Recommended Reading - A Prevention Perspective

Recommended weekend reading from The Future of Children, via MCH Alert:

The Fall 2009 issue of The Future of Children Journal presents research on policies and programs designed to prevent maltreatment.

The issue, published by Princeton University's Woodrow Wilson School of Public and International Affairs and the Brookings Institution, examines the gradual shift in the field of child maltreatment toward a "prevention perspective" and explores how insights into the risk factors for maltreatment can help target prevention efforts to the most vulnerable children and families.

Contributors assess whether a range of specific programs, such as community-wide interventions, parenting programs, home-visiting programs, treatment programs for parents with drug and alcohol problems, and school-based educational programs on sexual abuse, can prevent maltreatment.

They also explore how child protection system agencies, traditionally seen as protecting children who are maltreated from further abuse and neglect, might take a more active role in prevention.

The full-text issue, executive summary,policy briefs, and article summaries are available at http://www.futureofchildren.org/futureofchildren/publications/journals/journal_details/index.xml?journalid=71

The lead article describes progress towards the notion of preventing inflicted harm, instead of dealing with the consequences...

Progress toward a Prevention Perspective - Summary Link
Matthew W. Stagner, Jiffy Lansing
Preventing Child Maltreatment Volume 19 Number 2 Fall 2009

Matthew Stagner and Jiffy Lansing chart developments in the field of child maltreatment and propose a new framework for preventing child abuse and neglect. They begin by describing the concept of investment-prevention as it has been applied recently in fields such as health care and welfare. They then explain how the new framework applies to maltreatment prevention, noting in particular how it differs from the traditional child protective services response to maltreatment.

Whereas the traditional response aims to prevent a recurrence of maltreatment once it has already taken place, the new framework focuses on preventing maltreatment from occurring at all.

Rather than identifying risk factors for maltreatment and addressing the problems and deficiencies of the primary caretaker, the new framework focuses on strengthening protective factors and building family and social networks to reinforce the ability of parents to care for their children.

Whereas the orientation of the traditional child welfare service approach is legal and medical, the new framework has a more developmental and ecological orientation. It aims to build on the strengths children have at particular points of the life stage and enhance the social context of the child.

Rather than putting families into the hands of unknown professionals who shuffle them from one program to another, including foster care, the investment-prevention model seeks to integrate professionals and paraprofessionals from the family’s community into their everyday life, as well as to ensure an interconnected system of services.

Finally, rather than seeking to minimize harm to the child, it aims to maximize potential—to strengthen the capacity of parents and communities to care for their children in ways that promote well-being.

Friends of Children events:

FOC Briefing, Preventing Child Maltreatment,Washington, DC, October 1st. Link

FOC, Policy Research Institute for the Region, and ACNJ present "Preserving Programs that Prevent Child Abuse and Neglect During a Time of Economic Crisis: A Research and Policy Conference," at Princeton University, November 13th. Link

Resources:

Future of Children Author Testifies on Home Visitation Programs

Deborah Daro testified on June 9, 2009, before the U.S. House of Representatives Income Security and Family Support Subcommittee about research that shows home visitation programs can promote early childhood learning and strengthen parent-child relationships. Link to testimony

Prevention: Exchange Club Family Skills, Birmingham, AL

CBS42.com in Birmingham, Alabama reports that the Exchange Club Family Skills Center partnered with several agencies for a Child Safety Fair at the Marks Village Community Center. One of the focal points was a display which offered a detailed demonstration of what happens to a baby's brain when it is shaken.

Resources:

Exchange Club Family Skills Center, Birmingham - Link
Exchange Club SBS Education Program - Link
Exchange Club Resources - Link
Realityworks SBS Simulator Doll - Link

Legislative Alert: Home Visiting Services

In August, the Child Welfare League of America sent an email reminder about home visiting services.

It's still timely: action you can take to ensure your legislators are aware of the importance of providing new parents with home visiting services (Congress should be returning home at the end of October). Link to CWLA resources on home visiting...

Home visiting provides opportunity - not an obligation - for parents to learn more about raising children and keeping them safe...(and here's a link to take CWLA's survey about prevention initiatives: so far, "prevention of child abuse and neglect was ranked by 16% of respondents as the number one priority...ahead of other critical areas such as strengthening child protective services (14%) and youth transitioning out of foster care (11%)...CWLA is going to use these survey findings to gather more information on each of the critical issues.")

Home visiting provisions have been included in health reform legislation. While your U.S. Senators and Representative are back in your state and district...tell them to keep home visiting in the final health reform package!

Before making your call, review CWLA's one pager explaining why home visiting is important! See http://www.cwla.org/advocacy/HomeVisitingisImportant.pdf

ACTION REQUIRED

Call your U.S. Senators and Representative and tell them to support home visiting in health reform legislation. The toll-free number to be connected to your lawmakers' offices is 1-800-828-0498

Support comprehensive health reform legislation!

Support the home visiting amendments that will reduce child maltreatment and save on unnecessary healthcare costs down the road.

BACKGROUND

The U.S. House and Senate are debating comprehensive health reform legislation. This legislation is too important to be trampled by partisan politics. The home visiting elements that are in the current health reform legislation refer to evidence based models that deliver parent education and family support to parents with young children.

Home visitation is an effective, research-based and cost-efficient way to bridge the gap between vulnerable families and the resources that will ensure that children grow up healthy and ready to learn.

There are many families who are in need of the prenatal and maternal health services that these home visits can provide.

Children who experience maltreatment are at a greater risk of adverse health effects and home visiting not only educates parents, but also provides access to mental health, educational, and social services that might be available in the community.

For more information on current home visiting legislation, check out http://www.cwla.org/advocacy/homevisitation.htm

Preventing Injury: Tampa, Florida

The St. Petersberg Times reports on an interesting campaign in the Tampa area intended to keep infants safe. I do hope the "safe caregivers" portion includes education about SBS prevention...

Child advocates launch Hillsborough County campaign to save lives
By Stephanie Bolling, Times Staff Writer
In Print: Saturday, September 19, 2009

TAMPA — Susan Martin- Warren looks at her 4-year-old son. A brace on his right ankle. A splint on his limp right hand. He talks and walks, but she worries about his development.

When Graham was just months old, his father caused permanent trauma to the left side of his brain. Doctors called it shaken baby syndrome. Authorities sent the father to prison.

Graham will live with the impairment for the rest of his life.

"We don't know what he will face as an adolescent and young adult. I worry about him everyday," said Martin-Warren.

It's the sort of incident that has led child advocates to launch a major campaign to reduce preventable deaths and traumatic injuries of young children.

"I got sick of hearing about kids dying from being wedged in a couch cushion or drowning in 6 inches of bath water. They had loving parents that didn't know any better. Their deaths were completely preventable," said Nick Cox, the Suncoast regional director for the Department of Children and Families.

So he and other child advocates have teamed up and launched an ambitious new effort. The campaign has gained sweeping momentum county-wide with partnerships between the Children's Board of Hillsborough County, the Department of Children and Families, Healthy Start Coalition of Hillsborough and public and private organizations.

"Most parents have good intentions and want the best for their child and most communities are equipped with the resources to aid parents, but the challenge is connecting the two together," said Carolyn Eastman, director of communications for the Children's Board of Hillsborough County.

