Military Families and Shaken Baby Syndrome: Not Better, Not Worse

Researchers at the Kempe Center, at the University of Colorado School of Medicine, have found that an infant in a military family has about the same risk of suffering head trauma from violent shaking as civilian babies. Department of Defense records show between 26 and 34 out of every 100,000 babies born into military families had substantiated abusive head trauma in the first year of life. That was similar to civilian rates during the study period. As Reuters Health reports:

However, "Within the military there are some children who are particularly at higher risk, including the children of enlisted men," said Dr. Desmond Runyan, director of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect at the University of Colorado School of Medicine in Aurora. 

Baby boys, as well as those born early or with birth defects, were also at increased risk for shaken baby syndrome. So were infants with young mothers, parents in lower pay grades or mothers in the military. Babies between two and four months old are at the highest risk of shaken baby syndrome, which can cause seizures and permanent brain damage. One in four children with the condition dies as a result.

In general, shaken baby syndrome is most common among families who are poor, have little social support and are under stress, Runyan and his colleagues said. Inconsolable crying is one of the main triggers for shaking. "These risk factors for shaken baby syndrome can get magnified a little bit due to the stresses of being in the military," Runyan told Reuters Health.

Many military families are removed from their extended families, live in lower-quality housing and earn relatively low wages, all of which could make child abuse more likely, he said. On the other hand, being in the military may protect against some forms of abuse, like neglect, since members of the military have to pass an aptitude test, have steady employment and have access to family support programs. Past studies on the topic have been inconsistent: some showed an increased risk for shaken baby syndrome among military babies, while others failed to show a link.

One issue, Runyan said, is that some of those studies were done on military training bases where there are a lot of young families - so the results may represent the experience of mostly higher-risk infants. For the new study, the researchers looked at Department of Defense medical records for 676,827 infants born between 1998 and 2005 and linked them to investigative findings from military family advocacy programs confirming cases of abuse. Of those infants, 230 had substantiated shaken baby syndrome and 73 had probable or possible shaken baby syndrome.

Using U.S. Centers for Disease Control and Prevention criteria for a diagnosis of shaken baby syndrome, the researchers calculated there were 34 substantiated cases in the first year of life for every 100,000 military babies during the study period. They then did the same analysis with criteria that have been used to study shaken baby syndrome among civilians, which produced a rate of about 26 cases per 100,000 babies. That is similar to the 28 cases per 100,000 infants found in a past study of civilian babies in 2000, the researchers write in Pediatrics.

Gia Gumbs, who led the study at the Naval Health Research Center in San Diego, California, told Reuters Health in an email that studies of civilian families "may underestimate the number of cases" of shaken baby syndrome if they use less sensitive criteria for diagnosis.

One hopeful note:

"The military has been very responsive and active to the concerns raised about shaken baby syndrome in infants," Runyan said.

SOURCE: bit.ly/15tWduU Pediatrics

Safer Child Care: Comment Period on HHS regulations

A window briefly reopened for comment on proposed health and safety changes to the federal child care regulations.

 

The federal government announced today that  it will extend the comment period on proposed changes to its Child Care and Development Fund regulations to August 23, 2013.

 

The changes are intended to strengthen health and safety requirements.

This is an opportunity to point out the importance of requiring training and 

education for child care providers, about the vulnerability of young children 

to inflicted head injury and about the need to have coping skills for the inevitable moments of frustration and anger that come with caring for young children.

That message can come from anyone who knows a child affected by an inflicted head injury, but the parents of a child injured by a care provider can perhaps best emphasize the point.

Nationwide standards for education about SBS and the vulnerability of young children 

to inflicted head injuries would not cover all child care providers, but it would be a good start.  

A national standard could also provide impetus and motivation for child care providers 

to talk with parents and other caregivers, not just to keep children safe, but to keep themselves safe.

