Nevada Shaken Baby Syndrome Prevention

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Nevada Shaken Baby SyndromePrevention

• By
• Pamela S. Rowse, RN, BS
• Member PCAN PREVENT SBS Nevada Team
• Kindred Hospital Kierra Harrison Foundation for
  Child Safety
• February 15, 2008

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What is SBS?

• Shaken Baby Syndrome
• is a serious form of child maltreatment most
  often involving children younger than 2 years but
  may be seen in children up to 5 years old.

AAP Technical Report -2001
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AAP Description

• It occurs commonly, yet
• May be misdiagnosed in its most subtle form
• AND Under-diagnosed in its most serious form.

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Acceleration And Deceleration
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What is the Force Involved?

• There is no evidence that the findings in
  SBS/SIS (shaken impact syndrome) can result from
  accidental falls in the home.
• Including falls down the stairs, off beds,
  couches or tables,
• Or from a caretakers arms.
• SBS/SIS results from a violent inflicted injury
  producing immediate signs and symptoms

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Bridging Vessel Shearing

• Fragile Vessels between the dura and the brain
  begin to shear
• This causes diffuse bleeding in the sub-dural
  space
• The length and the force determine the outcome.

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Retinal Hemorrhaging
Normal Retina

• Occurs in approximately 75 - 80 of the cases.
• Takes great force.
• Does NOT occur in CPR, Seizures etc. per
  documented studies.
• One of the hallmark signs in combination with the
  other findings for SBS

Retinal Hemorrhages
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Axonal Shearing

• Microscopic nerve endings delivering information
  between brain cells.
• Shear and tear with the acceleration,
  deceleration and rotational motion involved in
  the shaking.

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Accompanying Fractures

• Rib fractures -primarily posterior
• Buckle fractures -extremities
• Explanation doesnt meet the clinical picture

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Shaking With Impact

• Most of the time there is impact.
• Soft surfaces create additional deceleration
  mechanism.
• Other injuries may occur if impact surface is
  harder.

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Immediate Signs and Symptomsof Severe Shaking

• A severely shaken baby can show one or more of
  the following signs
• Absence of response to stimulation
• Lethargy
• Convulsions
• Inability to make sounds
• Inability to track movement visually
• Difficulty breathing
• Blue-looking or dusky skin tone
• Unconsciousness
• Vomiting
• Crying quieted to whimpering due to brain damage
• Rolling eyes

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Signs of a Less-Severe Shaking

• These less-dramatic signs may indicate a baby has
  been shaken
• An unusual or unexplained change in sleeping
  pattern
• Confusion, restlessness, or agitation
• Absence of energy or motivation
• Slurred speech
• Uncontrollable crying
• Unexplained inability to be consoled
• Unexplained inability to nurse or eat

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Long-Term Effects

• The long-term effects of shaking a baby can be
  significant
• Learning and cognitive disabilities
• Behavioral disorders
• Blindness
• Paralysis on one or both sides
• Trauma-induced seizure disorders
• Loss of motor control

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Controversies!

• Mild shaking can kill
• Vaccine reactions
• Impossible to generate enough force
• Junk Science cant prove in scientific studies
• Short falls are deadly
• CPR

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Statistical SBS Overview

• How many cases?
• Who perpetrates it?
• What is the cost?
• How can WE intervene?
• How can WE
• PREVENT IT?

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Children's Hospitals Today, Spring 2007By Karen
Seaver HillDirector, Child AdvocacyNACHRI

• Shaken babies are a small but significant portion
  of the estimated 900,000 victims of child abuse
  and neglect every year.
• Of the estimated 1,500 children killed annually
  by abuse, one in four is a victim of shaken baby
  syndrome (SBS).
• For every casualty of SBS, three other babies are
  shaken severely enough to require medical
  treatment and will have lifelong complications
  including seizures, blindness and paralysis.
• No one knows how many thousands of other less
  severe cases of shaking are never brought to a
  physicians attention and go undiagnosed

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How Many Cases?

• 1,300 to 1,600 infants children are seen in
  healthcare facilities every year for shaken baby
  syndrome.
• Approximately 25 - 30 of them die.
• Survivors are faced with a shortened expected
  life spans and major neurological damage.

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New Statistics

• Rate in the first 2 years of life to be
  17/100,000 children 29.7/100,000 in the first
  year of life and 3.5/100,000 in the second year
  of life.
• We would estimate 1362 AHT ICU hospitalizations
  or deaths in the US each year for children under
  2. 
• In a different study we found that 2.6 of US
  parents reported shaking a child under age 2 "for
  discipline." The ratio of these two numbers means
  that there are 152 children under 2 shaken for
  every single child hospitalized in an ICU or
  dying of AHT. 

Dr. Desmond Runyan - professor of pediatrics and
chair of the Department of Social Medicine at
UNC-Chapel Hill from 1999 to 2007
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Profile of a Shaken Child

• Research shows that SBS victims havesome
  characteristics in common
• Most victims are less than one year old
• The majority are under 6 months old
• Twins or multiples have a higher chance of being
  shaken than single children

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Who ARE The Perpetrators?

• No Social or Economic boundaries.
• Parents, boyfriends, grandparents, child care
  providers, anyone caring for an infant or child
  that cant control their frustration responses.
• Average age 22 years.
• 58 to 68 are male.

