Shaken baby prevention education for providers
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Shaken Baby Prevention Education for Providers. Goals of the Shaken Baby Prevention Program. Decrease the incidence of Shaken Baby Syndrome (SBS) in the military Grow stronger military families by preventing family violence

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Shaken baby prevention education for providers

Shaken Baby Prevention Education for Providers


Goals of the shaken baby prevention program

Goals of the Shaken Baby Prevention Program

  • Decrease the incidence of Shaken Baby Syndrome (SBS) in the military

  • Grow stronger military families by preventing family violence

  • Educate and influence new parents as they develop effective parenting skills


What do healthcare providers need to know about sbs

What do Healthcare Providers need to know about SBS?

  • Review the incidence, risk factors, presentation and prognosis of Shaken Baby Syndrome (SBS).

  • Discuss the role of healthcare staff in educating military families.

  • Highlight the value in education to decrease the incidence, morbidity and mortality of SBS.


Shaken baby prevention action plan

Shaken Baby Prevention Action Plan

  • Provide one-on-one SBS education to parents of every child born in a MTF including deployed new fathers

  • Ask every new parent to voluntarily sign a commitment statement acknowledging receipt of SBS information about the dangers and consequences of SBS

  • Educate and encourage fleet healthcare providers to address prevention of SBS and family violence with sailors and marines


What is shaken baby syndrome

What is Shaken Baby Syndrome?


Definition

Definition

  • SBS is defined as a non-accidental traumatic injury resulting from violent shaking of an infant or child.


What is the history of shaken baby syndrome

What is the History of Shaken Baby Syndrome ?

  • Original description “Whiplash Shaken Baby Syndrome” (Caffey, 1970)

    • Retinal hemorrhages

    • Subdural and/or subarachnoid hemorrhage

    • Little or no evidence of external trauma

    • May or may not have associated fractures


What is the mechanism of injury

What is the mechanism of injury?

  • The rapid and repetitive flexion and extension of the neck and head leads to two main types of injury:

    • Direct trauma to the brain as a result of it striking the skull;

    • Disruption of bridging vessels that surround the brain, leading to hematoma formation (most common pathologic intracranial finding associated with SBS).


Fast facts for discussion

Fast Facts For Discussion

  • Abusive head trauma is the leading cause of trauma related deaths among children

    (AAP Policy Statement, July 2001)

  • 80% of head trauma deaths in infant and children < 2 years were due to child abuse (Bruce and Zimmerman, 1989)

  • Estimated 3.3 to10 million children witness violence between intimate partners each year

    (Family Violence Prevention Fund, September 2002)

  • Concurrence of child abuse and domestic violence 30-60%

    (Edelson, 1999)


What are the consequences of shaking a baby

What are the Consequences of Shaking a Baby?

  • Babies are not able to fully support their heavy heads. As a result, violent and forceful shaking causes a baby's brain to be injured. Too often, this leads to the death of a baby. It also can lead to:

    • Bleeding around the brain

    • Blindness

    • Hearing Loss

    • Speech or learning disabilities

    • Chronic seizure disorder

    • Brain damage


Shaken baby prevention education for providers

What is the Incidence of Shaken Baby Syndrome in Children under 1 year of Age?(inflicted Traumatic Brain Injury – iTBI)

  • 29.7/100,000 in NC

    Keenan et al, 2003

    (odds ratio 4.7 for military dependents)

  • 24.6/100,000 in Scotland Barlow & Minns, 2000

  • Over 1400 cases annually in the U.S.


Known military cases of sbs

Known Military Cases of SBS

  • 44 SBS cases in last 18 months as of SEP05 per Armed Forces Center for Child Protection

  • 30% of cases are USN/USMC families

  • Likely only the tip of the iceberg

  • There are no clear reporting mechanisms in DoD

  • These cases were all preventable!


What is the outcome of sbs

What is the outcome of SBS?

  • 1/3 die (mortality 15-38%)

  • 1/3 severe disability

  • 1/3 short-term “normal”  1/2 will develop late findings:

    microcephaly, developmental delay, learning disability, mental retardation, psych/behavior difficulties, seizures, blindness, paralysis


Estimated cost of shaken baby syndrome

Estimated Cost of Shaken Baby Syndrome*

  • $60,000

    • Initial hospitalization

  • $100,000

    • First year treatment & rehabilitation

  • $4 -14 Million

    • Lifetime care of each child victim

* University of Pennsylvania Data


What usually triggers the violent shaking event

What usually triggers the violent shaking event?