She says the campaign focuses on three initiatives: safe sleeping, safe caregivers and water safety. To promote these messages, CBS Outdoor will post 16 billboards of rotating child safety messages, and HARTline buses will display 30 full-length ads on buses traveling all routes of Hillsborough County.

Hospitals will also play a big role, according to Jane Murphy, executive director for the Healthy Start Coalition. Beginning this fall, updated informational packages will be distributed to new mothers. The package will include a 95-page pamphlet outlining infant developmental processes and safety guidelines with a listing of community resources and phone numbers; a parenting DVD focusing on child safety that features mother Martin-Warren and her son Graham; a onesie reading "Put me on my back to sleep"; and a letter that parents will be asked to sign promising the child good care.

Some hospitals will offer one-on-one training and screening, including risk assessments, where they can provide parents with helpful advice, like where to get the best child care or how to obtain free car seats and baby beds.

Throughout the county, five Family Support and Resource Centers see about 60,000 families a year.

They too have committed to supporting the campaign and will tailor information and resources specific to their surrounding communities, Eastman said.

"The best result is when the entire community sees it as their responsibility to protect a child," she said. "If they don't know how to do it, then they will know how to find a resource and come together as community to help the impact of the needless amount of children that die every year."

The campaign will run at least through the end of next year, Cox said.

"If it saves one child, then it is worth it," he said.

Stephanie Bolling can be reached at (813) 226-3408 or sbolling@sptimes.com.

Awareness Vigil: Middletown, CT - 9/15

If you're near Middletown CT on September 15th, the Hartford Courant reports that the Connnecticut Children's Trust Fund is joining with a local group to sponsor a candlelight vigil.

Unfortunately, increasing awareness is not only a good thing, but apparently a necessary one...

Three Middletown babies have been injured recently after being shaken severely by an adult.

The Connecticut Children's Trust Fund and the local group, Shaken Baby Syndrome Committee, are sponsoring a candlelight vigil at 6 p.m. Tuesday at Middletown South Green to talk about shaken baby syndrome.

SBS Survivors: Trae Caster, Texas

Trae Caster is a member of the Trinity High School marching band. You might not think that unusual, unless you know he survived injuries inflicted by a (licensed) child care provider when he was an infant. Now, he's playing with the band.

The Fort Worth Star-Telegram reports on his accomplishments (with video). It sounds like band director Mario Casanova deserves some kudos too!)...Link

Trae’s vision, his mother said, "comes and goes." He struggles to form words and walks with an uneven gait. But the slender youth clutching a pair of drumsticks is no less a part of the Trinity band than any of its other members — a fact that underscores the school’s mission statement.

"We . . . strive to educate, respect and recognize all students," it reads in part.

Band director Mario Casanova said he had no qualms about inviting Trae to make music with other students. Last year, a senior who played the trumpet marched with the Trojan band despite being legally blind. After his graduation the student embraced the band leader and thanked him for treating him like everyone else.

"We don’t know what Trae can or can’t do," Casanova said. "He doesn’t even know. But whatever he can do, more power to him. He loves music. And he’s having a great time.

SBS Awareness: Arizona

School Notes in the Arizona Star reports on an award-winning awareness project by Mountain View High School junior Londyn Whittier presented at the Family, Career and Community Leaders of America's National Leadership Conference.

Kudos to Ms. Whittier and her teachers at Mountain View HS...

Mountain View High School junior Londyn Whittier received a gold medal in Applied Technology at the 2009 Family, Career and Community Leaders of America, or FCCLA, National Leadership Conference held in July in Nashville, Tenn.

Whittier earned a score of 91.3 out of 100 for her project on shaken baby syndrome in the Applied Technology category.

She used a computer, video camera and a shaken baby syndrome simulator, which is a doll with a transparent head that lights up areas of the brain to indicate damaged areas when it is shaken, as part of her project.

Whittier also received a 10 out of 10 score for her oral presentation.

CDC Webinar: Child Maltreatment Prevention - 9/10/09

Ooo! Ooo! - "Tootie", Car 54

Couldn't help it - I channeled Tootie when I saw the speakers scheduled for this webinar. Should be interesting to hear their take on prevention, especially Jack Shonkoff....

Webinar Invitation

A Better Start:

Child Maltreatment Prevention as a Public Health Priority

Did you know some of the worst adult health problems in the nation can be linked to the toxic stress resulting from adverse experiences in childhood? Population health priorities, including obesity, heart disease, and diabetes are associated with harmful childhood experiences such as abuse or neglect.

The Centers for Disease Control and Prevention’s Division of Violence Prevention invites you to learn how your public health agency can make a difference in the lives and health of both children and adults at an upcoming webinar. James Mercy, PhD, and Jack Shonkoff, MD, experts in child maltreatment prevention and early childhood development, respectively, will discuss several topics including:

• The important role public health agencies can and do play in preventing child maltreatment
• The body of research linking harmful childhood experiences with long-term quality of life
• How public health agencies can prevent child maltreatment by using the concept of safe, stable, nurturing relationships
  

The goals of this webinar are to develop a shared understanding of how the prevention of child maltreatment not only promotes optimal development but also reduces disparities in health and explore the important role public health agencies play in improving the health of children and families by preventing childhood abuse and neglect.

Speakers:

• Ms. Francie Zimmerman - Doris Duke Charitable Foundation – Child Abuse Prevention Program

• Dr. Jack Shonkoff - Harvard University – Center on the Developing Child

• Dr. James Mercy - CDC – Division of Violence Prevention
  

Date: Thursday, September 10, 2009

Time: 1:00 pm – 2:00 pm EST

Webinar Registration:

Click here to register for A Better Start: Child Maltreatment Prevention as a Priority.

Click here to learn more about CDC’s child maltreatment prevention efforts.

Reading List: SBS Articles

From my alert...

MG Ward, S Bennett, and WJ King
Prevention of shaken baby syndrome: Never shake a baby.
Paediatr Child Health 1 May 2004 9(5): p. 319.
http://highwire.stanford.edu/cgi/medline/pmid;19657516

L Meskauskas, K Beaton, and M Meservey
Preventing shaken baby syndrome: a multidisciplinary response to six tragedies.
Nurs Womens Health 1 Aug 2009 13(4): p. 325.
http://highwire.stanford.edu/cgi/medline/pmid;19686555

Ana Isabel Curcoy, Victoria Trenchs, Marta Morales, Alicia Serra, Merce Pineda, and Jordi Pou
Do retinal hemorrhages occur in infants with convulsions?
Arch Dis Child 6 Aug 2009.
http://highwire.stanford.edu/cgi/medline/pmid;19666457

Legacy: Positive Parenting

Science Daily reports on a new parenting study, with an important insight: effective parenting education can become a legacy for generations to come....

A new study that looks at data on three generations of Oregon families shows that "positive parenting" – including factors such as warmth, monitoring children's activities, involvement, and consistency of discipline – not only has positive impacts on adolescents, but on the way they parent their own children.

The study will be published in the September issue of the journal Developmental Psychology in a special issue devoted to findings of some of the few long-term studies of intergenerational family processes.

Kerr said there is often an assumption that people learn parenting methods from their own parents. In fact, he said most research shows that a direct link between what a person experiences as a child and what she or he does as a parent is fairly weak.

"Instead, what we find is that 'negative' parenting such as hostility and lack of follow-through leads to 'negative' parenting in the next generation not through observation, but by allowing problem behavior to take hold in adolescence," Kerr said. "For instance, if you try to control your child with anger and threats, he learns to deal in this way with peers, teachers, and eventually his own children.

