Abusive head trauma and crying infant-Public awareness of newborn and infant trauma.

AIM: Crying seems to be a common trigger for abusive head trauma (AHT), which is the leading cause of fatalities from physical abuse in infants. Our objective was to evaluate knowledge of AHT, crying infants and correct behavioural measures in a general population. METHODS: An online questionnaire (LimeSurvey) was created to assess the risk of shaking. The online survey contained a total of 41 questions, including a demonstration of a previously recorded video in which an infant doll is shaken. RESULTS: A total of 319 people, 245 of them (76.8%) with own children, participated in the study. Almost all respondents (98.4%) were aware of serious injuries due to shaking, even to the point of death (98.1%). Most participants (97.5%) had heard the term 'shaking trauma' prior but did not receive any professional information, neither before nor after birth (85.2% or 86%), or during follow-up examinations (88.5%). The majority of the participants (95%) considered that useful coping strategies in infant crying were inappropriate. CONCLUSION: The consequences of shaking an infant were common knowledge in a normal population, whereas there was a knowledge gap regarding the management of excessive crying infants. Prevention programmes should mainly focus on male caregivers during postnatal care.

Childminder knowledge of shaken baby syndrome and the role played by childminders in prevention: An observational study in France.

BACKGROUND: Shaken baby syndrome (SBS) triggers negative short- and long-term outcomes. In France, registered childminders are the principal source of daycare. They may encounter SBS imparted by caregivers or simply excessive infant crying. The aim of the study was to explore childminder knowledge on SBS, the source of information, the responses to infant crying, how childminders perceived their roles in terms of caregiver SBS prevention, and the factors associated with a good knowledge of SBS. METHODS: The participants were registered childminders working in the French department of Gironde who had email accounts. This observational study employed an anonymous online questionnaire distributed by the maternal and child health services unit of the Gironde department over 5 weeks from 16 September 2021. Data on childminder characteristics, knowledge on SBS, responses to infant crying, and perceptions of their roles in SBS prevention were collected. The knowledge score ranged from 0 (all wrong answers) to 30 (all correct answers). RESULTS: A total of 779 registered childminders participated; 43.9 % had learnt about SBS during their initial training and 75 % before (other training) or after initial training. The median knowledge score was 19/30 (interquartile range [16; 21]). A higher educational level, previous other professional experience, training on SBS, and responsibility for few children were associated with higher scores. Ten reported that they did not advise caregivers who complained of infant crying. CONCLUSION: Childminders require training on SBS and SBS prevention.

The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis.

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.

Shaken Baby Syndrome (SBS) or Pediatric Abusive Head Trauma from Shaking: Guidelines for Interventions During the Perinatal Period from the French National College Of Midwives.

Shaken baby syndrome is the most severe head injury in children. Shaking is an extremely violent gesture, often repeated. The children affected are generally less than a year old, in 2/3 of cases, less than 6 months old. More than 10% of them die, and more than three-quarters of the survivors have long-term effects. Prevention is therefore essential. When a parent (or any person) is strongly upset by an infant's uncalmable crying, the best thing for them to do is to lay the child down in a supine position in his or her bed, leave the room, and then ask for help.

Abusive head injuries in infants: from founders to denialism and beyond.

INTRODUCTION: Abusive head injuries is a major cause of severe morbidity and the main cause of mortality by head trauma in infants. MATERIAL AND METHODS: Based on published data and their own clinical and medicolegal practice, the authors review briefly the historical roots and emergence of the concept of abusive head injuries (AHI), until the present scientific understanding of shaken baby syndrome (SBS) and Silverman syndrome. They then discuss the present epidemic of denialism and how this challenge to science should be seen as a stimulus to increase research and improve the accuracy of diagnosis and medical practice. RESULTS: The denial of SBS is especially damaging because it undermines the possibilities of prevention and reparation for victims. The authors expand on AHI being part of a wider context of domestic violence and the prevention of child abuse being part of a broad and long-term endeavor to defend civilization values. CONCLUSIONS: Prevention of AHI is a major challenge for the future. In the fields of science and prevention of child abuse, the input of pediatric neurosurgeons should not be underestimated.

The effect of a shaken baby syndrome prevention program on Turkish mothers' awareness and knowledge: A randomized controlled study.

