From KETV in Omaha, Nebraska, a tale of redemption, I suppose. It is welcome to see a father accept responsibility for caring for the child he injured..

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

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

POSTED: 8:42 pm CDT July 14, 2008

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In this article, we review literature related to inflicted childhood neurotrauma (ICN). We discuss the rationale for use of the term "ICN," rather than the more benign, commonly used "shaken baby syndrome." The change in language alters the discourse about a potentially lethal outcome or lifelong problem for survivors. A description of ICN is followed by a discussion of ethical parameters and obligations of those who care for infants and children and professionals who are sentinels to these events such as law enforcement officials, nurses, physicians, and social workers.

And a couple of interesting sleep related studies ... one finding that maternal depression during pregnancy, breastfeeding and a lower socioeconomic status are all associated with less infant sleep duration in the first six months of life, and one finding that parents don't sleep well with if they're sharing a bed.

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

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

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

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

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

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

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

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

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

An interesting study by way of ScienceDaily.com

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

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

Of special note:

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

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

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

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

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

Non-parental Care Of Infants Tied To Unfavorable Feeding
Practices
ScienceDaily (July 13, 2008) — With more new mothers in the workplace than ever before, there has been a corresponding increase in the number of child-care facilities in the United States.
At the same time, data from a variety of sources point to a growing prevalence of overweight infants and toddlers.
Is there a connection?
According to a new study co-written by University of Illinois community health professor Juhee Kim and Karen Peterson, a professor of nutrition and society at Harvard University’s School of
Public Health, child-care factors and feeding practices may indeed play a role.
“Our study is the first to report, to our knowledge ... the potential importance of infant child care on infant nutrition and growth,” the researchers said in an article published in the July issue of the Archives of Pediatrics & Adolescent Medicine, a publication affiliated with the Journal of the
American Medical Association. “The results of this study indicate that structural characteristics of child care, such as age at initiation, type and intensity, were all related to infant feeding practices and weight gain among a representative sample of U.S. infants.”
Specifically, Kim and Peterson found that 9-month-old infants who routinely receive non-parental care – provided by relatives, licensed day-care centers or more informal child-care providers – may experience higher rates of unfavorable feeding practices. The babies also weigh
more than those whose primary caregivers are their parents.
The researchers’ findings could have significant public-health ramifications, as weight gain in
infancy can ultimately be a predictor of obesity later in life.
Obesity, in turn, is linked to a number of chronic illnesses, such as diabetes and
hypertension, as well as adulthood morbidity and mortality.
In their study, Kim and Peterson analyzed baseline data from a nationally representative sample
of 8,150 9-month-old infants to determine whether infant-feeding practices and non-parental care might be a factor in the rise in weight of the infants. They used data collected for children enrolled in the Early Childhood Longitudinal Study, Birth Cohort, conducted by the U.S. Department of Education’s National Center for Education Statistics.
Kim and Peterson found that 55.3 percent of the infants had received regular, non-parental child care, with half of those infants receiving full-time child care. Among babies in child care, 40 percent began receiving such care at age 3 months; 39 percent, between 3 and 5.9 months,
and 21 percent at 6 months or older.
“Weight gain and the prevalence of overweight were lowest among infants who received care by parents,” the researchers noted in the published article.
The researchers also examined data regarding breastfeeding initation for babies receiving parental and non-parental care, along with the stage at which solid foods were introduced to
the infants. Only starting solid foods before 4 months of age was associated with increased overweight among infants.
“Infants who initiated child care before 3 months of age had lower rates of ever having been breastfed and higher rates of early introduction of solid foods,” they wrote. “Infants in parental
care were more likely to have breastfeeding initiated and solid foods introduced after 4 months of age compared with those in child-care settings.”
Further, infants in part-time child care gained more weight – 175 grams – by 9 months of
age, compared with those receiving only parental care. Those being cared for by relatives also showed a weight gain – 162 grams.
“A strength of our findings,” the researchers noted, “is that the observed effects of child-care
factors remained significant after controlling for maternal pre-pregnancy BMI (body mass index) and a child’s birth weight.”
“Although both factors are known to be strong predictors of childhood overweight status, in our study, only birth weight was a significant factor in weight gain.”
Kim said there are a couple of important take-home messages from their research results for parents and child-care providers.
“Parents may (may?) want to have enough communication with child-care providers about when, what and how to feed their babies during their stay in day care, which is important to avoid potential risk of overfeeding or underfeeding at home,” she said.
“Child-care professionals can encourage parents’ active involvement in the decision process of what, when and how to feed infants. Child-care providers also need to participate in nutrition-education/training programs to understand the importance of starting solid foods, transition from breast milk or formula to foods, and how to implement recommended practices to ensure a healthy eating environment.”
Kim hopes to be able investigate relationships among child care, feeding practices and weight gain in children in other parts of the world.
“It would be interesting to conduct a cross-cultural study,” she said. “Considering eating is
a socio-economical and cultural event, the impact of child care on infant feeding practices – food consumption – might be different among different countries.”
The current research was supported in part by the Berkowitz Fellowship of the department of nutrition, Harvard School of Public Health; an Early Childhood Longitudinal Study, Birth Cohort training grant from the National Center for Education Statistics; and training grants on statistical
analysis for education policy from the American Educational Research Association.
Adapted from materials provided by University of Illinois at Urbana-Champaign.

