Published online April 1, 2005
PEDIATRICS Vol. 115 No. 4 April 2005, pp. e470-e477 (doi:10.1542/peds.2004-1896)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Dias, M. S.
Right arrow Articles by Shaffer, M. L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Dias, M. S.
Right arrow Articles by Shaffer, M. L.
Related Collections
Right arrow Office Practice

ELECTRONIC ARTICLE

Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based, Parent Education Program

Mark S. Dias, MD, FAAP*, Kim Smith, RN{ddagger}, Kathy deGuehery, RN{ddagger}, Paula Mazur, MD, FAAP§, Veetai Li, MD{ddagger} and Michele L. Shaffer, PhD||

* Departments of Neurosurgery
|| Health Evaluation Sciences, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania
{ddagger} Departments of Neurosurgery
§ Pediatrics, State University of New York, Kaleida Health Women's and Children's Hospital, Buffalo, New York

Objective. Abusive head injuries among infants (shaken infant or shaken impact syndrome) represent a devastating form of child abuse; an effective prevention program that reduces the incidence of abusive head injuries could save both lives and the costs of caring for victims. We wished to determine whether a comprehensive, regional, hospital-based, parent education program, administered at the time of the child's birth, could be successfully implemented and to examine its impact on the incidence of abusive head injuries among infants <36 months of age.

Methods. All hospitals that provide maternity care in an 8-county region of western New York State participated in a comprehensive regional program of parent education about violent infant shaking. The program was administered to parents of all newborn infants before the infant's discharge from the hospital. The hospitals were asked to provide both parents (mothers and, whenever possible, fathers or father figures) with information describing the dangers of violent infant shaking and providing alternative responses to persistent infant crying and to have both parents sign voluntarily a commitment statement (CS) affirming their receipt and understanding of the materials. Program compliance was assessed by documenting the number of CSs signed by parents and returned by participating hospitals. Follow-up telephone interviews were conducted with a randomized 10% subset of parents, 7 months after the child's birth, to assess parents' recall of the information. Finally, the regional incidence of abusive head injuries among infants and children <36 months of age during the program (study group) was contrasted with the incidence during the 6 preceding years (historical control group) and with statewide incidence rates for the Commonwealth of Pennsylvania during the control and study periods, using Poisson regression analyses with a type I error rate of 0.05.

Results. During the first 5.5 years of the program, 65 205 CSs were documented, representing 69% of the 94 409 live births in the region during that time; 96% of CSs were signed by mothers and 76% by fathers/father figures. Follow-up telephone surveys 7 months later suggested that >95% of parents remembered having received the information. The incidence of abusive head injuries decreased by 47%, from 41.5 cases per 100 000 live births during the 6-year control period to 22.2 cases per 100000 live births during the 5.5-year study period. No comparable decrease was seen in the Commonwealth of Pennsylvania during the years 1996–2002, which bracketed the control and study periods in western New York State.

Conclusions. A coordinated, hospital-based, parent education program, targeting parents of all newborn infants, can reduce significantly the incidence of abusive head injuries among infants and children <36 months of age.

Key Words: shaken baby syndrome • shaken impact syndrome • nonaccidental head injury • abusive head trauma • child abuse • head trauma • injury prevention

Abbreviations: WCHOB, Women and Children's Hospital of Buffalo • WNY, western New York State • CS, commitment statement

Accepted Nov 8, 2004.




This article has been cited by other articles:


Home page
 Child MaltreatHome page
J. Klevens and D. J. Whitaker
Primary Prevention of Child Physical Abuse and Neglect: Gaps and Promising Directions
Child Maltreat, November 1, 2007; 12(4): 364 - 377.
[Abstract] [PDF]

Home page
 AAP Grand RoundsHome page
B. Spivack
Educational Efforts to Prevent Abusive Head Trauma
AAP Grand Rounds, September 1, 2005; 14(3): 26 - 27.
[Full Text] [PDF]