PURPOSE: This study aimed to develop an evidence-based education program to increase mothers' awareness and knowledge of shaken baby syndrome (SBS) and evaluate program effectiveness. DESIGN AND METHODS: Mothers with babies between 2 and 4 months of age were completed the study (intervention group = 43 and control group = 44). This single-blind randomized controlled study was conducted between September 2020 and February 2021. The intervention group participated in an 8-week follow-up. Outcome variables were assessed at baseline and 8 weeks after commencement of the intervention, which included measures to evaluate the administration of the shaken baby syndrome prevention program (SBSPP). The study was approved by ClinicalTrials.gov NCT04568538. RESULTS: Scores for the SBS assessment survey were significantly higher in the intervention group than in the control group. PRACTICE IMPLICATIONS: Developing effective interventions for SBS is an important public health goal. This study is the first to prove the effectiveness of an SBSPP conducted by nurses in Turkey. We believe that the implementation of this program in a larger sample will make a significant contribution to SBS reduction. Pediatric nurses identify the needs of parents with babies younger than 6 months and support them to manage this process correctly.

[The need to prevent Shaken Baby Syndrome]. / La nécessaire prévention du syndrome du bébé secoué.

Shaken Baby Syndrome, or non-accidental head injury, is a serious syndrome that can have fatal consequences for the baby. For a long time unknown to the general public and, moreover, difficult to diagnose, it requires the implementation of a comprehensive prevention programme in order to protect children and parents from this tragedy. After the awareness of professionals, it is now a question of relaying and disseminating the information as widely as possible.

Period of Purple Crying Program for the Prevention of Abusive Head Trauma/Shaken Baby Syndrome.

The Period of PURPLE Crying Program is an educational program delivered to parents of newborn children that aims to reduce the incidence of abusive head trauma/shaken baby syndrome1. The program was developed by a research-based, non-profit organisation and has already been implemented in many countries around the world. It educates parents on what to expect during the first few months of their newborn infant's life, allowing parents to become more informed and better prepared to care for their child. The recent surge in the number of cases of abusive head trauma in children during the COVID-19 pandemic has highlighted the need for greater resources being made available to parents. The Period of PURPLE Crying Program is one such resource that could be implemented in Ireland.

Abusive head trauma: Canadian and global perspectives.

Canada has come a long way since Dr. C. Henry Kempe first described battered-child syndrome in 1962. The year 1999 was crucial in Canada's battle against shaken baby syndrome/abusive head trauma (SBS/AHT), when the first national conference on the topic was held in Saskatoon. This was followed by the issuance of a national statement and multidisciplinary guidelines, recently updated in 2020. Incidence of AHT in Canada is similar to that found in population-based studies from Switzerland and New Zealand. The mainstay of prevention of AHT in Canada is education of parents and caregivers with respect to their response to infant crying. Population-based data for global incidence of AHT are lacking, largely because of social and cultural differences contributing to poor understanding of AHT as a medico-legal entity. India faces a distinct challenge in the battle against female feticide and infanticide.

Preventing abusive head trauma: can educating parents reduce the incidence?

Abusive head trauma (AHT) is the most lethal form of child abuse; preventing AHT should be a national priority, but research into this area is woefully underfunded. Prevention programs have primarily focused on universal parent education during the neonatal period, a time when parents are a captive audience of the health care establishment whose focus is on the needs of their newborn infant, and who will soon be exposed to the frustration and anger of infant crying. Research has suggested a strong causal link between infant crying and AHT, and parents - particularly fathers and father figures - have been identified as the most common perpetrators of AHT. A number of studies have suggested that educating parents during the postnatal period about the normalcy of inconsolable infant crying and its evolution over the first several months of postnatal life improves parental knowledge about infant crying and a number of positive parenting behaviors, and decreases emergency room visits for crying. In 1998, we began a pilot program in Upstate New York near Buffalo that led to a 47% reduction in AHT incidence. Similar studies have demonstrated 35-75% reductions in incidence, which has led to enthusiasm for this approach to preventing AHT. We, as well as another group, have enacted statewide programs in Pennsylvania and North Carolina; unfortunately, these two large statewide replication trials failed to demonstrate any impact of such an intervention on AHT rates. Serial messages for parents, provided repeatedly over the period of greatest risk for AHT, might be another avenue of research.

[Effectiveness of an educational video about infant crying on prevention of shaken baby syndrome among pregnant Japanese women and their partners].

