And here's an interesting blog entry that looks at the effect of depression on parenting.

And it's not just mothers

And a study reported in Pedatrics found that when we don't deal with neglect in the early years of life, it comes back to haunt us. Researchers at the Univ. of Maryland School of Medicine (MD MDs) found that failure to care properly for a young child can be as damaging as physically or sexually abusing them, when it comes triggering aggression in later childhood.

One more reason to prevent child abuse: a new study suggests that being maltreated in childhood contributes to the co-occurrence of depression and inflammation later in life. According to UK researchers, this finding should help identify depressed adults with elevated inflammation levels who have a greater risk for cardiovascular disease.

The SBS Awareness Week resolution was adopted by the Senate on Monday, April 21.

Most importantly, it recognizes those hospitals, child care centers and schools which are helping educate parents and caregivers about the danger of shaking and what they can do to help protect children from shaking injuries.

Our thanks to Senator Dodd for sponsoring the resolution and Senators Alexander and Kennedy for joining as cosponsors of the Resolution.

S.RES.518
Title: A resolution designating the third week of April 2008 as "National Shaken Baby Syndrome Awareness Week".
Sponsor: Sen Dodd, Christopher J. [CT] (introduced 4/16/2008) Cosponsors (2)
Related Bills: S.RES.163
Latest Major Action: 4/21/2008 Passed/agreed to in Senate.
Status: Resolution agreed to in Senate without amendment and with a preamble by Unanimous Consent.
COSPONSORS(2)
Sen Alexander, Lamar [TN] - 4/18/2008
Sen Kennedy, Edward M. [MA] - 4/21/2008

S. RES. 518
Designating the third week of April 2008 as `National Shaken Baby Syndrome Awareness Week'.
IN THE SENATE OF THE UNITED STATES
April 16, 2008
Mr. DODD submitted the following resolution; which was referred to the Committee on the Judiciary
--------------------------------------------------------------------------------
RESOLUTION
Designating the third week of April 2008 as `National Shaken Baby Syndrome Awareness Week'.
Whereas the month of April has been designated `National Child Abuse Prevention Month' as an annual tradition initiated in 1979 by President Jimmy Carter;
Whereas the National Child Abuse and Neglect Data System figures reveal that more than 900,000 children were victims of abuse and neglect in the United States in 2006, causing unspeakable pain and suffering for our most vulnerable citizens;
Whereas more than 4 children die as a result of abuse or neglect in the United States each day;
Whereas children younger than 1 year old accounted for approximately 44 percent of all child abuse and neglect fatalities in 2006, and children younger than 3 years old accounted for approximately 78 percent of all child abuse and neglect fatalities in 2006;
Whereas abusive head trauma, including the trauma known as Shaken Baby Syndrome, is recognized as the leading cause of death among physically abused children;
Whereas Shaken Baby Syndrome can result in loss of vision, brain damage, paralysis, seizures, or death;
Whereas 20 States have enacted statutes related to preventing and increasing awareness of Shaken Baby Syndrome;
Whereas medical professionals believe that thousands of additional cases of Shaken Baby Syndrome and other forms of abusive head trauma are being misdiagnosed or are undetected;
Whereas Shaken Baby Syndrome often results in permanent, irreparable brain damage or death of an infant and may result in extraordinary costs for medical care in only the first few years of the life of the child;
Whereas the most effective solution for preventing Shaken Baby Syndrome is to prevent the abuse, and it is clear that the minimal costs of education and prevention programs may prevent enormous medical and disability costs and immeasurable amounts of grief for many families;
Whereas prevention programs have demonstrated that educating new parents about the danger of shaking young children and how to protect their children from injury can significantly reduce the number of cases of Shaken Baby Syndrome;
Whereas education programs raise awareness and provide critically important information about Shaken Baby Syndrome to parents, caregivers, childcare providers, child protection employees, law enforcement personnel, health care professionals, and legal representatives;
Whereas National Shaken Baby Syndrome Awareness Week and efforts to prevent child abuse, including Shaken Baby Syndrome, are supported by groups across the United States, including groups formed by parents and relatives of children who have been killed or injured by shaking, whose mission is to educate the general public and professionals about Shaken Baby Syndrome and to increase support for victims and the families of the victims in the health care and criminal justice systems;
Whereas the Senate previously designated the third week of April 2007 as `National Shaken Baby Syndrome Awareness Week'; and
Whereas the Senate strongly supports efforts to protect children from abuse and neglect:

Now, therefore, be it
Resolved, That the Senate--

(1) designates the third week of April 2008 as `National Shaken Baby Syndrome Awareness Week';

(2) commends hospitals, child care councils, schools, community groups, and other organizations that are--
(A) working to increase awareness of the danger of shaking young children;
(B) educating parents and caregivers on how they can help protect children from injuries caused by abusive shaking; and
(C) helping families cope effectively with the challenges of child-rearing and other stresses in their lives; and

(3) encourages the people of the United States--
(A) to remember the victims of Shaken Baby Syndrome; and
(B) to participate in educational programs to help prevent Shaken Baby Syndrome.

