to cope with caring for a baby.12

■ rustration or anger resuting from an infant’s crying,

■ eing tired,

■ Having imited anger management or coping skis,

■ limited socia support,

■ Young parenta age,

■ Unstabe famiy environment,

9Homan, JM. case of shaken baby syndrome after discharge from the newborn intensive care unit. dv eonata Care 2005;5(3): 135–46.

10ack D, Heyman R, mith ep M. Risk factors for chid physica abuse. ggress Vioent ehav 2001;6(2–3): 121–88.

11Keenan HT, Runyan DK, Marsha W, ocera M, Merten D, ina H. popuation-based study of inicted traumatic brain injury in young chidren. JM 2003;290(5):621–6.





8

■ low socioeconomic status,

■ Unreaistic expectations about chid deveopment and chid-rearing,

■ Rigid attitudes and impusivity,

■ eeings of inadequacy, isoation, or depression,■ eing a victim or witness to intimate partner vioence, or

■ egative chidhood experiences, incuding negect or abuse.

Diagnosing SBS

Heath care providers may be aerted to a possibe injury by any of the foowing:13

■ ny infant or young chid who presents with a history that is not pausibe or consistent with the

presenting signs and symptoms,■ The presence of a new adut partner in the home,

■ history of deay in seeking medica attention,

■ previous history or suspicion of abuse,

■ The absence of a primary caregiver at the onset of injury or iness,

■ Physica evidence of mutipe injuries at varying stages of heaing, or

■ Unexpained changes in neuroogic status, unexpained shock, and/or cardiovascuar coapse.

There are a number of diagnostic toos that heath care providers can use to assess the possibiity of in injured babies. In addition to a thorough history and physica exam, incuding ophthamoogic

examination, physicians may use computerized tomography, magnetic resonance imaging, skeeta

surveys, and other medica tests to diagnose .




9

G e t t i n g

S t a r t e d

GETTING STARTED:Working Towards Success

Knowing what needs to be done and prioritizing where to start can oten be a challenging task. Start

by using a prevention model, rooted in behavioral science, as a practical tool to create an efective

strategy. The model can guide decisions to identiy your organization’s role in the issue, align activities

with your mission, and leverage your reach to the community to maximize impact.

BUILDING A FRAMEWORK FOR PREVENTIONPrevention requires understanding the actors that inuence violence. CDC uses a our-level social-

ecological model to better understand violence and the efect o potential prevention strategies.14

This model considers the complex interplay between individual, relationship, community, and societal

actors and is more likely to sustain prevention eforts over time than any single intervention.

The model serves as a practical

ramework to build your strategy.

The activities, messages, partnership,and policy suggestions outlined in

this guide already build upon each

o the our levels o the ramework.

Additionally, you can also use the

model as a reerence or guide to

assess ways to use resources and

reach audiences at various levels.

14Dahlberg LL, Krug EG. Violence a global public health problem. In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health. Geneva,

Switzerland: World Health Organization; 2002:1–56.




10

r, it can be used to hep buid a more feasibe pan

by identifying appropriate partners with more optima

resources to address mutipe eves.

Individual-level strategies are ones that can be aimed

at changing parents’ or caregivers’ knowedge and skis.

Relationship-level strategies are ones that are

aimed at trying to change the interactions between

peope—parents and chidren, parents and other

caregivers, parents and heath care providers,

bystanders, and parents.

Community-level strategies are those that are

aimed at modifying the characteristics of settings that

give rise to vioence or that protect against vioence

(e.g., address socia and economic factors; access and

avaiabiity of parenta support programs, eary chid

care, respite care centers).

Societal-level strategies are aimed at changing cutura

norms surrounding parenting, as we as aws and

poicies aimed at supporting parents.

lRIG UT D RM XITIG PRGRM

tart with what is avaiabe, feasibe, and has the greatest eve of evidence of eectiveness. There

are a number of existing prevention programs and resources avaiabe that can be impemented.

aance the options beow to buid on programs you aready have, or to reach audiences you areadywork with.



11

G e t t i n g

S t a r t e d

Many of these programs strive to raise awareness about , educate parents and other caregivers

about the serious eects of -reated injuries, and inform them about infant crying behavior and

safe ways to reduce and prevent injuries. These strategies address the mutipe eves of the

prevention mode. xampes of common prevention strategies incude:

■ Coordinated hospita-based primary prevention programs targeting parents of newborns,

■ Home visits for new parents (home visits bring community resources to famiies in their homes;

heath professionas provide information, heath care, psychoogica support, and other services

that can hep peope to be more eective parents and caregivers),

■ nticipatory guidance at we-baby visits in pediatric practice and/or heath cinics,

■ choo prevention programs for junior high and high schoo students providing students with

an understanding of chid matreatment issues, anger management techniques, and chid careskis. or exampe, the ationa Center on haken aby yndrome oers a schoo-based

program for junior and senior high schoo students, which teaches students about the “medica

aspects of shaking injuries, combined with basic anger management and chid care skis. The

program reaches young aduts as potentia caregivers

and future parents. Teaching students how frustration

can ead to shaking heps them understand the

importance of appropriate coping skis,”15

■ Programs targeting maes, especiay new fathers,with information and resources for providing safe and

nurturing care for their new infants and safe strategies

for coping with frustration caused by crying babies,16

■ Professiona education and trainings for doctors, nurses,

socia workers, and others providing famiy services, and

■ ducationa print and video materias provided at the

time of deivery, as we as at pediatric oces and

prenata casses.

This is Important

When possibe, it is important to use

evidence-based practice as the

foundation for any intervention. vidence-

based practice, as dened by the Institute

of Medicine (IM), is a combination of

three factors:

1. est research evidence

2. est cinica experience, and

3. Consistency with patient vaues.17

15ationa Center for haken aby yndrome [onine]. [cited 2010 March 1.] vaiabe from URl: www.dontshake.com/udience.aspx?categoryID=10&Pageame=choobased.htm.

16ationa Center for haken aby yndrome, Dads 101 [onine]. [cited 2010 March 1.] vaiabe from URl: www.dontshake.com/udience.aspx?categoryID=10&Pageame=Dads101.htm.

17Committee on Quaity of Heath Care in merica, Institute of Medicine. Crossing the quaity chasm: new heath system for the 21st century. (2001). ationa cademy

Press: Washington, DC



P r e v e n t

i n g S h a k e n B a b y S y n d r o m e

12

Upstate New York Shaken Baby Syndrome Education Program

The Caifornia vidence-

ased Cearinghouse for

Chid Wefare (CC) has

designated the Upstate ew

York haken aby yndrome

ducation Program as

having Promising Research

Evidence.18 Deveoped by Dr. Mark . Dias and

coeagues, this hospita-based, parent education

program provides information to parents at the time

of birth about the eects of vioent shaking, as we as

aternatives for responding to crying infants. s part

of this intervention, nurses were asked to have both

parents read a pamphet, view a video tited Portrait

of Promise: Preventing Shaken Baby Syndrome, and

sign a commitment statement to indicate that they

received and understood the information before

their baby was discharged from the hospita.

indings from foow-up teephone surveys with

parents 7 months after the birth suggest that

more than 95 percent of the parents remembered

receiving the information. In addition, after 5 years,

this eort resuted in signicanty decreased

incidence of abusive head trauma among chidren

ages 36 months and younger.19 The program, which

began in December 1998, has been adopted by

many states and hospitas across the nation.

s part of CDC-funded research, Dr. Dias is

repicating a revised version of the program in

Pennsyvania. The components of this

evauation incude:

1) Time series anaysis of reported cases in

Pennsyvania to examine the trends in

cases before, during, and after the program

is introduced, and comparing resuts,

2) Time series anaysis of hospita discharge data

in Pennsyvania and surrounding states,

3) Randomized tria in 31 counties in centra

Pennsyvania to evauate the eectiveness of

providing additiona information at pediatric

we visits, and

4) n economic anaysis to examine program

costs and benets.

