Transcript ABUSIVE HEAD TRAUMA PREVENTION PROJECT

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
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
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
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)
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
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
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
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.
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.”
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.”
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
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!!!
The 5 “S’s”
1
1.
Swaddling
2.
Side/Stomach
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.
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 feelgood positions for unhappy babies.
When you put your infant to sleep,
however, the back is the only, safe
position.
4.
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
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.
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.
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.
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 .
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.
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.
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
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.
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
TEACHING AIDS
PCAV SBS Bears
PCAV Hand-outs
Happiest Baby on the Block Video