Monday, June 30, 2008

The CDC has a health marketing initiative

The CDC is sponsoring a series of workshops that focus on how key audiences use technology to learn and make decisions about health

The September 15-16 workshop focuses on moms...
As of June 30, 2008, the Care2 Petition Site has 12,865 signatures on a petition sponsored by the American Humane Society in support of the SBS Prevention Act legislation.

They set a goal of 15,000 by August 16, 2008. If you haven't signed on yet, please visit the webpage and drop your elected representatives a line...

Help Prevent Shaken Baby Syndrome!
Target: US Congress
Sponsored by: American Humane Association

Shaken Baby Syndrome (SBS) is a form of child abuse that results from violently shaking an infant or from abusive impact to an infant's head. Between 1,200 and 1,600 of the nation's children suffer from SBS each year.

Congressional findings estimate that between one-quarter and one-third of SBS victims die as a result of their injuries, while one-third suffer permanent and severe disabilities, including traumatic brain injury, paralysis, seizures and loss of hearing or vision.

To protect the nation's most vulnerable citizens from such tragic and preventable maltreatment, Senator Chris Dodd and Rep. Nita Lowey have introduced the Shaken Baby Syndrome Prevention Act of 2007 (S. 1204 and H.R. 2052).

The bill enables the Secretary of Health and Human Services to develop a national public health campaign that would inform the general public, new parents, child care providers, health care providers and social workers about the risks and dangers associated with SBS.

Sunday, June 29, 2008

My response to a query posted on ParentDish, about what to say to a friend about their child - who seems to be displaying autisic behaviors?...

Having done Shaken Baby prevention education for eight years, I'd have to say I'm adverse to "telling" anyone about sensitive subjects like these.

As an education workshop title aptly put it, "telling ain't teaching."

Educating is different, especially if it is based on your own experiences and your collected wisdom. And I think it's especially important to reframe early intervention as an opportunity, not a stigmatization.

In our experience, that requires education at many levels. Educators, health care professionals, media and what I call reference parents - those who are perceived in their community as models of effective parenting and sources of knowledge.

Unfortunately, while it's a lot easier to have such conversations in an informed and educated social context, those contexts are by far still the exceptions.

That can change.

For example, New York (and 10 other states) now requires hospitals to offer SBS education to new parents before they leave the hospital.

Our pediatrician says this has made it much easier for him to talk to new parents about the danger of shaking young children and the need to have a coping plan. It's no longer a question for the parents why their pediatrician thought it necessary to talk to them about child abuse. Now, it's just one more thing he can do to help them keep their child safe.

Individual action, in the absence of social action, is a much harder slog.

Hopefully, the increased concern about autism will not only raise anxiety, but raise the information in the community about the importance of early remedial action.

Wednesday, June 25, 2008

A curious proposition about child abuse reported on the Child Safety Experts blog:

Posted by: Joyce in child abuse on May 19, 2008

Child abuse prevention takes a quantum leap forward. There is an interesting theory today from a researcher in Montreal that is a big step in child abuse prevention. He thinks one of the best ways to prevent child abuse is through directly going to the community for awareness and support, not directly the parents. Combating mistreatment of children is more effective at the grassroots level, not in the family. Things like summer camps for high-risk kids are absolutely critical in combating child abuse than family education programs. Most child abuse, because of the reporting system, is pushed toward thinking the best thing to do is involve the authorities. Reporting has to happen, but what comes with that often is turning our backs on the problem. There's not much the authorities can do without support from the community. Fascinating.

My response:

Check out Prevent Child Abuse America's policy memo on the disparity between public "awareness" of child abuse and action on child abuse. Most people are aware of abuse: they just think it involves "those" people.
Not them, not their family, not their friends. Those actions have reasons, so they are understandable. He's tired. The kid's a handful. Kids need discipline.
So, if they define abuse as essentially acts committed by someone I don't know or I don't like, how are they going to have any effect on actions by those people? Not to mention the options abusers have to isolate themselves and their kids, whether it's by hiding in the spaces of the suburbs and exurbs, or in the anonymity of the city.
The reality is that most people don't view child abuse as "their" issue. If they know someone and believe that person to be a good person, acts of abuse and neglect are excused by a variety of cognitive devices.
More community awareness to support parents, and to help new parents adapt and cope with the challenges raising kids in difficult times, will help. It's necessary, but far from sufficient.
Many of those parents need education that provides them with skills and abilities, while also helping them to understand and anticipate the frustration and anger that can come with raising young children.
Home visiting and other skill enhancing interventions clearly work.
The challenge is to find sufficient funding so that we can use them.
A very good post on the "Science Based Medicine" blog.

Well worth 10 minutes of reading time: while only a small portion touches on the SBS/vaccination claim, it puts the "Journal" in proper perspective. It shows that the quality of peer reviewed work is only as good as the quality of the peers...

