2. SAFE BABIES NEW YORK NURSE TRAINING MODULE ONE: ABUSIVE HEAD TRAUMA PREVENTION AND PROGRAM IMPLEMENTATION Created and Narrated by Jennifer Canter MD MPH FAAP Edited by Robin Altman MD FAAP and Patricia Patrick DrPh 1

3. 1.Safe Babies New York (SBNY) Program and the Role of the Maternity Nurse 2.Infant Crying: 1.Normal crying and three ways to cope with a crying baby 2.The dangers of shaking, slamming or throwing a baby 3.Methods to address parents’ questions about infant c rying and the dangers of shaking, slamming or throwing a baby OBJECTIVES – To Understand…

4. 1.A hospital based parent educational program to reduce infant morbidity and mortality from abusive head trauma and unsafe sleep 2.Education on normal infant crying and safe sleep 3.Two videos (one on abusive head trauma, other on safe sleep) 4.One brochure 5.For abusive head trauma prevention component: 1.Commitment statement 2.Reporting compliance via updated website (www.safebabiesny.com) 3 SAFE BABIES NEW YORK PROGRAM

5. 47% decrease in the incidence of abuse head injuries in Western New York

6. 75% decrease in incidence of abusive head injuries in Hudson Valley Region!

7. Five Core Program Components 1.Videos –Prevention of Abusive Head Trauma –Safe Infant Sleep 2.Brochure –Combines both messages 3.Education –Answer parents’ questions 4.Commitment Statement –Assures compliance with the 2004 NYS Mandate 5.Compliance –Tracks hospital participation for reporting to the NYS Office of Children & Family Services

8. 7 Helpful Tips for Program Introduction Present the information in a positive way: Let parents know that you are providing them information that will keep their baby safe and healthy Tell them that the information you are sharing with them is being provided to all parents of all newborns throughout New York State Share that this information is intended to be shared with anyone who may care for the newborn

9. 8 Step One - Videos Ask both parents to view two short videos available at your facility 1.Abusive Head Trauma Prevention 2.Safe Sleep

10. Step Two - Brochure Ask both parents to view review the Safe Babies New York educational brochure

11. Step Three - Education Address parents’ questions pertaining to the video and brochure contentAddress parents’ questions pertaining to the video and brochure content Core messages:Core messages: Cope with infant crying: Stop, Relax, Take a Break Practice safe sleep (addressed in Module 2): Alone, Back, Crib

12. Step Four – Commitment Statement In November 2004, NYS law requiring hospitals to provide parents with the opportunity to watch a video on abusive head trauma prevention and receive information. Ask parents to voluntarily sign a commitment statement affirming their participation in the program. Only one commitment statement needs to be signed for each family. Give one copy of the form to the parent.

13. What if a Parent Refuses Elements of Program? Although hospitals are mandated by New York State law to provide the information to parents, participation in the program is entirely voluntary. If they refuse to sign the commitment statement, document this on an unsigned form. If they refuse to see the video have them sign the video waiver.

14. Step Five – Hospital Compliance Participation in this program ensures your hospital’s compliance with the NYS mandate. One copy of the commitment statement will be used to track your hospital’s compliance with this program. Follow your nurse manager’s instructions regarding what to do with the other copies. A designated representative from your hospital is responsible for entering monthly compliance statistics into the program website (www.safebabiesny.com).www.safebabiesny.com

15. Training Nurses to Teach Patients Infant Crying Abusive Head Trauma Safe Sleep (Addressed in Module 2)

16. Infant Crying

17. 16 Teaching Parents About Coping With A Crying Baby Crying is a normal, everyday activity in the lives of babies. Some infants cry very little while others cry a lot. Not every baby is easy to calm. Crying is the only way babies have to communicate their needs. They might cry when they are hungry, lonely, tired or when their diaper needs to be changed. While crying is a normal part of every baby’s day, crying can also mean that the baby is sick or in pain. Parents must be told that if they think their baby is sick, it is important to contact their pediatrician.

18. 17 Teaching Parents About Coping With A Crying Baby If you have checked for all of the reasons why a baby might cry and your baby is still crying, you can try some of these suggestions: Rub her back or stroke her head as you count slowly out loud. Let him listen to a repeating sound, such as a clothes dryer. Walk outdoors with her. Gently rock him in your arms or walk with him against your shoulder. Hum or sing to her. Try a pacifier, or help him find his thumb to suck on. Put her in a car seat and take a car ride. Carry him in a “snuggly”.

19. 18 Teaching Parents About Coping With A Crying Baby If Crying Is Getting To You: STOP Place the baby in a comfortable and safe place where you can regularly check on him, such as a crib or play pen, and walk away. It is okay to let your baby cry while you calm down. Crying will not cause brain damage or harm your baby in any way. RELAX Walk outside for a couple of minutes or go into another room where the crying is not so loud. Sit down and take ten deep breaths. Listen to music, take a shower or do something physical. TAKE A BREAK If possible, call a trusted friend, neighbor, or family member to help you for a while so you can take a little break.

20. 19 How To Discuss This Topic With Parents Emphasize that anyone can become frustrated or angry when a baby cries a lot, and these feelings are normal. The information you are providing will give them tips to deal with these feelings in a positive way if and when they occur. Explain that you are providing this information to them so that they, as their infant’s strongest advocates, should share this information with all others who will care for their infant. Remind them to be careful in choosing babysitters for their infant, trying to avoid those with tempers or anger management issues and to trust parental instincts.

21. Abusive Head Trauma

22. 21 WHAT IS “ABUSIVE HEAD TRAUMA” Also known as “Shaken Baby Syndrome”. Serious intra-cranial and other injuries can occur when an infant, toddler, or child is forcefully shaken, slammed or otherwise injured by an adult. Serious form of child abuse with a 20-25% mortality rate. Most of these infants are less than 12 months old. It is estimated that 1,400 children die of abusive injuries in the United States each year, and most deaths are attributed to severe head injuries.

23. 22 What’s the Connection Between Crying & Abusive Head Trauma Peak incidence of abusive head trauma coincides with peak incidence of infant crying (2-4 months of age) Infant Crying Parental Stress Goal is for parents to develop skills to: –Understand crying. –Calm their baby. –Control their own frustration, anger and stress. –Be advocates in selecting the best caregivers for their newborn infant.

24. 23 Next Steps Familiarize yourself with video, brochure and commitment statement at your hospital. Complete the evaluation for this nurse training module on our website. Know who is the designated nurse manager in charge of this program at your institution. All hospitals’ program compliance will be available to the designated nurse manager via our website (For Hospitals/Newsletters). Watch the Safe Babies New York Module 2: Safe Sleep Thank you for your participation!

25. 24 www.safebabiesny.com