Objectives　Previous studies have shown that educating new mothers or pregnant women about infant crying, may prevent shaken baby syndrome (SBS). However, no studies in Japan have examined the effectiveness of educational materials during pregnancy. This study aims to determine whether pregnant women and their partners improve their knowledge about infant crying and SBS, after watching an educational video created by the Ministry of Health, Labour, and Welfare.Methods　The study was conducted from April 1, 2013, to March 31, 2014, in 46 municipalities nationwide. Pregnant women and their partners, who participated in prenatal classes, watched the educational video and responded to pre- and post-questionnaires that included questions about: the characteristics of parents and family, and knowledge about infant crying and SBS. Out of the 4769 respondents who completed the questionnaires, responses of 4647 respondents with knowledge about infant crying and SBS were analyzed. We asked six questions about infant crying, such as "When an infant cries it is always a sign that something is wrong", and two questions about SBS, such as "Shaking a baby is a good way to help a baby stop crying" using a 4-point Likert scale (0-3 points). The total scores were calculated and placed within the range of 0 to 100, where higher scores indicated better knowledge. These scores were then compared for the pre- and post-conditions. Furthermore, a stratified analysis was performed based on respondents' characteristics and a regression analysis was conducted to examine the differences in knowledge categorized by these characteristics.Results　The scores displayed a significant increase in knowledge about infant crying and SBS by 17.5 points (95% CI; 17.1-17.9) and 6.8 points (95% CI; 6.3-7.2) respectively, after watching the educational video. The results of the stratified analysis found that the effect of the intervention did not differ depending on characteristics such as age, sex, education, and prevalence of depression. Furthermore, our regression analysis on the scores of knowledge about infant crying and SBS found that the increases in knowledge were more pronounced among males and couples having their first child. Increase in knowledge about infant crying was more pronounced among those who were not depressed, while increase in knowledge about SBS was more pronounced among those who answered "unexpected but happy" for their feelings about pregnancy.Conclusion　The educational video on infant crying and shaken baby syndrome was effective in increasing knowledge about infant crying and SBS among couples during pregnancy, regardless of their characteristics.

Parental knowledge on infant crying and abusive head trauma and relevant shaking behaviors in China.

BACKGROUND: This study aims to characterize the knowledge about infant crying and abusive head trauma (AHT), and shaking behaviors in parents of children in China, which are lacking currently. METHODS: A cross-sectional survey was conducted in 2020. We collected information about the knowledge of the typical patterns of infant crying and AHT, and asked about beliefs of the effects of violent shaking on children's health, and shaking behavior among parents. RESULTS: A total of 568 parents completed the questionnaire, and only 1.6 % of them answered all nine knowledge questions related to infant crying correctly. Overall, 42.6 % of participants reported they had heard about AHT, but only 17.1 % of the parents reported they knew enough about the dangers of infant shaking. About 45 % of the parents acknowledged that they had shaken their infants at least once. Parents who were from western region of China (OR = 3.860; 95 % CI = 1.871, 7.966; p < 0.001) and have felt very frustrated because of the baby's crying over half of the time (OR = 3.401; 95 % CI = 1.862, 6.211; p < 0.001) had the highest risk of shaking. Majority of the parents reported that they needed further information about infant soothing techniques, knowledge of prevention and treatment about AHT. CONCLUSIONS: Majority of Chinese parents do not have enough knowledge about normal infant crying, nevertheless, most of them expressing needs in learning more. Community-wide advocating efforts aiming to educate parents on awareness and knowledge about AHT should be a health priority in China.

Effectiveness of an Educational Video in Maternity Wards to Prevent Self-Reported Shaking and Smothering during the First Week of Age: A Cluster Randomized Controlled Trial.

This study aimed to investigate whether watching an educational video on infant crying and the dangers of shaking and smothering within 1 week after delivery at maternity wards reduces self-reported shaking and smothering, at a 1-month health checkup. A cluster randomized controlled trial, stratified by area and hospital function, was employed in 45 obstetrics hospitals/clinics in Osaka Prefecture, Japan. In the intervention group, mothers watched an educational video on infant crying and the dangers of shaking and smothering an infant, within 1 week of age, during hospitalization at maternity wards, without blinding on group allocation. Control group received usual care. A total of 4722 (N = 2350 and 2372 for intervention and control group, respectively) mothers who delivered their babies (still birth and gestational age < 22 weeks were excluded) between October 1, 2014, and January 31 were recruited. Outcomes were self-reported shaking and smothering behaviors, knowledge on infant crying and shaking, and behaviors to cope with infant crying, assessed via a questionnaire at a 1-month health checkup. In all, 2718 (N = 1078 and 1640) responded to the questionnaire (response rate: 58.3%), and analytic sample size was 2655 (N = 1058 and 1597 for intervention and control group, respectively). Multilevel analysis was used to adjust for correlation within the cluster. Prevalence of shaking was significantly lower in the intervention group (0.19%) than in the control group (1.69%). Intention-to-treat analysis showed an 89% reduction in the reported prevalence of self-reported shaking (OR: 0.11, 95% CI: 0.02-0.53) due to watching the educational video. However, self-reported smothering behavior showed no significant reduction (OR: 0.66, 95% CI: 0.27-1.60). No side effects were reported. Watching an educational video on infant crying and the dangers of shaking and smothering within 1 week after delivery at maternity wards reduced self-reported shaking at 1 month of age. UMIN Clinical Trial Registry UMIN000015558.

