Shaken Baby Syndrome Prevention Program. Lisa Carroll RN, BSN

Shaken Baby Syndrome Prevention Program Lisa Carroll RN, BSN

Shaken Baby Syndrome in US Occurs when infant or young child is violently shaken Most violent form of Child Abuse in US; between 1,200 1,800 cases in U.S. per year Missed 1/3 of time - under-diagnosed diagnosed Accounts for majority of severe head injuries in babies less than 1 year old (typical age: 5-9 months, usually under 3 years, rare cases up to 5 years) Male > Female infants Mortality: 25% Morbidity: 75% - life-long long disabilities

Shaking Misconception that shaking is not harmful - not tossing nor bouncing! Acceleration/deceleration injury Head goes backward/forward/side to side

The vulnerability of the Infant Head of infant 25% of total weight (10% in adult) Weak neck muscles (can t t support weight of head) Intracranial space larger in babies brain hasn t finished growing Brain not stable and moves around within skull Myelination not complete brain and nerves are soft Size difference between victim and perpetrator

Equivalent to force of 1000 kg gorilla shaking adult

Sequence of Events 90% of time CRYING is TRIGGER for caregiver to shake baby Caregiver attempts to soothe baby due to crying Hopelessness, frustration, anger Picks up baby begins to shake 2-44 violent shakes can kill Baby is exhausted, caregiver lays baby down/delays medical attention Baby dies Without recognition of pathophysiology of SBS, this death could be labeled SIDS or accidental injury from a fall

Crying 2-2-22 Excessive crying begins at 2 weeks of age Crying can t t be controlled Peaks @ 2 months Tapers off by end of 4 months Crying can last 2-33 hours Average crying spell is 30-40 minutes Usually happens in late afternoon/evening Research shows that crying is normal not due to any illness/colic often NOTHING can be done to soothe baby

Potential Risk Factors for SBS Male caregivers, due to being less familiar with infant soothing skills (and self-coping practices) More limited bonding with infant Resentment toward infant non-biological child Premature or colicky infants Unrealistic expectations about parenthood and caring for an infant Other family stressors

Shaken Baby Syndrome Typical Perpetrators 13% Mothers 37% Fathers/ Step- Fathers Fathers/ Stepfathers Mom's Boyfriend Babysitters 21% Babysitters 21% Mom's Boyfriend Mothers * Fathers or father figures account for 60% of perpetrators

Classic Triad Sub-dural hematoma Cerebral Edema Retinal Hemorrhage 70 90 %

Signs and Symptoms Non specific : lethargy, listlissness,, irritability (may look like flu ), anorexia Often no apparent external sign of injury Rib fractures and long bone fractures

Long-Term Morbidity of SBS Brain damage : Deafness Cortical Blindness Seizures Cerebral Palsy Paralysis Learning Disabilities

Costs Total medical costs for one case can exceed $1 million The cost of an effective primary prevention program could easily be regained from the medical savings to society

Diagnosis of SBS Diagnostic Tools Physical exam High Index of Suspicion Pediatric ophthalmologist CT scan, MRI Specific diagnosis coding helps assessing number of true cases of SBS (ICD 9)

Focal subdural hematoma

Subdural hematomas

Axonal shearing

Post-traumatic traumatic cerebral necrosis

Posterior rib fractures due to shaking

MRI subdural hemorrhages

Retinal hemorrhages

SBS Prevention Evidence Base Developed by Mark Dias, MD Neurosurgeon in New York State Based on hospital-based parental education program Components: leaflet re: SBS, 11 minute video, sign commitment statement (voluntary) Reference: Dias et al, Pediatrics Volume 115:4, 2005, e470. Preventing Abusive Head Trauma Among Infants

SBS Prevention Evidence Base Outcome : a) Prior to intervention : 41.5 cases/100,000 live births of confirmed abusive head injury (6 years prior) b) Study period (6 years) : 22.2 cases/100,000 live births 47% reduction in incidents (p = 0.017)

Shaken Baby Prevention Program 2001 Ohio, USA

Implementation Staff Training Video: Highlights families affected by SBS Bedside education by nurse or social worker Teaching card: 2-52 5 minutes of key prevention message Documentation of education by nurse Optional: Signed document parents intention never to shake Reinforcement materials (bibs, flyers -on line, door hanger) Costs: $2 - $3 per child depending on components used

Highlights of Prevention Program Normal crying patterns Dr. Barr Coping with crying Soothing techniques Dangers of shaking No matter how ANGRY, FRUSTRATED or RATTLED, never shake a baby

Our expertise Trained staff in 31 hospitals 50,000 professionals (includes childcare agencies, pediatricians, social service agencies, child abuse organizations) Ohio now has law 2008 Requires ALL relevant to educate parents & families regarding SBS

Claire s s Law

Shaken Baby Syndrome 100% Preventable Healthy children of the future rests in our hands