ABUSIVE HEAD TRAUMA
PREVENTION PROJECT
KARYN M. PATNO, MD
CHILD PROTECTION PROGRAM OF VT
CLINICAL DIRECTOR
LAURA MURPHY, MD
PROJECT INSTRUCTOR
KAY SHANGRAW, RN
PREVENT CHILD ABUSE VERMONT
SBS PREVENTION COORDINATOR
COLLABORATORS

Prevent Child Abuse- VT

American Academy of Pediatrics- VT Chapter

Department for Children and Families

Vermont Department of Health

Vermont Child Health Improvement Program
ABUSIVE HEAD TRAUMA IN VT
Since the fall of 2007 there has been a dramatic
increase in the incidence of abusive head
trauma; also known as “Shaken Baby
Syndrome”
There have been 22 cases; 7 of these fatal
The cause for the increase is unclear, but may
include the economy, job loss, social stress
OBJECTIVES

TO IMPACT THE INCIDENCE OF ABUSIVE
HEAD TRAUMA through:

Educating new parents around issues of infant
crying and dangers of shaking

Educating primary care providers on the risk
factors for AHT; also known as “Shaken Baby
Syndrome”

Strengthening primary care providers in
anticipatory guidance around the issue of
infant crying
RECOGNIZING RISK FACTORS



Risk Factor assessment should start in the
prenatal period when possible
Risk Factor assessment continues in the
newborn period and at each well child visit
Review known risk factors prior to each well
child visit
RISK FACTORS



Parent with a previous, “Termination of Parental
Rights” (TPR)
Parent with a child currently in DCF custody
Teen Parent(s); especially when there is poor
extended family support

Parent(s) with drug/alcohol abuse history

Maternal Depression

Parent(s) with history of ADHD
RISK FACTORS


Unwanted pregnancy; unwanted child
Non-biological father figure in household, e.g.,
boyfriend, step-father


Note: Having a grandfather as the “father
figure” is not a risk factor
Special Needs Child (premature, congenital
defects)

Twins

Infant with fussy or irritable temperament
ANTICIPATORY GUIDANCE

Newborn Visit

First Week Visit

2-4 Week Visit

2 Month Visit

4 Month Visit

6 Month Visit
NEWBORN VISIT
BF pg. 276





Review and identify risk factors
Talk about coping with the “newness” of the
baby
Discuss sleep deprivation and the need to take
care of maternal needs
Reassure parents that it is NORMAL to feel
stressed and frustrated with the baby
Introduce the topic of infant crying and let
parents know that crying is normal
NEWBORN VISIT
continued




Remind parents that crying is how their baby
communicates to them.
Sometimes babies cry “for no apparent reason”;
this is also NORMAL.
Review strategies: Check that basic needs are
met, hold and rock the baby, sing or talk softly
When nothing seems to work: Put the baby
down, take a break, ask for help
FIRST WEEK VISIT
BF pg. 294

Review/Update risk factors

Assess for postpartum depression


Discuss Infant Crying: Is your baby fussy?
What do you do to calm him? Have you ever
been unable to calm him? What did you do, or
what would you do, if you were unable to calm
him?
Discuss newborn brains and their delicacy.
Talk about the danger of shaking or hitting.
FIRST WEEK VISIT
continued

Discuss strategies:



Check baby's needs: hungry? Needs to
burp? Needs diaper change? Over-tired?
Sick?

Hold infant and talk or sing to him

Rock infant

Go outside for a walk or drive in the car
Talk about getting “to the end of your rope”
Realize that everyone's rope is a different
length. Moms tend to be longer than dads.
FIRST WEEK VISIT
continued



If dad is not at visit, encourage mom to talk to
him about infant crying and about these
strategies
Ask how mom thinks dad is coping with the new
baby
PEARL OF WISDOM: No baby has ever hurt
himself by crying. Babies get hurt when parents
get to the end of their rope and shake or hit
them.
ONE MONTH VISIT
BF pg. 310




Review Risk Factors: Assess for domestic
violence
Talk about infant crying: Do you feel your
baby's crying is excessive? What do you do to
calm your baby? Do you ever get frustrated or
stressed by your baby's crying?
Crying peaks around age 1-2 months
Remind parents that crying is normal and that it
is not a sign of bad parenting.
ONE MONTH VISIT
continued


