Just a note - an alert came my way about three new journal articles that discuss SBS, including one by the "Buffalo Girls" (as I fondly refer to the excellent nurse-coordinators of the Upstate NY SBS Prevention Project), and one that discusses educational strategies for SBS education....

Shaken baby syndrome: diagnosis and treatment.
A Reynolds - Radiol Technol 1 Nov 2008 80(2): p. 151.
http://highwire.stanford.edu/cgi/medline/pmid;19005097

Shaken baby syndrome education program: nurses making a difference.
KM Smith and KA deGuehery - MCN Am J Matern Child Nurs 1 Nov 2008 33(6): p. 371.
http://highwire.stanford.edu/cgi/medline/pmid;18997573

Testing educational strategies for Shaken Baby Syndrome.
M Bailey, T Gress, D Bolden, and L Pfitzer - W V Med J 1 Nov 2008 104(6): p. 22.
http://highwire.stanford.edu/cgi/medline/pmid;19006900

It's time to start work on SBS Awareness Week 2009 (actually, it's a bit past time to start, but don't let that stop you - there's plenty of time left..)

Senator Dodd's 2008 resolution and the supporting organizations for that resolution follow below.

2009 would be a good year to seek a concurrent resolution in the Senate AND the House for a couple of reasons: there will be new members and new committee assignments in both chambers, and this will be a new Congress, which means pending legislation has to be reintroduced.

Hopefully, SBS Awareness Week can springboard the SBS Prevention Act. It may help that the incoming administration seems to have an interest in early childhood issues. For example, President-elect Obama has joined as a Senate cosponsor of the Education Begins At Home Act.

So, any thoughts out there on:

- how the 2009 resolution can be crafted to highlight prevention?
- how to enhance support for SBS prevention in the House?
- additional organizations that should join as sponsors?
- local or regional activities during the Week that could help improve awareness?

Organizations that sponsor the resolution will be invited to put info and links on their website and include an article in their spring newsletter.

Any other ideas for synergy?

SBS Awareness Week Resolution 2008

S. Res. 518

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.

Association of University Centers on Disabilities
Brain Injury Association of America
Child Welfare League of America
Children's Healthcare is a Legal Duty
Children's Safety Network
Congress of Neurological Surgeons
Easter Seals
Hannah Rose Foundation
National Association of Child Care Resource & Referral Agencies
National Association of State Head Injury Administrators
National Center for Learning Disabilities
National Child Abuse Coalition
National Exchange Club Foundation
Prevent Child Abuse America
Shaken Baby Prevention, Inc.
Shaken Baby Syndrome Prevention Plus
The Arc of the United States
The Center for Child Protection and Family Support
The National Association of Children's Hospitals and Related Institutions
The National Shaken Baby Coalition
United Cerebral Palsy
Voices for America's Children
D.C. Children's Trust Fund
National Family Partnership

Uh-oh!

The Exchange Club has a wonderful SBS awareness project, and has supported some great awareness activities, including support for the Period of PURPLE Crying campaign.

So, given that SBS is described as violently shaking a child, it's a bit surprising that a regional representative of the Exchange Club was quoted in an article in the Katy Times, TX yesterday as saying

“Please keep in mind that SBS does not always occur out of anger,” said Brenda Robinson, vice president of Region 5 of the National Exchange Club.

“Sometimes it’s simply playing with your child, bouncing them on your knee or just simply setting that child on your shoulder so they can see a parade roll by and they let go and fall back.”

It's become pretty clear to me that the best way to prevent inflicted injuries is not only educate parents and caregivers about the danger of shaking young children, but to help them understand the opportunities and learn what the kinds of things they can do to help the parent-child dyad flourish.

With that in mind, it's encouraging to see significant economic actors like the World Bank providing info on early childhood development.

Forgive me for being a bit cranky, but today brought a news story from WPTZ in Vermont that once again highlights how clueless (and I mean that in a literal, not unkind way - they may be clueless, but at least they're trying) about prevention some media folks can be.

A 13 month old boy is injured as a result of being shaken by a "babysitter."

Following a shot of the hospital, Reporter interviews "experts": Nurse, who teaches a babysitting course. Reporter then interviews director of the local child care resources center. Well-meaning people all...

If you watched it, the "lessons" you learned were:

- First, hire a licensed child care provider who knows CPR (um, CPR is good, but irrelevant: does Vermont require child care providers to be trained about the causes and consequences of shaking young children? I couldn't find anything about SBS prevention on the VT DCF site for child care providers, which isn't that unusual - most states don't require it. I did find some good SBS training, but it's for child welfare specialists: unfortunately, that's cart-before-the-horse training on how to deal with the consequences, instead of prevention...).

- Second, check references and do a criminal background check (um, "has she ever shaken your child?" - while this perpetrator is the exception to the rule, having a domestic violence "charge" driving with a suspended license, and having parole violations, most SBS cases don't involve someone with a criminal background). Oh, and given that most children are shaken by a parent or relative, just how helpful is advice to "hire someone you know personally"?