18Caifornia vidence-ased Cearinghouse for Chid Wefare [onine]. [cited 2010 March 1.] vaiabe from URl: www.cachidwefarecearinghouse.org/scientic-rating-scae.

php#rating3.

19Dias M, mith K, deGuehery K, Mazur P, li V, haer Ml. Preventing abusive head trauma among infants and young chidren: hospita-based, parent education program.

Pediatrics 2005;115(4):e470–7.



13

G e t t i n g

S t a r t e d

Period of PURPLE Crying®

The CC has designated the Period of PURPl

Crying© program as having Promising Research

Evidence. This program was deveoped by Dr. Ronald

Barr and coeagues at the ationa Center on haken

aby yndrome (C). Two randomized controed

trias of the program showed increases in knowedge

about crying and and “wak away behavior when

the mother was frustrated.”20

s part of CDC-funded research, Dr. Desmond K.

Runyan is testing the program in orth Caroina.

The state-wide program wi educate parents about

norma infant crying patterns, how to respond to

crying, and the dangers of shaking. The information

wi be disseminated in a manner designed to reach

every new parent three times. urses wi educate

parents of every newborn at a 86 hospitas/birthing

centers in orth Caroina, using discussion, a video,

and a booket about infant crying. In addition:

■ County heath departments, pediatricians,

and famiy physicians wi provide a dose of

the intervention in prenata casses and/or at

2-week we-chid checks; and

■ The C and the University of orth

Caroina choo of Journaism and Mass

Communications wi deveop a statewide

media campaign that addresses socia

norms about shaking and reinforces

program messages directy and through

famiy and friends.

Period of PURPLE Crying®

P - Peak Pattern

Crying peaks around 2 months, then decreases.

U - Unpredictabe

Crying for long periods can come and go for

no reason.

R - Resistant to oothingThe baby may keep crying for long periods.

P - Pain-ike look on ace

l - long outs of Crying Crying can go on

for hours.

- vening Crying

Baby cries more in the afternoon and evening.

ource: ationa Center on haken aby yndrome

20ationa Center on haken aby yndrome. Randomized Controed Trias on the ectiveness of the PURPl Materias: Parae tudies in the state of Washington (U) and the

province of ritish Coumbia (Canada) [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.dontshake.org/sbs.php?topavID=4&subavID=32&subnav_1=172&navID=176.




14

Period of PURPLE Crying® (continued)

The muti-eve evauation strategy for the project

incudes:

1) ctive surveiance of traumatic brain injuries in

a Pediatric Intensive Care Units,

2) nonymous surveys of parents on discipine

practices before and after the intervention,

3) Time series anaysis to examine the trends

in abusive head trauma cases before, during,

and after the program is introduced and

comparing resuts,

4) Process evauation of the deivery of the messages,

5) ested case-contro study of abusive head trauma

cases, compared to other hospitaized chidren

with brain injury and the entire cohort of chidren

under age 2, and

6) n economic anaysis to examine program costs

and benets.

Reviews and ratings used to determine the research

evidence for other interventions reated to chid

wefare are ocated on Web sites, such as the

ationa MCH Center for Chid Death Review,

www.childdeathreview.org , the RD Promising

Practices etwork on Chidren, amiies and

Communities, www.promisingpractices.net, and theCaifornia vidence-ased Cearinghouse for Chid

Wefare, www.cachildwelfareclearinghouse.org.



15

G e t t i n g

t h e M e s s a g e O u t

GETTIGthe MESSAGE OUT:

The Right Message, Right Person, Right Time

CRTIG CTIV MG

Prevention messages are often drowned out in the thousands of messages seen and heard by peope

every day. That’s why it is important to focus your message to make sure it reaches the right audience

for the right resuts. ince a ideas and words do not resonate with a audiences, it is important to

taior specic messages to each audience to make them eective.

Using messages to communicate about prevention can range from deveoping a compex

campaign to using a few appropriate messages in your existing programs and activities. o matter the

size of your eort, using the exampe messages beow consistenty with the right audiences can hep

reframe as a preventabe pubic heath probem, and can be used to address each of the four

eves of the prevention framework.

To prevent chid matreatment, it is important to focus on making peope aware of what to normay

expect as a chid deveops, how to support parents, and steps they can take in dierent situations.21

ecause crying is one of the primary triggers for shaking a baby, messages that teach how to cope

with crying may be most eective. Messages shoud aso be specic and focus on awareness and

action. It is important to make peope not ony aware of and their roe in preventing it, but aso

21Wrisey . Reframing the issue: new chid matreatment prevention message. C Med J 2005;66(5):367–9.




16

give them specic and feasibe actions for prevention.

Messages shoud aso match activity goas and can be

used to:

■ Increase awareness of in a particuar audience.

■ Hep make an audience more open to participating

in programs or taking specic action for prevention.

■ Hep support poicies.

■ Hep decisionmakers, such as poicymakers,

partners, or organizationa eadership, understand

as a preventabe issue that needs their support.

Heath communication toos are avaiabe

to hep you pan, design, impement,

and evauate an prevention communicationcampaign. eow are some exampes:

■ Adding Power To Our Voices: A Framing Guide

for Communicating About Injury (www.cdc.gov/

injury)

■ CDCynergy: Violence Prevention Edition

(www.cdc.gov/ncipc/dvp/CDCynergy/

CDCynergy.htm)

■ National Cancer Institute’s Making Health

Communication Programs Work, (www.cancer.

gov/pinkbook)

The exampe messages beow can hep guide you in

addressing key audiences with the power to prevent

: parents, caregivers, bystanders, and heath care

providers.

Example Messages for Parents and Other Caregivers:

1) Crying is norma for babies.

a) Crying is one way babies communicate.b) xcessive crying is a norma phase in infant deveopment.

■ abies cry most between 2 and 4 months.

■ Proonged, inconsoabe crying generay essens when babies are around 5 months od.22

■ Most babies who cry a great dea are heathy and stop crying spontaneousy.

c) You are not a bad parent if your baby continues to cry after you have done a you can to

cam him or her.

d) Remember, this wi get better.

22t. James-Roberts, I. ective services for managing infant crying disorders and their impact on the socia and emotiona deveopment of young chidren. In: Trembay

R, arr RG, Peters RDeV, eds. ncycopedia on ary Chidhood Deveopment [onine]. 2004:1–6. vaiabe from URl: http://www.chid-encycopedia.com/pages/PD/

tJames-RobertGxp.pdf.



17

G e t t i n g


2) When a baby cries, there are steps you can

take to try to comfort him or her.

a) Check for signs of iness or discomfort

ike a dirty diaper, diaper rash, teething,fever, or tight cothing.

b) ssess whether s/he is hungry or needs

to be burped.

c) Rub his/her back, genty rocking him/her;

oer a pacier; sing or tak; take a wak

using a stroer or a drive in a propery-

secured car seat.

d) Ca the doctor if you think the chid is i.e) Remember you are not a bad parent or

caregiver if your baby continues to cry after you

have done a you can to cam him or her.

