Sunday, July 27, 2008

A good overview article from USA Today

'The right time' for action

"Parents already knew that violent shaking was a bad thing," says Mark Dias, a neurosurgeon who developed prevention programs in New York and Pennsylvania. The program has parents review information about the syndrome, and they have one-on-one counseling with a nurse after the baby's birth. "They needed to be reminded in the right time and in the right setting." [the "teachable moment"]

Researchers are hoping to replicate results of a pilot program created by Dias in upstate New York that reduced such cases by 47% from 1998 to 2003.

In North Carolina, every family with a new baby now receives a DVD and a booklet describing the "period of PURPLE crying," an acronym that helps parents understand all children increasingly will cry uncontrollably from about 2 weeks old until about 5 or 6 months. P stands for peak of crying; U for unexpected; R for resists soothing; P for pain-like face; L for long-lasting; E for evening.

The message is repeated by a nurse after the birth and again by a pediatrician at the child's checkups at 2 months and 4 months.

Message received

"We're trying to get people — the whole society, not just mothers and fathers … to understand early infant crying is not because the baby is bad or because the parents are bad," says Ron Barr, who created the PURPLE program and studied the link between shaken babies and crying.

The programs encourage parents to put a crying child in a safe place and walk away before they get too frustrated.

"What I see here is the relief when a parent hears (uncontrollable crying) is normal," says Cindy Brown, a pediatrician at Mission Hospital in Asheville, N.C., one of the first medical centers in the state to distribute the prevention materials.

Both programs, which are financed for five years in part by the Centers for Disease Control and Prevention, will track infant head traumas until 2012.

Says Runyan, "It's our view that the majority of shaken babies are not premeditated but a desperate parent who has run out of gas who needs the kid to be quiet."

Some good words from a new father that show the value of hospital based education for new parents. Following that, a mother talks about colic and the feelings that follow ...

In the hospital they made us watch this really sad movie on shaken baby syndrome (Serene probably doesn't even remember it) and I thought how in the world could someone do that to their baby? I was shocked! Then, after about a week of 1.5 hour catnaps it all started to make sense how someone could lose control. I had to turn on the light sometimes just to make sure that the writhing object in my arms was in fact my baby and not a screaming banshee. I write with some hyperbole to emphasize the point but rest be assured that I never considered hurting my baby even during her most demonic frenzies.

Now, from The Mommy 'n Baby Page, an excellent perspective on what colic means to a mother...

Colic31st July 2008, 06:42 pm Some of us are lucky enough not to have to have a colicky baby, but others aren’t so blessed. My son was never diagnosed with colic, but often he would cry for hours each day, sometimes as many as four or five.

I can’t imagine having a baby who cries more then that, but there are some. My husband’s uncle would tell us stories of the two colicky babies that he and his wife raised. He would talk about two am drives to put the baby asleep and get some peace and quite.

Unfortunatly colic isn’t something we understand. We aren’t sure why some babies re colicky and others aren’t.

Without knowing the cause we aren’t sure how to make it stop either. If you have spent hours singing, pacing, dancing (I used to dance with my son who would sometimes quiet down with this method, at least until I stopped!), driving, crying, feeding, changing, and in all other ways trying to get through it, then you know what it is like to wish there was a way out.

Sometimes thoughts creep up, especailly after hours of hard work trying to make the crying stop to no avail. However, you have to work to combat these thoughts. One of the most common is that you are a bad mom. This thought can creep in as you aren’t making your baby happy.

It is hard to handle, but if you are trying and you care then you are a good mom. You have to remind yourself of the times when your baby isn’t crying and the love you feel then. You’re a good mom who is facing a difficult challenge! You are doing your best and that is better then many. Sure it isn’t easy, but you love your baby (especially when they aren’t crying) and you face it each day.Often times it is easy to feel alone when you are dealing with a colicky baby. Few people admit to having a colicky child because they are feeling insecure and alone too. However, you should look for others who are in the same boat as you are. Colic is something that happens to a lot of families and while it is hard to handle, you most certainly aren’t alone. You can even look for groups of moms with colicky babies online for someone to talk
to. Sometimes it is easy to feel like you are doing something wrong or that you are just nuts (”She only cries when she is alone with me!” or “Am I imagining this?”). This can be heightened by family who just doesn’t believe that your little angel is anything but, a little angel. You can get some relief. Leave the baby with the friends and family who don’t believe at the time time your baby is most colicky. Do some errands, take a break, and make it work for you. You won’t feel so alone and you will be sure to find it isn’t just you and you aren’t crazy! While colic isn’t necessarily something wrong with the baby, it sure can feel like it is and as such can make it feel like you have done something wrong.

