Friday, April 24, 2009

Of Apple, iPhones Apps and AHT - I Do Hate to be Uncooperative, but...

sometimes there isn't a choice.

When Philadelphia Business Today reported on the controversy about the Apple "Baby Shaker" app, it went to Cindy Christian, a pediatrician at Children's Hospital of Philadelphia for comment.

Two things bother me about the resulting story:

First, Dr. Christian is quoted as saying that shaking causes 1,000 fatalities a year. That's a bit surprising, since the general consensus is that there are 1400-1600 cases a year that come to medical attention and about 20-25% of those cases result in death.

That estimate of incidence is based in part on research by Keenan et al., published in the JAMA in 2003. When the results found in that study were extended nationwide, it was estimated that there are 300 deaths a year due to shaking. Link; Link to JAMA PDF of Keenan article.

But misquotes happen...

Second, while there are sound reasons to prefer the use of AHT in the medico-legal contexts that follow an inflicted injury, it's a step backwards in the context of prevention.

Prevent Child Abuse America has advocated the reframing of prevention messages about SBS from the context of child abuse to the world of injury prevention and safety that most parents inhabit. When the very name presents it as "abusive" action, that will anchor it firmly in a world parents don't want to acknowledge, let along inhabit. Link to PCAA White Paper.

Plus, "baby" just gathers up the attention of parents in a way that a term focused on the injuries that result from shaking/impact can't...

Prevention education is not about medicine: it's about human behavior, cognition and marketing (now, that's where Apple could really make amends). In significant respects, it's about telling stories that engage people at a teachable moment in ways that change behavior, not about engaging their logical minds.

So, that's why I think I will continue to favor use of the term "Shaken Baby Syndrome" in the context of prevention and that's why I will decline to use the term AHT - in that context.

Of course, as Dennis Miller used to put, I could be wrong.

It would be great if some psychology, education and marketing students and faculty combine on a study to evaluate the way that parents respond to these terms, and most importantly, how the terms affect their real-world behaviors.

For instance, would new parents be more forthcoming in talking to their child care provider about coping behaviors to prevent SBS or AHT? Can the AHT terminology coexist with reframing prevention messages to promote the prevention of injury and the opportunity to help keep a child safe?

Inquiring minds want to know...

Outrage over iPhone 'Baby Shaker' app

In the latest example of the dicey line between the virtual world and the real one, Apple Inc. yesterday apologized for selling Baby Shaker, an iPhone application that let users silence an imaginary crying infant by shaking the multimedia device.

The 99-cent "app" was removed from Apple's online store on Wednesday, two days after it debuted (although it endures on YouTube). Outraged child-welfare groups that decried it as "horrifying" and "reckless" demanded an apology - which they finally got.

Apple spokeswoman Natalie Kerris said in a statement that the software was "deeply offensive" and should not have been approved for sale.

Searching for a silver lining, pediatrician Cindy Christian, co-director of the Center for Child Protection and Health at Children's Hospital of Philadelphia, thanked Apple for finding "an unfortunate way to raise awareness" of child abuse.

"Unfortunately, more than 1,000 babies die each year from being shaken and countless more are left with permanent brain damage," she said. "I'll use any way we can get the message out: It's not OK to take your frustrations out on a crying baby."

* * *

Coincidentally, the American Academy of Pediatrics on Monday will issue an updated policy statement, coauthored by Cindy Christian of Children's Hospital, urging doctors to abandon the well-known "shaken baby syndrome" terminology in favor of "abusive head trauma."

The change, Christian explained, reflects the fact that injury is often a combination of shaking, beating and throwing an infant.

"Shaking is a very important mechanism, but not the only mechanism," she said. "To call all of it 'shaken baby syndrome' is not accurate. A lot of these cases go to court, where mechanisms need to be accurate."

"This area is really quite controversial," she added. "There is a small group of professionals who don't believe you can do harm by shaking a baby."

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