All babies cry. Good parents are those that recognize
when they are getting to the “end of their rope” and take
precautions not to shake their infant.
Review Interventions: The 5 S's

Swaddle

Side position

Shushing

Swinging

Sucking
When nothing seems to work:
Put the baby on her back in her crib/bassinet
and walk away!!!
The 5 “S’s”
1
1.
Swaddling
2.
Side/Stomach
A Feeling of Pure “Wrap”ture
Tight swaddling is the cornerstone of
calming, the essential first step in soothing
your fussy baby and keeping him soothed.
Wrapping makes your baby feel magically
returned to the womb and satisfies his
longing for the continuous touching and
snugness he enjoyed there. Swaddling
also protects your baby from accidentally
flipping onto the stomach. Always check
sure your baby is not overheated and do
not allow him to sleep in bed with loose
blankets.
Your Baby’s Feel –Good Position
The side/stomach positions soothe your
fussy newborn by instantly shutting off the
Moro Reflex (the panicky feeling of falling).
That’s why these are perfect feel-good
positions for unhappy babies.
When you put your infant to sleep,
however, the back is the only, safe
position.
4.
Few impulses are as powerful as a
parent’s desire to calm her crying baby.
Although this instinct is as Ancient as
parenting itself, Calming a baby is a
skill that takes some practice. Vigor is
Swinging
Rock-a Bye Baby
To your baby, fresh out of the womb -lying on
a soft, motionless bed is disorienting and
unnatural. Newborns are like sailors who
come to dry land after nine months at sea; the
sudden stillness can drive them bananas.
That’s why rhythmic, monotonous, jjggly
movement - what we call swinging - is one of
the most common methods parents have
always used to calm their babies. To get your
baby to stop crying, the swinging should be
like a shiver (fast, tiny movements) . Then,
once he is settling down you can use a slower,
broader rocking motion to keep him calm.
the Essential Tip for calming Baby. The
fastest way to succeed in stopping your
baby’s cycle of crying is to meet his level
of intensity. This need for vigor often
seems odd to first-time parents, but after
your screaming baby pauses for a few
moments can you gradually slow your
motion, soften your shushing, and guide
him down from his frenzy to a soft landing.
3. Shhhhing
Your Baby’s Favorite Soothing Sound
A loud, harsh shushing sound is music
to your baby’s ears. Shhhing comforts
him by mimicking the whooshing noise
your blood made as it flowed through
the arteries of the placenta. And, the
louder your baby cries, the louder the
Shhhing has to be in order to calm him.
5. Sucking
The Icing on the Cake
One of the most perfect ways to soothe
your cranky baby is to let her suckle.
Sucking takes a baby who is beginning
to quiet and lulls her into a deep and
profound state of tranquility. Sucking
triggers your baby’s calming reflex and
leads to a rich and satisfying
Level of relaxation.
The Happiest Baby
on the block .
2 MONTH VISIT
BF pg. 328





Review/Update Risk Factors
Discuss Infant Crying: Remind parents that this
is the age where crying is peaking. Crying
tends to decrease between 3-4 months.
Ask how they are coping with the infants crying.
What works to calm their baby?
Review infant brain fragility and the dangers of
shaking: Permanent brain damage or death
Review strategies again
4 MONTH VISIT
BF pg. 343




Review/Update Risk Factors
Discuss infant crying: Is your baby crying more
or less then the last visit? How are you and the
father coping with your baby's crying?
Have you or the father ever felt like you were at
the end of your rope? What did you do when
this happened?
Are you and the father comfortable putting the
baby down and taking a break?
4 MONTH VISIT
continued



Who else takes care of the baby? Have you
talked to them about your baby's crying and
what works to calm him?
Have you used baby sitters yet? Don't forget to
talk to them about what to do when your baby
cries.
Remind other people who take care of your
baby to never shake, hit or yell.
6 MONTH VISIT
BF pg. 359

Review/Update Risk Factors



Are parents still together? If not, is there a
new “father figure” in the picture. How is he
adjusting to the baby?
Discuss Infant Crying: Even though the infant is
6 months old, he may still have crying spells
where you cannot calm him. Remember, it is
ok to put him in his crib and let him “work it out”.
Have you ever had to do this?
Review day care issues, baby sitters