3) When you fee frustrated, angry, or stressed whie caring for your baby, take a break.

a) Ca a friend, reative, neighbor, or a parent hepine for support.

b) Put your baby in a crib on his or her back, make sure the baby is safe, and then wak away

for a bit, checking on him or her every 5 to 10 minutes.c) Remember, this wi get better.

4) e aware of signs of frustration and anger in yoursef and others caring for your baby:

a) ee a heath care professiona if you have anger management or other behaviora concerns.

b) nsure others caring for your baby see a heath care professiona if they easiy become angry

or frustrated around your baby.




18

Focusing on Positive Parenting

ocus on promoting protective factors in your prevention messages. Messages that encourage

positive and protective factors through parenting skis can create a positive norm of good parenting.

ecause young chidren experience the word through their reationships with parents and other

caregivers,23 protective factors at both the famiy and community eves provide a buer for chidren

at risk for abuse or negect. cientic evidence shows that a supportive famiy environment is a key

protective factor against abuse or negect. pecicay, safe, stable, and nurturing relationships

between chidren and aduts protect against matreatment and other adverse exposures occurring

during chidhood that compromise heath over the ifespan.

Example Messages for Bystanders

1) Crying is norma for babies.

a) xcessive crying is a norma phase in

infant deveopment.

b) ometimes babies cry for no apparent

reason.

c) It is not aways possibe to consoe a

crying infant.

ystanders re Important

Many parents fee pressured on some eve,

by others, to make their baby stop crying (CDC

2007 Healthstyles Survey ). ystanders are peope

who are not caring for an infant, but who may be

aected by an infant’s crying or other behaviors.

2) upport parents and other caregivers of babies.

a) s appropriate, oer to provide chid care so that parents get needed breaks.

b) e sensitive and supportive in situations in which parents or caregivers are trying to cam a

crying baby.

c) Communicate to the parent or caregiver that you understand that it is dicut to care for a crying

baby and oer to hep (this may incude giving the parent a heping hand or a break, sharing

a parent support hepine number, or just acknowedging that parenting can be dicut and

exhausting at times).




19

G e t t i n g


“Crying Curve”

Infant crying begins to increase

around 2 to 3 weeks of age, and

peaks around 6 to 8 weeks of age.

s iustrated beow, it then tapers o

when the baby is 3 to 4 months od.

Hours of ussing

per 24 Hours

5

4

3

2

1

ge in Weeks

3 4 5 62 7 8 9 10 11 12

Upper Quartile

Lower Quartile

Median

Source: Crying in Infancy , T. erry razeton. Reproducedwith permission from Pediatrics, Vo. 29, Pages 579-588,

Copyright © pri 1962 by the P

Example Messages for Health Care Providers

1) Remind parents and caregivers that crying is norma

for babies.a) xpain to parents that excessive crying is a norma

phase of infant deveopment.

b) hare the Crying Curve with parents.

2) upport parents and other caregivers of babies.

a) During routine pediatric visits, be sure to ask parents

how they are coping with parenthood and their feeings

of stress.b) ssure them that it is norma to fee frustrated at ong

bouts of crying and a sudden decrease in seep, but that

things wi get better.

c) Give parents the number to a oca hepine or other

resource for hep.

d) Tak with them about the steps they can take when

feeing frustrated with a crying baby, such as putting

the baby safey in a crib on his or her back, makingsure that he or she is safe, waking away and caing

for hep or a friend, whie checking on the baby every

5 to 10 minutes.

e) let parents know what to check for when their baby is

crying: signs of iness, fever or other behavior that is

unusua, or discomfort ike a dirty diaper, diaper rash,

teething, or tight cothing, or whether he or she is hungry

or needs to be burped.



P r e v e n

t i n g S h a k e n B a b y S y n d r o m e

20

WRKIG WITH TH MDI

Messages through the media can have wide reach to

mutipe audiences. The media can aso uniquey hep to

reframe as a pubic heath probem, rather than justa crimina investigation. CDC has created a companion

guide for the media on reporting on . You can share

this guide with oca media or use it to deveop messages

when you speak to journaists. The guide, “ Journaist’s

Guide to haken aby yndrome: Preventabe

Tragedy,” as we as radio pubic service announcements

(in ngish and panish) and broadcast-quaity video that

incudes -ro, fu-screen tips, and downoadabe scenarios, are avaiabe at: www.cdc.gov/Injury .

eow are some additiona steps you can take to work with your oca media.

■ Proactivey buid reationships with oca radio, print, onine, and teevision outets that cover

famiy, heath, and chid matreatment issues; informing journaists about and your

organization’s education and prevention activities.

• Pitch a deskside brieng—a visit with a journaist to brief him or her on the issue of .

• Hod a media roundtabe or virtua roundtabe to inform a group of journaists aboutthe issue.

• Hod a teebrieng, where journaists dia in to earn about from experts, physicians, and/or

parents who have a chid with .

• Write an op-ed or artice for oca newspapers or Web sites.

• Pitch stories to community aairs programs.

■ Contact journaists after a story about is reported in the news to oer the pubic heath

perspective, data, prevention tips, experts for interviews and to carify misinformation as needed

(ee ppendix : Prevention Tips for Parents and Caregivers). rganizations are best preparedto respond quicky when a story breaks if they have previousy deveoped a media pan that

identies the organization’s spokesperson and key prevention messages and taking points.



21

S t r e n g t h i n u m b e r s

STREGTH in UMBERS:

uiding Partnerships to Prevent

CllRTIG WITH THR RGIZTI D TH UI CMMUITY

Partnerships and coaborations can be critica eements for achieving success. They can be

instrumenta in expanding your reach to new audiences, augmenting resources, adding outreach

channes, faciitating message dissemination within the community, and oering referra sources for

your program. or exampe, when your partners coaborate to deiver the same prevention messages

through communication channes used by your target audience, it extends the messages’ reach andfrequency. ective messages that are deivered to the same audience through mutipe channes are

more ikey to be remembered and move the audience to take the desired action.

IITITIG PRTRHIP

Whie every situation and partnership is unique, here are some genera steps often used to buid

partnerships:

1) Assess your current situation. Panning your prevention eort shoud invove a carefu anaysisof your organizationa resources and needs, incuding sta, funding, faciities, technoogy, and

expertise. This information wi hep carify when a potentia coaboration with another organization

can support your program goas.

2) Identify potential partners. The reationship shoud be mutuay benecia. Identify organizations

that support your mission of preventing injuries and improving heath and safety for new parents

and their babies. Determine how coaboration wi mutuay support short- and ong-term goas. irst

consider those with which you have successfuy partnered in the past. Then consider new partners,

such as the media and business communities. These organizations can hep you reach new parents

with key information and resources and strengthen your advocacy for prevention eorts, or perhaps



P r e v e n


22

combine resources with you and other organizations to deveop a coaborative prevention eort in

the community supported by a range of ike-minded civic groups. or exampe, an empoyer’s “unch

and earn” program for new parents in a business setting, or buiding reationships with human

resource or empoyee assistance professionas in arge corporations may ead to other opportunitiesto buid community support for parents.