Not one mention that it might be a good idea to ask someone taking care of your child whether she has learned about shaken baby syndrome (or, for that matter, if your child is not a year old yet, SIDS), and whether she has a coping plan for those inevitable moments of frustration that do come when caring for a young child.

Given the absence of that critical info, it's particularly unfortunate and misleading that the televised report is "How You Can Protect Your Children..."

More on the story from the Burlington Press

Gooznews.com comments on legislation introduced by Senator Clinton to create a federal trust for prevention health services.

It's not apparent from this (necessarily) short summary that the legislation will enable prevention efforts that "look upstream" for prevention opportunities. An obvious step would be education for new parents that enables them to influence health behaviors in early childhood.

Educating parents can have significant near-term benefits: a UCLA research project found that health literacy training for Head Start parents produced significant savings for Medicaid by helping parents learn to care for common childhood illnesses instead of bringing their children to emergency rooms and clinics for care.

October 14, 2008
Trust Wellness

New legislation dropped in the final days of a Congressional session obviously isn't going anywhere. But it does signal what that legislator thinks is important and plans to push next year. And when that legislator is Sen. Hillary Rodham Clinton and the bill involves health care, it merits close attention.

On October 1st, the junior senator from New York introduced a bill that would channel existing payments by both public and private insurers for preventive health services into a new Wellness Trust, which would then pay for all preventive services in this society. You can think of it as Medicare Part "P," except that it isn't just for the nation's elderly.

The new Wellness Trust would be run by 7-member board appointed by the president and approved by the Senate. Under S. 3674, the Wellness Trust in its first year of operation would commission and then issue reports on the best way to supplement the existing health care workforce with certified "prevention health workers"; establish new reimbursement systems that would "align incentives" with health promotion and disease prevention goals; and analyze current expenditures on prevention, which the bill estimates at 1 to 3 percent of health care costs or $20 billion to $60 billion.

A year in, with those reports in hand, the trustees would then begin collecting all payments made by Medicare, Medicaid and insurance companies for existing prevention services. The agency would then designate its own "prevention priorities." These would include community-based strategies like tobacco and alcohol counseling or diabetes prevention education, as well as the usual clinical services like the colonoscopies, mammograms and vaccinations that most people associate with preventive care.

With these priorities and money in hand, the Wellness Trust trustees would enter into contracts with certified prevention providers to deliver the services deemed the highest priorites "without regard to the insurance status of such individuals."

The legislation tracks closely to a report that Jeanne Lambrew, now at the University of Texas, wrote for the Hamilton Project at the Brookings Institution, which was created by former Secretary Treasury and Citicorp board member Robert Rubin to serve as a policy think tank for the next Democratic administration.

There's an outside chance the proposal will find a receptive ear in the next administration, whoever is elected. Prevention is included in the health care planks of both candidates. Yet neither has stressed the issue on the campaign trial.

That's not surprising. The conventional wisdom that recently emerged from the health care policy world is that strategies for preventing chronic disease -- which is responsible for 75 percent of all health care expenditures -- don't pay. They only add another layer of cost to the system and won't lower other health care expenditures for many years, if at all.

In my view, that's hogwash. Some prevention interventions lower costs, and some cost far more than they are worth -- just like health care interventions. For a critique of the new conventional wisdom on prevention, intially laid out in a New England Journal of Medicine article, see this GoozNews post.

The Clinton bill pushes back even harder. By centralizing all the money spent on prevention in a single agency, the government could deploy those limited resources in the most cost-effective manner. Moreover, it could target the populations most in need of prevention information, advice and services -- low and moderate-income people who are the most at risk of chronic disease because of poor education, low income, high stress, poor diet, and the lack of exercise that lead to unidentified or untreated pre-disease conditions like hypertension, high blood sugar, smoking, and alcohol abuse.

Right now, the prevention priorities of the nation are driven by who is best insured and a member of what University of Minnesota bioethicist Carl Elliott has called the worried well: educated consumers who know how to demand every high-end preventive service that health care providers can dream up. Have you been told yet that you ought to get a heart scan just to make sure there aren't any blockages forming in your arteries? I have, and I didn't appreciate the pressure to spend money out of my own pocket to get something I probably don't need.

I hope to start building some profiles of prevention programs to supplement the series of profiles available on the NACHRI site. This is only the conceptual framework, but the Ontario SBS Prevention Project being developed by Richard Volpe and the Ontario Neurotrauma Foundation is a good place to start.

With John Lewko, Richard has written a casebook on evidence based prevention programs. It's an excellent resource.

This chapter describes the Upstate NY SBS Prevention Project developed by Mark Dias.

NB The Upstate New York SBS Prevention Project was rated "promising" by the California Evidence Based Clearinghouse/

The Robert Woods Johnson Foundation Center at the University of New Mexico will host a discussion with Ron Barr on prevention efforts...