Senator Dodd introduced the 2008 SBS Awareness Week resolution in the Senate on Wednesday, April 16, designating the third week of April 2008 as `National Shaken Baby Syndrome Awareness Week'. S. RES. 518

[It was adopted on April 21 without ado]

Now, it would be a good thing to call your Senators and ask them to join Senator Dodd in sponsoring S.1204 The Shaken Baby Syndrome Awareness Act of 2008.

Want a good use of free weekend minutes? Call your Senators and your Congress person at their DC offices over the weekend and leave a message - phone numbers are listed on http://www.congress.org/)

Kudos to the Florida Department of Health, the Department of Children and Families, and Healthy Start, which joined to recognize SBS Awareness Week 2008

Shaken Baby Syndrome Posted: 12:22 PM Apr 16, 2008 Reporter: Luciana Da Silva Email Address: luciana.dasilva@wjhg.com A crying baby can be stressful for many parents and caregivers, but there are proper and safe ways to calm your baby's tears. The Florida Department of Health, the Department of Children and Families, and Bay County's Healthy Start program is recognizing this week as Shaken Baby Syndrome Awareness Week. The goal is to educate parents and caregivers about the effects of shaking a baby. Shaken Baby Syndrome is one of the most common causes of death by physical abuse to children in Florida. About 80 percent of Shaken Baby Syndrome cases are caused by young men and caregivers. Shaken Baby Syndrome sometimes happens when a frustrated caregiver loses control and violently shakes a young child. The shaking can cause permanent brain damage or death, but it can also happen anytime your baby's head is not properly supported. Sharon Owens, Executive Director of Healthy Start, said, "If you're going to leave your baby with someone just make sure they know how to best get your baby to stop crying and know what to do. Put down the baby safely, make sure its basic needs are being taken care of, and walk away from the situation for just a few minutes and make sure the baby is safe." The death of a child can be something very difficult to deal with, which is why healthy start is trying to put together a grief support group for families in this situation. If you would like to help start this program or if you have experienced a loss of a child and need support, contact Healthy Start at 1-800-895-9506.

Find this article at: http://www.wjhg.com/news/headlines/17811069.html

The Juceam family, both individually and with family and friends who've joined in support of the Hannah Rose Foundation, is working successfully to increase awareness in California.

Take a peek at this article from the Auburn Journal.

This press release has made the rounds fairly well, even turning up on a Bulgarian website, but it's worth repeating...

Leading Experts Investigate Shaken Baby Syndrome

ScienceDaily (Apr. 10, 2008) — Shaken Baby Syndrome (SBS), also known as childhood neurotrauma or inflicted traumatic brain injury, is the leading cause of death from childhood maltreatment. Unlike many types of child abuse, the action that causes SBS is known, occurs quickly, and is, theoretically, largely preventable.

An international symposium sponsored by the National Center on Shaken Baby Syndrome examined how to establish the incidence of inflicted traumatic brain injury in young children and explored issues of definitions, passive versus active surveillance, study designs, proxy measures, statistical issues and prevention. Key findings are published in a Special Supplement to the April 2008 issue of the American Journal of Preventive Medicine.

SBS is a form of intentional injury to infants and children caused by violent shaking with or without associated contact with a hard surface. The mortality rate of victims of this intentional brain injury is about 25%, while survivors do very poorly. In a recent Canadian study, investigators found that after 10 years only 7% of the survivors were reported as "normal," 12% were in a coma or vegetative state, 60% had a moderate or greater degree of disability and 85% would require ongoing multidisciplinary care for the rest of their lives.

Guest Editors Robert M. Reece, Desmond K. Runyan, and Ronald G. Barr and an international group of authors significantly contribute to the increasing visibility of violence against children in general and child maltreatment in particular. They state that although prevention has been a highly desired but elusive goal in the field of child abuse, the apparent potential for prevention of inflicted childhood neurotrauma in particular through universal educational initiatives, both in North America and potentially around the world, has contributed considerable urgency to the importance of addressing these challenges. The symposium participants who convened to address these measurement issues were very cognizant of these challenges.

Presentations addressed two main themes: (1) the adequacy of current and/or projected systems for measuring the incidence of shaken baby syndrome; and (2) a review of available strategies for evaluating the effectiveness of primary programs for its prevention in large jurisdictions.

Reece addressed the complex issue of nomenclature variants and how they might (or might not) be integrated. Runyan described the challenges and emerging evidence concerning rates of the caregiving risk behavior of shaking. Keenan, Minns and Trent described their experiences with active and passive surveillance systems. Bennett described the countrywide Canadian Pediatric Surveillance Program, and Ryan described the design and proposed use of the Department of Defense Birth and Infant Health Registry to measure inflicted childhood neurotrauma.

