Crying and Abusive Head Trauma Idaho Perinatal Project

Crying and Abusive Head Trauma Idaho Perinatal Project Conference - October 2014 Paul McPherson, MD Medical Director, CARES Program St. Lukes Childrens Hospital Objectives Case report of Abusive Head Trauma/SBS Review statistics of SBS Discuss triggers of SBS

Review Prevention Literature Case report 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 Fractures Subdural blood (blood on the brain) Incidence of AHT vs. Childhood

Cancer 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 24 -32 /100,000. Cases of Severe Physical Abuse (evaluated at St. Lukes Childrens Hospital) 9 cases of severe child physical abuse (required hospitalization)

11 cases of severe child physical abuse (required hospitalization) 5 of the 9 were from abusive head trauma

(shaken baby syndrome) 8 of the 11 were from abusive head trauma (shaken baby syndrome) 3 under the age of 1 2 between 1-2 years old

2012 7 under the age of 1 1 between 1-2 years old 2013 Continuation of case report 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. Situations That Trigger Abusive Events The

most commonly described and welldocumented 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. Risk Factors for Physical Abuse / Abusive Head Trauma 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. Continuation of case report 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.

Infant Crying and Abuse Parental Self Report Study 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 underrepresents the true incidence. Prevention Efforts Primary Prevention Hospital Based, Parent Education Program 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 Continuation of case report The dad eventually indicated that he couldnt get him to stop crying he shook him out of frustration to get him to stop. like I said, thats exactly what happened. Thats the first time in my life Ive ever shook a baby like that honestly I feel responsible. And it kills me

cause I feel responsible for hurting my son. Just in case Shaken baby syndrome can occur in all family types. Whats Next ??? Next Steps Crying Plan ANY QUESTIONS ??? Thank you

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