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

Here's an interesting story from Florida - 18 families auditioned to have a TV nanny teach them how to handle their children...

Frustrated parents came from Cape Coral, Lehigh Acres, Naples and Fort Myers for a shot at getting Nanny Jo, a gentle yet firm nanny from England, to help control their children.

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

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

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

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

The biggest thing Christiansen learned from Nanny Jo?

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

This certainly seems to suggest that the need for parenting education and parent support skills is relatively widespread.

The Ontario Injury Prevention Resource Centre (which has some excellent injury prevention resources available to share with the rest of the world - "Thanks, Ontario!") has made the text, Powerpoint and audio available for an interesting presentation by Ron Barr on the Prevention of Shaken Baby Syndrome.

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

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

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

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

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

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

Infant Crying and Shaken Baby Syndrome: The Evidence Base for Implementing the
“PURPLE” Prevention Program
May 6, 2008 - Dr. Ronald G. Barr

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

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

* * *

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

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

Session Materials
Session OutlinePowerPoint SlidesPDF Slides Audio of session

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

The CDC has a health marketing initiative

The CDC is sponsoring a series of workshops that focus on how key audiences use technology to learn and make decisions about health

The September 15-16 workshop focuses on moms...

As of June 30, 2008, the Care2 Petition Site has 12,865 signatures on a petition sponsored by the American Humane Society in support of the SBS Prevention Act legislation.

They set a goal of 15,000 by August 16, 2008. If you haven't signed on yet, please visit the webpage and drop your elected representatives a line...

http://www.thepetitionsite.com/takeaction/276923007

Help Prevent Shaken Baby Syndrome!
Target: US Congress
Sponsored by: American Humane Association

Shaken Baby Syndrome (SBS) is a form of child abuse that results from violently shaking an infant or from abusive impact to an infant's head. Between 1,200 and 1,600 of the nation's children suffer from SBS each year.

Congressional findings estimate that between one-quarter and one-third of SBS victims die as a result of their injuries, while one-third suffer permanent and severe disabilities, including traumatic brain injury, paralysis, seizures and loss of hearing or vision.

To protect the nation's most vulnerable citizens from such tragic and preventable maltreatment, Senator Chris Dodd and Rep. Nita Lowey have introduced the Shaken Baby Syndrome Prevention Act of 2007 (S. 1204 and H.R. 2052).

The bill enables the Secretary of Health and Human Services to develop a national public health campaign that would inform the general public, new parents, child care providers, health care providers and social workers about the risks and dangers associated with SBS.

My response to a query posted on ParentDish, about what to say to a friend about their child - who seems to be displaying autisic behaviors?...

Having done Shaken Baby prevention education for eight years, I'd have to say I'm adverse to "telling" anyone about sensitive subjects like these.

As an education workshop title aptly put it, "telling ain't teaching."

Educating is different, especially if it is based on your own experiences and your collected wisdom. And I think it's especially important to reframe early intervention as an opportunity, not a stigmatization.

In our experience, that requires education at many levels. Educators, health care professionals, media and what I call reference parents - those who are perceived in their community as models of effective parenting and sources of knowledge.

Unfortunately, while it's a lot easier to have such conversations in an informed and educated social context, those contexts are by far still the exceptions.

That can change.

For example, New York (and 10 other states) now requires hospitals to offer SBS education to new parents before they leave the hospital.

Our pediatrician says this has made it much easier for him to talk to new parents about the danger of shaking young children and the need to have a coping plan. It's no longer a question for the parents why their pediatrician thought it necessary to talk to them about child abuse. Now, it's just one more thing he can do to help them keep their child safe.

Individual action, in the absence of social action, is a much harder slog.

Hopefully, the increased concern about autism will not only raise anxiety, but raise the information in the community about the importance of early remedial action.