To assess strategies for evaluating the effectiveness of prevention programs in large jurisdictions, Rivara presented the strengths, weaknesses, and potential pitfalls of available designs applicable at a jurisdictional level, and Shapiro discussed whether case control designs used successfully in disease prevention research could be applied to SBS. Finally, Ellingson, Leventhal, and Weiss described comparative rates derived from retrospective passive surveillance data sets to those derived from prospective active surveillance studies, and Runyan, Berger and Barr provide an integrative proposal for the "ideal system" to measure inflicted neurotrauma incidence.

[As someone who wishes hospital education had started at my end of New York in 1998, instead of Buffalo, I have to point out that while there's nothing wrong with pursuit of a perfect system, in a real world of limited resources, things largely function on the principle of satisficing behavior: educate parents first, evaluate second. The second worst thing that could happen is finding out that it doesn't work; the worst is finding out that it did work, but that children died because it wasn't done quickly, completely or effectively...]

These articles appear in a Special Supplement to the American Journal of Preventive Medicine, Volume 34, Issue 4 (April 2008), Supplement 1, published by Elsevier.

The Symposium was supported by the Doris Duke Charitable Foundation of New York and the Centers for Disease Control and Prevention (CDC). The Supplement was supported by the Division of Violence Prevention, National Center for Injury Prevention and Control (NCIPC) at the CDC, Atlanta. [Thanks, DDCF and CDC!]

This is a good column by Silas Lyons in the Redding Record Searchlight, followed by some comments I emailed to him.

We need more folks to write columns like this to bring "The Moment" out of the closet (hopefully, it will emerge with a coping plan in hand ....)

Lyons: A word can help young parents cope

Redding Record Searchlight

http://www.redding.com/news/2008/apr/13/a-word-can-help-young-parents-cope/

By Silas Lyons, Columnist (Contact)
Sunday, April 13, 2008

Any honest parent will tell you that not every moment with a newborn is pure joy.

Those little voices of theirs, gathered into raspy, screeching cries, are designed to scratch at the soft lining of our inner ears until we do something.

Add exhaustion, disorientation and a sense of inadequacy -- as in, I have no idea what I'm doing and I'm sure I'm already screwing up -- and you can quickly begin to lose perspective. The love and protectiveness you feel begin to cloud over with frustration and helplessness.

I know I had those moments with Emerson. I'd find myself scooping him up and gritting my teeth, digging deep for will-power just to relax and hold him and let the feeling pass.

It happens. It's normal. Good pediatricians and parenting books try to prep you for it.

But it doesn't always end so well.

This week, for the third time since last October, a local young man was arrested and charged with violently shaking an infant. Jimmy Lee Shasteen, 22, has at least his age and gender in common with two others whose vicious attacks on newborns bore striking similarity.

The crimes are sickening, but I'll let the courts sort out their punishment. The more useful question is whether there's a way to protect the next baby. Because there will be a next baby, probably soon.

In addition to being young and male, risk factors for being a baby shaker include anxiety, depression and feelings of inadequacy. Anyone think an economy that leaves more young men out of work is going to help with that?

I'd be willing to bet that at least some of the adults who shake babies later feel true regret. How did they get to that point? Maybe they didn't see it coming.

And maybe that's because we don't like to talk about this. I had a hard time just writing the sentence above, even admitting to myself that I felt so frustrated with my son.

But, I was lucky. I had been told what to expect, and that it was normal, and I was able to cope. If you get a chance, tell a young parent-to-be the same thing. It might help.

…Editor Silas Lyons may be reached at 225-8210 or slyons@redding.com.

I thought you wrote a great column on an issue that most parents (as well as caregivers of young children) experience, but few admit.

It's a subject that I've learned a lot about, but not by choice. Our eleven month old son was shaken by a child care provider and died three days later.

She was a grandmother who had raised four children of her own. That day, she was also caring for her grandson.

Since that time, we have worked with family and friends to support education for parents and caregivers about the vulnerability of young children to shaking injuries and what they can do to help keep their children safe.

At first, it used to surprise me how many people would have a story to tell about "the moment" when they realized they wanted to hurt their child. Now, it surprises me when someone tells me they've never had such a moment.

A couple of things you might want to bring to the attention of your readers:

- in 1998, Mark Dias, a pediatric neurosurgeon at Children's Hospital of Buffalo, had a moment like yours when he was up in the night with his new son. As he tells the story, he realized then that he no longer had to wonder why his pediatric patients had been shaken by their parents shake their children.

Using a video and a few minutes of a nurse's time, he started a program at Buffalo area hospitals to educate new parents. The results were published in 2005: a 47% reduction in inflicted head injuries (Pediatrics, April 2005).


