ABUSIVE HEAD TRAUMA PREVENTION PROJECT

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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

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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

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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

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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)

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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

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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

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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

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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.

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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.

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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 cant 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.

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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

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BRIEF COUNSEL (Interventions)

• Review the 5 Ss
• Swaddle
• Side Position
• Shushing
• Swinging
• Sucking
• When nothing seems to work Put the baby on her
  back in her crib/bassinet and walk away!!!

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The 5 Ss
1 1. Swaddling A Feeling of Pure
Wrapture 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 Babys Feel Good
Position The side/stomach positions soothe your
fussy newborn by instantly shutting off the Moro
Reflex (the panicky feeling of falling). Thats
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 Babys Favorite Soothing
Sound A loud, harsh shushing sound is music to
your babys 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. Thats 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 parents 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 babys 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 babys calming reflex and leads to a rich
and satisfying Level of relaxation. The
Happiest Baby on the block .
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BRIEF COUNSEL (Education)

• Nurse Explains that it is important not to let
  the babys 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 Thats right and we want to never have
  that happen to your baby.

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BRIEF COUNSEL (education)

• Nurse explains The babys 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 dont realize
  how fragile baby brains are. They dont mean to
  hurt their babies but it can happen if they shake
  or slam.

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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

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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.

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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

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TEACHING AIDS

• PCAV SBS Bears
• PCAV Hand-outs
• Happiest Baby on the Block Video