A curious proposition about child abuse reported on the Child Safety Experts blog:

Posted by: Joyce in child abuse on May 19, 2008

Child abuse prevention takes a quantum leap forward. There is an interesting theory today from a researcher in Montreal that is a big step in child abuse prevention. He thinks one of the best ways to prevent child abuse is through directly going to the community for awareness and support, not directly the parents. Combating mistreatment of children is more effective at the grassroots level, not in the family. Things like summer camps for high-risk kids are absolutely critical in combating child abuse than family education programs. Most child abuse, because of the reporting system, is pushed toward thinking the best thing to do is involve the authorities. Reporting has to happen, but what comes with that often is turning our backs on the problem. There's not much the authorities can do without support from the community. Fascinating.

My response:

Check out Prevent Child Abuse America's policy memo on the disparity between public "awareness" of child abuse and action on child abuse. Most people are aware of abuse: they just think it involves "those" people.
Not them, not their family, not their friends. Those actions have reasons, so they are understandable. He's tired. The kid's a handful. Kids need discipline.
So, if they define abuse as essentially acts committed by someone I don't know or I don't like, how are they going to have any effect on actions by those people? Not to mention the options abusers have to isolate themselves and their kids, whether it's by hiding in the spaces of the suburbs and exurbs, or in the anonymity of the city.
The reality is that most people don't view child abuse as "their" issue. If they know someone and believe that person to be a good person, acts of abuse and neglect are excused by a variety of cognitive devices.
More community awareness to support parents, and to help new parents adapt and cope with the challenges raising kids in difficult times, will help. It's necessary, but far from sufficient.
Many of those parents need education that provides them with skills and abilities, while also helping them to understand and anticipate the frustration and anger that can come with raising young children.
Home visiting and other skill enhancing interventions clearly work.
The challenge is to find sufficient funding so that we can use them.

A very good post on the "Science Based Medicine" blog.

Well worth 10 minutes of reading time: while only a small portion touches on the SBS/vaccination claim, it puts the "Journal" in proper perspective. It shows that the quality of peer reviewed work is only as good as the quality of the peers...

The Journal of American Physicians and Surgeons: Ideology trumps ...By David Gorski For example, JPANDS has become arguably the foremost “respectable” promoter of the claim that many cases of “shaken baby syndrome” are in actuality due to “vaccine-induced” encephalitis. Indeed, it has published numerous articles making ...

On the theory that hospitals should know better, I'm starting a list of hospitals which have safety pages for parents about babysitters for babies, and whether or not they advise parents to ask babysitters if they know about the SIDS risk reduction techniques or have a coping plan for frustration to avoid SBS.

Let's start with:

- Childrens' Hospital of Pittsburgh: NO and NO

Court of Appeals reverses ’06 ruling Cases involved two men accused of injuring their infants by shaking
By KENNETH HART - The Independent

GREENUP — The Kentucky Court of Appeals has reversed a 2006 ruling by a former Greenup circuit judge that affected cases involving two men accused of injuring their infant children by violently shaking them.

In a ruling handed down Friday, a three-judge panel of the appeals court ruled that now-retired Judge Lewis D. Nicholls erred when he barred prosecutors from introducing expert testimony regarding shaken-baby syndrome.

Because of the ruling, Greenup Commonwealth’s Attorney Clifford Duvall was unable to bring the cases against the two defendants, Raymond Martin and Christopher A. Davis, to trial. Martin and Davis were indicted in separate cases in 2004 for allegedly abusing their infant sons. Martin was charged with second-degree assault; Davis with first-degree criminal abuse.

The victims — who were three and four months old, respectively, at the time of the alleged abuse — both exhibited the classic signs of shaken-baby syndrome: bleeding in the brain, also known as subdural hematoma, and bilateral hemorrhaging, or bleeding behind both eyes.

Shaken-baby syndrome was first recognized in the 1970s and the diagnosis has been accepted by the American Association of Pediatrics and the National Association of Medical Examiners. However, at a March 29, 2006, hearing, attorneys for Martin and Davis presented expert testimony they maintained was proof that the diagnosis wasn’t reliable enough to send their clients to prison.

Dr. Ronald Uscinski, an associate professor of neurosurgery at Georgetown University, testified during the hearing that a recent study had shown shaking alone would cause infants’ necks to snap before it would cause bleeding in their eyes and brains. Experts for the prosecution countered that Uscinski’s conclusions were flawed and could not be proved in controlled experiments because researchers couldn’t shake real infants.

On April 17, 2006, Nicholls ruled that testimony from the prosecution’s chief expert, Dr. Betty S. Spivack, a forensic pediatrician at Kosair Children’s Hospital in Louisville, did not meet the standard for scientific reliability, and concluded, based largely on the testimony of Uscinski, that shaking alone could not have caused the type of injuries suffered by the two infants.

“To allow a physician to diagnosis shaken-baby syndrome with only the two classical markers, and no other evidence of manifest injuries, is to allow a physician to diagnose a legal conclusion,” Nicholls wrote. Duvall appealed Nicholls’ decision, which child advocates said set a dangerous precedent and had the potential to hamper the ability of the criminal justice system to protect children.