You may blame yourself or search for something that happened during your
pregnancy or that you are doing wrong that may have “caused” this problem. While
researchers don’t know what causes colic, they do know that it isn’t you. Mom’s
everywhere may feel a little guilty, but they don’t have a right to be. There is
nothing that you could have done to make your baby colicky.

When I was eight months pregnant a very kind woman was talking to me about having the baby. She told me that at one time she was home alone and her daughter had been crying and crying. The crying had grated on her nerves and she suddenly thought about throwing her baby out of the window. She didn’t hurt her baby and felt guilty for thinking of that. When hearing this story I was appalled. I couldn’t believe that this woman was telling me this. She ended her story by telling me it was
okay if I had bad thoughts during a crying episode, as long as I didn’t act on them

In the hospital they showed a movie on shaken baby syndrome and I was amazed. How could people do that to beautiful babies? Then one day Marcus cried and cried and cried. I remembered both the story that was told to me and the shaken babies. While I could never shake a baby, any baby, I suddenly understood what prompted others to shake the babies and try and make the quiet. If you think, “I can’t take this anymore!”, if you yell at your baby, or you think bad thoughts you aren’t alone. It isn’t a good thing, but it is understandable. You should seek help if you need it (after all there are many psychological professionals who liken a colicky baby with post traumatic stress disorder). If you are thinking thoughts often, feeling like you might hurt yourself or your baby. Don’t feel ashamed to get help. However, it is fairly normal and if you just have an occasional thought just remember that you aren’t alone!Colic is a horrible thing to have to deal with. You should think ahead. After all, it isn’t going to happen forever. Over time you will find your baby outgrows the colic
and will soon become a little person, one you will probably like a lot more!

When we read a personal story, a narrative that explains one person's reaction, it can make a deeper impression than all the facts in the world: this Scientific American article helps explain why our brains value the evidence provided by compelling anecdotes over evidence produced by the scientific progress...

The reason for this cognitive disconnect is that we have evolved brains that pay
attention to anecdotes because false positives (believing there is a connection
between A and B when there is not) are usually harmless, whereas false negatives
(believing there is no connection between A and B when there is) may take you
out of the gene pool. Our brains are belief engines that employ association
learning to seek and find patterns. Superstition and belief in magic are
millions of years old, whereas science, with its methods of controlling for
intervening variables to circumvent false positives, is only a few hundred years

Saturday, July 19, 2008

The Washington Post reports that the EPA has updated its assessment of the value of a human life.
Someplace else, people might tell you that human life is priceless. In Washington, the federal government has appraised it like a '96 Camaro with bad brakes.

Last week, it was revealed that an Environmental Protection Agency office had lowered its official estimate of life's value, from about $8.04 million to about $7.22 million. That decision has put a spotlight on the concept of the "Value of a Statistical Life," in which the Washington bureaucracy takes on a question usually left to preachers and poets.
The Consumer Product Safety Commission isn't quite as impressed:
An example of this kind of analysis was used by the federal Consumer Product Safety Commission this year:

A proposal to make mattresses less flammable was expected to cost the industry $343 million to implement. But, a spokeswoman said, the move was also expected to save 270 people. The commission calculated that each life was worth $5 million, which meant a benefit of about $1.3 billion.

That was greater than the expense, she said, so the move made sense.
So, let's see what the cost benefit would be if an effective hospital education for new parents was nationwide and reduced the estimated 300 SBS related deaths by 50%: using the lesser CPSC value, the benefit would be $750,000,000.

The estimated cost of implementing education nationwide ($10 per birth): $41,000,000

The net benefit: $7000,000,000 in savings, even before adding in the costs of prosecuting and incarcerating the perpetrators in those cases.

And before adding in the medical, rehabilitation and educational costs associated with a comparable reduction in the 600 to 900 cases a year where children survive with significant trauma that requires significant caregiving and results in physical and cognitive disabilities (especially learning disabilities that require 12 years of special education costs). Plus even greater costs for prosecution.

And before adding the costs of those children with unrecognized cases of inflicted injury - "mild TBI" - and the resulting costs of special education.

So, spend $41 million, save more than $1 billion.

Not a bad return on investment...

Let your congressional representative know that the SBS Prevention Act also makes compelling economic sense
This isn't really SBS related, but the blog had an interesting post on design awards for a baby bottler holder and a baby pram.

In one case, they did something useful and in the other, they didn't...

As anything which makes caring for a child more frustrating can increase the potential for a parent or caregiver to lose control - frustration is cumulative - I suppose good - and bad - design is related...

Friday, July 18, 2008

Below, a good op-ed by Senator Chris Dodd, who introduced the Shaken Baby Prenvention Act (S. 1204). It ran in the New Haven Register in 2007, but unfortunately remains just as cogent today.