RWJF Offers Lecture, Workshop on Shaken Baby Syndrome
Robert Wood Johnson Foundation Center for Health Policy at UNM presents a lecture, “Where the Rubber Hits the Road: How science can be translated into policy for prevention of shaken baby syndrome,” on Thursday, Nov. 13 from 12:30 – 2 p.m. in the Barbara & Bill Richardson Pavilion room 1500. Then, from 2:30 – 4 p.m., a workshop, “Community-wide, Culturally-sensitive Prevention Programs for Shaken Baby Syndrome: Principles and Challenges for Implementation,” is set in the same location. The events are part of the RWJF Fall Lecture Series.

Photo: Ron Barr, professor of Pediatrics, Faculty of Medicine, University of British Columbia

The lecture features Ronald Barr, Canada Research Chair in Community Child Health Research at the University of British Columbia. Barr is a professor of Pediatrics on 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. He is also director of the “Experience-based Brain and Biological Development” Programme of the Canadian Institute for Advanced Research.

Barr will describe a primary, universal, community-based prevention program for Shaken Baby Syndrome.

This presentation will:

· Delineate four convergent lines of evidence for the program,
· describe the stages of its development,
· discuss the prerequisites for a primary prevention initiative,
· describe the development (including cross cultural focus groups), testing (randomized controlled trials of knowledge and behavior) and,
· discuss strategies and challenges for jurisdiction-wide implementation in North Carolina and British Columbia

Continuing Medical and Nursing Education is available.

The workshop features Marilyn Barr, founder and executive director of the National Center on Shaken Baby Syndrome in Canada, and Ronald Barr.
In this symposium workshop, the Barrs will describe their experience of effectively implementing the Period of PURPLE Crying prevention of shaken baby syndrome program. The Barrs will illustrate their discussion using specific examples from recent implementation projects in North Carolina and British Columbia.

Topics include:
· basic principles that need to be met to justify implementation jurisdiction-wide

· importance of timing and “doses” of intervention

· challenges and processes required for effective translations of the materials into eight languages

· importance of bringing about a cultural change in order to establish long-term
sustainability

· discussion of the 10 most “frequently asked questions” that implementation raises

For more information contact the RWJF Center at 277-0130 or rwjf@unm.edu.

Media Contact: Carolyn Gonzales, (505) 277-5920; e-mail: cgonzal@unm.edu

An article from Montana that once again points out the difficulty in prosecuting many SBS cases. One interesting aspect is that the case was tried in federal court, presumably because it took place on a reservation...

Jury acquits dad in shaken-baby case
By CLAIR JOHNSON
Of The Gazette Staff

A federal jury Tuesday afternoon acquitted a Busby man accused of seriously injuring his infant son by shaking him.

The panel found Merlin Wade Littlesun Sr., 22, not guilty of assault resulting in serious bodily injury after deliberating about 2½ hours in the two-day trial.

As the clerk announced the verdict, about a dozen of Littlesun's family members and supporters jumped to their feet and applauded and cheered the verdict, prompting an angry rebuke from Chief U.S. District Judge Richard Cebull.

"Get them out of here," yelled Cebull, who stood up and pointed at the group. Courtroom security guards directed Littlesun's supporters out of the courtroom and the building. After the courtroom had been cleared, the judge dismissed the indictment against Littlesun and ordered him released from custody.

Littlesun testified Tuesday morning that he did not shake his son as alleged on May 10, 2006. Littlesun's testimony lasted barely five minutes, and he gave mostly yes-or-no answers. Littlesun said he was sleeping when he is alleged to have shaken his 4-month-old son, Merlin Wade Littlesun Jr., hard enough to cause head trauma. He drove the baby's mother, Nicole Fisher, and his son to meet the ambulance as it was coming from Lame Deer, he said. Then he returned home to get a diaper bag and baby supplies.

Under questioning by Assistant U.S. Attorney Lori Suek, Littlesun said he was aware of bruises on the baby and asked Fisher about it but did not call the police or get the bruises checked. He suspected Fisher caused the injuries because "she just looked down," he said.

Littlesun also said he told the FBI agent he took responsibility for what happened even though he didn't do it. He acknowledged that he didn't tell investigators he suspected Fisher of causing the injuries.

The prosecution's witnesses included Fisher, others who were present in Littlesun's residence at the time and doctors who treated the baby.

Dr. Richard Stevens, a pediatrician who treated the infant, said the boy is now doing "quite well" even though his injuries were life-threatening. He was flown to a Denver hospital, where pressure on his brain was relieved.

In closing arguments, Suek recalled Fisher's testimony that she saw Littlesun in their bedroom holding the baby in his arms and that his head was shaking violently. She told him to stop and left the room. She could hear her baby crying but was afraid of Littlesun, she said.

Fisher went back in a few minutes later, picked up her baby and was holding him when he began having a seizure.