If you do not track where your child is, others will take over your job of teaching him about the world.

"We knew that these negative pathways can be very strong," Kerr said. "What surprised us is how strong positive parenting pathways are as well. Positive parenting is not just the absence of negative influences, but involves taking an active role in a child's life."
* * *
The researchers found that children who had parents who monitored their behavior, were consistent with rules and were warm and affectionate were more likely to have close relationships with their peers, be more engaged in school, and have better self-esteem.

"So part of what good parenting does is not only protect you against negative behaviors but instill positive connections with others during adolescence that then impact how you relate with your partner and your own child as an adult," Kerr said

"This research shows that when we think about the value of prevention, we should consider an even wider lens than is typical," he added. "We see now that changes in parenting can have an effect not just on children but even on grandchildren."

Link

Texas: You Can't Have Too Much Awareness...

The Killeen Daily Herald reports that the Bell County Commissioners Court voted Monday to designate September as Shaken Baby Syndrome and Child Safety Awareness Month in Bell County.

A statistic cited by County Judge Jon Burrows suggests there is a need for education.

The court also agreed to declare September as Shaken Baby Syndrome and Child Safety Awareness Month. About one in three Texans polled doesn't know it is dangerous to shake babies, Burrows said.

Although the Texas legislature did pass hospital prevention legislation (SB 316) in 2005, it only requires hospitals to provide a brochure. Unfortunately, effective education requires more, but fortunately some hospitals in Texas are going beyond the minimum requirements of the law.

Resources:

2009 SBS Awareness Week Resolution, US Senate - Link
2009 SBS Awareness Week Resolution, Texas Senate, SR 429 - Link
Hospital education requirement, Texas - Link to Senator Lucio's bill memo
Story of one family's effort in Texas to increase awareness link

Prevention: Another DVD

24Dash.com reports that parenting educators in Staffordshire, with support from the Queen's Nursing Institute and the West Midlands Innovation Fund, will be creating a DVD to educate new parents and students about the causes, consequences and prevention of SBS.

The DVD will be piloted in 5 local high schools.

Hopefully, they will look around to see what's been done already...

Future parents in south Staffordshire are to be given new life skills educational support and advice about the dangers of rough handling and shaking babies to help prevent Shaken Baby Syndrome.

Stop That Shake – Babies Break! – is a innovative project set up between South Staffordshire Primary Care Trust’s (PCT) and Torc Vocational Centre, Tamworth. Project leads Janine McKnight, Specialist Community Public Health Practitioner for South Staffordshire PCT and Alison Mennell, Health Tech Project Co-ordinator, of Torc, will also be working with safeguarding teams, police, paediatricians and students from Torc Vocational Centre.

The project has been given a £7,500 cash boost from the Queen’s Nursing Institute (QNI) and NHS West Midlands Innovation Fund to develop a DVD covering the cause, consequences, risks and prevention factors around Shaken Baby Syndrome.
* * *
In addition to funding Janine and Alison, who is also a nurse and midwife, will be given professional leadership support and enjoy project management training from QNI and West Midlands Innovation Fund team to develop their unique project.

It sounds like a great project, and the project staff surely have good intentions, but it doesn't seem that creating a DVD about SBS prevention is a "unique" project.

Now, if the DVD is useful and informative, and helps parents talk to other caregivers about the need for a coping plan, AND they put it on YouTube for parents and students around the world to use, that might do qualify it as "unique"...

New Zealand: Increased Child Abuse Drives SBS Prevention Program

The New Zealand Sunday Herald reports on research by doctors Patrick Kelly, Judith MacCormick and health board social worker Rebecca Strange that looks at increasing rates of child abuse in NZ and the failure of child protection services to cope with that increase. Link to PubMed abstract (not surprisingly, it has a somewhat different emphasis).

One encouraging sign: the adoption of a shaken baby prevention program.

Dr Patrick Kelly, a paediatrician at Starship children's hospital, said there were great hopes the programme would save lives. In it parents will be spoken to "in the first few days after [the birth] to talk about the dangers of shaking a baby". They would then have to sign a sheet of paper acknowledging the discussion and the ways to avoid abuse. If successful, the pilot scheme may be rolled out across the country. In the United States it has resulted in a 40 per cent reduction in abuse. Health professionals at Starship hope to have it running by the end of this year. The Shaken Baby Prevention Programme is being funded by the Ministry of Social Development, and is based on a programme developed by US professor Mark Dias. Kelly said the programme was suited to New Zealand's independent midwife network. The trial was awaiting the appointment of key staff and development of material such as a video.

Surviving SBS: Jack Koller, Boulder, CO

From 9News. com in Boulder, Colorrado, another remarkable story of survival.

About half-way through the story, the reporters added the word "preventing" to a quote by the maternal grandmother. She had apparently said she was going to become "a huge advocate for abuse and shaken baby syndrome".

A small thing, but in a way it's telling: those who suddenly find themselves volunteers in the effort to prevent inflicted injury often lack the words to move the focus from consequences to the prevention.

Family determined to bring good out of baby's survival story
by: Jeffrey Wolf and: Cheryl Preheim

BOULDER - A 2-month-old who doctors did not think would survive was released from the
hospital on Monday evening.

His father, 27-year-old Ben Koller, is in jail accused of shaking, hitting, biting and suffocating his infant son. Social Services has given custody of Baby Jack to his grandmother, Claudia Riggs, his mom's mother. "I am just glad he's home," Riggs said. "The first few days they told us that he wasn't going to survive.

But everyday he's been amazing us. He just keeps getting better and better." The 2-month-old has survived what seemed like the impossible. "Three weeks ago, if you would have seen him, you would have thought it was time to plan a funeral," said Mark Schmidt, the baby's grandfather, also on his mother's side.

Jack Koller had a fractured skull and couldn't breathe or eat on his own. He was also blind, but has regained his sight. "The MRI showed significant brain damage," Schmidt said. "It's horrendous. The one person who was supposed to be protecting was the person he knew to have the most fear about."

Police say Koller shook the baby when he wouldn't stop crying. Koller is being held at the Boulder County Jail on a $1 million bond. He faces charges of child abuse resulting in serious bodily injury.

Now, after 20 days at The Children's Hospital in Aurora, Riggs and Jack got to leave together. Riggs says they leave with a greater purpose. "He was happy to walk outside," she said. "It would be my hope that this would never happen again to another child. Somehow we are going to make really good things come out of this."

At home in Boulder, gifts were waiting from friends to help Riggs, who has just left her job as a ibrarian to be a full-time grandma to care for Jack. "I know I am going to become a huge advocate for [preventing] abuse and shaken baby syndrome. I may have a new career," she said.

Jack's mother is 20 years old and says she did not know about the abuse. She will be allowed to have supervised visits and she is getting parenting classes and counseling.

As for Jack's long term prognosis, doctors say they'll know more with time but he could have challenges with walking, talking and could have learning disabilities. But he's already shown he's a fighter so his family expects great things.

While Baby Jack still has a long recovery ahead, at least he gets to continue it at home. "This is a wonderful day. He is a miracle," Riggs said. As she held him in her arms, she told him, "We are all here to protect you and take care of you."