The appeals court ruled that Nicholls abused his discretion in keeping out the testimony and ordered the cases reversed and remanded for further action. The panel concluded Nicholls’ decision to exclude Spivack’s testimony was erroneous “because it was founded on the unsupported legal conclusion that because there was dispute amongst the experts as to the possible cause of the infants’ injuries, it was the court’s rule to choose the side it found more convincing and exclude the side it found less convincing.”

Judges also wrote Nicholls should have allowed both experts to testify and a jury to choose the one it found more credible because the “gatekeeping” function assigned to judges is restricted to keeping out “junk science” and unreliable expert testimony. Under the law, attorneys for Martin and Davis now have 30 days to request a discretionary review by the Kentucky Supreme Court.

Duvall said Friday, if the defense does appeal, further action on his part would have to await a ruling from the high court. “If it remains in our favor, we will set those cases for trial,” he said.

“We worked very hard on these cases and we feel vindicated by the decision,”Duvall said. “We also give lots of credit to James Shackleford, who briefed the issues before the court of appeals for (former Kentucky Attorney General) Greg Stumbo.”

Short falls don't seem to be as dangerous as some defense experts suggest...

June 2, 2008 PEDIATRICS Vol. 121 No. 6 June 2008, pp. 1213-1224

REVIEW ARTICLE
Annual Risk of Death Resulting From Short Falls Among Young Children: Less Than 1 in 1 Million

David L. Chadwick, MDa,b,c, Gina Bertocci, PhDd, Edward Castillo, PhD, MPHe, Lori Frasier, MDa,f, Elisabeth Guenther, MD, MPHa,f, Karen Hansen, MDa,f, Bruce Herman, MDa,f and Henry F. Krous, MD

OBJECTIVE. The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday.

METHODS. A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed.

RESULTS. The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers.

CONCLUSIONS. The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

An interesting study from the University of North Carolina, published in the June issue of Pediatrics.

It looks at one of the consequences that results when cases involving inflicted injuries work through the criminal justice system. While this is a relatively small sample (N:30) from North Carolina, it raises an important concern. It is important for that the system work fairly for victims and alleged perpetrators so that justice results.

Also of interest (and no surprise to anyone who follows investigation, prosecution and sentencing in SBS cases):

- nearly one-third of the identified cases apparently weren't prosecuted.
- sentences varied widely, even when the child died - from probation to life.
- 30% (3 of 10) of the cases that went to a jury resulted in acquital.

If you accept the premise that mercy falls most easily and often upon those who look and act like "us", I wonder if these findings in "SBS" cases also suggest that the easier it is for us to place ourselves in the defendant's shoes, the lesser the charge and the lesser the sentence, eg when we think they are a "good parent" who has done a bad act.

In which case, the quality of justice is reduced for the injured child of those who seem most like us...

George

PS. My anecdotal experience educating child care providers suggests that the adequacy of the sentence in a case is important: in every presentation, someone always asks what happened to the child care provider who shook our son.

When I tell them she was sentenced to jail, they always ask: "for how long?"
Non-whites Receive Harsher Sentences for Inflicted Traumatic Brain Injury of Children
Libraries - Medical News - http://www.newswise.com/articles/view/541447/