Senator Dodd: Stopping Child Abuse Before It Starts

May 25, 2007

Two-month-old Amanda was in grave danger from the day she was born. Her mother, a Connecticut resident, had a long history of physically abusing her children; she had already lost custody of nine of them. But Amanda was a newborn, and protective services couldn’t save her. On January 23, 2006, her 2 a.m. hunger cries enraged her father; and Amanda’s mother only looked on as he viciously took her life.

While Amanda is now beyond our power to protect, let’s remind ourselves that we still have the means to defend children like her—to stop abuse before it starts. True, the task is a daunting one: Numbers released last month by the Department of Health and Human Services reveal that nearly 900,000 American children were abused or neglected last year. We don’t know how many more thousands of victims were hidden from the child protective services. But we do know that abuse or neglect killed almost 1,500 children last year. And the youngest, like Amanda, suffer most: More than three quarters of those killed were younger than four.

Each year we spend billions to protect those children who have been so injured, so endangered that home is no longer safe. No one grudges that expense. But fighting child abuse is a lot like fighting sickness: We can pay exorbitantly to fight the advanced symptoms of disease, or we can seek preventive medicine. In far too many cases, we choose the first approach—and we wait to step in until the abuse has boiled over.

A preventive approach would require the work of whole communities. Government, teachers, businesses, doctors, clergy, friends, neighbors—they would all have a role to play, working together to create communities that care about children and offer parents the resources they need. We know that reducing the pressures on parents makes abuse much less likely: A 2005 study by the National Center on Child Abuse and Neglect found a link between parental stress and child maltreatment.

Those services—like home visits, respite care, and parent support groups—can help parents solve problems before they become crises. Rather than intervening when it may be too late, preventive services aim to strengthen families from the start. Primary medical checkups, for instance, don’t just keep children healthy and immunized—they help parents learn how to care for their children. Respite care doesn’t just keep children secure—it helps moms and dads deal with the inevitable stress of parenting. Above all, preventive services draw parents into a sense of community and belonging, giving them the tools to navigate an often isolating environment.

One outstanding effort is the shaken baby prevention program led by the Connecticut Children’s Trust Fund. The Children’s Trust Fund raises awareness of this deadly form of child abuse by offering home visits, educational programs in schools, and videos for new parents in hospitals. And a bill I’ve introduced—the Shaken Baby Syndrome Prevention Act—would strengthen efforts like those by launching a nationwide prevention campaign.

With this new, forward-looking approach, communities across America are pioneering similar family-friendly strategies to keep abuse down:

Organizing support groups for new parents;
Offering paid or unpaid family leave for the birth of a new baby;
Promoting volunteerism to assist early childhood programs in the community;
Seeking on-site child care or child care vouchers from employers;
Developing partnerships with local Head Starts, Boys and Girls Clubs, and other community programs serving young children and their families.

But services like these are just the first small steps—truly preventing child abuse will require a much larger effort.

Let’s be honest: It will cost us up-front. But all good investments do. We can pay comparatively little now for child abuse prevention: early-childhood programs, assistance to new parents, and community-based help for overburdened families. Or we can pay much more for the aftermath of abuse: protective services, foster care, law enforcement, courts, prisons, and treatment for adults recovering from abuse. To any smart investor, the choice is obvious.

But compassion compels our choice, as well. When we wait for abusers to make the first move, children like Amanda suffer; all too often, they die. For the sake of their memory, the first move must be ours.

Wednesday, July 16, 2008

Summer reading, part III - Prevent Child Abuse America makes it easy to support the Education Begins At Home Act.

April 1, 2007

Preventing harm requires two things: knowing what NOT TO do, and knowing what TO do -the "do's" and the "don'ts".

Hospital education about SBS does the first. There is clear evidence that home visiting programs do the second [including this recent RAND report]. This legislation will help expand home visiting programs.

From PCAA's Prevention Advocate

Take Action on the Senate Home Visitation Legislation
Ask Your Senators to Cosponsor S. 667

Please ask your Senators to cosponsor the Education Begins at Home Act (EBAH, S. 667), recently reintroduced in the Senate by Senators Kit Bond (R-MO) and Hillary Clinton (D-NY). EBAH would establish the first dedicated federal funding stream to support parents with newborns and young children through quality, voluntary home visitation. If enacted, EBAH would extend to a broad range of families the opportunity to benefit from home visiting programs like Healthy Families America. Making quality home visitation programs more widely available in all communities is one of Prevent Child Abuse America’s top priorities.
As of March 27th, the following Senators have already joined Senators Bond and Clinton as cosponsors to S. 667: Senators Jeff Bingaman (D-NM), Benjamin Cardin (D-MD), Susan Collins (R-ME), John Kerry (D-MA), Claire McCaskill (D-MO), Pat Roberts (R-KS) and John Rockefeller (D-WV). If your Senator is on this list, please be sure to thank him/her.