Fisher initially lied to investigators and medical personnel about what happened because she was scared of Littlesun's family, Suek said. She told the truth after she moved out of the house about a year later, she said.

Defense attorney Robert Kelleher Jr. argued in closing that Fisher caused the injuries and that there were serious problems with her testimony. According to Fisher's account, it was about 20 minutes after she allegedly saw Littlesun shaking their son until they called an ambulance.

But defense witness Dr. Thomas Bennett, a forensic pathologist who has studied shaken-baby syndrome, said a baby would experience seizures almost immediately after being shaken, Kelleher said. Bennett also said it can take only a few seconds to shake a baby hard enough to injure its brain.

Fisher was a 17-year-old mother of an infant and also had a toddler at the time, Kelleher said. She was "multitasking," trying to get breakfast ready and walking around the house with the baby, he continued, and "it only takes a second for her to snap and do this to the baby."

He also discounted Fisher's fear of Littlesun and his family. Fisher was alone with the doctors at St. Vincent Healthcare, where her son had been transferred from Lame Deer, and had the opportunity to say Littlesun caused the injuries.

"She did not tell anybody. Why? Because she's the one who did it," he said.

And welcome to the Hallmark Health Systems hospitals in Melrose and Medford, Masssachusetts, who have joined an effort spurred by Middlesex County's District Attorney, Gerry Leone, to educate new parents about Shaken Baby Syndrome before they leave the hospital.

Three news stories about Shaken Baby Syndrome caught my eye today:

Today's Hartford Courant has a compelling article by Kathy Megan about SBS. It shows the consequences of shaking a child, and discusses prevention activities in Connecticut...

The Cambridge Chronicle reports that the Cambridge Health Alliance and eight other Massachusetts hospitals will be joining an initiative undertaken by District Attorney Gerry Leone to educate new parents about the vulnerability of young children to shaking injuries.

Aiden Stein turned five this week. This article demonstrates that SBS truly begets tragedies upon tragedy. He survived being shaken by his father, but was left dumb and blind. His maternal grandmother believes his time has come. His paternal grandmother believes Aiden suffers from a birth defect.

And finally, sad news from the UK about a paramedic arrested for shaking his three month old son.

Mothergoosemouse posted about the changes that come with motherhood, anticipated or not.

She describes watching a shaken baby prevention video in hospital....

Before I had children of my own, I reacted to news of tragedies concerning children much differently. I was saddened, disturbed, sorry for the family - but it didn’t prey on my subconscious like it does now.

I can’t read the articles or listen to the news reports. I struggle with the blog posts,which are mercifully few and far between. Before being discharged from the
hospital with CJ, I was required to watch a video about shaken baby syndrome. I burst into tears afterward, and the visuals from the video stay with me even now. The “Never Shake a Baby” radio and TV ads cause me to change the channel. Even typing these words makes me well up.

This was my response....

I’m curious to know whether you think the hospital could have “framed” the
info in a way that would have changed your response.
We advocate for hospital based prevention education and encourage the nurses to present the information not as an obligation (”you should never shake your baby”) but as an opportunity (”this will help you learn about the causes of shaking injuries
so you can help protect your baby against injuries”).
It’s easier for the parents and for the educators. It’s easier for hospitals too: everyone benefits.
And it’s very important for parents to be able to educate - not just tell - all the other caregivers around their child (not just child care, but baby sitters, sibling, the neighbor who’s an emergency backup): shaking is dangerous to young children (up to 5 years old) and frustration is normal, so even good caregivers need to recognize when that response is getting out of hand and have a simple coping plan ready.
It can be as simple as putting the child in a safe place, catching your breathe and calling someone to vent for a few minutes. The first step can be hardest, especially for a parent: you have to acknowledge the stress…
And the best thing is that once a parent understands the importance of positively educating other caregivers, and accepts the role of educator, they reinforce their own knowledge and behavior.
It’s certainly scary to learn about something that could hurt your child which you
have no control over: it’s much better to learn about the danger and what
you can do to protect your child.
Eduation is effective. Hospitals in the Buffalo area of New York have been doing education since 1998: since they started, the rate of inflicted infant head injury has dropped by 50%.
So you may not be able to avoid thinking about the tragedies - there are more than most people realize - but I hope you will also take advantage of your opportunity to
share knowledge about preventing those injuries.

This summary of Australian research on parenting education prompts three thoughts:

- why did they create a parenting program (the "first"), rather than adapt and evaluate one that has been shown effective, such as the home-visiting program developed by David Olds?;
- as research seems to show that birth is the "teachable moment", why did they wait until 8 months to implement it?; and
- doesn't it seem that a reduction in harsh or abusive parenting behavior is a worthwhile result?

