ABUSIVE HEAD TRAUMA PREVENTION PROJECT

1. ABUSIVE HEAD TRAUMA PREVENTION PROJECT Karyn M. Patno, MD VT Child Protection Program Laura Murphy, MD Project Instructor Kay Shangraw, RN Prevent Child Abuse VT

2. OBJECTIVES • To reduce the incidence of abusive head trauma in infants through early education of new parents in the newborn nursery • To educate parents on the dangers of infant shaking and impact • To educate parents on the relationship between infant crying and infant shaking

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 19 cases; 7 of these fatal • The cause for the increase is unclear, but may include the economy, job loss, social stress

4. PROJECT DESIGN • The newborn nursery phase will be designed after the Dias model: Dias et al., Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based Parent Education Program, Pediatrics 115(4): e470, (2005)

5. PROJECT DESIGN • OB Nursing staff will be trained to give a brief “counsel” to new parents on infant crying and ways to handle a fussy infant • OB Nurses will provide the parents with an opportunity to view a short video on SBS • OB Nurses will then answer any questions that might come up after the video • OB Nurses will have the parents sign a contract of understanding

6. RISK FACTORS FOR AHT • Parent(s) with prior TPR • Parent(s) with child in DCF custody • Teen Parents (especially if there is no extended family support system) • Drug/Alcohol Abuse • Maternal Depression • Parent(s) with history of ADHD

7. RISK FACTORS (continued) • Unwanted pregnancy/unwanted child • Non-biological father figure in home, e.g., boyfriend, step-father • Premature infant (requiring prolonged stay in NICU) • Special Needs Infant • Twins

8. BRIEF COUNSEL • Before discharge the OB nurse will discuss infant crying with the parent(s). Having both parents present is optimal, since male caregivers are at greater risk of shaking.

9. BRIEF COUNSEL (Introduction) • Example: Nurse: “One of the things we like to talk to parents with new babies about is Infant Crying. All babies cry. They cry when they are hungry, want to be changed, are bored, are tired, are sick, are over stimulated...and sometimes for no good reason. They may cry for a few minutes; other times they may cry for 30 minutes or more.”

10. BRIEF COUNSEL (Introduction) • Nurse: “Crying can be very stressful for parents. Especially if they are tired, hormonal, or nervous with a new baby. Sometimes they feel bad that they can’t console their baby; sometimes they feel frightened that something is wrong. I would like to talk to you about some of the things you can do when your baby cries.”

11. BRIEF COUNSEL (Interventions) • Attend to babies needs: • Hungry?---feed • Uncomfortable?---change diaper • Bored?---play or distract • Over Tired?---soothe in quiet place • Sick?---check temperature; call doctor • Too Hot/ Too Cold?---remove/add clothes

12. BRIEF COUNSEL (Interventions) • Review 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!!!

13. 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.

14. BRIEF COUNSEL (Education) • Nurse Explains that it is important not to let the baby’s crying get mom or dad to the “end of their rope”. • Nurse can ask: “What might happen if you got too frustrated or angry with the baby?” • Mom/Dad responds: I might yell or shake the baby. • Nurse: That’s right; and we want to never have that happen to your baby.

15. BRIEF COUNSEL: (education) • Nurse explains: The baby’s brain is very soft and fragile. When you shake or slam him on the mattress, it can bruise the brain. This can result in mild brain damage but can sometimes cause serious brain damage or death. • Nurses explains that often parents don’t realize how fragile baby brains are. They don’t mean to hurt their babies but it can happen if they shake or slam.

16. INTRODUCE VIDEO • Next the OB nurse will invite the parents to view a short video on “Shaken Baby Syndrome” • Allow the parents to view the video alone • Come back after the video is over and ask if they have any questions • Have the parents sign the contract of understanding

17. CONTRACT • The contract states that they (parents) received the information about SBS and understand it. • This contract DOES NOT become a part of the medical record and is NOT legally binding in any way. • One copy goes to the parent and one copy is sent to Kay Shangraw at PCAV.

18. CONTRACT • The contract is important because it gives a sense of “binding” to the material presented. • Parents remember signing the contract and may think again before shaking or yelling or loosing their cool with their baby. • The contracts may allow some data collection in the future

19. TEACHING AIDS • PCAV SBS Bears • PCAV Hand-outs • Happiest Baby on the Block Video