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1 A Promising Model for Shaken Baby Syndrome Prevention Jane Swenson, CNP.

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Presentation on theme: "1 A Promising Model for Shaken Baby Syndrome Prevention Jane Swenson, CNP."— Presentation transcript:

1 1 A Promising Model for Shaken Baby Syndrome Prevention Jane Swenson, CNP

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3 3 Preventing SBS: Why Bother? Second most common cause of death due to trauma in children 1/3 die of their injuries, 1/2 of remainder suffer permanent neurological and visual sequelae Responsible for > 95% of serious head injuries in children < 1 y/o 1400 deaths from SBS in U.S. annually

4 4 Jacy Showers, Ed.; 1982,1983,1987, 1990,1992 Inadequate knowledge about the dangers of shaking 24-50% of parents/adults did not know shaking was dangerous Pre and post test scores indicate adults can be educated about dangers of shaking young children

5 5 Starling SP, Holden JR, Jenny C.; infants with AHT and perpetrator identification: Male/female perpetrators = 2.2:1 68.5% male - Birth fathers 37% Mother’s boyfriends 20.5% Stepfathers 3.1% Male babysitters 3.9% 31.5% female - Female babysitters 17.3% Birth mothers 12.6%

6 6 Gray JD, Cutler CA, Dean JG and Kempe CH; 1979 Kempe family stress index: - Parent’s childhood history - Potential for violence - Stressors/concerns - Perception of infant

7 7 Gray JD, Cutler CA, Dean JG and Kempe CH; 1979 (cont.) - Substance abuse - Discipline issues - Unrealistic expectations? - Support systems - CPS involvement?

8 8 Milner, J, 1991; Coody D, Et Al, 1994 Risk factors for child abuse: - Childhood history of CA - Isolation - Unrealistic expectations - Substance abuse history

9 9 Milner, J, 1991; Coody D, Et Al, 1994 (cont.) - Violence history - Lack of family/social support - Impulsive behavior - Depression - Relationship problems - Financial difficulties

10 10 National Incidence Study of Child Abuse & Neglect (NIS-3),1996 Important contributing factors to CA: – Family structure and size – Poverty – Alcohol & substance abuse – Domestic violence – Community violence

11 11 What’s Been Done?  Public Awareness  Community Education

12 12 Public Awareness Brochures Billboards Buscards Transtop posters

13 13 Community Education Portrait of Promise video Young babysitter curriculum Daycare provider licensure requirement Prenatal education Early childhood education classes Parenting classes “Father”education Male audiences; JDC, Prisons

14 14 Upstate N.Y.SBS Education Project : Premises Most people know that shaking is bad SBS represents a momentary lapse in control, likely secondary to frustration 75% of perpetrators are parents, and 60% are fathers or father figures (stepfathers, boyfriends) Therefore any educational effort needs to target parents, and especially fathers/father figures

15 15 Upstate N.Y.SBS Education Project : Premises Average age of victims is 5-9 months Education needs to remind both parents at the correct time – on the birth of the child, when they: –Are a captive audience –Are focused on their infant –Will soon be exposed to the frustrations of parenting

16 16 Upstate N.Y.SBS Education Project : Premises Parents can be advocates by disseminating information to other caregivers

17 17 Upstate N.Y.SBS Education Project : Approach Congratulations on your new baby! You are the best advocates for your child’s safety We want to educate you about the dangers of shaking infants Please help us ‘spread the news’ to everyone who cares for your child!

18 18 Upstate N.Y.SBS Education Project : Protocol All parents (mothers and fathers) asked to review both written and video materials: –video, brochure on SBS, information on coping with crying,Commitment Statement All materials provided in English and Spanish

19 19 Upstate N.Y.SBS Education Project : Protocol Both parents asked to voluntarily sign a commitment statement (CS) –Signed by both parents whenever possible –Asks a few simple demographic questions for tracking –Witnessed by nurse/educator Identifying information expunged if parents refuse –Copies sent monthly by participating hospitals to the study coordinators for tracking

20 20 Upstate N.Y.SBS Education Project : Goals 1) Educate every parent of every child 2) Confirm receipt of information –Track number of returned commitment statements 3) Monitor regional cases of abusive head injury

21 21 Upstate N.Y.SBS Education Project : Results ( ) CS recorded from 37,136 families –Represents 61% of the region’s live births –Steadily increasing numbers of returned CS each subsequent year –Currently receiving CS from > 80% of live births 96% of CS signed by mothers, and 75% by fathers or father figures

22 22 Upstate N.Y.SBS Education Project : Results ( ) Information was very well received - of people returning CS: –92% think information is helpful –95% recommend information for all parents 93% already know that shaking an infant is dangerous ~ 10% contributed positive comments, few negative comments

23 23 Upstate N.Y.SBS Education Project : Results ( ) 18.3/100, Study 49% (< 0.05) 35.5/100,00 0 Annualized Incidence 54% (< 0.05) 7.0 Cases/Year 72 Time Period (months) 42 # of Cases % Reduction Control

24 24 Upstate N.Y.SBS Education Project : Case Analysis 2Born at participating hospital, CS returned 3Born at participating hospital, no CS 5Born at non- participating hospital 2Born before program Number of cases

25 25 Upstate N.Y.SBS Education Project : Results ( ) Results appear to be specific –No change in the frequency of other regional abuse referrals in WNY –No comparable decline reported in other US metropolitan areas (SIGCA listserve query)

26 26 SBS Prevention: Conclusions A coordinated and comprehensive program of hospital based parent education may be significantly effective in reducing the incidence of abusive infant head trauma These results need to be verified and expanded upon in larger trials

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28 28 Twin Cities Metro SBS Prevention Program task force created 2001 materials developed and translated implementation plan: TC Metro –15 hospitals, 7 counties collaboration with MDH for data

29 29 SBS Visits at Home Visits Be direct and clear…it is NEVER ok to shake a baby Educate re: normal crying behavior Educate re: how to cope with crying Engage parents as advocates for baby’s safety Include dad/father figure in SBS and ALL education

30 “It is clear that even though the media, politicians, and the public would like to believe that quick fixes can be found, the nature of child maltreatment, the depth to which it is ingrained in our society and the complexity of the problem all defy simple solutions.” Krugman, 1997


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