Riggs wants to make sure every day is a day they can look forward too. "Grandma is going to give you a bath tomorrow. We have a big day planned," she said. "I just want Jack to know he's very loved. I want to one day take him for a walk in the park. It will be a special day when that day comes," Schmidt said.

Nevada: Bad News, Good News

KVVU (Fox5Vegas) reports that child abuse is increasing in the Las Vegas metro area.

The good news is that they also report the Metro Police Department is working with local hospitals to educate new parents.

Child Abuse In Vegas Rises 17 Percent
Police: Clark County Has Surge Of Child Abuse Cases

POSTED: 3:24 pm PDT July 27, 2009

LAS VEGAS -- After months in which accidental child shootings and parental arrests have dominated news headlines, Las Vegas Metro police confirmed what many already suspected.
Clark County is seeing a surge in child abuse cases. The numbers have risen 17 percent, according to authorities.
“More broken bones, more shaken baby syndrome,” said Metro Lt. Ray Steiber, who believes the weakened economy and stress on families is partly to blame for the increase.
“Being out of work, wondering how you're going to pay for that next meal or how to pay the light bill. We do see that and sometimes it transitions into the way people tend and care for their children,” Steiber said.
Through July of this year, Metro Police have dealt with seven cases of shaken baby syndrome. Police responded to nine total cases in 2008. There have also been four cases of murder by child abuse, police said, tying the same number of cases from last year.

Related Link: Clark County Department of Family Services

In April, the police department launched its “Just Step Back” prevention program, a partnership with area hospitals that’s intended to educate new parents before they go home with their children.
“[Parents] will be seeing a video that gives information as well as signing off on a checklist from the hospital,” Steiber said.

News: Education Begins At Home Hearing

The Children's Monitor Online, an e-newsletter from CWLA (and a great source of info on action at the federal level - subscribe here) reports that the House held a hearing on the Education Begins At Home Act...

Key Committee Hearing on Home Visiting

On Tuesday, June 9, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on proposals to provide federal funding for early childhood home visitation programs. The focus was largely placed on how to produce the best practical, cost-effective home visiting programs. Chairman Jim McDermott (D-WA) began the hearing by bringing attention to the startling fact that less than 15% of families in need of home visitation actually receive services. He also indicated the possibility of the legislation, the Early Support for Families Act, HR 2667, moving as part of health care reform.

The hearing included many expert witnesses. The first witness, Joan Sharp, Executive Director of the Council for Children and Families of Washington in Seattle, echoed the appropriateness of thinking about home visiting in the context of health care reform, as there are many negative health outcomes for children who are victims of child abuse and neglect. Dr. Jeanne Brooks-Gunn, a developmental psychologist, centered her testimony on the outcomes that should be associated with any form of intervention, strategies for enhancing the lives of children and their families, the factors that determine the effectiveness of a given program, and how to best invest in home visiting. Cheryl D'Aprix, a Family Support Worker with the Starting Together Program in Canastota, New York, described her experience with home visiting as both a participant and a home visitor, and expressed the life changing possibilities of home visiting. Finally, Sharon Sprinkle, a Nurse Consultant with the Nurse Family Partnership (NFP) shared her success with the NFP model and asked that Congress look closely at this program as a way to improve the lives of low-income, vulnerable families. For a complete copy of the testimonies from the hearing, visit the Ways and Means Committee website.

A number of themes dominated the hearing, including the cost for this new initiative and how to meet it, as well as determining how to reach the most vulnerable families, finding approaches for including fathers, and understanding that no one program will reach all families because different families have different needs. CWLA has endorsed HR 2667 and will continue to work with Congress to refine and to pass this initiative.

Brain Injuries: Diagnosis and Management

The New York Times reports on a controversy about the identification and management of concussions in high school sports...Link

It points out the importance of social context in framing the issue for high school students.

New Guidelines on Young Athletes’ Concussions Stir Controversy
By ALAN SCHWARZ
Published: June 7, 2009

New guidelines for the care of youth athletes who sustain concussions are causing controversy among brain-injury experts, reigniting the debate over whether strict rules regarding concussions can actually leave athletes at greater risk for injury.

An international panel of neurologists, updating their recommendations on concussion care in the May issue of The British Journal of Sports Medicine, said that any athlete 18 or younger who was believed to have sustained a concussion during a game or practice should never be allowed to return to the playing field the same day. The group had previously said that such athletes could return if cleared by a doctor or certified athletic trainer, but now contend that such determinations are too difficult and dangerous for same-day return to be considered safe.

Other doctors, many of whom work the sidelines of high school athletic events, said they feared the effects of such strictness. They predicted that athletes would respond by hiding their injuries from coaches and trainers even more than they are already known to do, leaving them at risk for a second and more dangerous concussion.

The panel’s recommendation to remove all players suspected of concussion has no direct influence on rules governing United States youth sports, which are generally made at the state and local levels. But it does spotlight how some attempts to improve concussion-related safety can instead compromise it, a paradox encountered at levels as high as the N.F.L.

“So many bad decisions are made when trying to assess whether a player is symptomatic or not,” said Dr. Robert Cantu, an author of the guidelines who is also a director of the Neurological Sports Injury Center at Brigham & Women’s Hospital in Boston. “We know that an unacceptable number of kids are being sent back while symptomatic, and sometimes with devastating effects. The majority believe that the bullet should be bitten, and not let a kid go back into the same contest.”

But Dr. Bob Sallis, a past president of the American College of Sports Medicine and a longtime sideline doctor in Southern California, said he saw the recommendation as a step backward.

“More kids will be hurt seriously because of this, either by players not admitting they might have gotten a concussion or coaches encouraging them not to be up front about their symptoms, whether subtly or overtly,” Sallis said.

Asked how the guidelines could have any influence on league rules throughout the country — in Iowa, for example — Sallis said: “It does put the people in Iowa in scrutiny. When a kid gets hurt, they’ll get sued and be told, why didn’t you follow those guidelines?”

High school athletes in nine primary sports sustained an estimated 137,000 concussions in the 2007-8 school year, according to a study conducted by the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. Football had the most, with more than 70,000, followed by girls soccer (24,000), boys soccer (17,000) and girls basketball (7,000). These were only reported concussions; more were almost certainly sustained but went unrecognized or ignored.

“Sometimes, postconcussion symptoms can be delayed for hours or even days, like difficulty sleeping or concentrating,” Cantu said. “It’s a clinical decision that’s difficult or sometimes damn near impossible to be made on the sideline, and we aren’t doing a very good job at it. Athletes, even when assessed by qualified people, seem to be returning to contests prematurely or when symptomatic — an unacceptable number of cases.”

The panel also emphasized the importance of not just physical rest for players found to have a concussion, but cognitive rest as well. It said that teenagers should be kept from activities ranging from schoolwork to video games and text messaging while recovering from a concussion.

“That is the No. 1 management issue in our clinic — how do we manage the cognitive activity that stresses that brain’s abnormal metabolism?” said Gerry Gioia, the chief of pediatric neuropsychology at Children’s National Medical Center in Washington. “Studying for an algebra exam, reading a lengthy text, sitting in a classroom for an hour and a half trying to keep notes and keep up — it extends recovery, it feels miserable to the kid, and it’s misunderstood by the school and public.”

SBS Survivors: Evan Coleman, West Allis Wisconsin

WISN.com in Milwaukee has a compelling video news report on the consequences of SBS.

