1. Baby Shaking, Infant Crying, and the Alberta Shaken Baby Syndrome Prevention Campaign
What Professionals Need to Know

2. Session Overview
description of traumatic baby shaking and the injuries that can result
risk factors for shaking
the link between crying and shaking
preventing baby shaking in Alberta
your role in prevention

3. The Problem of Baby Shaking
In 1972, John Caffey published a landmark study about infant brain damage due to shaking.
27 cases described – multiple injuries resulted from shaking.
Whiplash shaking could be a major, unrecognized cause of mental retardation and permanent brain damage.

4. Whiplash Shaking and Brain Trauma
Whiplash shaking = violently shaking an infant or young child by the arms, chest or shoulders causing the head to whip back and forth with or without impact against a hard surface.
Shaking may occur one or many times.
The shaking force needed to produce brain trauma cannot occur in any normal activity.

5. Whiplash Shaking and Brain Trauma
cont.
Results in “Shaken Baby Syndrome.”
Also called “Abusive Head Trauma” or “Inflicted Traumatic Brain Injury.”
Shaken Baby Syndrome accounts for some of the most devastating cases of child abuse.

7. Characteristic Injuries of SBS
bleeding in the space between the brain and the skull
brain swelling
bleeding in the retina in the back of the eyes
broken posterior ribs and/or long bones.
All injuries may not be present in every child who has been shaken.

8. Shaken Baby Syndrome in Canada
King, MacKay & Sirnick’s retrospective Canadian study identified 364 victims under the age of five among hospitalized children between 1988 to 1998.
These cases are just “the tip of the iceberg”.
The incidence of Shaken Baby Syndrome is likely significantly underestimated.

9. Outcome for SBS Victims
364 healthy children
Subjected to shaking
19 % died (n = 69)
81% survived (n = 295)
Among the 295 survivors:
55% had a neurological deficit
65% had a visual impairment
85% required ongoing multi-disciplinary care
King, MacKay & Sirnick Study (2003)

10. Risk Factors for Shaking
What increases the risk of shaking in terms of:
Becoming a victim?
Becoming a perpetrator?
The situation?
Infant crying - - a trigger for shaking.

11. Risk Factors for Being a Victim
age
gender
greater demands for care, for example illness, pre-maturity, or other special needs of some kind

12. Risk Factors for Being a Perpetrator
Perpetrator’s Relationship to Victim
In general, most perpetrators are:
Male
< 25 years old
Father/father figures
1998 Child Fatality Review Teams - USA

13. Risk Factors for Being a Perpetrator
cont.
history of abuse
poor anger management or impulse control
mental illness
drug and alcohol abuse
inexperience or unrealistic expectations

14. Situational Risk Factors
can all contribute to the stress load of a caretaker
an unintended pregnancy
social isolation
financial problems
lack of a support system
BUT shaking also occurs in families with no apparent problems.

15. Infant Crying
Sleeping problems, toileting mistakes and disobedience have all been given as the reason for a shaking episode, but . . .
the most common reason given for shaking is frustration dealing with infant crying.

16. Understanding Infant Crying
Why do babies cry?
What is normal crying?
What is colic?
What do parents and other caregivers need to know?

17. Babies Cry to Communicate
Quotes about 
12 year old
2 month old
hunger
“When’s dinner? I’m starved.”
“CRY!”
discomfort
“I’m not wearing dress pants, they’re too tight.”
over-stimulation
“Leave me alone.”
under-stimulation
“I’m bored. There’s nothing to do.”
fatigue
“I’ve had a long day”

18. Why is the Baby Crying?

19. All Babies Cry - It is Normal
Infant Crying:
follows a predictable pattern
is universal
is not typically a sign that a baby has a medical problem or that a parent is not doing a good job

20. What is Colic?
“Colic” is derived from the Greek “kolikos” which means suffering in the large intestine.
Is something medically wrong with the baby?
Is the baby in pain?
Does “infant colic” simply refer to a baby that cries a lot?

21. When is Crying a Problem?
Research shows that:
Parental complaints about crying are not proportional to the actual amount of crying.
Some people have a lower threshold for crying than others.
A parent’s or caregiver’s perception of infant crying determines whether or not it is problematic.

22. What to Tell Parents about Crying
Crying is normal.
Crying will greatly decrease by the time the baby is 3 to 4 months old.
Colic ≠ greater risk for long-term problems.
Seek help if crying is problematic for you or your baby.
Acknowledge that normal doesn’t always mean easy!