The Federal Register Notice has instructions for submitting comments.  Link to Notice

Notice:

 

This announcement is to notify you that the Office of Child Care (OCC) has reopened the comment period for the Child Care and Development Fund (CCDF) Notice of Proposed Rulemaking (78 FR 29441). Today a notice was published in the Federal Register to formally reopen the comment period for 10 days. Public comments on the proposed rule are due by 11:59 p.m. (eastern daylight time) on Friday, August 23. Comments can be submitted electronically by visiting the Federal Register Web site link below, or you can submit written comments to the following address: Office of Child Care; Aerospace Building, Fifth Floor East; 370 L’Enfant Promenade, S.W.; Washington, DC 20024; Attention: Cheryl Vincent, Office of Child Care.

 

 

It's the same all over: perspective on child abuse reporting in Malaysia

The topic of the study abstracted below was child abuse reporting in the Malaysian press, but the conclusions are relevant to media reporting in the US.

The mainstream press largely reports on the consequences of child abuse: the death and injury of a child, the tragedy that falls suddenly on a family, and, far less less frequently than one might expect, the punishment of the perpetrator.

It is the uncommnon story that examines the circumstances that precipitated the abuse.  Even less common is the story that looks at prevention programs.

The coverage of cases varies inversely with how well we can understand it.  A simple search on Google News shows that the most uncommon cases, involving horrendous cases of deliberate and persistent physical abuse, are picked up by hundreds of media outlets across the nation.  The much more common case of a parent or caregiver losing control and inflicting injury on a crying infant rarely reaches outlets outside of the community in which it happens.

Allow me to offer two possible reasons.

First, those horrendous acts of physical violence transgress some of our strongest norms and define evil for many.  The perpetrators of such acts are beyond the pale, and such acts mark foreign territory for most of us.  By allowing us to divide and define the world into good and evil, in which evil acts are done by bad people unlike us - "them" - they help define "us."   Framing child abuse properly aids understanding, and understanding aids prevention.  Good work on framing from PCAA.

Second, acts of momentary rage violate the same norms, but are far too understandable for many.  To the extent that the perpetrator is someone like ourselves, it creates cognitive dissonance, and we struggle for explanation.  Those stories are not consistent with our division of the world, as "good" people do bad things.  So, we look less deeply, and the grey areas of the story attract less media interest.

For example, Google Trends shows differential responses to "shaken baby" and "Casey Anthony."

The final point of interest: society seems to devolve blame on the mother.  The universality of that response especially obvious if you read the comments on most shaken baby news stories.  A substantial proportion blame the mother for her choice of caregiver or just for putting the child in child care.

And so we justify our choices.

Unfortunately, many comments suggest that some still feel parents are invulnerable to the circumstances that precipitate abuse.  The statistics show otherwise, and those who believe that "good" parents are not at risk of haring their child simply have acquired a false sense of security.

The ‘social tsunami’: Media coverage of child abuse in Malaysia’s English-language newspapers in 2010

Sara Niner  Monash University, Australia

Yarina Ahmad Monash University, Australia

Denise Cuthbert School of Graduate Research RMIT University, Australia

1. Sara Niner, Sociology, School of Political and Social Inquiry, Monash University, Building H Caulfield Campus (H.5.43) 900 Dandenong Road, Victoria 3145, Australia. Email: sara.niner@monash.edu

Abstract
Since the early 1990s, Malaysian society has displayed a deepening concern over steady increases in reported cases of child abuse in the country. For many Malaysians, knowledge of this issue comes from the mainstream media. This research analyses media coverage of child abuse in two mainstream English-language daily newspapers throughout 2010.

The analysis focuses on how this issue is presented and ‘framed’ in the media. Through the use of simple episodic framing and a distorted focus on extreme cases of child abuse, media coverage internationally obscures the reality of child abuse as it occurs within the context of contemporary social, cultural, religious or political systems. This hinders any genuine understanding of the problem, leading to flawed solutions. We find these international patterns largely replicated in Malaysia.