DescriptionNon-white defendants are nearly twice as likely to receive harsher prison sentences than white defendants in North Carolina criminal cases stemming from inflicted traumatic brain injury of young children.
Newswise — Non-white defendants are nearly twice as likely to receive harsher prison sentences than white defendants in North Carolina criminal cases stemming from inflicted traumatic brain injury of young children.
That’s the conclusion reached by researchers from the Injury Prevention Research Center at the University of North Carolina at Chapel Hill, who tracked down what happened in every such case prosecuted in North Carolina in 2000 and 2001. Their study appears in the June issue of the journal Pediatrics.
Inflicted traumatic brain injury is a specific form of child abuse, which includes but is not limited to shaken baby syndrome.
“We expected to find that whether or not the child died would be the factor most predictive of the punishment that was imposed,” said Dr. Desmond K. Runyan, the study’s senior author, professor and chair of the social medicine department in UNC’s School of Medicine. Runyan is also a professor in the pediatrics department and an adjunct professor in the School of Public Health’s epidemiology department.
“But we found instead, much to our surprise, that the race of the defendant was the most predictive factor,” Runyan said. “Death of the child didn’t matter nearly as much in terms of the sentence, and neither did any of the other factors we examined.”
Defendants whose race was defined as non-white (which included African Americans, Hispanics and Native Americans) were 1.9 times more likely than white defendants to receive a severe sentence. For the purposes of the study, severe sentences were defined as 90 days in prison or longer. Sentences defined as not severe included probation, community service and prison time of less than 90 days.
Runyan said the study raises serious questions of public health and social policy, including whether or not harsh prison sentences for the perpetrators of traumatic brain injury in young children is the most beneficial way for society to deal with this problem.
“In most of these cases the perpetrators are not acting with the intent of hurting the baby. Instead they are usually frustrated young parents who respond to a crying baby with 30 seconds of stupidity, because they weren’t educated about the dangers of shaking a baby,” Runyan said. “In my view, harsh prison sentences may not be the most appropriate response in this situation, and we need to seriously consider other ways of dealing with what is a significant public health problem.”
The study’s lead author is Heather T. Keenan, Ph.D., who was a graduate student at UNC and now is an associate professor at the University of Utah. Maryalice Nocera, a research nurse with the UNC Injury Prevention Research Center, is a co-author.
“It is difficult to know what the appropriate judicial response should be to these cases as the value of the child’s lost life or abilities need to be recognized,” Keenan said. “However, it is clear that the response should not be based on the defendants’ race or ethnicity.”
This study follows up on an earlier study by the same researchers, which was published in the Journal of the American Medical Association in 2003. Their goal this time was to find out how the justice system treats suspected perpetrators of one specific form of child physical maltreatment, inflicted traumatic brain injury.
They found 75 substantiated cases of inflicted traumatic brain injury among children ranging from infants to 2-year-olds. Of these, criminal charges were filed in 54 cases. Forty-one of the defendants pleaded either guilty or no contest to the charges and 10 defendants went to jury trial. Three were found not guilty, leaving 48 defendants with criminal convictions. Of these, 30 (63 percent) were sentenced to time in prison.
Whether or not the child died was found to have an effect on the severity of charges that were filed; defendants faced more serious charges when the child died. However, even in cases where the child died sentencing outcomes varied widely, ranging from probation to life in prison.
Several other potential predictive factors of sentencing outcomes were examined, including perpetrator age, gender, relationship of the perpetrator to the child and whether or not the child died, but none were found to be statistically significant.
Runyan said these findings raise many questions for additional research, including whether or not the quality of the defendants’ legal representation made a difference in sentencing outcome. Many of the defendants were poor and thus were represented by court-appointed attorneys.

This study might be a bit peripheral, but touches on why education in the hospital is important: parents and child may not get to the doctor's office.

Uninsured kids in middle class have same unmet needs as poor

Nationwide, uninsured children in families earning between $38,000 and $77,000 a year are just as likely to go without any health care as uninsured children in poorer families. More than 40 percent of children in those income brackets who are uninsured all year see no physicians and have no prescriptions all year, according to new research from the University of Rochester Medical Center.

“There’s an assumption that children in families with higher income levels don’t need insurance, that they are uninsured but are somehow still receiving health care anyway,” said Laura Shone, an assistant professor of pediatrics at the University of Rochester Medical Center and author of the study.

“This study shows that in reality, a large percentage of these children don’t receive any care at all – which pediatricians say is unacceptable, and parents know is unrealistic. Even healthy, older children need to see their physicians at least once over the course of a year.”


Overall, almost 3 million uninsured children had no medical care and no prescription use for a full year, according to an analysis of nationally representative data from the 2004 Medical Expenditure Panel Survey.

The percentage of uninsured children who forego all health care for a full year is:
55 percent at 0 to 100 percent of the federal poverty level ($0 to $19,157 for a family of four)
51 percent at 101 to 200 percent of the federal poverty level ($19,158 to $38,314)
42 percent at 201 to 300 percent of the federal poverty level ($38,315 to $57,471)
44 percent at 301 to 400 percent of the federal poverty level ($57,472 to $76,628)
30 percent for those over 400 percent of the federal poverty level ($78,629 and above)

There have been four or five shaking cases (at least that I've read about) where a person who shook a child was reported to have seen an educational video in the hospital.

In response to a question about a recent case in Albany (where it is unknown whether the father had seen the video), I had some thoughts on video education programs...

- first, it's important to recognize that the law in New York and other states usually doesn't require that parents watch the video: it requires that hospitals offer all new parents the opportunity to do so.

The effectiveness of the program is a function of several things, including whether the hospital sets up an effective and efficient way to make that opportunity available, how it is managed by the staff, and how the educational opportunity is presented to the parents.

"Do you want to watch a video about shaken baby syndrome?" is a very different question than "We'd like to show you a video that will help you learn how you can help keep your child safe from shaking injuries. Is that OK?"

As I recall, the stats last year indicated that the "watch" rate varies in the hospitals supported by the regional program here varies between 45% to 75%.

Some of the hospitals close to the NYC metro area have problems because they rely on a signfiant number of per diem nurses to provide care, and those nurses don't necessarily get training on the program.