The Journal of American Physicians and Surgeons: Ideology trumps ...By David Gorski For example, JPANDS has become arguably the foremost “respectable” promoter of the claim that many cases of “shaken baby syndrome” are in actuality due to “vaccine-induced” encephalitis. Indeed, it has published numerous articles making ...

Thursday, June 19, 2008

On the theory that hospitals should know better, I'm starting a list of hospitals which have safety pages for parents about babysitters for babies, and whether or not they advise parents to ask babysitters if they know about the SIDS risk reduction techniques or have a coping plan for frustration to avoid SBS.

Let's start with:

- Childrens' Hospital of Pittsburgh: NO and NO

Sunday, June 15, 2008

Court of Appeals reverses ’06 ruling Cases involved two men accused of injuring their infants by shaking
By KENNETH HART - The Independent

GREENUP — The Kentucky Court of Appeals has reversed a 2006 ruling by a former Greenup circuit judge that affected cases involving two men accused of injuring their infant children by violently shaking them.

In a ruling handed down Friday, a three-judge panel of the appeals court ruled that now-retired Judge Lewis D. Nicholls erred when he barred prosecutors from introducing expert testimony regarding shaken-baby syndrome.

Because of the ruling, Greenup Commonwealth’s Attorney Clifford Duvall was unable to bring the cases against the two defendants, Raymond Martin and Christopher A. Davis, to trial. Martin and Davis were indicted in separate cases in 2004 for allegedly abusing their infant sons. Martin was charged with second-degree assault; Davis with first-degree criminal abuse.

The victims — who were three and four months old, respectively, at the time of the alleged abuse — both exhibited the classic signs of shaken-baby syndrome: bleeding in the brain, also known as subdural hematoma, and bilateral hemorrhaging, or bleeding behind both eyes.

Shaken-baby syndrome was first recognized in the 1970s and the diagnosis has been accepted by the American Association of Pediatrics and the National Association of Medical Examiners. However, at a March 29, 2006, hearing, attorneys for Martin and Davis presented expert testimony they maintained was proof that the diagnosis wasn’t reliable enough to send their clients to prison.

Dr. Ronald Uscinski, an associate professor of neurosurgery at Georgetown University, testified during the hearing that a recent study had shown shaking alone would cause infants’ necks to snap before it would cause bleeding in their eyes and brains. Experts for the prosecution countered that Uscinski’s conclusions were flawed and could not be proved in controlled experiments because researchers couldn’t shake real infants.

On April 17, 2006, Nicholls ruled that testimony from the prosecution’s chief expert, Dr. Betty S. Spivack, a forensic pediatrician at Kosair Children’s Hospital in Louisville, did not meet the standard for scientific reliability, and concluded, based largely on the testimony of Uscinski, that shaking alone could not have caused the type of injuries suffered by the two infants.

“To allow a physician to diagnosis shaken-baby syndrome with only the two classical markers, and no other evidence of manifest injuries, is to allow a physician to diagnose a legal conclusion,” Nicholls wrote. Duvall appealed Nicholls’ decision, which child advocates said set a dangerous precedent and had the potential to hamper the ability of the criminal justice system to protect children.

The appeals court ruled that Nicholls abused his discretion in keeping out the testimony and ordered the cases reversed and remanded for further action. The panel concluded Nicholls’ decision to exclude Spivack’s testimony was erroneous “because it was founded on the unsupported legal conclusion that because there was dispute amongst the experts as to the possible cause of the infants’ injuries, it was the court’s rule to choose the side it found more convincing and exclude the side it found less convincing.”

Judges also wrote Nicholls should have allowed both experts to testify and a jury to choose the one it found more credible because the “gatekeeping” function assigned to judges is restricted to keeping out “junk science” and unreliable expert testimony. Under the law, attorneys for Martin and Davis now have 30 days to request a discretionary review by the Kentucky Supreme Court.

Duvall said Friday, if the defense does appeal, further action on his part would have to await a ruling from the high court. “If it remains in our favor, we will set those cases for trial,” he said.

“We worked very hard on these cases and we feel vindicated by the decision,”Duvall said. “We also give lots of credit to James Shackleford, who briefed the issues before the court of appeals for (former Kentucky Attorney General) Greg Stumbo.”

Wednesday, June 04, 2008

Short falls don't seem to be as dangerous as some defense experts suggest...

June 2, 2008 PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1213-1224

Annual Risk of Death Resulting From Short Falls Among Young Children: Less Than 1 in 1 Million

David L. Chadwick, MDa,b,c, Gina Bertocci, PhDd, Edward Castillo, PhD, MPHe, Lori Frasier, MDa,f, Elisabeth Guenther, MD, MPHa,f, Karen Hansen, MDa,f, Bruce Herman, MDa,f and Henry F. Krous, MD

OBJECTIVE. The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.

METHODS. A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.

RESULTS. The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.

CONCLUSIONS. The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.
An interesting study from the University of North Carolina, published in the June issue of Pediatrics.