23. Video

24. Alberta’s SBS Prevention Campaign
the provincial approach to SBS prevention
campaign principles
key messages
resources
how to use campaign resources and strategies in your work
evaluation

25. Alberta’s SBS Prevention Approach
Accomplished as of Fall 2006:
acquired funding for stage one
established the Alberta SBS Prevention Network
developed a provincial campaign
launched website

26. SBS Prevention Campaign Principles
Target parents, youth, and other caregivers:
specific knowledge &
skill building
general asset building
 knowledge about crying and SBS
 skills for soothing crying infants
 skills for managing caregiver frustration
 emergency planning and help seeking behaviours among caregivers

27. SBS Prevention Campaign
Key Messages
All babies cry.
It is more important to stay calm than to stop the crying.
It’s OK to ask for help.
Never shake a baby for any reason.
Take a break, don’t shake.
Know you can trust your baby’s caregiver.

28. SBS Prevention Campaign
 Knowledge
Increased crying is a predictable part of normal infant development.
There are times when babies are inconsolable. This can be frustrating and overwhelming.
It’s normal to need help with infant care.

29. SBS Prevention Campaign
 Knowledge
Even a few seconds of shaking can cause serious damage.
Parents need to educate others who look after their babies.

30. SBS Prevention Campaign
 Skills
Learn ways to soothe a crying baby.
Learn ways to calm oneself when frustrated.
Plan ahead for who to call for help.

31. SBS Prevention Campaign
 Skills
Take a break, don’t shake.
Put the baby in a safe place.
Shut the door. Leave for up to 15 minutes.
If you are calm, try again to soothe the baby.
If you are not calm, seek help. Call someone.

32. SBS Prevention Campaign Resources
resources for parents with babies
Education Resource Kit
posters for young men
All resources are available at

33. Resources for Parents with Babies
“When your BABY can’t stop CRYING” resources
“Ask for Help” magnetic notepad, mini-poster and stickers
Crying Plan
Crying Display

34. Resources for Parents with Babies
“When Your BABY Can’t Stop CRYING”
brochure
low literacy version
translated versions
All of the CHR PHNs surveyed said that this brochure helps meet client needs and almost all (96%) said that it is easy to use.

35. Resources for Parents with Babies
“Ask for Help”
magnetic notepad
mini-poster
stickers

36. Resources for Parents with Babies
Crying Plan
encourages parents/ caregivers to have ways to soothe the baby and to calm themselves
emphasizes:
“It’s OK to ask for help.”
“Take a break, don’t shake.”

37. Resources for Parents with Babies
Crying Display

38. Resources for Parents with Babies

39. Resources for Parents with Babies
Reaching the Target Groups
community health visits
service providers
embedded messages in other resources
website -

40. Education Resource Kit
Shaken Baby Syndrome
Prevention
Education Resource
Guide
designed for use by service providers
includes instructional guide, professional development session, education sessions for target groups, and audio-visual resources

41. Education Resource Kit
Professional Development Session
Prepares you to:
counsel clients on managing infant crying
effectively use campaign resources
deliver educational sessions to youth, parents and other caregivers
deliver this session to others
other professionals or volunteers
potential supporters of local SBS prevention work

42. Education Resource Kit
Education Sessions for Primary Target Groups
sessions for youth (Grade 6 & High School), parents, and other caregivers
communicate all key campaign messages
include interactive components on topics such as why babies cry, how to soothe babies, and how to calm oneself
are flexible in content and length

43. Education Resource Kit
Distribution
Shaken Baby Syndrome Prevention Education Resource Kit DVD/CD ROM

44. Posters for Young Men
These are suitable for different target groups and uses, but developed with year old males in mind.

45. Campaign Evaluation Process Evaluation Outcome Evaluation
pre-tested resources with target groups and service providers during development
Outcome Evaluation
surveys with target groups
survey of service providers
tracking the incidence of SBS cases

46. Who has a Role in Preventing SBS?
We all do!
promote campaign messages
distribute campaign resources
teach others about managing crying and SBS prevention
join the Alberta SBS Prevention Network or a local committee

47. Any Questions About . . .
the injuries that can result from shaking and the factors that increase the risk of shaking
what constitutes normal crying
the components of the Alberta SBS Prevention Campaign
how you can use campaign resources in your existing work

48. Thank You
Your participation in this worthwhile and important campaign may very well save a child’s life.
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