Dr Angela Rosas and the Hannah Rose Foundation are working with hospitals in the Sacramento area to implement a similar program and Linda Loma has also been doing it. Legislation is pending to establish a demo program for 10 counties in CA (although one wonders why a demo program since 10 states have already adopted similar legislation: NY, MO, IL, WI, RI, MA, OH, NE, MN, SC and statewide programs exist in NC, PA and AZ)

- last year, legislation was introduced in Congress to establish the Shaken Baby Prevention Act of 2007 (S.1204/HR 2052). Several members of California's Congressional delegation have joined as cosponsors, but we're still waiting on Senator Feinstein to join Senator Dodd as a sponsor of the Senate bill.

George Lithco
SKIPPER Initiative
Poughkeepsie NY
www.SkipperVigil.com

It might be useful to remind readers where the name "SKIPPER" comes from.

It is, first and foremost, the name of our first son. He died on December 3, 2000 as the result of injuries inflicted when he was shaken by his child care provider, a 51 year old grandmother, who had raised four children of her own and was also caring for her grandson at the time.

A few weeks later, a group of family and friends had formed to work on prevention. Casting about for a name, the group came up with a wonderful one that encapsulates the meaning of our organization: "Shaking Kills: Instead Parents Please Educate and Remember."

The SKIPPER Initiative has been working since then to educate parents and others who care for young children about the vulnerability of young children to shaking injuries, and what parents can do to help protect their child from those injuries.

The first step in prevention is to replace ignorance with information. No parent should ever have the opportunity to say "if only I had known..."

That simple step has powerful consequences. Since a simple education program started at Buffalo area hospitals in 1998, using a short video and a few minutes of a nurse's time, the incidence of inflicted head injuries has been reduced by 47%.

But education is more than telling parents what not to do. Information about how to cope with the inevitable moments of frustration is also necessary. Colic, teething, tantrums and other events challenge the patience of parents.

Information about coping is especially important in today's society where small families and larger dispersion means many parents and caregivers are less familiar with the realities of raising small children.

Perspective is equally important. Faced with a colicky baby, many parents wonder if their parenting skills are fundamentally inadequate. That feeling of frustration may contribute to post partum depression and stress the entire family.

Awareness and support can help parents understand that their behavior isn't creating a colicky babies and that there are constructive ways to cope with those challenges.

In the long run, supportive parenting education that helps parents anticipate and understand the challenges of the first year of life, and to learn about the DO's - those things they should do - not just the DON'Ts, will be the best prevention tool.

One of those things will be to educate other caregivers.

In today's society, children have many caregivers before they turn 3 years old. Recent estimates are that 7 to 8 million children under age 5 are in child care for all or part of a week.

In addition to making sure each one of those caregivers is aware of the danger of shaking injuries, parents have to remember to pass along their knowledge of their child. Knowing that a child is sick or teething or or irritable because of a vaccination - or even that the child just didn't sleep well last night - can help that child's caregiver be prepared to cope with frustration.

Reframing the message: moving from "child abuse prevention" to "injury prevention and safety" helps everyone hear the message.

Shaking can kill or injure a child. Parents can help protect their child by remembering the consequences, remembering how to cope and educating other caregivers.

We've not yet found a caregiver who didn't respond favorably when asked to help keep a child safe.

In some of the states that have adopted prevention legislation, the legislature has included provision for monitoring the effectiveness of prevention education. Massachusetts and Ohio come readily to mind.



In addition, the CDC has funded statewide prevention programs in Pennsylvania and North Carolina. Presumably, those efforts will also include efforts to assess the effectiveness of the program being implemented.



It seems that one common result of greater awareness is an increase in the number of cases being identified and reported. Absent perspective on the difficulties in identification and diagnosis, as well as the factors that affect reporting in the absence of a coherent effort to collect reliable statistics, it may seem that prevention efforts lead to an increase in inflicted head injuries.



Another issue is developing a consensus on incidence. Some of the epidemological studies that have estimated SBS incidence did so by examining patient histories. Apart from the difficulties in identifying inflicted head injuries from charts, those studies only included certain age ranges: none reviewed charts of children over three years of age, and one only looked at infants.



It would be useful if the variety of evaluation programs getting under way would collaborate on developing a standard methodology so that fewer issues of consistency result.

Well, it's been a long time...

Since 2003:

- laws requiring SBS prevention education have been passed in several states;

- the hospital education program in Buffalo was joined by a regional program in the lower Hudson Valley, and they are about to go statewide;

- a statewide education support program is operating in Pennsylvania and one is about to start in North Carolina, with funding from the CDC.

- April 20-26 will be recognized by the US Senate for the fourth time, along with New York and several other states, as SBS Awareness Week 2008.

Let's talk more about those things in future posts...