Why Congress Should Pass EBAH:

Home visitation is an effective, evidence-based, and cost-efficient way to bring families and resources together and help families to make choices that will give their children the chance to grow up healthy and ready to learn.
Home visitation delivers parent education and family support directly to parents with young children in their homes providing guidance on how parents can enhance their children’s development from birth through kindergarten entry.
Quality early childhood home visitation programs lead to proven, positive outcomes for children and families, including improved child health and development, improved parenting practices, improved school readiness, and reductions in child abuse and neglect.
Existing home visitation programs like Healthy Families America serve only a small percentage of families in need of prevention and family support services. EBAH dollars would enable programs to reach thousands more families who have very young children -- the same cohort of children that suffers disproportionately from abuse and neglect in this country.
Take Action on EBAH!
Take action by e-mailing your Senators through Prevent Child Abuse America’s Legislative Action Center. Prevent Child Abuse America has created a sample e-mail asking Senators to cosponsor EBAH that we encourage you to personalize. All Senators can (and should) be asked to cosponsor the EBAH. Support from the Senate Health, Education, Labor and Pensions (HELP) Committee is crucial, however, because it has jurisdiction over the legislation and can move EBAH forward.

Edward M. Kennedy (MA), Chair
Christopher J. Dodd (CT)
Tom Harkin (IA)
Barbara A. Mikulski (MD)
Jeff Bingaman (NM)
Patty Murray (WA)
Jack Reed (RI)
Hillary Rodham Clinton (NY)
Barack Obama (IL)
Sherrod Brown (OH)

Bernard Sanders (VT)

Michael B. Enzi (WY), Ranking Member
Judd Gregg (NH)
Lamar Alexander (TN)
Richard Burr (NC)
Johnny Isakson (GA)
Lisa Murkowski (AK)
Orrin G. Hatch (UT)
Pat Roberts (KS)
Wayne Allard (CO)
Tom Coburn
It's summer - time for some reruns...

A reminder about the SBS Prevention Act of 2008

April 28, 2007
SBS Prevention Act of 2007 - Support
By geolith

The Shaken Baby Prevention Act of 2007 was introduced in Congress this week: Senate bill S.1204 (Dodd) on Wednesday -House bill HR 2052 (Lowey) on Thursday. It's a first: a national awareness and education initiative to prevent Shaken Baby Syndrome and other inflicted head trauma.

Some suggestions for garnering support:

- email and call your Senators and your Representative. Ask them to "cosponsor" those bills [not just to "vote" for it if it gets to the floor: the more cosponsors, the speedier a bill goes from committee to the floor].

- engage local and state elected officials. Ask them to contact federal legislators and urge support.

- begin some "buzz": visit websites of the local papers in your area and write a letter to the editor to let people know why it's a good idea; contact journalists who cover SBS cases; post to blogs read by parents; if you have educated a group about SBS, ask them to write their legislators and tell them why they should support prevention education.

- email friends and relatives, especially in other states, asking that they email their federal legislators and ask for support.

And please email Senator Dodd and Congresswoman Lowey thanking them for their initiative.

Contact info for federal legislators:

For the text of the bills search [shaken]

[110th]H.R.2052 : To enhance Federal efforts focused on public awareness and education about the risks and dangers associated with Shaken Baby Syndrome.
Sponsor: Rep Lowey, Nita M. [NY-18] (introduced 4/26/2007) Cosponsors (33)
Committees: House Energy and Commerce
Latest Major Action: 4/26/2007 Referred to House committee. Status: Referred to the House Committee on Energy and Commerce.

[110th]S.1204 : A bill to enhance Federal efforts focused on public awareness and education about the risks and dangers associated with Shaken Baby Syndrome.
Sponsor: Sen Dodd, Christopher J. [CT] (introduced 4/25/2007) Cosponsors (8)
Committees: Senate Health, Education, Labor, and Pensions
Latest Major Action: 4/25/2007 Referred to Senate committee. Status: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

From their joint announcement of introduction

Senator Chris Dodd (D-CT), a senior member of the Senate Health, Education, Labor, and Pensions Committee, and the Chairman of its Children and Families Subcommittee, today introduced the Shaken Baby Syndrome Prevention Act of 2007.