That's still better than the participation was at Albany Medical Center a couple of years ago, when I was told that about 25% of the parents watched the video. They were not involved with either of the regional prevention support programs and I was told by one parent that the nurses basically asked the first question: "do you want to watch a video about SBS?"

On the other hand, when I was at a baby safety fair in the Albany area a couple of years ago, I informally sampled parents with infants and it seemed that St. Peter's Hospital was doing the best job of the 5 maternity hospitals in the Albany area.

- second, while all of the hospitals make an effort to show the video to both parents, I believe they usually manage to get only about 60% of the fathers.

- third, and in some respects most critically, there are individuals who see the video and either don't get the information or don't acknowledge and act upon it.

I don't think there are any simple explanations that fits all cases.

For many fathers, the birth experience is not only the opening of a door into a strange, new world with new and enormous responsibilities, but it is a time of disruption, confusion and chaos. It's frequently the beginning of a long period of intermittent exhaustion, coupled with anxiety and apprehension.

In those circumstances, even when the father is present, getting him to stop, participate and focus on the video, and not just to watch it, but to understand and apply it to themselves, is a challenge. I suspect the an appeal to fathers to learn how "you can protect your baby" theme is most likely to be effective, but this is an area that requires some real psychologically based outcomes research.

- Fourth, some of those fathers (and the relatively few articles reporting on a shaking event by a parent who has seen the video all involved males) are going to watch that video and refuse to accept that it has any lessons which apply to them.

In particular, I think individuals with control issues are not disposed to learn the lessons being offered.

Video education is, I think, a very effective way to prevent shaking from ignorance - and while it didn't assess specific knowledge about the danger of shaking, the recent study which found 1/3 of parents are ignorant about important aspects of child development suggests there is significant ignorance about the nature of that danger too - and probably works to prevent many instances where parents are generally indifferent to the welfare of their child.

I think one thing that is needed is education for mothers that models ways to effectively engage their spouse in the routines of child care and child safety, especially in contexts where domestic violence is a concern.

One reason that education in the hospital is important is that research suggests education following birth takes advantage of a "teachable moment" - at least for mothers - when parents are usually receptive to education about how their behavior can affect children. It has been shown to increased the effectiveness of smoking prevention programs targeted at mothers.

In the Buffalo study area, there has been a sustained reduction in inflicted head injuries of 50%.

I believe that while some parents are involved in the cases that are still happening, the precentage is lower than the nationally reported statistics and many of those parents didn't actually see the video (I suspect partially because of the reasons noted above, and partially because some parents didn't want to watch a video about "child abuse" - another area where research needs to replace speculation).

Considering that a typical prevention program is touted as a success when there is a 10%-15% change in the targeted behavior, this is extraordinary success (as recognized by the Joint Commission on Accreditation of Healthcare Organizations).

That said, we all recognize that it won't be successful enough until there is a 100% change.

The Washington Post has an interesting story on how one doctor has started a breast cancer education and prevention program for Latino immigrants.

The doctor is Elmer Huerta, who happens to be the current president of the American Cancer Society. The program is the Cancer Preventorium, a one-of-a-kind clinic that is part of the cancer institute at Washington Hospital Center. It is aimed at drawing in low-income Latino women, not for treatment but for prevention.

He's done some excellent outreach to the Hispanic community that should be a model for SBS education:

Huerta, the president this year of the American Cancer Society, used to be an oncologist in his native Peru. But he changed his focus in the late 1980s after seeing women with cancerous tumors bulging out of their breasts. "They didn't know anything about health," he said, "because they were ashamed to show anyone what was wrong and because they thought the absence of pain is the absence of anything wrong."

Many of these patients, however, knew the latest celebrity gossip, the subplots of every TV soap opera and the scores of every big soccer match. If radio and television were that powerful, Huerta recalls thinking, "would it be possible to sell health to the public through the media?"

In 1986, he began producing and then starring in a health education TV show in Lima; he discontinued the show in 1987 when he moved to the United States to complete a fellowship at the Johns Hopkins Oncology Center. He began a medical residency program in Baltimore and started recording five-minute health-care spots on a Spanish-language radio station in Laurel. In 1994, the same year the Cancer Preventorium opened, Huerta created a live weekly television program on health promotion and disease prevention.

Today, Huerta's radio spots, called "Cuidando Su Salud" ("Taking Care of Your Health"), air daily on more than 120 stations in the United States and more than 350 in Latin America. His television program, "Hablemos de Salud" ("Let's Talk About Health"), is distributed nationally.
Three months ago, Huerta's local call-in program expanded to two hours after being syndicated nationally. Now called "Cita Con el Doctor" ("Appointment With the Doctor"), it reaches Latinos in 14 states five days a week.