It's the story of Evan Coleman, who's eight years old, and the story of how his parents are working to increase awareness - even though his father is responsible for those injuries...Link

Evan's father spent seven years in prison.

His son's sentence will last much longer."He now has epilepsy. He's been hospitalized four or five times for seizures. His behavior, his social skills -- he's 8 years old and his social skills are about a 4-year-old level," Coleman said.

Coleman said a portion of Evan's brain -- the part that regulates reasoning and emotion -- is permanently damaged, so Evan goes into rages and tantrums.

The news video includes an interview with his father, who admitted that he lost was responsible for those injuries.

Evan's father, who 12 News is not identifying, was caring for him one day in 2001 when he said Evan's constant crying pushed him over the edge.

"I lost it, and I picked him up, and I shook him. I think two or three times, and I kind of tossed him into his crib, and that's when I think he hit his head on the railing of the crib," Evan's father said. "As soon as I did it, I couldn't believe what had happened, what I had done.

"He drove his son to Children's Hospital. Evan's mother -- who had been at work -- rushed to be with them.

"I remember walking into the room, and Evan was laying there in a little bed, and his eyes were black and blue, and he had cuts all over his face. He had tubes in his head. He looked like the life was pretty much sucked out of him," Jenny Coleman said. "I said, 'I will find who did this to you and they will pay.'"

She didn't have to look far.

"I was so ashamed of myself. I couldn't bring myself to say it," Evan's father said.

Within hours, Evan's father confessed.

Action: Wisconsin Awareness PSA, Radio Blocks

TMJ4 reports the folks in Milwaukee have done a radio block - an amazing awareness event that enlists all radio stations in the listening area to broadcast the sound of a crying baby - followed by a short SBS awareness message - for one minute. Link to video news report

Kudos to Gary Mueller, the prevention advocates in Milwaukee, and participating radio stations.

Resource: Story of the first Milwaukee radio block Link (from Free Range Thinking: also a good resource - published by A Goodman - Good Ideas for Good Causes)

Unfortunately, increased awareness does seem to be a very necessary thing in Milwaukee these days...

Shaken Baby Announcement you Can't Escape
Diane Pathieu

MILWAUKEE - A crying, screaming baby, on your radio, for 60 seconds.

60 long, ear-popping seconds. It's on every radio station you turn to. And that is the point.

Gary Mueller is behind creating this public service announcement designed to teach people not to shake a baby, and end the climbing number of baby deaths in our area. "It was a message of crying that you cannot escape and I think it's an unforgettable one."

Gary is right. He's tried that before, and the numbers have dropped.

"The shaking's stopped," Mueller says.

In order to target men, Gary even created stickers placed on products that men often buy, like WD-40, spray paint, and even garden products in 3 local ACE Hardware stores.

"75% of the perpetrators of shaken baby cases are men, and they are very difficult to reach so we thought let's catch them by surprise," says Mueller.

With four kids of his own, Gary says this campaign is very close to his heart, and hopes it works for good.

8 Year Old Boy - SBS Alleged

From WSMV.Com in Nashville comes a report of an eight year old boy in Cookeville, Tennessee with symptoms of SBS....Link

Perspective: More Unmarried Mothers

Underscoring the need for techniques that help mothers educate males in their household about SBS prevention, the Washington Post reports on a dramatic increase in the number of unmarried mothers...Link

The mothers are part of a far-reaching social trend unfolding across the United States: the number of children being born out of wedlock has risen sharply in recent years, driven primarily by women in their 20s and 30s opting to have children without getting married. Nearly four out of every 10 births are now to unmarried women.

"It's been a huge increase - a dramatic increase," said Stephanie J. Ventura of the National Center for Health Statistics, which documented the shift . . . based on an analysis of birth certificates nationwide. "It's quite striking."

Of course, "unmarried" doesn't necessarily mean "single"...

About 1.7 million babies were born to unmarried women in 2007, a 26 percent rise from 1.4 million in 2002 and more than double the number in 1980, according to the new report. Unmarried women accounted for 39.7 percent of all U.S. births in 2007 -- up from 34 percent in 2002 and more than double the percentage in 1980.

"If you see 10 babies in the room, four them were born to women who were not married," Ventura said.

Although experts have been concerned about a recent uptick in births to older teenagers after years of decline, that is not the driving force in the overall trend but more likely a reflection of it, Ventura said. Instead, much of the rise is due to significant increases in births among unmarried women in their 20s and 30s. Between 2002 and 2006, the rate at which unmarried women in that age group were having babies increased between 13 percent and 34 percent, the report found.

The rates increased for all races, but they remained highest and rose fastest for Hispanics and blacks. There were 106 births to every 1,000 unmarried Hispanic women in 2006, 72 per 1,000 blacks, 32 per 1,000 whites and 26 per 1,000 Asians, the report showed.

...Previous research indicates that about 40 percent of births to unmarried women occur in households where couples are cohabitating.

Wisconsin SBS Awareness Video News: Men, SBS Awareness, and a Hardware Store

WITI-TV in Milwaukee, Wisconsin, the local Fox affiliate, reports on an innovative and inexpensive SBS awareness initiative. It's a story involving a hardware store, an awareness message and, needless to say, guys. Link to story, news video

It's a couple of minutes long, and well worth watching...

The folks in Wisconsin who put this campaign together deserve compliments.

Two things I noticed:

- one of the student volunteers mentioned he learned about SBS in seventh grade, showing school-based SBS education does make a difference;

- the reporter mentioned a dramatic rise in SBS cases being treated this year at the Children's Hospital, emphasizing the impact of economic stresses on families and communities.

To help prevention efforts, the Milwaukee Journal Sentinel reports that the Shaken Baby Association is planning another radio PSA campaign. Link to article, PSA

By the way, Benjamin Moore might be a good sponsor if you want to replicate this locally...

Resource: Radio PSAs, Radio Block - Link

Rear View Mirror: Child Abuse Prevention Month Proclamation

April 1, 2009

NATIONAL CHILD ABUSE PREVENTION MONTH, 2009- - - - - - -

BY THE PRESIDENT OF THE UNITED STATES OF AMERICA

A PROCLAMATION When the child next door is maltreated, we all suffer. Every American has a stake in the well-being of our Nation's children. They are members of our communities, and they are our future.

National Child Abuse Prevention Month provides the opportunity to underscore our commitment to preventing and responding appropriately to child abuse. This month, we emphasize the importance of understanding child abuse and the need for all Americans to help families overcome this devastating problem.

The tragedy of child abuse may afflict American children in different ways. Abuse may occur physically, sexually, and emotionally. Child neglect, another form of child maltreatment, may occur physically and emotionally.

Understanding the forms of child abuse is critical to preventing and responding to maltreatment.A well-informed and strong family is the surest defense against child abuse.

To help educate and strengthen families, community members can offer their time and counsel to parents and children who may need assistance.

For example, parent support groups provide an organized forum for assistance. More informally, community members may simply offer a helping hand to families under stress.

More information about what families and communities can do is available at www.childwelfare.gov/preventing.

Civic organizations and government also have an important role to play. Civic groups offer essential support through education, assistance to those at risk, and treatment for victims.

Government at the local, State, and Federal level must provide funding for services, conduct public education projects, and enforce child abuse laws.

As we recognize that we all suffer when our children are abused, that we all benefit from mutual concern and care, and that we all have a responsibility to help, more American children will grow up healthy, happy, and with unlimited potential for success.

NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and laws of the United States, do more hereby proclaim April 2009, as National Child Abuse Prevention Month.

I encourage all citizens to help prevent and respond to child abuse by strengthening families and contributing to all children's physical, emotional, and developmental needs.

This is the Proclamation, transliterated by the cool tool at Wordle.net

And this is the Proclamation, circa 2001
title="Wordle: Child Abuse Prevention Month 2001">alt="Wordle: Child Abuse Prevention Month 2001" style="padding:4px;border:1px solid #ddd">

Persistent Effects of Pediatric TBI

Science Daily reports on two studies that describe the persistent effects of traumatic brain injuries in children....

Traumatic Brain Injury Haunts Children For Years With Variety Of Functional Problems

ScienceDaily (May 12, 2009) — Children who suffer traumatic brain injuries can experience lasting or late-appearing neuropsychological problems, highlighting the need for careful watching over time, according to two studies published by the American Psychological Association.

In one study, a team of psychologists used a longitudinal approach to gain a better idea of what to expect after traumatic brain injury (TBI). The researchers found that severe TBI can cause many lasting problems with day-to-day functioning. Some children may recover academically but then start acting up; other children do surprisingly well for unknown reasons.

In the second study, the first systematic meta-analysis summarizing the collective results of many single studies, the researchers found that problems lasted over time and, in some cases, worsened with more serious injury. Some children with severe TBI started to fall even further behind their peers than one would normally expect, in a snowball effect that requires further study.

The Centers for Disease Control in 2000 cited traumatic brain injury as the single most common cause of death and disability in children and adolescents...

Journal references:

Fay et al. Predicting longitudinal patterns of functional deficits in children with traumatic brain injury.. Neuropsychology, 2009; 23 (3): 271 DOI: 10.1037/a0014936

Babikian et al. Neurocognitive outcomes and recovery after pediatric TBI: Meta-analytic review of the literature.. Neuropsychology, 2009; 23 (3): 283 DOI: 10.1037/a0015268

Read more...Link

As Science Daily notes, the authors of the second study draw attention to a very important consequence of TBI in very young children:

That makes severe brain injuries at younger ages a "double hazard," the authors noted. Because younger children have more development ahead of them, the same injury can affect a 4-year-old and a 12-year-old very differently. This finding highlights the importance of targeted treatment developed specifically for children with severe TBI.

Perspective: Child Abuse Detection

Perri Klass writes in today's New York Times about her experience with child abuse detection and the evolution of expertise in the pediatric profession...

The conclusion is especially important:

The child abuse experts don’t want the rest of us in the profession to stop thinking about the subject. “I think the average pediatrician can diagnose this, even though it’s becoming a specialty,” Dr. Legano said.

But it’s an emotionally difficult diagnosis for a pediatrician to contemplate, especially when it concerns a family you feel you know well. And all too often, it is a diagnosis we fail to consider in families that don’t match our mental profiles of abusers. That’s why pediatricians and parents alike need all the clinical experience and all the science we can get, deployed on the side of the children.

While "average" may be statistically accurate, this excellent article by Dr. Cindy Christian describes the minimal levels of training that medical students receive, and the resulting perception among a significant number of practicing physicians that they lack skills needed to evaluate cases.

Resource: Professional Education in Child Abuse and Neglect, Cindy W. Christian, http://www.pediatrics.org/cgi/content/full/122/Supplement_1/S13

Abstract: Physicians have reported feeling that they were not adequately trained to identify and report child abuse. This article reviews the current state of medical education and residency training and the needs of physicians in practice and proposes changes and additions that can be made to improve the ability and confidence of physicians who are faced with the responsibility of keeping children safe. Pediatrics 2008;122:S13–S17

Two thoughts. First, "child abuse detection", not prevention, seems an apt term to describe this important process. Second, I wonder how medical students and practicing physicians would describe their training and skills in prevention education? There's one skill set required to know how to diagnose the consequences: the skill set to do something about preventing the consequences is likely to be much different...

News; PURPLE Prevention Program Planned for Kansas

The Topeka Capitol Journal reports on plans by the Wichita Child Abuse Fatality Community Response Team to implement the PURPLE prevention program in Wichita, KS...

WICHITA -- Amid a recent spate of child-abuse deaths, a community group has announced a campaign to teach parents how to cope with a crying baby.

The program is the first initiative of the Wichita Child Abuse Fatality Community Response Team, which formed in the fall in response to eight homicides in the city that were linked to child abuse or neglect in 2008.

Their so-called “Period of Purple Crying” initiative starts June 1.

Parents giving birth at Wichita hospitals or birthing centers will watch a brief DVD before leaving with their newborn. Parents also will get a copy of the DVD and a booklet titled “Did you know your infant would cry like this?” The materials were developed by the National Center on Shaken Baby Syndrome.

The idea is to prevent child abuse, particularly shaken-baby syndrome, by emphasizing that it is normal for babies to cry, sometimes for hours and for no apparent reason. It also assures parents it is OK to put a crying baby down and walk away for a few minutes.

The simple reminders are especially important now because incidents of child abuse and domestic violence usually increase during times of economic stress, said Vicky Roper, director of Prevent Child Abuse Kansas at the Kansas Children’s Service League.

Her group hopes parents will share the video with anyone who might care for their baby.

“To have a baby that cries and cries and cries despite all your best efforts — that’s probably the time when you feel the absolute worst as a parent,” said James Haan, a Wichita doctor with four children, including two sets of twins under the age of 3.

Haan, medical director of trauma services at Via Christi Medical Center, said he already is seeing more cases of possible abuse. Shaken-baby syndrome can cause permanent paralysis, brain damage and death.

“Things are tough and money is tight, and a baby can stress things out even more,” he said.

The Kansas Department of Social and Rehabilitation Services is funding the $35,000 campaign through a grant from the federal Child Abuse Prevention and Treatment Act.

“We want to make sure that all children in our community are safe,” said Jean Hogan, regional director for Social and Rehabilitation Services.

Apple iPhone App: Continued...

The San Franscico Chronicle has a letter to the editor today

Commendable coverage

As pediatricians and members of the San Francisco Child Abuse Prevention Center's board of directors, we commend The Chronicle's coverage of the iPhone "Baby Shaker" application and the focus on this deeply disturbing issue.

Each year in the United States, more than 1,500 children die after being shaken by their caretakers. These situations are often due to the caretaker's inability to cope with the child's persistent crying.

The action of rapidly shaking an infant may cause severe brain injury. If the infant does not die, shaking can cause lifelong injury, including cerebral palsy, mental retardation and blindness.

The five delivery hospitals in San Francisco have partnered with the Department of Public Health and the center to create the San Francisco Shaken Baby Project. This project educates nurses who then educate every new parent about the danger of shaking. The project provides community resources, including a 24-hour talk line - (415) 441-KIDS - to help caretakers cope with the stress of parenting.

We urge Apple to join the effort to educate the public on the dangers of shaking a baby. Perhaps they could create "an app for that," too.

CHRIS STEWART, M.D., SHANNON THYNE, M.D., San Francisco

Making Amends: making the iPhone educational

This editorial from the Times-Call in Longmont, Colorado includes an inspired suggestion for an iPhone app that will allow Apple to atone for the atrocious "Baby Shaker."

We presume Jenn Ooton, the Editorial Page Editor, deserves kudos for the suggestion.