Furthermore, gendered socialization processes in Malaysia make women and mothers principally responsible for family life and there is a tendency to blame and punish mothers for child abuse even when they are not the perpetrators. Internationally, child welfare experts and academics have advised the media to focus reporting on the underlying causes of abuse so that the issue can be better understood and addressed and this advice is pertinent for Malaysia today.  

From Boston MA to Enid OK, Missing the Real Point on Keeping Babies Safe

From the Enid News & Eagle, a reminder that there is often an interesting contrast between the words said, and the headline that results..

Shaken baby syndrome often happens with first-time parentsBy Phyllis Zorn, Staff WriterEnid News & EagleENID, Okla. — Marie Holsten, district director for Oklahoma Department of Human Services, said incidents of shaken baby syndrome often happen with first-time parents, but that’s not always the scenario.
Shaking of the baby can happen when the child is in the care of anyone not prepared to deal with the crying, or when the person caring for the child already is overwhelmed and frustrated by other things, and the crying of the baby becomes the trigger that prompts their frustration to boil over, she said. 

It's actually a fairly good article, as far as it goes.  However, this is how it ends:

Holsten emphasizes parents should be mindful of who they leave in charge of their children.
“A lot of people are going back to work,” Holsten said. “Make sure you get a licensed day care provider. You need to be careful who you are leaving your child with.”

While there's nothing wrong with recommending that parents hire a licensed day care provider, there's much more than needs to be done besides checking for a license (it should be no surprise that not everyone who claims to be licensed actually is...).  My thoughts:

Good article, but hiring a licensed day care provider is not sufficient by itself:  a parent needs to take three more steps. 
 First, ask every caregiver if they know that children as old as 5 years of age are vulnerable to an inflicted head injury, and if they have participated in a safety education program that included info about shaken baby prevention.  Second, ask if they have a coping plan for the inevitable moments of frustration.  Third, give them permission to call you if there are times when they need to talk.  
If it feels awkward, ask yourself if you'd rather leave your baby with someone who doesn't know how vulnerable babies and infants are, who doesn't have a plan to cope, and who is going to be afraid to call you if they need to.
If it still feels awkward, just let the caregiver know that you only want to help her (or him) know what they need to know to help you keep the child safe.

The advice from Enid is not much different than this MD blogger who writes on the Boston.com site

Three things parents can do to keep their child safe from child abuse Comments (12) 

Posted by Dr. Claire McCarthy  January 23, 2013 11:25 AM

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The news of the Cambridge toddler that recently died from injuries has parents terrified.

While this is really understandable, I think that instead of just being terrified we should use this as a moment to really think about what we can do to keep children safe from child abuse. While nothing can prevent all abuse, there are things that parents can do. Here are three:  

Never shake a baby. Shaken Baby Syndrome (SBS), which is when children are shaken hard enough to cause brain damage, is the leading cause of child abuse death in the United States. The most common reason SBS happens? Inconsolable crying. When you mix a baby that won't stop screaming with a stressed-out, overwhelmed caregiver, bad things can and do happen.
If you've got a baby that screams a lot, check in with your doctor--but often it's just normal crying. And in those cases, you need to take care of not just your baby but yourself. Sometimes the best way to care for both of you is to put the baby in a safe place, like his crib, and take a moment to calm down. Here in Massachusetts, you can call the Parental Stress Hotline at 800-632-8188.
Make sure that everyone who cares for your child knows the dangers of shaking. To learn more about SBS and how to prevent it, visit the CDC's Heads Up: Prevent Shaken Baby Syndrome website.

Know the signs of child abuse. It's not always obvious. The Department of Health and Human Services has a fact sheet that has all sorts of information about recognizing abuse and neglect, but here are some of the signs that parents and caregivers should watch for:

• Any unexplained bruise or other injury (or an explanation for one that doesn't make sense)

• Frequent bruises or injuries, even if an explanation is given

• Changes in behavior, such as acting withdrawn, sad, angry or afraid. An occasional off day is usually normal, but if the changes are persistent or recurrent it could be a sign of a problem.