Parenting Program Does Not Prevent Toddler Behavior Problems, Study Shows
ScienceDaily (Feb. 3, 2008) — A study of the first universal parenting programme, designed to prevent early child behaviour problems, shows that it has little impact on toddler behaviour.
Behaviour problems affect up to 20 per cent of children and have major personal, societal and economic ramifications. Left untreated, up to half of behaviour problems in preschool children develop into later mental health problems.
Prevention targeted to high-risk families can be effective, but has limited reach and may stigmatise. Universal programmes offered to all families could address these concerns, but their effectiveness is uncertain.
The study, conducted at the Centre for Community Child Health (CCCH) in Melbourne, Australia, is published by the British Medical Journal.
Researchers from the CCCH and the Parenting Research Centre, with input from maternal and child health nurses, designed a programme suitable for all parents to be delivered by trained health professionals in primary care. The programme aimed to prevent child behaviour problems, such as defiance and aggression, and improve parenting and maternal mental health.
Over 700 mothers of 8 month-old infants participated in the study and were randomised to either the programme (three sessions at age 8-15 months) or usual care from their local Maternal and Child Health centre. Mothers were surveyed throughout the study and their mental health was assessed when their children reached 18 and 24 months.
At 18 months, child behaviour and parenting scores were similar between the two groups. By age 24 months, parents on the programme were less likely to report harsh or abusive parenting and unreasonable expectations of child development, but there was no improvement in maternal distress or toddler behaviour.
This was the first trial to evaluate a universal parenting programme involving families from all social backgrounds, say the authors.
They conclude that the outcomes are insufficient to support widespread introduction of this programme to prevent toddler behaviour problems.

BMJ-British Medical Journal (2008, February 3). Parenting Program Does Not Prevent Toddler Behavior Problems, Study Shows. ScienceDaily. Retrieved September 1, 2008, from http://www.sciencedaily.com/ /releases/2008/01/080131214534.htm

The New York State Fatherhood Initiative is hosting a statewide conference in Albany

On October 6th-9th the Office of Temporary and Disability Assistance, along with the Office of Children and Family Services, will host the first New York Statewide Fatherhood Conference. The conference will take place at the Desmond Hotel in Albany. Participants from around the country will convene to explore the issues, concerns, and impact of fatherlessness in
the lives of our children and families.

They've doing some good work: for instance, while it used to be said that babies
don't come with an owner's manual, they've published one. It's an interesting
tool for new dads and it does include information about Shaken Baby Syndrome...

OTDA has released A Driver's Manual for New Dads (1mb, PDF) that offers new dads information
that will help them be a good dad to their child, including supporting a partner emotionally during and after pregnancy and tips on interacting with a new baby.

An interesting story from MSNBC's archives on how parents can help kids cope with the pain of vaccination.

Of course, in some cases, vaccinations can cause soreness and irritability that persists for a few days. That's important information to share with child care providers and other caregivers, so they're prepared to cope.

Soothing the screams from childhood vaccines
Study suggests sweetened pacifiers, blowing bubbles and other distractions

CHICAGO - Some children sob, others scream, and some get so upset they have to be restrained by medical staff. But a new study suggests parents can ease the anxiety about immunizations by telling a joke, reading a book or bringing a favorite toy from home.

Other proven distraction techniques include blowing soap bubbles and, for under six months, using a pacifier dipped in sugar water.

“All of those kinds of things can take children’s minds away from the needle poised to go into their arm,” said lead author Dr. Neil L. Schechter, the director of the Pain Relief Program at Connecticut Children’s Medical Center.

The study appears in the May 2007 edition of Pediatrics.

Parents who are overly apologetic or excessively reassuring during the procedure can actually cause more distress, the research found. Instead, parents should adopt a “matter-of-fact, supportive, nonapologetic approach,” researchers said.

Schechter’s team reviewed hundreds of previous studies regarding pediatric immunizations and referenced about 120 in their article, in which they also make recommendations for doctors.

While some may dismiss the shots as a rite of passage, children’s fear can interfere with important discussions pediatricians need to have with parents, said Schechter, who is also a professor of pediatrics at the University of Connecticut School of Medicine and a pediatrician at Hartford’s St. Francis Hospital.

At Children’s Memorial Hospital in Chicago, child life specialist Emily Rogers helps young patients deal with procedures including injections and getting their blood drawn.

Rogers said she believed the study was a valuable one. While somewhat surprised with findings that overly empathetic parents can cause more distress, she theorized it’s because children became scared and confused when they feel their parents lack control over a situation.

She carries a “distraction bag” packed with pinwheels, bubbles, whistles and books, and she also helps young patients practice relaxation and breathing techniques.

Rogers said it’s important parents not bargain with their child, instead emphasizing while it’s OK to feel scared, the medical procedure is designed to help them and the child isn’t being punished.
And a reminder of why vaccination is still a necessary thing...

Vaccine refusals mean more measles
Aug. 21: The CDC reported Thursday that the number of measles cases in the U.S. is at its highest level since 1997, almost half of which involve children whose parents refused to have them vaccinated. (NBC's Robert Bazell reported this story in August, 2007)

Diane at Foster Family Talk has a post about a shaken baby case in Florida. She reminds parents of the importance of checking references of child care providers.