  • Momentary loss of control

  • Frustration, anger, even rage response by caretaker

  • Infant crying and fussiness - persistent, inconsolable


Crying facts for discussion

Crying Facts for Discussion

  • Peak age 2-3 months

  • Unpredictable

  • Resistant to soothing

  • Painful facial expression

  • Long bouts, lasting 30-40 minutes or MORE!

  • Evening crying

  • Babies outgrow it!


Usaf sbs data review 2002 usn dod data search 2004

2/3’s of victims are < 6 months age

Roughly equal male/female victim ratio

First baby for that family

Offenders: biological father

Offenders: married to mother

Offenders: active duty males 20-25 years old

Alone acting as caretaker at time of incident

“Crying” as trigger

USAF SBS Data Review 2002, USN DoD Data Search 2004

Military Shaken Baby Syndrome Cases


Shaken baby prevention education for providers

Risk Factors Identified in Perpetrators of Child Abuse


Sbs offenders

SBS Offenders


Infant risk factors

Infant Risk Factors

  • Frequent crying, inconsolable, “colicky”

  • Small body size

  • Large ratio of head to body size

  • Weak neck muscles

  • Lack of head control

  • Prematurity

  • Special needs

  • Low birth weight

  • Poor bonding

  • Less than 12 months of age

  • Male


Caregiver risk factors

Caregiver Risk Factors

  • Male (70%)

  • Single Parent

  • Low education level

  • Impulsive or childish behavior

  • Depression

  • Mentally challenged

  • Domestic violence


Environmental and social risk factors

Environmental and Social Risk Factors

  • Social isolation

  • Lack of social support

  • Low income

  • Poor prenatal care

  • Diminished marital satisfaction

  • Poor family functioning


Clinical presentation of sbs

Clinical Presentation of SBS

  • Seizures

  • Apnea/Respiratory Arrest

  • Loss of consciousness

  • Vomiting

  • Lethargy

  • Irritability


Consequences of sbs

Consequences of SBS

  • Increased intracranial pressure results from the hemorrhage, cerebral edema, and increased cerebral blood flow from the injury.

  • Death is usually the result of uncontrolled cerebral edema.


Delicate bridging veins

Delicate Bridging Veins


Subdural hematoma

Subdural Hematoma


Subdural hematomas on ct scan

Subdural Hematomas on CT scan


Retinal hemorrhage

Retinal Hemorrhage


Shaken baby on life support in pediatric intensive care unit

Shaken Baby on Life Support in Pediatric Intensive Care Unit


Analysis of missed cases of abusive head trauma jenny et al jama 1999 281 621 626

Analysis of Missed Cases of Abusive Head Trauma,Jenny et al, JAMA 1999;281:621-626

Physicians failed to diagnose abusive head trauma at 1st visit 31.2% of the time (N=173)

  • Age: younger

  • Race: more likely to be Caucasian

  • Family: more likely live with both parents

  • Severity of Symptoms: more likely be seen for nonspecific vomiting or irritability


Tips for not missing an sbs case

Tips for not missing an SBS case

  • Look for the presence of bruises or abrasions on the faces or heads of children presenting with non-specific symptoms.

  • Consider head trauma in the differential diagnosis, when evaluating infants and toddlers with non-specific symptoms (such as vomiting, fever, or irritability).

  • Perform a head-to-toe physical examination, check the fontanelles (soft spots) on the babies heads, measure the head size and be alert for signs of trauma.

  • Look for signs of previous bleeding or old blood in the spinal fluid when doing a spinal tap

  • Consult pediatric radiologists to interpret X-rays and head CTs in cases of suspected child abuse.


Reporting suspected child abuse

Reporting Suspected Child Abuse

  • The Child Abuse Prevention and Treatment Act of 1974 is a federal law that requires mandatory reporting of abuse by designated personnel.

  • Physicians are required to report in all 50 states whenever abuse is suspected.

  • Proof is NOT required.


Reporting guidance

Reporting Guidance

  • It is good practice to inform families when suspected abuse is being reported.

  • This helps maintain communication and trust.