• Changes in appetite or sleep (including trouble falling asleep, nightmares, or bedwetting). Again, only worrisome if persistent--and there can be lots of other explanations.

• Behaviors or statements from children that are odd or not normal for their age (like talking about sex)

• Negative comments about the child from the parent or caregiver--and/or lack of nurturing/happy interactions with child

• The child expresses fear or dislike of the parent/caregiver

Remember--these are just a few of the signs, and could have other explanations. But if you see them, let someone know--like your doctor, or the Department of Children and Families.

Check out all your child's caregivers thoroughly. If you use a daycare center or family daycare, be sure that they are licensed--and check with your local licensing board to find out if there have ever been any concerns or complaints. If you use a nanny or babysitter, do background checks--including in other states the person has lived. Since most child abuse happens when a child is left alone with a caregiver, doing your homework is really important. Get plenty of references. Ask lots of questions--and be sure you communicate with them regularly about your child's behavior and needs. Ask friends and neighbors who might interact with the nanny or babysitter to keep an eye out and let you know if anything concerns them--and make surprise visits regularly.
It's impossible to know everything about anybody, no matter how well you do your homework--that's what so scary about this. Keeping your antennae up can help; if for any reason something about a caregiver doesn't feel quite right to you, listen to that feeling. Don't ignore it. It's always better to be safe--after all, nothing will ever be more important than your child.
For more about how all of us can help to prevent child abuse, visit the website of Prevent Child Abuse America.

This is what I said then (and I'll say it again):

geolith01/24/2013 12:03 AMWell, as advice goes, this is better than nothing, but it falls short of good.

First, given that the impetus for the advice is a child shaken by a nanny, it would be far more effective to discuss how important it is that parents educate caregivers about the vulnerability of young children to inflicted head injury, and how to do that in a constructive, non-accusatory way.   Telling someone that "you shouldn't shake a baby" is hard to do, and hard to listen to.  Telling someone that I want you to help protect our child from head injury is a lot easier for both.

Second, background checks on a child care provider are poor advice for a number of reasons.   Most people who have options trust their own judgment about who to leave their child with, so see little reason to take the time and bear the cost of having a background check done.  Plus, once you've decided, the reality is that it's more than a little awkard to bring up the background check.  And more often than not, caregivers who inflict injury have no record.

Third, all those recommendations, and not ONE mention of the most important step?  Parents need to talk TO the caregiver and find out what he or she knows about the danger of inflicted injury and how they plan to cope with the inevitable moments of frustration.  And please, give them permission to call you if they even begin to feel the frustration is taking over.
I admire and respect doctors.  

But medical school teaches them how to treat illness, not how to educate people about prevention.  If you're learning how to drive, you don't need a mechanic or a body shop operator to tell you about the consequences of motor vehicle accidents; you need an educator to help you learn how to stay out of one.

By the way, Mass Campaign for Children has been doing some excellent work educating new parents and caregivers.  Ask Jetta Brinnier to do a follow up article about the experience of learning how to give good advice to new parents...

Perspective: Train a Parent, Spare a Child

Bruce Feiler has an interesting article in the New York Times about parent and child interaction:  "Train a Parent, Spare a Child."

That title caught my eye.  

It would be an apt one for advocating new parent education to prevent acts of abuse.

While the article covers more common ground - whether should parents bribe kids in the tween ages to induce behavior - it does point up the need to educate parents about the parentchild (no space intended) interaction.

That includes educating parents about the consequences of their choices not just for the two people involved, but for the interaction between them.

The article's worthwhile reading for those of us with children who've taken the first steps across the threshold of free will.

It's also worthwhile to consider how it applies to parents in the period between birth and preschool, when children aren't able to state their intentions, let alone negotiate behaviors.

That's when training a parent to respond appropriately to frustration may indeed spare a child.

NB It will also be interesting to see how parenting styles and parent personality traits inform the comments on the article.  When articles in the Times discuss parenting styles, the commentary becomes quite the Rorschach test....