This was my response:

A parent should certainly research all available references and history.

However, while that's necessary, it's not sufficient to ensure that you've done everything you can to protect your child.

You must talk with your child care provider about the danger of shaking young children, that frustration and anger is a normal response to caring for young children, and they need to agree to follow a simple coping plan: recognize that frustration, leave the baby in a safe place and call someone, either as a safety vent or to acknowledge the frustration. They need to know that it's OK with you to have feelings of frustration.

It can be done in a manner that doesn't accuse, but instead talks about sharing knowledge and opportunity to protect your child from injury. If your child is an infant, it can be especially effective coupled with SIDS information.

In New York and several other states, licensed providers must have training on the causes, consequences and prevention of shaken baby. That obligation doesn't extend to "exempt" providers, and it's not complete assurance - providers have attended training and still shaken children.

But this education model is based on a program for new parents in Buffalo that reduced the incidence of shaken babies and inflicted injuries by 50%.

Not perfect, but for a simple 15 minute intervention, pretty effective insurance!...

So, if a parent just checks references, they will have a false sense of security.

Sharing information with all other caregivers of your child about the causes and consequences of SBS and the need for a simple coping plan - and ensuring they share your commitment to using it - is the key.

And not only will that help protect your child, it will help protect others.

For more info, visit the resources page on www.skippervigil.com

Unfortunately, the new Revolution Health website provides some good examples of lost opportunities to prevent shaking and other inflicted injuries....

Searching the website finds numerous pages on colic, which make no mention of the frustation and anger that a caregiver can experience when dealing with a colicky child, or how parents can help prepare a coping plan.

The overview page on colic suggests indirectly that colic could be upsetting, but offers only this advice on managing that upset:

Do what you can to comfort your baby, but accept that sometimes nothing works. If you feel stressed or worn out, ask a friend or family member to give you a
break. Take good care of yourself, and remember that colic will go away soon.

What to expect from colic is another page that fails to mention that frustration and anger can be a normal response, or that it is even more necessary to talk with the other caregivers of your child and discuss coping behaviors, so these less experienced caregivers have an opportunity to prepare for colic.

On the other hand, a page on crying under age 3 does discuss SBS. It could be improved by redirecting the focus from "you shouldn't shake your baby" and not claiming that throwing a child in the air will cause SBS

Never shake or harm your child. Shaking a child in anger or playing rough, such as throwing him or her into the air, can injure the brain.

While the Revolution site does have several pages on SBS, it's only the last page that talks about prevention.

On a health oriented website, that seems to be putting a cart before the horse.

If you wonder why journalists write about child abuse, but not prevention efforts, this teaser for the Dart Fellowship suggests one explanation:

JOURNALISM FELLOWSHIP Applications will be accepted through July 30 for the 2008 Dart Center Ochberg Fellowships in Journalism and Trauma.

The Dart Center Ochberg Fellows Program is designed for mid-career journalists who want to deepen their knowledge of emotional trauma and improve coverage of violence, conflict and tragedy.

Details and applications available at www.dartcenter.org/fellowships.

A book review in the New York Times points out some reasons why thinking we're safe can be unsafe....

Some of those "thinks" to keep in mind, whether designing community prevention initiatives or an individual, personalized prevention program for your child:

- we think we're more skilled than experience suggests;
- when routines allow us to think less about safety, we are distracted from anticipating stress events and less prepared to cope; and
- we think we - and other caregivers, like babysitters and child care providers - know what we need to know about the skills required to raise a child.

Assuming you're safe can be fatal. Assuming you "know" what any individual taking care of your child will or won't do can also have tragic consequences.

Nowadays, the cause of collisions, or one of them, is people believing they’re better drivers than they are. We base our judgment on the number of crashes we’ve been in, rather than on the number of accidents we narrowly avoid, which, if we’re being honest (or we’re being me), happen just about every time we drive.

Compounding this vehicular hubris is the fact that most of the driving we do appears to be safer than it is. Driving rarely commands 100 percent of our attention, and so we feel comfortable multitasking: talking on the phone, unfolding a map, taking in the Barca-Lounger on the road’s shoulder. Vanderbilt cites a statistic that nearly 80 percent of crashes involve drivers not paying attention for up to three seconds. Thus the places that seem the most dangerous — narrow roads, hairpin turns — are rarely where people mess up. “Most crashes,” Vanderbilt writes, “happen on dry roads, on clear, sunny days, to sober drivers.” For this reason, roads that could be straight are often constructed with curves — simply to keep drivers on the ball.

This basic truth — feeling safe kills — lies beneath many of the book’s insights. Americans think roundabouts are more dangerous than intersections with traffic lights. Roundabouts require you to adjust your speed, to merge, in short, to pay attention. At an intersection, we simply watch the light. And so we may not notice the red-light runner coming at us or the pedestrian stepping off the curb. A study that followed 24 intersections that had been converted from signals or stop signs to roundabouts showed an almost 90 percent drop in fatal crashes after the change.