Which Mothers Know That All Babies Cry? A Randomized Controlled Trial of a Child Abuse Prevention Program for Low-Income New Mothers.

This study evaluated an intervention for low-income new mothers, half from Spanish-speaking homes, that provides education around infant crying and abusive head trauma (AHT). At enrollment, non-US-born mothers were less likely than US-born mothers to have heard of shaken baby syndrome (60% vs 89%, P ≤ .0001) or to know shaking babies could lead to brain damage or death (48% vs 80%, P < .0001). At follow-up, non-US-born intervention mothers had improved knowledge of the peak of crying (31% vs 4%, P = .009), improved knowledge that shaking a baby could lead to brain damage or death (36% vs 12%, P = .035), and identified more calming strategies for parenting stress compared with non-US-born control mothers (+0.8 [SD = 1.1] vs -0.4 [SD = 1.4]). This study identifies a gap in AHT knowledge at baseline of non-US-born mothers. These mothers had improved knowledge with intervention and are an important population for similar prevention efforts.

Abusive Head Trauma in Infants and Children.

Abusive head trauma (AHT) remains a significant cause of morbidity and mortality in the pediatric population, especially in young infants. In the past decade, advancements in research have refined medical understanding of the epidemiological, clinical, biomechanical, and pathologic factors comprising the diagnosis, thereby enhancing clinical detection of a challenging diagnostic entity. Failure to recognize AHT and respond appropriately at any step in the process, from medical diagnosis to child protection and legal decision-making, can place children at risk. The American Academy of Pediatrics revises the 2009 policy statement on AHT to incorporate the growing body of knowledge on the topic. Although this statement incorporates some of that growing body of knowledge, it is not a comprehensive exposition of the science. This statement aims to provide pediatric practitioners with general guidance on a complex subject. The Academy recommends that pediatric practitioners remain vigilant for the signs and symptoms of AHT, conduct thorough medical evaluations, consult with pediatric medical subspecialists when necessary, and embrace the challenges and need for strong advocacy on the subject.

Effectiveness of using an educational video simulating the anatomical mechanism of shaking and smothering in a home-visit program to prevent self-reported infant abuse: A population-based quasi-experimental study in Japan.

BACKGROUND: A video that simulates the anatomical mechanism of shaking the infant head, which may have a stronger impact on the viewer, and a tool to prevent self-reported smothering in response to crying, has never been investigated. OBJECTIVE: To investigate whether watching an educational video at home visit at 2 months postpartum on infant crying and the dangers of shaking and smothering reduces self-reported shaking and smothering behaviors at 4 months postpartum. METHOD: In a quasi-experimental study in A city in Japan, the video intervention was implemented at home visits by a midwife, public health nurse or trained volunteers when babies were 2 months old. At the 4-month health checkup, participants received a questionnaire about the video, self-reported shaking and smothering behaviors and other covariates. The impacts of watching the video and self-reported shaking or smothering were analyzed using multiple logistic regression. RESULTS: In total, 5961 caregivers provided valid response for this study (valid response rate: 73.8 %). In the adjusted model, those who watched the video were 74 % less likely to shake their infants (odds ratio (OR): 0.36, 95 % confidence interval (CI): 0.21-0.64), 43 % were less likely to smother their infants (OR: 0.57, 95 % CI: 0.37-0.89), 52 % were less likely to shake or smother (OR: 0.48, 95 % CI: 0.33-0.69) their infants. CONCLUSION: The educational video on infant crying and the dangers of shaking and smothering, with anatomical mechanism of shaking, may halve the risk of self-reported shaking and smothering at 4 months of age.

[Effectiveness of an educational video on infant crying for prevention of shaken baby syndrome among Japanese caregivers of infants].