3) Develop your “pitch.” fter strategicay seecting groups with which you might work, deveop

your “pitch,” or seing points, and your “ask,” that is, what you want the organization or individua to

do as part of the coaboration. or exampe, you may want to ask them to join you in incorporating

prevention messages and parent support activities into their ongoing communication activities

with parents, caregivers, and other reevant audiences. This wi vary based on the resources, needs,

and priorities of each organization. In addition, showcase the benets that your potentia partners wigain by coaborating. e sure to highight benets that are most reevant to their vaues and mission.

4) Make contact. Whenever possibe, deiver your partnership proposa in person. Consider bringing

at east one other person, because dierent communication styes and demeanors can inuence an

encounter. However, make sure that your team speaks with one voice, based on the messages you

deveop. Deivering mixed messages creates confusion and weakens your credibiity.

5) Establish the partnership. eing credibe and oering incentives are important, but these may not

be enough. Use your passion to make potentia partners beieve they shoud be invoved. Describe

how your programs and services can make a dierence. hare information about the emotiona

and nancia burdens caused by . Underscore how your community wi benet from your

coaborative eorts, how others are getting invoved, and how even seemingy sma contributions

can hep prevent injury and death. Conrm how the proposed partnership is mutuay benecia. e

specic about what you are asking the organization to do.

6) Give thanks. ever forget the power of the phrase “thank you.” cknowedge partnership

agreements prompty. look for creative ways to convey your gratitude to partners often and thank

them pubicy.



23

S t r e n g t h i n u m b e r s

too to hep you pan your partnership outreach is avaiabe in ppendix C.

WRKIG TGTHR: Rl HlTH DPRTMT D CMMUITY-

D RGIZTIRoles for Health Departments in Preventing SBS

s eading agencies in the community, heath departments (both state and oca) are we positioned to

ead prevention activities aimed at a four eves of the prevention framework. They can aso forge

partnerships to create momentum to hep other state or oca organizations take action.

prevention activities for oca heath departments may incude:

■

Deivering and/or reinforcing prevention messages in heath department contacts withexpectant and new parents,

■ Creating partnerships with oca community-based organizations (Cs) that can provide

training, education, message dissemination, and foow-up support to parents identied in heath

department settings as needing additiona resources or information,

■ Identifying community eaders and organizations interested in chidren’s heath and safety to

support programs, such as oca hospitas, cinics, pediatric oces, urgent care centers,

pharmacists, Cs, and other heath faciities,

■

Providing consistent and appropriate prevention messages to the media and other organizationsin the community. (hare CDC’s “ Journaists Guide to haken aby yndrome: Preventabe

Tragedy” with your oca media, avaiabe at www.cdc.gov/Injury ),

■ Deveoping a media outreach and response strategy to bring the pubic heath prevention perspective

to media coverage of and to position the heath department as a resource for information on

prevention (see specic suggestions under Roles for CBOs in Preventing SBS), and

■ Creating and/or disseminating existing education and training materias to share with

community organizations that wi impement education eorts.



P r e v e n


24

Roles for CBOs in Preventing SBS

Cs are uniquey positioned to incorporate consistent prevention messages and interventions into

their ongoing community programs to address a four eves of the prevention framework. or exampe,

individua-, reationship- and community-eve strategies can be directed to new parents, caregivers, heathcare workers, socia workers, and others who provide services to famiies in existing programs, such as:

■ Prenata casses,

■ Parenting casses,

■ Postnata support programs,

■ tress management casses,

■ Mentoring activities,

■ Home visitation programs,■ Training for babysitters and chid care providers,

■ Menta heath programs, and

■ Training programs for heath care providers and socia workers.

ther prevention activities for Cs incude:

■ orging partnerships with state and oca heath departments,

■

Referring new parents to organizations for information and support,■ dding information about prevention to existing, reguar communications with other

community organizations through Web sites, newsetters, and reguar maiings,

■ dvocating with poicymakers and funding bodies for eective poicies and resources to support

parents in providing safe, stabe, nurturing reationships for their infants (see Taking Public Health

Solutions to the Next Level: Impacting Policy ), and

■ Working with the media by providing consistent and appropriate messages (see section on

Creating Eective Messages and CDC’s “ Journaists Guide to haken aby yndrome:

Preventabe Tragedy”).



25

S t r e n g

t h i n u m b e r s



P r e v e n


26

IDTIYIG PTTIl PRTR

There are many diverse groups you coud consider approaching for support, just as there are a

variety of ways they might be abe to work with you. The chart beow oers exampes of both:

Type of Organization

Civic and service organizations

Potential Collaborative Activities to Support SBS Education

■ Hep identify oca programs that might incorporate crying and coping

education and messages and promote those programs.

■ Disseminate prevention materias to their own members, as appropriate.

■ Disseminate information through existing channes, such as newsetters, yers,

and Web sites.

■ Provide community forums where information can be shared.

Local hospitals ■

■

■

■

■

Provide crying and coping education materias and messages to new parents.

er training courses to new and expectant parents.

ponsor heath and weness fairs incorporating crying and coping

education information.

Incorporate education in heath care empoyee training.

Pubish messages about crying behavior and coping in hospita weness

pubications that are distributed to the pubic.

Faith-based organizations ■

■

Incude crying behavior and coping messages in newsetters, marriage/parent

education casses, daycare faciities, etc.

Distribute prevention information at community heath fairs and other

appropriate forums.

Government programs that

serve families and children,

such as Women, Infants, and

Children (WIC)

■

■

■

■

Incude messages and education materias in outreach to new and young parents.

Dispay crying and coping information on buetin boards and incude it as part

of reguar communication with cients.

Put inserts into maiings and/or other types of reguar statements.

Incorporate crying and coping messages in trainings, job preparation casses,

maternity casses, work/ife baance sessions, etc.

Large employers ■

■

■

Post information on buetin boards and Web sites.

er information at empoyee brown bag unches and

for parents.

Incude messages on pay stubs.

other empoyee activities



27

S t r e n g

t h i n u m b e r s

Type of Organization

Large employers

(continued)

Potential Collaborative Activities to Support SBS Education

■ Incude crying and coping messages in empoyee heath fairs and other forums.

■ sk empoyee assistance programs to incorporate messages and education materias into their

counseing for new parents, and to direct new parents to resources that address “new baby” stress.

Elementary schools, Head Start,

nursery, and daycare programs

with access to new parents and

potential parents-to-be

■ ■ ■

end yers home with chidren.

Put information on message boards and in chidren’s schoo bags.

ponsor famiy heath fairs that incorporate crying and coping education materias.

Community centers, local

YMCAs, libraries, support

groups for parents, and other

local organizations sponsoring

children and family activities

■

■ ■

Incorporate messages and materias into ongoing casses for new and expectant parents,

exercise, and stress management casses, etc.

Dispay posters or other information on buetin boards.

ponsor famiy weness days that incorporate crying and coping messages.

Community and (new) parent

groups

■ ■

ponsor an event or gathering focused on crying and coping.

rganize a forum for new parent groups that incorporates messages.

Local merchants including:

baby retailers; bulk and big box

discount retailers; pharmacies;

grocery stores; gyms; depart-

ment stores; shoe stores; home

improvement stores; hair salons/

barber shops/nail salons/day

spas; coee shops; bookstores;theaters; movie theatres

■ ■ ■ ■ ■ ■

Insert messages in or on shopping packages.

Dispay prevention messages on saes sips.

Dispay brochures, posters, or yers.

ponsor in-store seminars for new parents as a way to bring them into their faciities for shopping.

