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Babies Cry, You Can Cope The background to ICON Dr Suzanne Smith PhD, MA, BA, RGN, RHV: ICON Founder and Chief Programme Advisor

 AKA Shaken Baby Syndrome  Child Abuse  Catastrophic injuries:  Brain injuries  Bleeding behind the eyes  Bony injuries  Causal mechanism rarely confirmed  Acceleration/deceleration  Impact  1 in 14 cases – fatal before hospital discharge  Half of severely injured survivors die before aged 21.

 2011 20 – 24 per 100,000 in first year  District General Hospital – paediatrician can expect to see a case every 1 or 2 years  2.6% of American parents admitted to shaking a child under 2 years;  9% felt like shaking  Cases seen by paediatricians – only a proportion of cases of AHT  It’s the leading cause of death and long -term disability for babies who are abused

 Survival with significant brain injury or death  Emotional cost  Inpatient hospitalisation (Paediatric Intensive Care)  Long term medical services –  Physiotherapy  Occupational Therapy  Speech and Language Therapy  Educational needs  Foster care  Family and criminal proceedings  Prison/probation  Serious Case Review cost (circa £75,000)  Loss of societal productivity and occupational revenue.

 70% perpetrators are males – fathers/male surrogates (Kesler et a 2008; Altman et al 2010)  Can occur in every socio-economic group  Coping with crying: Living on the edge  Caregivers lose control and shake – baby stops crying  Demonstrable relationship between the normal peak of crying and babies subject to AHT. (Barr et al 2006)  Increase in cases in the 1 st month of life, a peak at 6 weeks during the 2 nd month and a decrease during the 3 rd to 5 th months of life

 Success depends on controllability  Problem solving where the stressor cannot be controlled can lead to frustration and distress  support through the problem rather than solving the problem  The need for a careful approach towards a responsive professional intervention that is rooted in evidence is, therefore, crucial

 Travel to Learn: Return to Inspire  The aim of this Fellowship was to explore international programmes related to the prevention of child maltreatment with a particular focus on AHT in infants and to gain an understanding about the wider context of the delivery of care and the systems and processes in which they are provided and commissioned.

 SEEK (Safe Environment for Every Kid) Baltimore, Maryland  Shaken Baby Syndrome Prevention Programme Hershey, PA  Safe Babies New York Buffalo, NY  Period of Purple Crying Vancouver, BC  Period of Purple Crying and Child Advocacy Centre Helena, MT  Period of Purple Crying and Family Support Centre Wichita, KS

A practical evidence-based tool to briefly and systematically screen parents for prevalent psychosocial problems that are risk factors for child maltreatment, and that generally jeopardize children's health, development and safety.  Parental Depression  Parental Substance Abuse  Harsh Punishment  Major Parental Stress  Intimate Partner Violence  Food Insecurity The SEEK PQ is also: Designed to screen for, not diagnose, risk factors for child maltreatment. It is Validated for use in primary care practice and is intended for parents to complete, voluntarily, in advance of their child's regular check-up.

SEEK resulted in significantly lower rates of child maltreatment in all the outcome measures: fewer Child Protective Services reports, fewer instances of possible medical neglect documented as treatment non-adherence, fewer children with delayed immunizations, and less harsh punishment reported by parents. Families with prior child welfare involvement were not excluded from the study sample, blending results for primary, secondary, and tertiary prevention (intervention) samples.

 Dose 1: hospitals and birthing centres  Dose 2: strategic reinforcement of the PURPLE message outside of the hospital  Dose 3: increase the opportunity for public awareness of AHT through a ‘positive community norms’ campaign on AHT.  Video

Hospital Based Prevention Programmes  http://childrens.pennstatehealth.org/documents/ 11396217/11476368/2016+3rd+Quarter+Newslett er/db2cccdb-90ff-45c0-a917-7169cbf9362f  Safe Babies New York (same model) http://www.safebabiesny.com/wp- content/uploads/2016/06/20160615053919_Safe- Babies-NY-Brochure-ENGLISH-FINAL-2016-01.pdf

 A co-ordinated, hospital based parent education programme targeting parents of all newborn infants can significantly reduce the incidence of abusive head trauma in children less that 36 months. Dias et al (2005) Preventing Abusive Head Trauma Infants and Young Children: a hospital based prevention program Pediatrics 115: 470 – 477  16 infants who were born in the 8 year study period were treated at the children’s hospital for shaking injuries sustained during their 1 st year of life. Of those infants 14 were born during the 5 year control period and 2 during the 3 year post implementation period. The decrease from 2.8 injuries/year to 0.7 injuries/year represents a 75% reduction (P=03). Altman et al (2010) Parent Education by Maternity Nurses and Prevention of AHT.

 Although the frequency of AHT cases decreased, it is not possible to be absolutely certain that the educational programme was the cause of the decrease. Uncertainty about the cause and effect relationship is an inherent limitation of before/after study design, but the absence of changes over time in 3 nearby states without similar prevention programmes lends support to a cause/effect interpretation  Fathers and male surrogates are nearly 5 times as likely as mothers to shake an infant. From the parents surveyed only 40.4% of fathers watched the educational video. Finding better ways to reach male caretakers should be a priority Altman et al (2010) Parent Education by Maternity Nurses and Prevention of AHT.

 The primary aim of this study was to determine whether there was any change in visits of 0 to 5 month old infants to the Medical Emergency Room (known as the Emergency Department in the UK).  After program implementation, crying cases were reduced by 29.5% (p < .001). The most significant reductions were for crying visits in the first to third months of life.  The authors concluded that the findings imply that improved parental knowledge of the characteristics of normal crying secondary to a public health program may reduce Medical Emergency Room use for crying complaints in the early months of life. Barr R G, Rajabali F, Aragon M; Colbourne M., Brant R., Education About Crying in Normal Infants Is Associated with a Reduction in Pediatric Emergency Room Visits for Crying Complaints J Dev Behav Pediatr 36:252 – 257, 2015

 My WCMT report recommends a multi agency co-ordinated programme that touches on all the different levels of prevention.  Each ‘touch point’ is brief & can combine ‘safe sleep’ whilst reinforcing simple messages:  I nfant crying is normal  C omfort methods will sometimes be able to sooth the baby and the crying will stop.  it’s O K to walk away when you have checked your baby is safe and if the crying is getting to you.  N ever ever shake or hurt a baby.

 Charlee’s Angels: funded travel for families affected by AHT to an initial consultation event. Hosted private group on social media for consultation. Families have all commented on all parts of the process and materials.  Dynamic partnership with Kim Jones.  Established a national steering group initially in Rochdale, now transferred to Hampshire.  Engaged with Royal College of Paediatrics and Child Health and The University of Birmingham.  Presented ICON at a Winston Churchill Memorial Trust conference in March 18.

 Impact on numbers of AHT victims – not completely reliable as an indicator of success.  Impact on numbers of parents/carers attending Emergency Departments with ‘crying baby’ – and no signs of illness.  Qualitative measures – parental reports, do they remember the message, have they recalled it/used the materials when they needed to etc..  FUNDING.

Pause for thought……..

ICON – Hampshire’s Experience Kim Jones: Designated Nurse for Safeguarding Children West Hampshire Clinical Commissioning Group

Development of ICON Following a recommendation from Child U’s Serious Case Review for a local preventative campaign, contact was made with Dr Sue Smith A presentation was made to the Hampshire Safeguarding Children Board’s Learning and Inquiry Group A proposal and presentation for a campaign was made to the Hampshire Safeguarding Children Board’s Board meeting in June 2017, which was fully endorsed A task and finish group was formed