Objectives　Spreading awareness of shaken baby syndrome is considered to be essential in the prevention of infant deaths resulting from abuse. This study aimed to determine whether an educational video on infant crying, developed by the Ministry of Health, Labour and Welfare, was effective at increasing knowledge of infant crying and shaking among Japanese caregivers of infants aged under 1 year.Methods　We targeted caregivers who had infants aged under 1 year for intervention through health checkups and home visits in 29 municipalities across Japan from April 2013 to March 2014. The educational video on infant crying and danger of shaking and smothering was used as intervention. A questionnaire was administered to caregivers to assess their knowledge on infant crying and shaking prior to and after the intervention (N=1,444, response rate 93.8%). A sample of 1,232 caregivers was used for analysis, after excluding those who did not report the outcome of interest (i.e., knowledge on shaking or smothering) and demographics. In the analysis, pre- and post-test mean scores on crying knowledge scales and shaking knowledge scales (out of 100) were compared separately. Subgroup analysis and regression analysis were also conducted to examine whether the effect of the intervention varied by infant age, birth order, parent's sex, age, education, marital status, household income, grandparents' co-residence, postpartum depression, domestic violence during pregnancy, feelings about pregnancy, and resident area (urban/rural).Results　Scores on infant crying significantly increased by 12.4 points (95% confidence interval: 11.7-13.2), and those on shaking knowledge increased by 4.7 points (95% confidence interval: 3.9-5.6) after the caregivers had watched the educational video. Subgroup analysis confirmed that the effect of the intervention did not differ among the subgroups except shaking knowledge scores among those who were not married and those who experienced physical violence from their partner. A regression analysis on change in scores revealed that parents with higher education gained more knowledge on infant crying, and fathers and those not living with grandparents gained more knowledge on shaking than mothers.Conclusion　The educational video on infant crying was effective in increasing knowledge of infant crying and shaking, regardless of demographics of infants and parents and postnatal situation.

Evaluation of the effect of the child protection act on serious child physical abuse in Taiwan.

BACKGROUND: Few studies have examined the effects of the Child Protection Act on child maltreatment in Taiwan. OBJECTIVE: This study estimated the secular trends in the incidence rate of physical abuse of children requiring hospitalization between 1996 and 2013, and the subsequent in-hospital death proportion before and after implementation of the Act in 2003. PARTICIPANTS AND SETTING: The cases were children younger than 12 years old who were hospitalized due to child abuse, shaken-baby syndrome, neglect, or homicide between 1996 and 2013. A comparison group consisted of children requiring hospitalization for other reasons. We used the National Health Insurance database to identify patients. METHODS: The Joinpoint Regression Program was used to estimate temporal trends in the standardized incidence rates. RESULTS: Between 1996 and 2013, 2050 children required hospitalization for physical abuse. Before 2005, the annual percent change increased by 9.40 [95% confidence interval (CI), 4.98-14.00] per year, and after 2005 the annual percent change was -4.80 (95% CI, -9.53-0.17) per year. Among the 2050 physically abused children requiring hospitalization, 83 (4%) died in hospital. The in-hospital death proportion was 2.62% before 2003 and 4.90% after 2003, and the ratio of these two proportions was 1.43 (95% CI, 0.80-2.58). CONCLUSIONS: The trend in the incidence of hospitalization of children due to physical-abuse-related injuries started to decline 2 years after implementation of the Child Protection Act. However, the proportion of children who died in hospital as a result of physical abuse requiring hospitalization did not change.

[Improving child protection in healthcare: peer counseling, education, and research using the example of abusive head trauma]. / Kinderschutz im Gesundheitswesen verbessern: Fachberatung, Weiterbildung und Forschung am Beispiel des misshandlungsbedingten Kopftraumas.

Too often, diagnosis of maltreatment is missed by healthcare professionals - thus denying children in danger from necessary protection. Insufficient knowledge and insecurities towards professional confidentiality and how to approach child protection services may be the reasons for the failure to protect children effectively.In this article, we present how a comprehensive concept by the competence center of child protection in medicine of the state of Baden-Wurttemberg consisting of peer counseling, peer education, and research can add to the prevention of maltreatment. One component is peer counseling through a telephone helpline that is accessible 24/7, the medical child protection hotline. The requests to the helpline are analyzed and add to the generation of tailored content for the education of doctors, psychotherapists, nurses, and other healthcare professionals. As an example, we present the online course "Child protection in medicine - a basic course for all health professionals" (so far available only in German). One common issue when the child protection hotline is called for counseling is abusive head trauma. Research shows that sometimes a diagnosis of abusive head trauma might be missed. This condition is most prevalent in children under the age of 2 and represents one of the most severe forms of physical abuse with high mortality.Inquiries to the medical child protection hotline are constantly increasing, but making the service known nationwide to all healthcare professionals still poses a challenge. The online course is widely used and being constantly improved. The comprehensive concept of peer counseling, education, and research is an important contribution to the improvement of the prevention of child maltreatment.