Shaken Baby Syndrome (SBS) describes the trauma resulting from the violent shaking or abusive impact to the head of an infant or young child. SBS is a form of child abuse affecting between 1,200 and 1,600 children every year, of which between one-quarter and one-third will die and another one-third will suffer permanent, severe disabilities. Senator Dodd’s legislation would establish a national public health campaign to raise awareness about SBS, encourage prevention programs and provide preventative support for parents and caregivers, and provide support to families affected by abusive head trauma incidents. Congresswoman Nita Lowey (D-NY) introduced companion legislation in the House of Representatives.

“Young children are America’s most vulnerable citizens, and it is our responsibility to do everything in our power to protect them,” said Dodd. “Shaken Baby Syndrome is completely preventable, and I am hopeful that by educating parents, caregivers and the general public about the dangers of shaking a child, we will be able to eliminate this form of cruel and senseless abuse from our society.”

“Shaken Baby Syndrome tears apart families and impacts the lives of thousands of young children each year," Lowey said. "However, with better education for parents and other caregivers, we can dramatically curb this horrible form of abuse.”

Posted on: Sat, Apr 28 2007 5:32 AM
Babyzone features an excerpt from The Colic Chronicles, an insight into the world of a mom coping with a colicky baby and post-partum depression.
[Update - Mama Speaks also has a good review...]

It's an important perspective to share with new parents: colic is cited as a key precipitating factor in many shaking cases, and the feelings of failure, isolation and depression that accompany PPD makes caregiving harder for all of the family.

Knowing that others have dealt with the same issue, and learning about their coping techniques, can't help but put things into better perspective.

So many books today focus on soothing the baby but what about the poor soul who is trying to care for that baby! That is where The Colic Chronicles comes in. Tara shares some helpful hints, professional advice, and important mommy self-care tips and delivers all in a fun and easy-to-read style. Included in the appendix is a copy of "The Colic Commandments," a colic countdown calendar, and numerous references for making mom's life easier.

PS. I do wish that Babyzone included some reminders in its checklist that parents need to talk to other caregivers about colic (and teething, vaccinations, etc.), the feeling of frustration and anger that can result and help them prepare a coping plan.

Disclosure: when the book was in progess, we discussed the links between SBS and colic with the author, Tara Kompare. She is generously making a contribution to the SKIPPER Initiative.

Monday, July 14, 2008

The "English Nanny", Redux...

A nanny assaulted a baby, leaving him with a brain injury and a broken arm, after being hired to look after him during London Fashion Week, a court heard today.

Jasmin Schmidt, 32, told the baby's mother that he had been restless during the night and she had attempted to swaddle him in a blanket.

But the mother noticed the two and a-half-month-old was pale and had gone blue around his eyes, the Old Bailey heard.

Miss Schmidt, of Primrose Hill, denies two charges of grievous bodily harm with intent against the North Yorkshire baby, who cannot be identified.
From KETV in Omaha, Nebraska, a tale of redemption, I suppose. It is welcome to see a father accept responsibility for caring for the child he injured..

KETV has a video showing what Summer's life is like now...

Father Says Moment Of Anger Changed Course Of His Life
Avoiding Shaken Baby Syndrome: A Father's Story

POSTED: 8:42 pm CDT July 14, 2008

OMAHA, Neb. -- It seems once a month, you flip on the news and see the story of a child who's become a victim of Shaken Baby Syndrome.

Sometimes there's a mugshot of the accused, or a brief video of the home or day care where the alleged abuse took place. There's usually a quick condition report on the child, if the abuse doesn't kill them.

What happens to the babies who survive these devastating traumatic brain injuries?

"A third die, and that middle third, their injuries are just horrific," said Dr. Jeff DeMare, a child abuse expert at Omaha's Children's Hospital.

Summer Fuson is one of those children who nearly died after a violent encounter with her father. The 9-year-old was adopted by her paternal grandmother when she was an infant, after suffering traumatic brain injuries that left her mostly blind and unable to walk, talk or eat.

"I felt horrible," said Robbie Fuson, who served eight months in prison for injuring his daughter.

Robbie recently sat in his mother's duplex, rocking his young daughter in a large upholstered rocking chair. Every few minutes, he'd readjust her head, or rearrange her legs to keep the girl comfortable. She had no control over her arms or legs. Her eyes seemed to drift towards the light and she constantly tried to find her mouth with her thumb.

Robbie offered no excuses for causing the devastating injuries to his daughter, only an explanation of the desperate life he was living and the lasting impact on his life.

He said he was a teenaged father and his life was in a downward spiral as he worked three jobs and started using and selling drugs. Summer's mother, Amy Hajek, was found murdered in a ditch in Fremont about a year after Summer was injured. The homicide case remains unsolved eight years later.