  • If any safety concerns are raised, child protective services, police, or facility security should be present when the family is notified.


State laws mandating sbs parental education

State Laws Mandating SBS Parental Education

  • Florida “Kimberlin West Act” since 2002

  • New York since 2001

  • Pennsylvania and Maryland have legislation pending


Prevention education works

Prevention Education Works

  • The New York State hospital-based parent education program (Dias Model) targeted parents of all newborn infants.

  • This education program demonstrated a decrease in the incidence of abusive head trauma injuries by 47% during a 6 year period.


Schedule of sbs interventions

DOSE

DATE

Caregiver

Clients

Location

Format

#1

OB, 3rd ∆

RN, MD

Mom or Mom & Dad

OB/FP Clinic

Screening for risk;

New Parent Support Visiting RN referral

#2

Birth

RN

Mom & Dad

Hospital

Video; one-on-one discussion; SBS brochure; commitment statement

#3

2-6 weeks of age

Home RN, “Doc”, or senior enlisted

educator

Mom & Dad

Home, Workplace,

Medical Clinic

Video (if not seen)

One-on-one question & answer

Group discussion

#4

2, 4, 6 MOS WB

MD or “Doc”

Mom & Dad

Medical Clinic

Anticipatory guidance to Mom & Dad at well baby visits

Schedule of SBS Interventions


The shaken baby prevention process teach reach

The Shaken Baby Prevention Process: Teach & Reach

  • View Video: 11 minutes

  • Discussion with healthcare provider*

  • Voluntary signature on commitment statement

    • (*Experienced senior enlisted mentors may also deliver this important message to shipmates and new fathers)


Fleet initiative

Fleet Initiative

  • Operational HCPs incorporate SBS in new father debriefing sessions while returning to home port

  • Training Toolkit available on NMO web site:

    • http://navymedicine.med.navy.mil/womenshealth/

  • New fathers educated and given fact sheet

  • New fathers sign voluntary commitment statement (VCS)

  • Medical Staff send VCS to Armed Forces Center for Child Protection


Other efforts to reach deployed fathers

Other Efforts to Reach Deployed Fathers

  • OB prenatal screen to identify deployed parents and families needing support of home visitation RN

  • Fleet and Family Support: Baby Boot Camp; Couples Communication Classes

  • Fleet Medical Briefs – Tackle transition back to family life

  • Chaplain Programs – Marriage & Family Enrichment

  • Health Promotion & Wellness – Being A Fit Father

  • Father friendly Well Child Care visits with healthcare provider


Military families need to have a plan when the baby won t stop crying

Military Families Need to Have a Plan When the Baby Won’t Stop Crying

  • Stop! Take a time-out, call for help

  • Call a friend, relative or neighbor for support and advice.

  • Ask another adult to take care of the infant while you take a break.

  • Call a crisis hotline

    (1-800-4-A-CHILD).

  • Call your health care provider.


References

References

  • Keenan HT et al. A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children. JAMA. 2003; 290(5): 621-6

  • Herman-Giddens ME. Reducing Collateral Damage on the Home Front: Child Abuse Homicides within Military Families and Communities in North Carolina. September 2004, North Carolina Child Advocacy Institute: www.ncchild.org/maltreatment.htm

  • USUHS Courage to Care: www.usuhs.mil/psy/courage.html

  • American Academy of Pediatrics

    www.aap.org


Resources

National Center on Shaken Baby Syndrome

2955 Harrison Blvd

Suite 102

Ogden, UT 84403

(801) 627-3399 or 1-888-273-0071

http://www.dontshake.com

The Shaken Baby Alliance

P.O. Box 150734

Fort Worth, TX 76108

(877) 6-END-SBS

http://www.shakenbaby.com

US Department of Health and Human Services

http://www.hhs.gov

American Academy of Pediatrics

141 Northwest Point Blvd

Elk Grove Village, IL 60007-1098

(847) 434-4000

http://www.aap.org/

Prevent Child Abuse America

200 S. Michigan Avenue

17th Floor

Chicago, IL 60604-2404

(312) 663-3520

http://www.preventchildabuse.org

Childhelp USA (Hotline)

(800) 4-A-CHILD

National Committee To Prevent Child Abuse (Hotline)

(800) CHILDREN

Resources


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