For similar reasons, S.U.V.’s are more dangerous than cars. Not just because they’re slower to stop and harder to maneuver, but because — by conferring a sense of safety — they invite careless behavior. “The safer cars get,” Vanderbilt says, “the more risks drivers choose to take.” (S.U.V. drivers are more likely to not bother with their seat belts, to talk on cellphones, and to not wear seat belts while talking on cellphones.) So it goes for much of the driving universe. More people are killed while crossing in crosswalks than while jaywalking. Drivers pass bicyclists more closely on a road with bike lanes than on one without.

An interesting article by Sharon Begley in Newsweek discusses the diverse impact of genes on child behavior (and in the process, removes any doubt that every child is different).

There's an interesting point about fussy babies: their behavior is much more susceptible to being shaped by their parents.

Hopefully, as word spreads, it will help those parents with colicky babies, or with high need for control, to know that some things are indeed beyond their control.

PS. The asides about professionals in the child advice business are also of interest - when advice works, it may well be because the baby has characteristics that fit the advice, and many professionals resist, or are at least reluctant to acknowledge, the importance of genetic factors.

But I Did Everything Right!
DNA discoveries are revealing why even the best parenting doesn't have the effects experts promise, from breast-feeding to letting kids learn from mistakes.
By Sharon Begley NEWSWEEK
Published Aug 9, 2008 - Aug. 18-25, 2008 issue

If there is one thing experts on child development agree on, it is that kids learn best when they are allowed to make mistakes and feel the consequences. So Mom and Dad hold back as their toddler tries again and again to cram a round peg into a square hole. They feel her pain as playmates shun her for being pushy, hoping s he'll learn to back off. They let their teen stay up too late before a test, hoping a dismal grade will teach her to get a good night's sleep but believing that ordering her to get to bed right now will not: kids who experience setbacks rather than having them short-circuited by a controlling parent learn not to repeat the dumb behavior.

But not, it seems, all kids. In about 30 percent, the coils of their DNA carry a glitch, one that leaves their brains with few dopamine receptors, molecules that act as docking ports for one of the neurochemicals that carry our thoughts and emotions. A paucity of dopamine receptors is linked to an inability to avoid self-destructive behavior such as illicit drug use. But the effects spill beyond such extremes.

Children with the genetic variant are unable to learn from mistakes. No matter how many tests they blow by partying the night before, the lesson just doesn't sink in.

The discovery, reported last December, is part of what is fast becoming the newest frontier in studies of why children turn out as they do. Since the first advice book for American parents appeared in 1811, the child-rearing industry, as well as researchers who have made child development a science, have assumed that, although every child is an individual, there are certain universals. If parents are too take-charge about homework, the child becomes disengaged and eventually gives up; if they are warm and affectionate, kids don't act out. But while most children do respond the way research shows, there have always been "outliers," kids who don't turn out the way experts promise.

After years of ignoring those children, a few scientists now realize that they are telling us something that promises to revolutionize our understanding of child development. In an echo of "personalized medicine" (matching drugs to people's DNA), scientists are finding that how parents treat their children is filtered through the prism of DNA. Parents may intuit that, as they notice that what worked with one child is failing abysmally with another, but now science is pinpointing exactly what combinations of nature and nurture spell gridlock.

It is finally dawning on experts that "individual genetic differences are the 800-pound gorilla of child development," says Jack Shonkoff, director of the Center on the Developing Child at Harvard University. "The promise of genomics is that you will be able to tailor experiences as we tailor drugs."

Research showing that the most scientifically rigorous child-rearing advice can blow up on you couldn't come at a worse time for the millions of American parents who are desperate for direction. They are gobbling up how-to books and DVDs, even hiring coaches and consultants. They are tearing their hair out over conflicting advice on even such basics as sleep—let baby cry herself to sleep? Co-sleep? (As it turns out, the conflicting advice may reflect the fact that the "experts' " experience happens to have beenwith children whose genetic disposition is amenable to their way of doing things.)

More than earlier generations, new parents are panicked that they're going to screw up. That feeling is fed by posts on Web sites such as UrbanBaby, in which someone, somewhere, can be counted on to flame your every parenting decision.

But for parents who look back in sadness—perplexed that although they did everything "right," their child is not as kind, or intelligent, or self-confident, or well adjusted as the recipes promised—the emerging science offers an explanation, and perhaps an out: with the DNA stacked against you, it wasn't your fault.

One of the strongest and most counterintuitive findings in this nascent field is that children with a sweet temperament, which is under strong genetic control, are the least likely to emulate their parents and absorb the lessons they teach, while fussy kids are the most likely to do so.