PS. If you agree, why not let Dean G. Lehman, the Editor and President, and John Vahlenkamp, the Managing Editor, know: jvahlenkamp@times-call.com, dlehman@times-call.com opinion@times-call.com 

Times-Call Editorial
Publish Date: 5/6/2009
Create application to make amends for 'Baby Shaker'

Apple did the right thing when it pulled an application for the iPhone off the market after people complained that it was insensitive and inappropriate.

The “Baby Shaker” application caused the phone to cry like a baby until the user shook it.

As they vie for the attention of iPhone users, software developers have raced to create new and unusual applications for the “smart phones.” Developers have come up with virtual sheets of bubble wrap, fishing rods and applications to monitor the stock market, the weather, blood pressure, blood sugar and even the H1N1 flu virus.

The applications are downloaded for an average of 99 cents each. At up to 10,000 downloads a day, the money can add up for popular applications.

Though some of the applications might sound a bit inane, they’re typically harmless fun.

Not so in the case of the Baby Shaker.

Shaken baby syndrome is a serious problem and shouldn’t have been made a joke to profit this huge company and the small software developer that created the application.

Shaking can cause a baby or small child’s brain to bounce back and forth within the skull, causing brain damage, according to the National Institute of Neurological Disorders and Stroke. An estimated 1,200 to 1,600 babies suffer from shaking abuse each year, with one in four dying at the hands of their abusers. The others suffer long-term medical problems that can range from serious brain injuries and mental retardation, to paralysis, blindness, broken bones, seizures, learning difficulties and delayed development.

Shaking babies is no joke.

If Apple really wants to atone for releasing the Baby Shaker, perhaps it should develop a new application that would cry like a baby until the phone user figured out what the phone-baby needs — a diaper change, a feeding, a burping or other comfort. And if the user shook the phone, the phone might die, never to come back to life, or it might be so damaged that it could never again function as it should.

That could teach the people who played this mean-spirited game a little something about the real world.

I left a comment in response:

As the father of a shaken baby who has spent much of the last nine years advocating for education and awareness, I'd like to extend my compliments to the Times-Call and the author for an excellent editorial.

It not only makes the simple and straightforward case for what was wrong with Apple and its app, but has a wonderful suggestion for how Apple can atone.

As with parenting education, it's necessary to educate Apple on what not to do (the "don'ts", but it's not sufficient. They need to know about positive and constructive actions they can take to help parents and caregivers keep children safe ("the do's").

Survivors: Matthew Washburn, Colorado

KKTV.com in southern Colorado reports on the story of Matthew Washburn. The article includes a video report.   Link to story and video.

Every parent has had to comfort a crying baby.   But inconsolable crying can lead to danger. According to CASA, Court Appointed Special Advocates, this is the #1 cause of shaken baby syndrome.   What you do in that moment literally can mean life or death for the child.

But even if the baby is shaken… and lives... what will his life be like?

"Matthew is deaf and blind and in a wheelchair and in diapers and nonverbal” said Jackie Washburn. “What kind of life is that?"

She’s talking about her adopted son Matthew. He was shaken when he was just 31 days old. Jackie adopted Matthew when he was two.   Back then, she was hopeful.   But today...

“Matthew is 13 years old and functions like a 2-month-old,” said Jackie.

Dr. Paul Grabb is a pediatric neurosurgeon in Colorado Springs.   He says it doesn't take much shaking to cause injuries like Matthew's.   “It's only a moment necessary to cause irreversible and at times fatal brain injuries,” said Dr. Grabb.

What's even more disturbing is that it's happening more and more in our community.

“We have seen … a dramatic increase in shaken baby especially from January to March of this year,” said Trudy Strewler with CASA.   In that time, at Memorial Hospital alone, there were 12 suspicious cases. That's almost half of the number of cases seen there all of last year. 

These may just be numbers.   But they could represent kids just like Matthew.   He'll never ride a bike, or smile for his school picture.   And because of his feeding tube, he'll never even have birthday cake.   It's a difficult existence for his mother to watch.

"Sometimes I just think if he got pneumonia and would just pass and go to heaven and he would have wings and he'd run and he'd jump and splash and run with kids and feel the wind in his hair, said Jackie.   “Then think I must be a terrible person to think that.   But your heart breaks to see the life that he has.   I wouldn't want to live like that."

Despite her agony over the hardships Matthew faces, Jackie knows his life is not in vain.   "His purpose was to make life better for people.   And if it’s to suffer the way he does to give a lesson to someone, Matthew's life has purpose."

Resources: Abstracts on SBS cases in NYC, AAP and AHT

Just got an email with links to three article abstracts that sound interesting...

JR Gill, LB Goldfeder, V Armbrustmacher, A Coleman, H Mena, and CS Hirsch; Fatal head injury in children younger than 2 years in New York City and an overview of the shaken baby syndrome; Arch Pathol Lab Med 1 Apr 2009 133(4): p. 619.
http://highwire.stanford.edu/cgi/medline/pmid;19391663

CW Christian, R Block, and and the Committee on Child Abuse and Neglect; Abusive head trauma in infants and children; Pediatrics 1 May 2009 123(5): p. 1409.
http://highwire.stanford.edu/cgi/medline/pmid;19403508

Section on Radiology; Diagnostic imaging of child abuse; Pediatrics 1 May 2009 123(5): p. 1430.
http://highwire.stanford.edu/cgi/medline/pmid;19403511

Perspective: SBS Education in Prenatal Classes

If you've been wondering why pre-natal classes aren't a better place for SBS education than hospitals, this reflective post by CatandMuse deserves your attention (caution - well-placed, functional expletives were used in the making of this post...). Link to blog post (Thanks, Pam!)

During our birthing class, my husband and I learned and saw a lot of things we didn’t already know about the birthing process and newborn care. What neither of us expected was to continually hear the sentence, “NEVER, ever shake a baby” . It was almost annoying to hear that sentence repeated so casually and so frequently, I mean isn’t that OBVIOUS?

It was such an annoyance that Cybr and I spoke of it one night on our way home, agreeing that it was ridiculous that it need be repeated so much. Everyone knows that and surely it is few and far between that need be reminded.

This was our thinking before our baby was born.

After we had been home with Kira for a few weeks, that is when it became clear as to exactly why it is repeated so frequently. Bringing home a newborn is stressful, exhausting and frightening. It pushes you to limits mentally, physically and emotionally that you have never before been. This happens while mothers are simultaneously having EXTREME hormone fluxuation, sleep deprivation and more than likely self-doubt. I can also add burning a high fever and being in severe pain to that list, which I am certain others have experienced as well....

Baby Blues: The Night Shift

Looking at the website for the Baby Blues comic, I noticed this cover on their comic "scrapbook" called "The Night Shift": it encapsulates an important part of daddy parenting in the first year...

Ohio: Evaluating the Effectiveness of Hospital Based SBS Education

I read again the abstract of an evaluation of "Love Me, Never Shake Me", an Ohio SBS education progam sponsored by Prevent Child Abuse Ohio. Link to program; Link to abstract

On second blush, some interesting points to keep in mind:

- even though awareness of SBS is high, parents still say the education is important;
- hospital-based education is still likely to be the only opportunity to educate a new parent;
- a significant percentage of mothers don't appear to live with the father, emphasizing the importance of helping single mothers discuss SBS with unrelated males in the household.

