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