Framing "SBS" for Understanding and Action

A recent post on one of the SBS Listservs noted a blog post by a BMW owner that described an exhaust system problem as "shaken baby syndrome" and observed that the use of the term is finding its way into common speech.

In response, I offered two thoughts about why that's not necessarily good:

- as with many other technical phrases that find their way into common speech, being familiar with the phrase isn't necessarily understanding the phenomena.

When I do a Google blog search, it frequently finds SBS used as a modifier or adverb to connote an excessive, agitated or frantic level of an ordinary activity, such as "she danced so hard I thought she would get shaken baby syndrome" or "the ride was so bumpy I thought my baby would get shaken baby symdrome."

In some respects, that's cause for concern because (1) when the term is used in common parlance, it tends to have a trivializing/desensitizing effect and (2) it reflects an inacurate understanding of the actual physical process.

A related issue: awareness of the term "SBS" doesn't mean understanding, and it doesn't necessarily translate into prevention action. Prevent Child Abuse American wrote some important policy memos a few years back lamenting that the increased awareness of child abuse hasn't translated into increased prevention efforts and emphasizing the need to reframe prevention.

Awareness of the term is necessary, but it's not sufficient for prevention.

And that's especially apparent when the media focuses on reporting the crime, not what could have been done to prevent it.

Watching news reports will make parents aware of SBS, but the psychological process they use to "make sure" it won't happen to their child is to focus on the distinctions between "those people" and "us".

That's what makes child care cases especially unnerving for folks who have kids in child care: they want to know what was wrong with that child care provider and how he/she was able to fool the parents.

The work that Prevent Child Abuse America has done on "reframing" abuse is essential reading in order to develop persisting and effective prevention measures.

- second thought is just that the use of this term as part of common speech is still fairly unusual. Blog searches bring us the hits, but they don't tell us how common the term is.

George

By the way, the term "frenetic" seems like it was made to apply to the actions that lead to SBS
Definitions of frenetic on the Web:

frantic: excessively agitated; transported with rage or other violent emotion; "frantic with anger and frustration"; "frenetic screams followed ...
wordnet.princeton.edu/perl/webwn

Not that we need more reasons to prevent inflicted head injuries, but here's another one anyway

APA Annual Meeting 2008: Consequences of abuse, neglect, and trauma on the development of mental health disorders and the implications for prevention, diagnosis, and treatment.

"Stress early in life is related to persistent sensitization of the pituitary-adrenal and autonomic stress response. Sensitization of the stress response is likely related to an increased risk for adulthood psychopathology.

And MIT Technology Review also reports that the general state of TBI research isn't much better:

Yet much about brain injuries remains unknown. Despite decades of research, no treatments yet target the underlying pathophysio­logical cause of progressive brain damage. For patients so severely injured that they are in a minimally conscious state, medical knowledge is particularly lacking; in such cases, we are just beginning to understand the damage and the possibility of treatment (see "Raising Consciousness").
* * *
Finding treatments for those injuries that do occur will depend on better understanding the complex cellular events triggered by a brain injury. In TBI, a rapid mechanical deformation of the brain both physically disrupts and mechanically stimulates cells. Some cell damage is immediate, but most of the damage develops over days, weeks, and even months. The delayed and progressive nature of the neurodegenerative cascade represents a critical therapeutic opportunity: targeted intervention could halt the progression of cell damage and death. However, no therapeutic strategies yet exist that target the degeneration mechanisms.

MIT's Technology Review looks at military TBI.

Here's a telling comment:

"With IEDs, the insurgents have by dumb luck developed a weapon system that targets our medical weakness: treating brain injury," says Kevin "Kit" Parker, a U.S. Army Reserve captain and assistant professor of biomedical engineering at Harvard University who served in southern Afghanistan in 2002.

The article goes on to conclude:

Military doctors are only beginning to get a grasp on the number of soldiers who have suffered mild traumatic brain injury, the medical term for a concussion. Mild injuries are by far the most common type of brain trauma, but they are more easily missed than moderate and severe injuries (they typically don't show up on standard brain scans), and the lasting effects, especially of repeated concussions, are not yet clear. Surveys of troops to be redeployed in Iraq suggest that 20 to 40 percent still had symptoms of past concussions, including headaches, sleep problems, depression, and memory difficulties. "We don't know what it means in terms of long-term functional ability," says William Perry, past president of the National Academy of Neuropsychology.

In young children, the brain possesses great plasticity and can recover from enormous insults. Recovery will be much harder for these folks. Hopefully, much of what we belatedly learn about the mechanism of injury and the nature of mild TBI wil not only help advance their rehabilitation from those injuries, but transfer to children who were victims of inflicted head injuries.