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Profile of a Shaker

• Most shakers are male, in general because
• Men may be less familiar with babies needs
• Men may have financial or family stresses
• Men may not be used to a babys crying, and may
  use force to stop the crying
• Most men who shake a baby are the biological
  father of the child or the mothers boyfriend.
• Mothers, grandparents, stepparents, other
  relatives, and childcare providers can shake
  babies as well
• Anyone who may become frustrated is capable of
  shaking a baby

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What is the COST ?

• Approximately 1 million is spent in for each
  surviving victim in the first three years after
  the shaking incident.
• It is estimated that 4 to 9 million are spent
  in lifetime costs for these victims.
• Even with Insurance, max is reached early costs
  become the responsibility of the Tax Payers.

Taylor Shaken 3 mo Now 8 years old
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How Can WE Intervene?

• Early accurate recognition treatment.
• Multidisciplinary collaboration intervention.
• Accurate coding statistical tracking.
• Accurate documentation, communications
  reporting.

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Healthcare ProvidersHave Multiple Roles

• Clinical Intervention.
• Support for investigation criminal prosecution.
• Prevention education.

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How Can We PREVENT It?

• Awareness Education campaigns.
• Hospital based pre post partum education about
  SBS Normal Crying Events.
• Education materials for OB/GYN, WIC Offices,
  Pediatric Family Practice Offices Emergency
  Depts./Urgent Cares.
• Collaboration of ALL Providers with Prevent Child
  Abuse Nevada, the SBS PREVENT Team, CDR
  Childrens Services.

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Visuals

• Reality WORKS SBS simulator
• Doll donated to the PREVENT SBS Team in Nevada
• In the North, Martha Schott (SBS Prevent Team
  Member) has shared the doll with 4 major NFP
  Organizations with exciting results.
• In the South, Debbie Ruiz (SBS Prevent Team
  Member) has demonstrated the doll in several
  meetings.

Shows the DAMAGE
Cost of the doll is approximately 600
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Common Crying Behavior

• The National Center on Shaken Baby Syndrome
  (NCSBS) coined the acronym PURPLE for the Peak,
  Unpredictable, Resistant, Painful-looking,
  Lengthy, and Evening crying of a typical, healthy
  infant.

The Period of PURPLE Crying is a trademark of
the National Center on Shaken Baby Syndrome.
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Common Crying Behavior

• Many healthy infants show PURPLE crying
  behavior
• Crying reaches its PEAK frequency and duration at
  about two months of age.
• Crying during this time is UNPREDICTABLE and may
  start and stop without an obvious cause.
• This crying can be RESISTANT to all efforts to
  comfort.
• The infant may appear to be in PAIN, with her
  knees pulled up, and a painful expression on her
  face.
• This crying can be very LENGTHY, and may continue
  for a half-hour or longer.
• Late afternoon and EVENING are often the times
  when an infant will cry the loudest and longest.

The Period of PURPLE Crying is a trademark of
the National Center on Shaken Baby Syndrome.
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Successful Hospital Programs

• Primary and most impressive, is Dr. Diass
  program, adopted by multiple states.
• Started in NY with a 47 reduction in SBS cases
  in 3 counties.
• Resulted in State Legislation mandating SBS
  Education for hospitals, child care providers,
  the education system.
• After move to Pennsylvania, similar legislation
  was approved.
• Over 10 States have adopted similar legislation.

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Legislative Initiatives Nationally

• Amendment to Labor, HHS Education
  Appropriations Bill 2007 (Mr. Doolittle)
• Joint Commission as it relates to standard
  LD.1.30 Organizations following applicable laws
• The Shaken Baby Syndrome Prevention Act of 2007
  is sponsored in The United States Congress by
  Senator Christopher Dodd (S.1204) and
  Congresswoman Nita Lowey (H.R.2052).

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Nevada SBS Prevention Plan

• Target Populations in NV from Rural to Urban to
  include
• Parents/Caregivers
• Child Care Providers
• Community Members
• Legislature/Lawmakers
• Healthcare providers
• Law Enforcement Prosecutors.

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What Should We Think About

• Increase awareness of SBS by annually supporting
  programs projects related to the passage of
  AB-48 in the 2007 Nevada Legislative Session
• Advocate for the establishment of a sound
  accurate data base related to SBS in the State of
  Nevada
• Advocate for a Unified Prevention Program in
  Nevada to include an education campaign

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Advocacy Action

• Getting Others Involved

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Share The Information

• Stay abreast of local, state and national
  politics.
• Be aware of local cases who is involved with
  them.
• Be aware of pending legislation.
• Gather strength through resources.

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Elections - 2008

• Judges
• DAs
• Assembly/Senators, at Local State National
  levels.
• Know their voting/ruling records.
• Get out and vote
• Encourage others to do the same thing

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We Have an Obligation

• To Warn parents about what they can expect when
  they are caring for a baby or a toddler.
• To Provide them resources for dealing with this
  inevitable event.
• To Collaborate with the multidisciplinary teams
  to ensure appropriate education, intervention
  outcomes.

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Shaking Shatters Lives
Remember!
Never Shake A Baby
Share the Message!
Kierra Ashlie Danielle Harrison 12/05/95
03/05/1997
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Questions?