Fussy children have a hypersensitive nervous system that is keenly attuned to its surroundings—including what Mom and Dad do and say. In studies that are shaking up textbook dogmas, Jay Belsky of Birkbeck University of London has shown that fussy babies are therefore wired to be more strongly shaped by their parents than mellower children are.

It is the fussy baby who, read to night after dutiful night, is likely to develop a love of books; the mellow baby, given the same literary diet, might just as easily grow into a teen who has no interest in reading anything longer than a text message. The mellow baby, immune to your charms, is more likely to show signs of road rage from the day she first takes her tricycle out for a spin, even though she grew up watching your saintly temper control.

Children who go with the flow of new people and new situations are like Teflon: good parenting doesn't stick to them—but neither, necessarily, does bad parenting. They're the young adults who can't form close, meaningful relationships despite the unconditional love you showed them. "Kids with difficult temperaments are more sensitive to the effects of parenting," says Belsky. "You can get by with sloppier parenting if you have a 'good temperament' kid." Even children who fall between the extremes are generally closer to one than the other.

Although whether you have an easy or a fussy child is obvious, other innate differences that shape whether and how a child will respond to how parents raise them are less apparent. But since they reflect the presence of a DNA variant, they are all candidates for being pinpointed with a genetic test that will help parents know what to expect:

• The gene variant that influences whether children learn from their mistakes. With the misspelled gene, brains have about 30 percent fewer dopamine receptors and less activity in the brain's frontal cortex (the site of higher-order thinking, including monitoring negative feedback) and hippocampus (memory) than do people with the more common form of the gene. In an experiment at the Max Planck Institute for Neurological Research in Germany, people with the misspelling weren't able to avoid choices that they were told over and over were incorrect. Numerous other studies have linked this gene variant to addiction, obesity and compulsive gambling, suggesting that the underlying problem is trouble learning the negative consequences of your actions.

• The DNA variant that affects whether a baby's brain development will be spurred by breast-feeding, which has been reported to confer an extra half-dozen or so IQ points by kindergarten. But not all breast-fed babies are little Einsteins, making their mothers wonder why all the milk-stained blouses didn't seem to boost cognitive development. The reason seems to be that there are two forms of a gene called FADS2. In the 90 percent of babies who carry the "C" form, breast-feeding raises intelligence by an average of nearly seven IQ points, scientists led by Terrie Moffitt and Avshalom Caspi of Duke University reported last year. This version of FADS2 produces an enzyme that helps convert the fatty acids in breast milk into compounds that help signals zip along brain neurons and spur neurons to sprout connections, which underlie intelli gence, memory and creativity. The 10 percent of babies who carry the other form of the gene lack the enzyme and therefore derive no cognitive benefit from breast-feeding (though they still get an immune-system boost from it).

• DNA variants can protect children from bad parenting. For instance, most girls who are sexually abused are at higher risk for becoming alcoholics, as well as for developing other mental-health problems. But girls who have a "sluggish" version of the gene called MAOA seem to be vaccinated against this effect, reported scientists led by neurogeneticist David Goldman of the National Institute on Alcohol Abuse and Alcoholism last year. With the active version of MAOA, the brain's hippocampus—which processes emotional experiences and memories—becomes hyperactivated when it remembers something upsetting, such as abuse, and the woman turns to alcohol for solace. With the sluggish version, those memories lose their awful power.

Another protective gene insulates children from the effects of an emotionally distant mother, one who is cold and uncaring, who turns away when her child feels the pain of a skinned knee no less than from a crushed dream. That is supposed to make a child more likely to develop "externalizing behavior," acting out in a bid for attention. But children with a certain form of a gene called DRD4, which stands for dopamine-receptor D4, are Teflon-coated, at little to no risk of becoming emotionally insecure as a result of mothers who are emotionally distant, found a 2007 study.

The discoveries questioning the connection between what parents do and how children turn out has not exactly taken the science of child development by storm. That seems to reflect a culture clash within the field. Most researchers who study child development were trained as psychologists, and—to overgeneralize, but only a little—are uncomfortable with or even suspicious of genetics. Geneticists tend to see behavioral research as squishy, not hard science.

That produces a body of scientific literature that is remarkably ignorant of genetics. As we reported in this story, we were struck by how clueless so many "experts" in child development were about the new genetics—and how resistant they were to it. Almost all were unaware of the studies showing that genetics acts as a filter between environment and child, letting some influences in and keeping others out. "Even the stuff published in the best journals ignores the underlying genetics," says one leader in the field.

Since companies already offer storefront DNA tests, the day is not far off when parents can determine their child's MAOA or DRD4 status, or the presence of any other variant that influences the effect of parenting. But perhaps it is time to acknowledge that there is only so much influence parents can h ave. In her best-selling book "I Feel Bad About My Neck," Nora Ephron laments how American society "came to believe in the perfectibility of the child just as it also came to believe in the conflicting theory that virtually everything in human nature was genetic." Both views—that everything is genetic and that parents can transform a child like a lump of clay—are as wrong as wrong can be.