Incude messages on marquees, screens, or message boards.

ir targeted pubic service announcements (Ps) in movie theatres (Ps for maes during

movie genres targeted to young adut maes and for new mothers during mommy movie days,

seect days at some theaters when babies are wecomed).

Media ■ Deveop and air a P campaign (radio/TV/Web).■ Use on-air taent to host events, appear in Ps, and serve as spokespersons.■ btain media sponsorships for community events.■ Provide excusive stories.■ Provide ink/air time.

(Please note that partnering with one outlet may preclude work with a competitor and make it hard to pitch stories to other media.)

State and local healthdepartments

■

■ ■ ■

Provide appropriate data to dene the probem at the oca eve.Create and disseminate messages to frame as a preventabe, pubic heath issue.

ppy the prevention framework to intervention strategies.

Incorporate prevention messages in programs for and contacts with expectant and new parents.




28



TAIG PUBLIC

HEALTH SOLUTIOSTO THE ET LEEL:

Impacting Poicy

PlICY I CTIV PUlIC HlTH ITRVTIPoicy interventions are important and eective community and societa eve strategies for improving

the pubic’s heath. Poicy can be dened many ways, but one denition appicabe to pubic

heath poicy intervention describes poicy as: “aws, reguations, forma and informa rues and

understandings that are adopted on a coective basis to guide individua and coective behavior.”24

Pubic heath poicy interventions are targeted to inuence systems deveopment, organizationa

change, socia norms, and individua behavior to promote improvement in the heath of a popuation.

Poicy interventions are particuary vauabe because they are systems-based and impact popuationsby changing the context in which individuas take action or make decisions (i.e., making defaut

decisions safe and heathy). The eectiveness of a poicy intervention, though, depends on the eve of

awareness, education, acceptance, funding, impementation eorts, enforcement, and even programs

that accompany the creation or passage of the poicy.

24Waack l. Media advocacy: Promoting heath through mass communication. In: Ganz K, lewis M, Rimer K, eds. Heath ehavior and Heath

ducation: Theory, Research and Practice. an rancisco, Caif: Jossey-ass; 1990: 370–386.

29

T a k i n g

P u b l i c H e a l t h S o l u t i o n s t o t h e e x t L e v e l




30

There are dierent types and eves of poicy; each of them pays an important roe in improving the

pubic’s heath.

■

legisative, which is a aw, ordinance, or reguation:• loca (city or county),

• tate, and

• edera.

■ rganizationa, which coud incude the foowing exampes:

• loca education agencies and/or oca schoos or schoo districts,

• Private hospita or other heath care deivery sites ( i.e., physicians’ oces),

• on-governmenta organizations,

• Governmenta agencies,

• usiness, industria, or corporate, and

• Professiona associations or accredited organizations.

Examples of SBS Policy Initiatives

The foowing are two exampes that demonstrate just a few of the mutipe eves and types of poicy

changes that have been used in deveoping prevention initiatives.

1) Legislation/law at a state level.

“ew York passed i 08314, which requires a chid care providers in ew York to receive

training on . It is a mandate that a chid day care providers be educated and informed on

the identication, diagnosis and prevention of . This education is to be added to the training

providers aready receive on eary chidhood deveopment, nutrition and statues and reguations

toward safety issues.”25 (ee ppendix : State Initiatives on SBS, for a ist of exampes of state

egisative initiatives.)

25ationa Center on haken aby yndrome [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.dontshake.org/sbs.php?topavID=254&subavID=318.



31

T a k i n g

P u b l i c H e a l t h S o l u t i o n s t o t h e e x t L e v e l

This exampe provides guidance on the agency responsibe for impementation. The state heath

department is identied as the agency required to deveop and impement an ongoing pubic

information and educationa campaign to inform chid care providers about harmfu eects of .

2) Organizational policy at a local/regional level.

In response to a doubing of admissions in 2004, the administrative eadership of legacy

Heath authorized a mutidiscipinary task force to study the feasibiity of impementing a system-

wide prevention program. Though not mandated by either state, this regon and Washington

hospita system secured grant funding to research, deveop, and aunch a piot program. Program

design was informed both by patient satisfaction data and other patient care quaity initiatives.

successfu system-wide ro- out foowed within one year, as did the systematic integration of

prevention messages throughout the famiy-centered maternity and pediatric services continuum of

care procedures. Mandatory kis Day training for a 400 obstetric care registered nurses incuded

a 30-minute session on and viewing of a DVD/ooket.

In 2009, every famiy from every hospita went home with the Period of PURPLE Crying®

DVD/ooket; 90 percent of those famiies had both seen the DVD and received prevention

education from a nurse either at a discharge cass or during one-to-one education at the bedside.

YUR GCY/RGIZTI’ Rl I IMPCTIG PlICY

Whie the two exampes above do a good job of iustrating the potentia for poicy interventions used

to prevent at the state government and oca organizationa eves, it shoud be noted that neither

of them have been rigorousy evauated to determine their eectiveness in preventing . s a

matter of fact, there are no current exampes of evidence-based poicy interventions for prevention of

. However, an educationa approach has been shown to be eective in preventing and there

are a few evidence-informed prevention programs avaiabe (see section, Getting Started: Working

Towards Success). These are important factors to consider when thinking about activities to incude in

a poicy pan or intervention to prevent .



P r e v e

n t i n g S h a k e n B a b y S y n d r o m e

32

or exampe, whie we may not yet have

evidence-based policy interventions, there

are promising practice program interventions

for prevention of with research evidence.Therefore, it may be appropriate to start

with the deveopment of poicy interventions

focused on the impementation of promising

practice programs or to begin by identifying

an existing state egisative poicy or initiative

and work to enhance that poicy (i.e., incude

requirement of programs with promising

research evidence or incude dedicated

resources to impement the poicy intervention).

efore deveoping a poicy pan or engaging in activities to impact poicy reated to prevention,

it is important to assess the poitica and socia environment of your state or community. This wi hep

your agency dene its roe and target the type of poicy change that woud be most eective. Due

to the possibe restrictions or imitations regarding your organization’s activities reated to poicy ( i.e.,

federa doars are not aowed to be used to obby or advocate and/or state heath departments may

have imitations regarding the eve or type of invovement aowed in the egisative process), your

agency may not have the capacity or be most appropriate to take the ead for a eves of the poicy

initiative. This is why it is important to work together with your partners in deveoping and impementing

a poicy pan or initiative to prevent (ee section, Strength in Numbers: Building Partnerships to

Prevent SBS).

Regardess of these imitations, there are numerous activities your agency can engage in to participate

in deveoping, impementing, and evauating poicy interventions to prevent . Therefore, whether

a C or a oca or state heath department, you have an important roe to pay in impacting poicy

interventions that improve the pubic’s heath. inay, remember that successfuy impementing a

poicy intervention takes time and requires being ready when the opportunity presents itsef.



33

T a k i n g P u b l i c H e a l t h S o l u t i o n s t o t h e e x t L

e v e l

Examples of Activities that Impact Policy

Depending on the environment of the community and the roe of the agency, an organization or

program coud engage in any or a of these activities to aect pubic heath through poicy.