An interesting post from 2007 on Mindhacks discusses All in the Mind, an Australian TV program that looks at how neuroscientists are uncovering the neurobiological changes that take place during parental care, and how the brain can be markedly altered by abuse or neglect during the early years.

And there's a transcript

Unfortunately, this case from Schuykill County PA seems like a "classic" case of SBS...

www.mcall.com/news/local/all-b1_1baby.6387378may01,0,2300567.story

themorningcall.com
'Frustrated' father shook crying baby, police say
Schuylkill tot is 'critical'; Kyle Bluge faces assault charges.
By Chris Parker

Of The Morning Call

May 1, 2008

A 22-year-old Schuylkill County man who complained of being frustrated with his children was in county prison Wednesday, accused of shaking his 6-week-old son so hard the baby was hospitalized in critical condition with severe head trauma, police said.

Kyle J. Bluge of 512 E. Railroad Ave., New Ringgold, shook the baby between 12:55 a.m. and 1:05 a.m. Friday, state police at Frackville said. The baby was taken to Geisinger Medical Center in Danville, Montour County.

Bluge was arraigned before District Judge James Ferrier, Orwigsburg, on charges of aggravated and simple assault, endangering the welfare of children, reckless endangerment and harassment and jailed under $15,000 bail.

An affidavit of probable cause that state Trooper Collette M. Smith of Frackville filed with Ferrier gives this account:

The county Children and Youth Services agency notified police April 25 that the baby was in the hospital. About 1:30 a.m. that day, emergency medical crews arrived at the home Bluge shared with the infant, another child, his girlfriend and her father.

Bluge had called the ambulance, saying the infant was ''having trouble breathing because a toy was dropped on his abdomen,'' the affidavit says.

The baby was taken to Pottsville Hospital, then transferred to Geisinger. Smith was told the infant had severe head trauma, bleeding into his brain and retinal damage, all of which are common with shaken baby syndrome.

Bluge told police he had put the infant on the floor next to his crib while he went across the room to get diapers and wipes. He said he heard a ''bang'' and the infant began crying. Bluge told Smith he turned and saw a toy truck, apparently tossed by another child, near the baby's head and thought it had hit him in the abdomen, according to the affidavit.

Bluge later told Smith he had been trying to feed the infant, who was fussy. The baby cried and wouldn't take the bottle, he said. The baby was screaming and Bluge said he shook the bottle in the infant's mouth, causing his head to shake back and forth.

Bluge admitted having done that before, ''but never that severely,'' the affidavit says. Smith said he called 911.

The baby's mother, Jennifer Lynn Swope, told police Bluge sent her a text message at the fast-food restaurant where she works, saying he was ''frustrated with the kids'' and that the baby ''would not stop crying,'' according to Smith's affidavit.

Bluge told Swope he ''might have hurt'' the baby while trying to feed him.

Swope told police she had been concerned about leaving the children with Bluge. She said she was at work until about 1 a.m., and when she arrived home, her father told her the baby was hurt and the ambulance was on the way, according to the affidavit.

Swope said she held the infant, and ''saw that he could not open his eyes, he wasn't moving a whole lot and that he was having a hard time breathing,'' the affidavit says.

Police interviewed Bluge again April 28 at the Ronald McDonald House at Geisinger.

Bluge changed his story, admitting he had ''feelings building up from many things, money issues, living with Swope's father, the babies and the start of his new job being delayed,'' the affidavit says.

He said the children were crying and ''his feelings of everything seemed to explode in the wrong way,'' and he shook the baby's head roughly. The baby's head ''bounced off his arm hard on both sides and bounced up and down,'' Bluge said.

''After he realized what he did wrong he called 911,'' the affidavit says.

Police interviewed Swope later that day. She told them Bluge admitted he ''got frustrated and shook a bottle'' in the baby's mouth.

On April 28, pediatric optometrist Dr. Thomas Wilson of Geisinger told police the baby had retinal bleeding and other injuries that indicated he had been shaken. Attending physician Dr. Paul Bellino concurred.

Police then arrested Bluge.

Copyright © 2008, The Morning Call

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

And it's not just mothers

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

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

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

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

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

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

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

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

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

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

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

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

[It was adopted on April 21 without ado]

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

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

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

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

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

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

Take a peek at this article from the Auburn Journal.

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

Leading Experts Investigate Shaken Baby Syndrome

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

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

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

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

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

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

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

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

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

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

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

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

Lyons: A word can help young parents cope

Redding Record Searchlight

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

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

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

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

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

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

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

But it doesn't always end so well.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

George Lithco
SKIPPER Initiative
Poughkeepsie NY
www.SkipperVigil.com

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

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

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

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

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

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

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

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

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

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

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

One of those things will be to educate other caregivers.

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

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

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

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

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

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



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



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



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



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

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

Since 2003:

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

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

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

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

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