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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. ABUSIVE HEAD TRAUMA PREVENTION PROJECT. COLLABORATORS. Prevent Child Abuse- VT

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ABUSIVE HEAD TRAUMA PREVENTION PROJECT

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  1. 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 ABUSIVE HEAD TRAUMA PREVENTION PROJECT

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. ANTICIPATORY GUIDANCE • Newborn Visit • First Week Visit • 2-4 Week Visit • 2 Month Visit • 4 Month Visit • 6 Month Visit

  9. NEWBORN VISITBF 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

  10. NEWBORN VISITcontinued • 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

  11. FIRST WEEK VISITBF 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.

  12. FIRST WEEK VISITcontinued • 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.

  13. FIRST WEEK VISITcontinued • 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.

  14. ONE MONTH VISITBF 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.

  15. ONE MONTH VISITcontinued • 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!!!

  16. The 5 “S’s” 11. Swaddling 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. 2. Side/Stomach 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. • 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. 4.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. 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 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. 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.

  17. 2 MONTH VISITBF 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

  18. 4 MONTH VISITBF 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?

  19. 4 MONTH VISITcontinued • 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.

  20. 6 MONTH VISITBF 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

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