1) Coecting, anayzing, summarizing, and interpreting data and other scientic-based information

reevant to the frequency and seriousness of and its prevention,

2) Proactivey disseminating data inked to possibe soutions and making sure the data gets into

the hands of decisionmakers or those who can inuence decisionmakers,

3) Packaging, presenting, or promoting data and information in ways that resonate with the

audience and can be used to inform decisionmaking (i.e., cannot assume that data or information

can stand aone),

4) Utiizing media and partners to hep convey important messages to poicymakers and the pubic,5) Reviewing and/or drafting potentia poicies or egisation,

6) uiding coaition networks that are abe to advocate for poicy changes, educating the pubic,

and impementing programs that impact prevention of (ee section, Strength in Numbers:

Building Partnerships to Prevent SBS),

7) Identifying and anayzing existing -reated poicies in your community or state and working

to enhance them,

8) ngaging in awareness eorts and impementation of existing poicies that support prevention

of ,

9) Conducting a cost-benet anaysis reated to the burden of and predicting how a

science-based prevention eort wi impact the cost for an organization or society,

10) vauating existing/new poicies, incuding an assessment of eectiveness and cost

eectiveness, and

11) Meeting with poicymakers to inform or educate on the burden of and what works to

prevent .





35

R e s o u r c e s

RESOURCESCDC RURC

National Center for Injury Prevention and Control

Vioence prevention is a major focus of the ationa Center for Injury Prevention and Contro (Injury

Center). s the ead federa agency for injury prevention and contro, CDC’s Injury Center works cosey

with other federa agencies; nationa, state, and oca organizations; state and oca heath departments;

and research institutions.

www.cdc.gov/Injury

National Center on Birth Defects and Developmental Disabilities

The ationa Center on irth Defects and Deveopmenta Disabiities promotes the heath of babies,

chidren, and aduts, and enhances the potentia for fu, productive iving by providing positive

parenting tips and information on deveopmenta miestones and screening.

www.cdc.gov/ncbddd/child/default.htm

THR DRl RURC

Administration for Children and Families

The dministration for Chidren and amiies, within the Department of Heath and Human ervices, is

responsibe for federa programs that promote the economic and socia we-being of famiies, chidren,

individuas, and communities.

www.acf.hhs.gov

Administration for Children and Families, Children’s Bureau

The Chidren’s ureau is designed for professionas concerned with chid abuse and negect, chid

wefare, and adoption.

www.cbexpress.acf.hhs.gov



P r e v e


36

The Child Welfare Information Gateway

The Chid Wefare Information Gateway (a merger of the former ationa Cearinghouse on Chid buse and

egect Information and ationa doption Information Cearinghouse) provides access to information and

resources to hep protect chidren and strengthen famiies.

www.childwelfare.gov

FRIENDS National Resource Center

RID ationa Resource Center is a federay mandated Training and Technica ssistance Provider for

agencies working to prevent chid abuse.

www.friendsnrc.org

lI RURC

American Academy of Pediatrics

The merican cademy of Pediatrics (P) and its member pediatricians dedicate their eorts and resources to

the heath, safety, and we-being of infants, chidren, adoescents, and young aduts. The P has approximatey

60,000 members in the United tates, Canada, and latin merica. The P deveops guideines on a variety of

pediatric heath issues and distributes a wide range of patient education materias.

www.aap.org

American Professional Society on the Abuse of Children

The merican Professiona ociety on the buse of Chidren (PC) is a nonprot nationa organization focused

on meeting the needs of professionas engaged in a aspects of services for matreated chidren and their famiies.

speciay important to PC is the dissemination of state-of-the-art practice in a professiona discipines reated

to chid abuse and negect.

www.apsac.org/mc/page.do



37

R e s o u r c e s

The California Evidence-Based Clearinghouse for Child Welfare

The Caifornia vidence-ased Cearinghouse for Chid Wefare (CC) identies and disseminates information

about evidence-based practices reevant to chid wefare. The CC provides guidance to statewide agencies,

counties, pubic and private organizations, and individuas. This guidance is provided in a simpe, straightforward

format, reducing the user’s need to conduct iterature searches, review extensive iterature, or to understand and

critique research methodoogy.

www.cachildwelfareclearinghouse.org

Children’s Safety Network National Injury and Violence Prevention Resource Center

The Chidren’s afety etwork provides resources and technica assistance to materna and chid heath agencies

and organizations seeking to reduce unintentiona injuries and vioence toward chidren and adoescents. This is

one of four Chidren’s afety etwork Resource Centers funded by the Materna and Chid Heath ureau of the

U.. Department of Heath and Human ervices.

www.childrenssafetynetwork.org

Childhelp® USA

Chidhep® is a nationa nonprot organization dedicated to heping victims of chid abuse and negect. Chidhep’s

approach focuses on prevention, intervention, and treatment. The Chidhep ationa Chid buse Hotine,

1-800-4--CHIlD, operates 24 hours a day, seven days a week, and receives cas from throughout the United

tates, Canada, the U.. Virgin Isands, Puerto Rico, and Guam. Chidhep’s programs and services aso incude

residentia treatment services (viages); chidren’s advocacy centers; therapeutic foster care; group homes; chid

abuse prevention, education, and training; and the ationa Day of Hope®, part of ationa Chid buse Prevention

Month every pri.

www.childhelp.org

Child Welfare League of America

The Chid Wefare league of merica is an association of neary 800 pubic and private nonprot agencies that

assist more than 3.5 miion abused and negected chidren and their famiies each year with a range of services.

www.cwla.org



P r e v e


38

Circle of Parents

Circe of Parents provides a friendy, supportive environment ed by parents and other caregivers. It is a pace

where anyone in a parenting roe can openy discuss the successes and chaenges of raising chidren.

www.circleofparents.org

FrameWorks Institute

or severa years, the rameWorks Institute has conducted communications research on how peope think about

chidren’s issues in genera, and chid deveopment and parenting in particuar.

www.frameworksinstitute.org

The International Society for Prevention of Child Abuse and Neglect

The Internationa ociety for Prevention of Chid buse and egect’s (IPC) mission is to prevent cruety to

chidren in every nation, in every form: physica abuse, sexua abuse, negect, street chidren, chid fataities, chid

prostitution, chidren of war, emotiona abuse and chid abor. IPC is committed to increasing pubic awareness

of a forms of vioence against chidren, deveoping activities to prevent such vioence, and promoting the rights of

chidren in a regions of the word.

www.ispcan.org

National Alliance of Children’s Trust and Prevention Funds

The ationa iance of Chidren’s Trust and Prevention unds is a membership organization that provides

training, technica assistance, and peer consuting opportunities to state Chidren’s Trust and Prevention unds to

strengthen eorts to prevent chid abuse.

www.msu.edu/user/nactpf/

National Center on Shaken Baby Syndrome

The ationa Center on haken aby yndrome has a mission to educate and train parents and professionas,

and to conduct research that wi prevent shaking and abuse of infants in the United tates. It provides hep to

professionas and parents ooking for information, ideas, and answers to questions about .

www.dontshake.org



39

R e s o u r c e s

The National Children’s Advocacy Center Child Abuse Library Online

The Chid buse library nine of the ationa Chidren’s dvocacy Center is one of the argest professiona

coections of pubished knowedge, educationa materias, and resources reated to chid matreatment in the

United tates. It provides training, onine services, and annotated bibiographies to organizations and individuas,

and oers resource packages to decisionmakers and researchers.

www.nationalcac.org

National Exchange Club

The ationa xchange Cub (C) oundation is committed to making a dierence in the ives of chidren, famiies,

and our communities through its nationa project to prevent chid abuse. The C oundation’s most successfu

method of countering abuse is by working directy with parents through the parent aide program. The oundation

coordinates a nationwide network of neary 100 xchange Cub Chid buse Prevention Centers that use the parent

aide program and provide support to famiies at risk for abuse.