Secondary Analysis of the "Love Me...Never Shake Me" SBS Education Program, Deyo, Grace; Skybo, Theresa; Carroll, Alisa, Child Abuse & Neglect: The International Journal, v32 n11
p1017-1025 Nov 2008

Objective: Shaken baby syndrome (SBS) is preventable; however, an estimated 21-74 per 100,000 children worldwide are victims annually. This study examined the effectiveness of an SBS prevention program in the US.

Methods: A descriptive, secondary analysis of the Prevent Child Abuse Ohio (PCAO) "Love Me...Never Shake Me" SBS education program database included 7,051 women who completed a commitment statement, pre- and post-test, and follow-up survey.

Results: Participants were mostly White (76%), had at least some college education (62%), were privately insured (62%), and lived with the father and infant (63%). Mothers knew of the dangers of shaking (96%) and recommended SBS education for all parents (98%) because they found it
helpful (97%). Scores on the pre- and post-tests were significantly different, but there was no difference based on education site or demographics. There was a significant increase in a pre/post-test item pertaining to infant crying.

At follow-up, participants remembered postpartum SBS education (98%), but post-discharge did not receive SBS education from their primary care provider (62%). Most mothers practiced infant soothing techniques (79%) provided in the education; however, few women practiced self-coping techniques (36%) and accessed community support services (9%).

Conclusions: Postpartum SBS prevention education should continue. Development of SBS programs should result from these study findings focusing on education content and program evaluation.

Practice implications: Mothers report that shaken baby syndrome education is important for all parents and memorable at follow-up.

Postpartum SBS education should continue because the hospital is the primary place they receive education. Mothers' report they less frequently receive education from healthcare sources post-discharge.  Diligence of primary care providers to incorporate SBS prevention education in well child visits will increase parental exposure to this information.

Education may need to place greater emphasis on infant crying and soothing, as well as parent support and self-coping techniques versus the dangers of shaking.

Other resources:

Quebec hospital education program - Goulet et al. (2009) - Link to abstract

Vancouver PURPLE evaluation - Barr et al. (2009) - Link to abstract

PURPLE evaluation - Barr et al. (2009) - Link to abstract

Evaluation of SBS education techniques - Russell et al. (2008) - Link to abstract

Upstate New York SBS Prevention Project - Dias et al. (2005) - Link to abstract

Perspective: On Creating a Foundation for Seeing What Works

In 2007, students at the University of Maryland School of Social Work engaged in an interesting project:

Students in the School’s Child Welfare Research class have each conducted reviews of evidence about interventions that may increase child safety for children.

These reports range in focus from primary prevention programs (like education to prevent incidents of shaken baby to interventions that might address the consequences of child maltreatment and prevent the recurrence of child maltreatment, to interventions that focus on helping adolescents in foster care prevent future maltreatment of their children).

They post[ed] a brief version of their reports by replying to this post. I hope you join in the discussion about what “might” work to decrease the risk of child abuse and neglect and increase safety for children. [Link to the blog post]

The blog provides an interesting overview of prevention programs. While it appears to remain one of the more popular posts on the UMB, it doesn't seem that the online community took up the challenge to discuss prevention programs that work.

It's also unfortunate that this work remains a snapshot taken at one point in time. I visited the Acropolis in 1972: the perspective of viewing the world from a place that has been part of human experience for thousands of years and at least a hundred generations was profound.

So, this is the comment I left:

It would be a real service if this overview could be provided each year: so many survey articles capture a moment in time, without providing any sense of development over time.

For example, the SBS prevention program mentioned above has expanded to several other states. Ohio and Hawaii are conducting evaluations of its effectiveness in preventing SBS incidents, and the Ontario Neurotrauma Foundation has just published a guide to implementing the program at new sites.

http://skippervigil.blogspot.com/2009/04/resources-ontarios-cookbook-for.html

It would be really helpful if an academic program would look at the results of those evaluations (which are likely to vary themselves in effectiveness) and elict lessons learned in implementing the program in different contexts.

It would also give the students a unique perspective on prevention, based on a common foundation, and a sense of the challenges in implementing evidence based practices.

The literature is full of palliative interventions that are responsive to the consequences of the child welfare system. They are resource intense and focused on prevention of recurrences.

Let’s encourage prevention efforts that work to build strengths and to actually prevent those consequences.

The Paris Index Climbs to Record High

At the close of Child Abuse Prevention Month, the Paris Index (the ratio of news stories mentioning "Child Abuse Prevention" (1085 hits)  to stories mentioning Paris Hilton (2028 hits)) reached a record high in 2009: 53%...

All is not lost: Paris has launched a line of children's clothing and visited a children's hospital.

Resources: Ontario's Cookbook for Implementing SBS Prevention

The Ontario Neurotrauma Foundation has posted an excellent "cookbook" for implementing hospital-based SBS (oops, AHT for those who will be in court) prevention activities. 

Great resources!

Link to ONF SBS Prevention Program Implementation Guide (Outline, 2009)

Link to ONF "Preventing Inflicted Infant Head Trauma: A Best Practice Implementation" (2009)

Link to ONF SBS Prevention Program home page

Link to ONF SBS Prevention Resources: crying cards in 21 languages and more! 

Hearsay: Baby Brain Development

In the law, it's called hearsay evidence and discounted....

However, Vaughan at Mind Hacks speaks well of an article in today's Boston Globe by Jonah Lehrer, who has done some excellent science writing. Link to Boston Globe article.

It reminds us we have much to learn about the way a baby's brain functions. In the Mind Hacks review, this caught my eye:

Newborns start with fewer synapses than adults but this number rockets, so by six months of age we have approximately twice as many connections. This tails off as the brain prunes connections on a 'use it or lose it' basis.

I'm always slightly awestruck whenever I view that graph as it is a vivid illustration of the incredibly rapid changes changes that take place as we grow and learn to make sense of the world.

And reading the BG article, I thought this was interesting...

By using new research techniques and tools, they've revealed that the baby brain is abuzz with activity, capable of learning astonishing amounts of information in a relatively short time. Unlike the adult mind, which restricts itself to a narrow slice of reality, babies can take in a much wider spectrum of sensation - they are, in an important sense, more aware of the world than we are.

This hyperawareness comes with several benefits. For starters, it allows young children to figure out the world at an incredibly fast pace. Although babies are born utterly helpless, within a few years they've mastered everything from language - a toddler learns 10 new words every day - to complex motor skills such as walking. According to this new view of the baby brain, many of the mental traits that used to seem like developmental shortcomings, such as infants' inability to focus their attention, are actually crucial assets in the learning process.

Finally, how many times do parents almost get their infant to sleep, only to have the slightest noise or motion startle them into wide-eyed awareness?

They might be better prepared if they knew this:

While adults automatically block out irrelevant information, such as the hum of an air conditioner or the conversation of nearby strangers, babies take everything in: their reality arrives without a filter. As a result, it typically takes significantly higher concentrations of anesthesia to render babies unconscious, since there's more cellular activity to silence.

Stroll for SBS Prevention MA

Today, MassKids sponsored its third Annual Stroll for Shaken Baby Prevention.

Link to MassKids page on the Stroll.
Link to article about the Stroll.

As part of the lead up to the Stroll, WBZ interviewed Shannon Byron, the mother of a shaken baby, and ex-husband Sean Forant, the man who shook his child. It's worth a listen...

Link to WBZ interview