Robbie said neither of them had any parenting experience. "It's a rough road to go down and I hope nobody else has to do it," he said.

Robbie now works third shift as a sanitation worker in a meat-packing plant. He has a 6-year-old daughter and he's married.

Has he forgiven himself for Summer's injuries? "As much as you can," he said. But he said society is not as forgiving.

"You just live day to day because most people find out what you've done and they look at you in a different light. They say you're such a horrible person," said Robbie.

Robbie agreed to talk about his daughter to try to prevent other parents and caregivers from making the same mistake. "If you're getting frustrated with your kids, take a break. Go outside. Cool off. Think before you do anything. Definitely think," he said.

He credits anger management classes, parenting classes and living a drug-free life for his turn around. He said getting older has also helped him appreciate his past mistakes and learn from them. He said if caregivers have anger issues, seek counseling.

"I'm not a bad guy. I was just confused when I was younger," said Robbie.

Sandy Fuson said there was a time she would not allow her son to see his daughter. "He's come full circle where he's welcome to be a part of her life. And she welcomes him into her life," Sandy said.

The grandmother works full time and takes Summer to Children's Respite Care center where nurses oversee her medical care each weekday. The mother and son live just a block away from each other in Fremont, allowing them to stay connected.

"It's a great thing to forgive and move on and try to be the whole family you want to be," said Sandy.

Sunday, July 13, 2008

I found this article on From a medical standpoint, I see merit in standardizing on a descriptive label. From an advocacy standpoint, I think SBS rings better and is truer to the goal of engaging parents.

And I emphatically disagree that that SBS is a "benign" term: if anything, medical terminology such as "ICN" is opaque and sterile to parents and caregivers - in a world where the Surgeon General acknowledges that only 13% of the American population has "proficient health literacy", and health information is usually presented at sixth to eighth grade reading levels, those terms are likely to be incomprehensible.

See the Surgeon Generals report on Improving Health Literacy for some ideas on what we need to do to improve health communications

And it's not medical professionals who have to be engaged by a prevention campaign: it's parents, and "discourse" is not what effective education is about....

ANS Adv Nurs Sci. 2008 Apr-Jun;31(2):E1-8. Links
Inflicted childhood neurotrauma.Fiske EA, Hall JM.
Carson-Newman College, Jefferson City, Tennessee 37760, USA.

In this article, we review literature related to inflicted childhood neurotrauma (ICN). We discuss the rationale for use of the term "ICN," rather than the more benign, commonly used "shaken baby syndrome." The change in language alters the discourse about a potentially lethal outcome or lifelong problem for survivors. A description of ICN is followed by a discussion of ethical parameters and obligations of those who care for infants and children and professionals who are sentinels to these events such as law enforcement officials, nurses, physicians, and social workers.
And a couple of interesting sleep related studies ... one finding that maternal depression during pregnancy, breastfeeding and a lower socioeconomic status are all associated with less infant sleep duration in the first six months of life, and one finding that parents don't sleep well with if they're sharing a bed.

In the first study, researcher Michael D. Nevarezat of Harvard Medical School found that

..infants' mean sleep duration at six months, including daytime naps and nighttime
sleep, was 12.2 hours per day. Less household income and lower maternal
education were associated with shorter infant sleep duration.

Compared with Caucasian infants, African-American infants slept 0.94 fewer total hours per
day. Also, African-American, Hispanic, and Asian infants slept more hours during
daytime naps but fewer hours at night. Infants whose mothers had a history of
depression during pregnancy and those who were being breast-fed at six months
appeared to sleep fewer total hours per day.

* * *As with other complex pediatric conditions such as obesity, the amount of sleep children obtain, even during infancy, may have larger socioeconomic and cultural contexts that warrant consideration.

NB. It would have been interesting to see how the sleep patterns of infants and mothers correlate...

In the second study, researcher Molly Countermine, of Penn State University, focused on 45 families with infants between one and 24 months, and found adaptation (measured by parents' satisfaction with infants' sleep location, and bedtime and nighttime behavior) was poorer when infants spent any part of the night with their parents. That was true even when parents endorsed bedsharing.

It suggests that when infants are close at hand, parents presumably get less sleep, which does not seem to be a good mix.

[Interestingly, there is an Associated Professional Sleep Societies (APSS)].

NB. More research about the quality and quantity of parental sleep, and the effect that sleep deprivation has on the behavioral control of parents, would really be interesting. And useful.
An interesting study by way of

The researchers [Juhee Kim, a University of Illinois community health professor, and Karen Peterson, a professor of nutrition and society at Harvard University’s School of Public Health] classified a large sample of 9 month old infants by whether they were in child care, care by relatives or parental care.

