Paul McPherson, MD Medical Director, CARES Program St. Luke’s Children’s Hospital

 Case report of Abusive Head Trauma/SBS  Review statistics of SBS  Discuss “triggers” of SBS  Review Prevention Literature

 3 month old male  Mom leaves baby with his father, mom goes to work  Dad calls mom – baby not acting right  She returns home and they take him to the hospital. Bruises to the face

Rib FracturesSubdural blood (blood on the brain)

 Incidence: 9.2 / 1000 Child Victims of Abuse/Neglect  Incidence: 17.9 / 100,000 Child Cancer Diagnosis  Incidence: children younger than 1 year had an AHT rate of /100,000.

 9 cases of severe child physical abuse (required hospitalization)  5 of the 9 were from abusive head trauma (shaken baby syndrome) ◦ 3 under the age of 1 ◦ 2 between 1-2 years old  11 cases of severe child physical abuse (required hospitalization)  8 of the 11 were from abusive head trauma (shaken baby syndrome) ◦ 7 under the age of 1 ◦ 1 between 1-2 years old

 Dad was interviewed by law enforcement  He admitted the patient was fussy/crying.  He put his son down in the crib. Later he heard a “strange noise.”  He saw his son arching his back and acting weird. He picked him up and gently shook him. His son banged his head in the in the basinet, so he gently shook him a second time to snap him out of it.

 The most commonly described and well- documented trigger is infant crying.  Confluence of peak of crying and peak incidence of abusive head trauma makes crying a highly likely cause for the assault.  Environmental or care provider stressors, violence, psychopathology, or deficient parenting skills can be additional factors.  Triggers in older children include temperament, behavior, and toileting.

Babies less than 1 year of age (with the highest risk period at 2 to 4 months) are at greatest risk for SBS because they cry longer and more frequently, and are easier to shake than older and larger children.

 Family/ Caregiver Characteristics – Age of caregiver, mental health of caregiver, marital status, unrealistic child development expectations, history of caregiver having been maltreated as a child, victim or witness of domestic violence, single parent, criminal history, male caregiver are most frequent perpetrators of abusive head trauma.  Infant Characteristics – History of previous abuse, premature or disabled infant, Less than 6 months of age, multiple gestation, inconsolable and/or frequent crying.

 Second interview…  Dad reported that his son was screaming/crying the first time he shook him.  When he heard the cry, he picked him up “roughly” and flipped him over onto his back, then he shook him, hard.  Afterwards, he curled up into a ball, so he shook him again.  He demonstrated shaking his son hard for at least 5 seconds each time.  Vomiting and intermittent seizure like activity began.

 Of the parents of 6-month-old infants, 5.60% report to have shaken their infant to stop their crying or to have undertaken similar detrimental actions like smothering or slapping  3.35% of the parents of 6-month-old infants report to have shaken their baby at least once to stop their crying.  For parents of 1-month-old infants, this percentage is 1.10%.  Parental self report likely under-represents the true incidence.

 Preventing AHT education program was provided to available parents of newborns in an 8 county region of western NY during the first 5.5 years of the program.  Program included education about violent infant shaking and a voluntary signing of a commitment statement affirming understanding.  Follow-up telephone surveys were conducted 7 months later.

95 % of those surveyed 7 months later remember receiving information. Incidence of abusive head injuries during 6 year control period – 41.5/100,000. Incidence of abusive head injuries during 5.5 study period – 22.2/100,000 Represents a 47% reduction that is statistically significant (P =.0168) No comparable drop in incidence was noted in Pennsylvania during the control and study periods in Western New York State Hospital-based parent education program appears to significantly reduce the incidence of abusive head injuries. The curriculum included watching a video about the dangers of shaking and signing a “commitment statement.”

 The dad eventually indicated that he “couldn’t get him to stop crying” he shook him out of “frustration to get him to stop.”  “like I said, that’s exactly what happened. That’s the first time in my life I’ve ever shook a baby like that…”  “honestly I feel responsible. And it kills me cause I feel responsible for hurting my son.”

Shaken baby syndrome can occur in all family types.

Thank you