www.preventchildabuse.com

National Indian Child Welfare Association

The ationa Indian Chid Wefare ssociation (ICW) addresses the issues of chid abuse and negect through

training, research, pubic poicy, and grassroots community deveopment. ICW improves the ives of merican

Indian chidren and famiies by heping tribes and other service providers impement activities that are cuturay

competent, community-based, and focused on the strengths and assets of famiies.

www.nicwa.org

National Maternal and Child Health Center for Child Death Review: Keeping Kids Alive

This organization promotes, supports, and enhances chid death review methodoogy and activities at the state,

community, and nationa eves. It buids pubic and private partnerships to incorporate Chid Death Review (CDR)

ndings into eorts that improve chid heath. uiding on the extensive knowedge of current CDR programs, the

Center activey invoves states in its service deveopment.

www.childdeathreview.org/state.htm



P r e v e


40

National MCH Center for Child Death Review

The ationa Center for Chid Death Review is a resource center for state and oca Chid Death Review programs,

funded by the Materna and Chid Heath ureau. It promotes, supports, and enhances chid death review

methodoogy and activities at the state, community and nationa eves.

www.childdeathreview.org

National Scientic Council on the Developing Child

The ationa cientic Counci on the Deveoping Chid is a muti-discipinary coaboration comprising eading

schoars in neuroscience, eary chidhood deveopment, pediatrics, and economics.

www.developingchild.net

Parents Anonymous® Inc.

Parents nonymous® Inc. is a community of parents, organizations, and vounteers committed to strengthening

famiies and buiding strong communities; achieving meaningfu parent eadership and shared eadership; and

eading the ed of chid abuse and negect.

www.parentsanonymous.org

Prevent Child Abuse America

Prevent Chid buse merica works to prevent abuse and negect of our nation’s chidren. Through its chapters

in 43 states and its vountary home visitation services provided by Heathy amiies merica® in more than 400

communities nationwide, Prevent Chid buse merica heps provide heathy, safe, and nurturing experiences for

more than 100,000 famiies every year.

www.preventchildabuse.org/index.shtml

Promising Practices Network on Children, Families and Communities

The Promising Practices etwork (PP) is a group of individuas and organizations who are dedicated to providing

quaity evidence-based information about what works to improve the ives of chidren, famiies, and communities.

www.promisingpractices.net



41

R e s o

u r c e s

Shaken Baby Alliance

The haken aby iance coaborates with community agencies and professionas to provide support for

victim famiies (incuding adoptive and foster parents) of to advocate justice for victims, and to increase

awareness of the probem.

www.shakenbaby.com

Zero to Three

The mission of Zero to Three is to support the heathy deveopment and we-being of infants, todders, and their

famiies. The organization accompishes this by informing, educating, and supporting aduts who inuence the ives

of infants and todders.

www.zerotothree.org

The organizations and resources listed in this guide are additional resources only.

Their inclusion does not imply endorsement by the U.S. Department of Health and

Human Services, Centers for Disease Control and Prevention, National Center for

Injury Prevention and Control.





43

A p p e

n d i x A

APPEDI A:tate Initiatives on

Many states have initiated their own programs. oowing is a ist of state initiatives; some were

compied by the ationa ssociation of Chidren’s Hospitas and Reated Institutions (CHRI)

and others were ocated on the respective state’s egisative Web site. s information is continuay

updated, pease visit the CHRI Web site (www.chidrenshospitas.net) and state egisative Web sites

for the most up-to-date egisation.

California requires heath faciities and icensed midwives to provide information and instructiona

materias about to parents or guardians of newborns. The aw aso requires the heath department

to provide instructiona materias regarding the medica risks and ways of preventing , if avaiabe,

free of charge to chid care providers upon icensure and at the time of a site visit.26

Florida requires hospitas and birthing faciities to provide new parents with brochures.27

Hawaii authorizes hospitas that provide medica care to a newborn to provide each parent of the

newborn with written educationa information, approved by the department of heath and provided

by nonprot organizations, about the dangerous eects of and the dierent methods of

preventing .28

Illinois estabished an program to educate parents and primary caregivers about and

provides commitment statements.29

26Caifornia tate legisature [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.eginfo.ca.gov/cgi-bin/waisgate?WIdocID=26662315299+0+0+0&WIaction=

retrieve.

27ationa ssociation of Chidren’s Hospitas and Reated Institutions [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.chidrenshospitas.net/M/Tempate.cfm?ection=earch3&tempate=/CM/HTMlDispay.cfm&ContentID=46204.

28Hawaii tate legisature [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.capito.hawaii.gov/hrscurrent/Vo06_Ch0321-0344/HR0321/HR_0321-0033.htm.

29ationa ssociation of Chidren’s Hospitas and Reated Institutions [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.chidrenshospitas.net.M/Tempate.

cfm?ection=earch3&Tempate=/CM/HTMlDispay.cfm&ContentID=46204.

Indiana requires that the tate Department with the assistance of the Department of Chid ervices




44

Indiana requires that the tate Department, with the assistance of the Department of Chid ervices,

estabish a program that raises pubic awareness concerning the causes and nature of chidhood

hazards, incuding factors that pace parents, guardians, and other caregivers at risk for shaking an

infant, risks associated with shaking an infant, and suggestions for preventing .30

Iowa requires the Department of Heath to estabish a statewide prevention program to educate

parents and persons responsibe for the care of a chid about the dangers to chidren 3 years od or

younger caused by shaking babies and infants.31

Massachusetts created a hospita-based program for parents of newborns; education and training

programs for parents, caregivers, and professionas; support for victims of and their famiies; and a

surveiance and data coection program to measure the incidence of .32

Minnesota mandates distribution of information to new parents at hospitas and training for chidcare providers.33

Missouri stipuates that every hospita and birthing center oer a new parents a viewing of an

video prior to discharge.34

Montana mandates that the Department of Pubic Heath and Human ervices deveop educationa

materias that present readiy comprehensibe information on and post the materias on the

department’s Web site in an easiy accessibe format. The educationa materias must bedistributed by:

■ Chidbirth educators and sta of pediatric physicians’ oces and obstetricians’ oces— to an

expectant parent who uses the educator’s or physician’s services,

■ Hospitas— to each newborn chid’s parent before the chid is discharged from the faciity,

30Indiana Genera ssemby [onine] [cited 2009 ug 14] vaiabe from URl: http://www.in.gov/egisative/ic/code/tite16/ar41/ch40.htm.

31The Iowa Genera legisature 2009 enate Journa rchives [onine]. [cited 2010 March 1.] vaiabe from URl: http://search.egis.state.ia.us/XT/gateway.

d?qt=&f=tempates&xhitist_q=shaken+baby&fn=defaut.htm&xhitist_d=current-egisation.32ationa ssociation of Chidren’s Hospitas and Reated Institutions [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.chidrenshospitas.net/M/Tempate.

cfm?ection=earch3&tempate=/CM/HTMlDispay.cfm&ContentID=46204.

33Ibid.

34Ibid.