They found those infants who routinely receive non-parental care – provided by relatives, licensed day-care centers or informal child-care providers – were likely to experience higher rates of unfavorable feeding practices and weigh more than those infants whose parents (OK, we know they really meant mothers, don't we?) were primary caregivers.

Of special note:

First, this study confirms how important it is that a prevention strategy reach child care providers with awareness and education information.

The study looked at a nationally representative sample of 8,150 9-month-old infants and found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care.

Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months [thus, around 40% of the sample had another caregiver during the peak period for colic - and SBS], and 21 percent at 6 months or older.

Second, the researchers point out the importance of proactive communication between providers and parents. Another area where modeling those behaviors can help caregivers engage parents in communication. Once that conversation begins, it can extend to other ways to keep children safe.

Third, it suggests that non-parental caregivers might be feeding just to calm infants. Not the worst outcome, but worth considering...

Non-parental Care Of Infants Tied To Unfavorable Feeding
ScienceDaily (July 13, 2008) — With more new mothers in the workplace than ever before, there has been a corresponding increase in the number of child-care facilities in the United States.
At the same time, data from a variety of sources point to a growing prevalence of overweight infants and toddlers.
Is there a connection?
According to a new study co-written by University of Illinois community health professor Juhee Kim and Karen Peterson, a professor of nutrition and society at Harvard University’s School of
Public Health, child-care factors and feeding practices may indeed play a role.
“Our study is the first to report, to our knowledge ... the potential importance of infant child care on infant nutrition and growth,” the researchers said in an article published in the July issue of the Archives of Pediatrics & Adolescent Medicine, a publication affiliated with the Journal of the
American Medical Association. “The results of this study indicate that structural characteristics of child care, such as age at initiation, type and intensity, were all related to infant feeding practices and weight gain among a representative sample of U.S. infants.”
Specifically, Kim and Peterson found that 9-month-old infants who routinely receive non-parental care – provided by relatives, licensed day-care centers or more informal child-care providers – may experience higher rates of unfavorable feeding practices. The babies also weigh
more than those whose primary caregivers are their parents.
The researchers’ findings could have significant public-health ramifications, as weight gain in
infancy can ultimately be a predictor of obesity later in life.
Obesity, in turn, is linked to a number of chronic illnesses, such as diabetes and
hypertension, as well as adulthood morbidity and mortality.
In their study, Kim and Peterson analyzed baseline data from a nationally representative sample
of 8,150 9-month-old infants to determine whether infant-feeding practices and non-parental care might be a factor in the rise in weight of the infants. They used data collected for children enrolled in the Early Childhood Longitudinal Study, Birth Cohort, conducted by the U.S. Department of Education’s National Center for Education Statistics.
Kim and Peterson found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care. Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months,
and 21 percent at 6 months or older.

“Weight gain and the prevalence of overweight were lowest among infants who received care by parents,” the researchers noted in the published article.
The researchers also examined data regarding breastfeeding initation for babies receiving parental and non-parental care, along with the stage at which solid foods were introduced to
the infants. Only starting solid foods before 4 months of age was associated with increased overweight among infants.
“Infants who initiated child care before 3 months of age had lower rates of ever having been breastfed and higher rates of early introduction of solid foods,” they wrote. “Infants in parental
care were more likely to have breastfeeding initiated and solid foods introduced after 4 months of age compared with those in child-care settings.”
Further, infants in part-time child care gained more weight – 175 grams – by 9 months of
age, compared with those receiving only parental care. Those being cared for by relatives also showed a weight gain – 162 grams.
“A strength of our findings,” the researchers noted, “is that the observed effects of child-care
factors remained significant after controlling for maternal pre-pregnancy BMI (body mass index) and a child’s birth weight.”
“Although both factors are known to be strong predictors of childhood overweight status, in our study, only birth weight was a significant factor in weight gain.”
Kim said there are a couple of important take-home messages from their research results for parents and child-care providers.
Parents may (may?) want to have enough communication with child-care providers about when, what and how to feed their babies during their stay in day care, which is important to avoid potential risk of overfeeding or underfeeding at home,” she said.
Child-care professionals can encourage parents’ active involvement in the decision process of what, when and how to feed infants. Child-care providers also need to participate in nutrition-education/training programs to understand the importance of starting solid foods, transition from breast milk or formula to foods, and how to implement recommended practices to ensure a healthy eating environment.”
Kim hopes to be able investigate relationships among child care, feeding practices and weight gain in children in other parts of the world.
“It would be interesting to conduct a cross-cultural study,” she said. “Considering eating is
a socio-economical and cultural event, the impact of child care on infant feeding practices – food consumption – might be different among different countries.”
The current research was supported in part by the Berkowitz Fellowship of the department of nutrition, Harvard School of Public Health; an Early Childhood Longitudinal Study, Birth Cohort training grant from the National Center for Education Statistics; and training grants on statistical
analysis for education policy from the American Educational Research Association.
Adapted from materials provided by University of Illinois at Urbana-Champaign.