It looks at one of the consequences that results when cases involving inflicted injuries work through the criminal justice system. While this is a relatively small sample (N:30) from North Carolina, it raises an important concern. It is important for that the system work fairly for victims and alleged perpetrators so that justice results.

Also of interest (and no surprise to anyone who follows investigation, prosecution and sentencing in SBS cases):

- nearly one-third of the identified cases apparently weren't prosecuted.
- sentences varied widely, even when the child died - from probation to life.
- 30% (3 of 10) of the cases that went to a jury resulted in acquital.

If you accept the premise that mercy falls most easily and often upon those who look and act like "us", I wonder if these findings in "SBS" cases also suggest that the easier it is for us to place ourselves in the defendant's shoes, the lesser the charge and the lesser the sentence, eg when we think they are a "good parent" who has done a bad act.

In which case, the quality of justice is reduced for the injured child of those who seem most like us...


PS. My anecdotal experience educating child care providers suggests that the adequacy of the sentence in a case is important: in every presentation, someone always asks what happened to the child care provider who shook our son.

When I tell them she was sentenced to jail, they always ask: "for how long?"
Non-whites Receive Harsher Sentences for Inflicted Traumatic Brain Injury of Children
Libraries - Medical News -

DescriptionNon-white defendants are nearly twice as likely to receive harsher prison sentences than white defendants in North Carolina criminal cases stemming from inflicted traumatic brain injury of young children.
Newswise — Non-white defendants are nearly twice as likely to receive harsher prison sentences than white defendants in North Carolina criminal cases stemming from inflicted traumatic brain injury of young children.
That’s the conclusion reached by researchers from the Injury Prevention Research Center at the University of North Carolina at Chapel Hill, who tracked down what happened in every such case prosecuted in North Carolina in 2000 and 2001. Their study appears in the June issue of the journal Pediatrics.
Inflicted traumatic brain injury is a specific form of child abuse, which includes but is not limited to shaken baby syndrome.
“We expected to find that whether or not the child died would be the factor most predictive of the punishment that was imposed,” said Dr. Desmond K. Runyan, the study’s senior author, professor and chair of the social medicine department in UNC’s School of Medicine. Runyan is also a professor in the pediatrics department and an adjunct professor in the School of Public Health’s epidemiology department.
“But we found instead, much to our surprise, that the race of the defendant was the most predictive factor,” Runyan said. “Death of the child didn’t matter nearly as much in terms of the sentence, and neither did any of the other factors we examined.”
Defendants whose race was defined as non-white (which included African Americans, Hispanics and Native Americans) were 1.9 times more likely than white defendants to receive a severe sentence. For the purposes of the study, severe sentences were defined as 90 days in prison or longer. Sentences defined as not severe included probation, community service and prison time of less than 90 days.
Runyan said the study raises serious questions of public health and social policy, including whether or not harsh prison sentences for the perpetrators of traumatic brain injury in young children is the most beneficial way for society to deal with this problem.
“In most of these cases the perpetrators are not acting with the intent of hurting the baby. Instead they are usually frustrated young parents who respond to a crying baby with 30 seconds of stupidity, because they weren’t educated about the dangers of shaking a baby,” Runyan said. “In my view, harsh prison sentences may not be the most appropriate response in this situation, and we need to seriously consider other ways of dealing with what is a significant public health problem.”
The study’s lead author is Heather T. Keenan, Ph.D., who was a graduate student at UNC and now is an associate professor at the University of Utah. Maryalice Nocera, a research nurse with the UNC Injury Prevention Research Center, is a co-author.
“It is difficult to know what the appropriate judicial response should be to these cases as the value of the child’s lost life or abilities need to be recognized,” Keenan said. “However, it is clear that the response should not be based on the defendants’ race or ethnicity.”
This study follows up on an earlier study by the same researchers, which was published in the Journal of the American Medical Association in 2003. Their goal this time was to find out how the justice system treats suspected perpetrators of one specific form of child physical maltreatment, inflicted traumatic brain injury.
They found 75 substantiated cases of inflicted traumatic brain injury among children ranging from infants to 2-year-olds. Of these, criminal charges were filed in 54 cases. Forty-one of the defendants pleaded either guilty or no contest to the charges and 10 defendants went to jury trial. Three were found not guilty, leaving 48 defendants with criminal convictions. Of these, 30 (63 percent) were sentenced to time in prison.
Whether or not the child died was found to have an effect on the severity of charges that were filed; defendants faced more serious charges when the child died. However, even in cases where the child died sentencing outcomes varied widely, ranging from probation to life in prison.
Several other potential predictive factors of sentencing outcomes were examined, including perpetrator age, gender, relationship of the perpetrator to the child and whether or not the child died, but none were found to be statistically significant.
Runyan said these findings raise many questions for additional research, including whether or not the quality of the defendants’ legal representation made a difference in sentencing outcome. Many of the defendants were poor and thus were represented by court-appointed attorneys.