45

A p p e n d i x A

■ ervice providers under the MIMI project—to a chid’s parent during visits conducted in

accordance with that project,

■ Chid care faciities operating in this state—to each of its empoyees, and

■ Groups or entities that oer casses for babysitters.35

Nebraska requires that every hospita, birth center, or other medica faciity that discharges a newborn

chid request that each maternity patient and father of a newborn chid, if avaiabe, view a video

presentation and read printed materias about that are approved by the Department of Heath

and Human ervices and sign a form indicating they have viewed and read or refused to view or read

the materia.36

In addition, the ebraska Department of Heath and Human ervices sha conduct pubic awareness

activities designed to promote the prevention of udden Infant Death yndrome (ID) and .37 In

addition, the ebraska Department of Heath and Human ervices sha adopt and promugate rues

and reguations for mandatory training requirements for providers of chid care and schoo-age-care

programs. The training requirements for providers of chid care programs sha incude, but not be

imited to, information on ID, , and chid abuse.38

New York requires every hospita and birth center to ask a new parents to view an video and

sign a form indicating they have viewed or refused to watch the video. The requirements aso mandate

training for chid care providers on the identication, diagnosis, and prevention of .39

The ew York tate Department of Heath sha deveop and impement an ongoing pubic information

and educationa campaign to inform the genera pubic about brain injuries and other harmfu eects

that may resut from shaking infants and chidren under ve years of age. The program sha incude

educationa and informationa materias in print, audio, video, eectronic, and other media and pubic

35Montana legisature [onine]. [cited 2010 March 1.] vaiabe from URl: http://data.opi.mt.gov/bis/2009/bihtm/0442.htm.

36ebraska legisature. ebraska Revised tatute 71-2103 [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.egisature.ne.gov/aws/statutes.

php?statute=s7121003000.





39ationa ssociation of Chidren’s Hospitas and Reated Institutions [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.chidrenshospitas.net/M/Tempate.






47

A p p e n d i x A

In addition, the Department of Heath and nvironmenta Contro wi estabish a protoco for heath

care providers to educate parents or primary caregivers about the dangers of shaking infants and

young chidren and review these dangers with parents or caregivers associated with shaking infants at

we-baby visits.44

Tennessee requires that the departments of heath and human services sha jointy deveop

information and instructiona materias for distribution, free of charge, to heath care faciities, midwives,

and chid care agencies. The information and instructiona materias wi focus on the risks of shaking

infants and young chidren. The Department of Heath sha be the ead agency in deveoping such

information and instructiona materias.

The Department of Heath sha provide the information and materias free of charge to heath care

faciities and nurse midwives. Heath care faciities wi provide the materias free of charge to parents

or guardians of each newborn, upon discharge from the heath care faciity. If a home birth is attended

by a nurse midwife, the nurse midwife sha provide the information and instructiona materias to the

parents or guardians of the newborn. The Department of Human ervices sha provide the information

and instructiona materias free of charge to chid care agencies under the jurisdiction of such

department upon icensure and at the time of site visits.45

Texas requires icensed daycare faciities to receive education on the identication and prevention

of .46

Utah requires a daycare centers to receive training on prevention, ID prevention, coping with

crying babies, and brain deveopment.47

44The outh Caroina legisature [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.scstatehouse.gov/cgibin/query.exe?rst=DC&querytext=shaking&category=l

egisation&session=117&conid=4905947&resut_pos=0&keyva=1170518.45Michie’s lega Resources [onine]. [cited 2010 March 1.] vaiabe from URl: http://www.michie.com/tennessee/pext.d?f=tempates&fn=main-h.htm&cp=tncode.



47Ibid.



P r e v

e n t i n g S h a k e n B a b y S y n d r o m e

48

Virginia requires information on to be made avaiabe to maternity patients by nurse midwives,

icensed midwives, and hospitas with maternity services.48

Washington mandates that the Counci for Chidren and amiies conduct a proactive, pubic

information and communication outreach campaign regarding the dangers of shaking infants and

young chidren, and the causes and prevention of .49

Wisconsin stipuates that a new parents, prior to discharge, receive information and watch a

videotape on the dangers of . choo districts are required to educate grades 5, 8, and 11 on .

licensed chid care providers are trained regarding , and at-risk famiies receive education

through the Department of Heath and Human ervices.50

48Virginia Genera ssemby [onine]. [cited 2010 March 1.] vaiabe from URl: http://eg1.state.va.us/cgi-bin/egp504.exe?051+fu+CHP0518.

49Washington tate legisature [onine]. [cited 2010 March 1.] vaiabe from URl: http://apps.eg/wa/gov/RCW/defaut.aspx?cite=43.121.140.


cfm?ection=earch3&tempate=CM/HTMlDispay.cfm&ContentID=46204.



49

A p p

e n d i x B





51

A p p

e n d i x B

■ Understand that you may not be

abe to cam your baby and that it

is not your faut, nor your baby’s. It

is norma for heathy babies to cry

much more in the rst 4 months of

ife. It may hep to think of this as

the Period of PURPLE Crying® as

identied by the ationa Center for

haken aby yndrome (C).

or more information about the

Period of PURPLE Crying® and

C, visit

www.dontshake.org.■ Te everyone who cares for your

baby about the dangers of shaking

a baby and what to do if they

become angry, frustrated, or upset

when your baby has an episode

of inconsoabe crying or does

other things that caregivers may

nd annoying, such as interruptingteevision, video games, seep

time, etc.

■ e aware of signs of frustration and anger among others caring for your baby. let them know

that crying is norma and that it wi get better.

■ Do not eave your baby in the care of someone you know has anger management issues.

■ ee a heath care professiona if you have anger management or other behaviora concerns.

APPEDI C:




52

APPEDI C: Partnership Panning Too

This too may hep you pan your outreach to potentia partner organizations and individuas.

Overall Purpose of the Partnership

To identify and collaborate with community-based organizations to raise awareness about Shaken

Baby Syndrome and to undertake communication and prevention interventions in the community.

(xampe)

Brief Description of P Brief Description of Partnership Outreach S artnership Outreach Strategiestrategies

Participating Individuals and Organizations

Brief Description of Partnership Outreach Strategies



53

A p p

e n d i x C

Major Activities/Desired Outcomes of the Partnership

Needed Resources

Resource Who Provides Details Timing

ccess to new parents

Communication

xpertise

aciity/Venue(s)

unding

ta

ther




54

APPEDI D:

ducationa Resources

Source: These materias were created and produced by Prevent Chid buse Georgia in coaboration

with the Georgia Chapter, merican cademy of Pediatrics. or more information or to order these

materias, pease visit: www.preventchildabusega.org.

Front Back

Front Back



55

A p p

e n d i x D

Front Back

Certicate




56

Magnet



57

a

p p e n d i x

These educational resources are provided as example resources only. Their inclusion does

not imply endorsement by the U.S. Department of Health and Human Services, Centers for

Disease Control and Prevention, National Center for Injury Prevention and Control.

P r e v e nt i n g S ha



For more information—as well as radio PSAs and broadcast-qualityvideo that includes B-Roll, full-screen tips, and downloadable

scenarios—please visit: www.cdc.gov/TraumaticBrainInjury .

“Helping all people live to their full potential”

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

ak e n

B a B y S y

ndr ome : A G ui d ef or H e al t h D e p ar t m en t s an d C omm uni t y-B a s e d

Or g ani z a t i on s

Date post:	04-Apr-2018
Category:	Documents
Upload:	paceminterris
View:	217 times
Download:	0 times

Preventing Shaken Baby Syndrome:A Guide for Health Depts. & Community-Based Organiations

Documents