APA MLA University of Illinois at Urbana-Champaign (2008, July 13). Non-parental Care Of Infants Tied To Unfavorable Feeding Practices. ScienceDaily. Retrieved July 13, 2008, from­ /releases/2008/07/080711125729.htm

Here's an interesting story from Florida - 18 families auditioned to have a TV nanny teach them how to handle their children...
Frustrated parents came from Cape Coral, Lehigh Acres, Naples and Fort Myers for a shot at getting Nanny Jo, a gentle yet firm nanny from England, to help control their children.

*** Ast said she would call one or two families Saturday night and make arrangements to spend Sunday with them, filming their every move.

Then, she would travel back to California where a decision would be made whether to continue with a Southwest Florida family. And it’s possible, she said, if enough people from the area apply online at, she would be sent back to the area for even more interviews.

*** “I learned a lot from it,” he said of Super Nanny coming to his home. “It’s helped many families.”

His boys are much better behaved and act like nice young men, shaking hands and answering questions without grumbling about it.

The biggest thing Christiansen learned from Nanny Jo?

“It’s the parents,” he said of children’s behavior being out of control. “You have to be on the same wavelength. The bottom line is communication.”

This certainly seems to suggest that the need for parenting education and parent support skills is relatively widespread.
The Ontario Injury Prevention Resource Centre (which has some excellent injury prevention resources available to share with the rest of the world - "Thanks, Ontario!") has made the text, Powerpoint and audio available for an interesting presentation by Ron Barr on the Prevention of Shaken Baby Syndrome.

It provides a lot of context for the relationship of infant crying and SBS. The site summary of Dr. Barr's presentation is below.

The presentation discusses the use of the PURPLE campaign materials developed by the National Center (since I can't find the R in a circle font character used for that purpose, I should note that PURPLE is a registered trademark, presumably owned by the Center), which are being used in regional parent education programs in British Columbia, North Carolina and Utah.

It will be interesting to see the evaluations of those implementations and compare the effectiveness of that model with the Dias hospital-based prevention model developed at Children's Hospital of Buffalo in 1998 .

It was reported in Pediatrics, discussed as a model prevention program by the JCAHO newsletter, and was the model for state legislation now being implemented statewide in New York, Pennsylvania and Wisconsin.

The Pennsylvania project and the North Carolina project were funded by CDC in 2007.

The NACHRI site has an interesting article discussing various models for hospital-based SBS education.

Infant Crying and Shaken Baby Syndrome: The Evidence Base for Implementing the
“PURPLE” Prevention Program

May 6, 2008 - Dr. Ronald G. Barr

Ronald Barr MA, MDCM, FRCP(C) is the Canada Research Chair in Community Child Health Research at the University of British Columbia, Professor of Pediatrics in the Faculty of Medicine at UBC, and Director of the Centre for Community Child Health Research at the Child and Family Research Institute of the BC Children’s Hospital.

In addition, he is the Director of the “Experience-based Brain and
Biological Development” Programme of the Canadian Institute for Advanced
Research. Both his clinical work and research have focused on the needs of
infants and young children. He is well-known for his studies on the biological
and behavioral determinants of behavior, including pain, behavioral state and
crying, cognition and memory, as well as for the outcomes of early clinical
manifestations of these behaviors for later development (temperament,
reactivity). In addition, his current interests include primary community
prevention of Shaken Baby Syndrome.

* * *

The teleconference will focus on providing the evidence base behind
the primary community educational program called the Period of PURPLE Crying,
designed to prevent shaken baby syndrome and infant physical abuse, especially
under 1 year of age. It will briefly review

(1) the seriousness of shaken baby syndrome (abusive head trauma);
(2) the evidence for the normality of early increased crying in infancy;
(3) the relationship between increased crying and shaken baby syndrome;
(4) the components of the PURPLE programme;
(5) the conceptual frame behind the PURPLE program;
(6) preliminary results from an RCT to assess its ability to change
knowledge and behaviors relevant to SBS prevention; and
(7) the elements of
implementation throughout a jurisdiction.

Session Materials
Session OutlinePowerPoint SlidesPDF Slides Audio of session

Thursday, July 10, 2008

The first newsletter of the Brain Injury Task Force is available at Micheal Kaplen's Brain Injury Blog. It doesn't discuss Shaken Baby Syndrome, but it does discuss pending legislation that would provide support and service for those with brain injuries...