Children's Voice Sep/Oct 2006

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Saving Babies from Shaking

By Ann Blake and Jennifer Michael

Millions of people become new parents each year and are seldom prepared for the stress of the job. Crying, late-night feedings, spit-up on that new outfit, and changing smelly diapers day after day can, for some, escalate to uncontrollable frustration and aggravation.

Child advocate George Lithco likens it to the effects of war. "If you read about a lot of the physical symptoms people in combat have, it's something that parents can relate to--stress, trauma, exhaustion."

But as the old adage goes, "kids will be kids." They're simply exhibiting age-appropriate behavior. Children too often bear the brunt of parental frustration, and in just a few seconds, this frustration can be fatal for the child.

Eight children a day die or are severely injured by something that is 100% preventable: Shaken Baby Syndrome (SBS), a severe head injury caused by violently shaking an infant or child for as little as five seconds. It is the leading cause of child abuse deaths in the United States. SBS will afflict an estimated 1,200-1,400 children this year.

"People lose control," says Lithco, whose 11-month-old son was killed in 2000 after being shaken by a 51-year-old caregiver who was having a bad day. "People think it's about crying. Though that's the most frequent precipitator, it's about self-control. It's a flux of things.

"Most cases entail some prolonged crying with children under 1 year old," Lithco explains, "and the parent, who is under a lot of stress, loses control, goes into some sort of rage mode, and does something really violent in a very short amount of time. In most cases, at the time, parents don't even know they're doing it."

Most parents and caregivers prosecuted in shaking incidents have no record of abusive behavior, Lithco says. "You look at some of these cases, and the perpetrators are doctors, lawyers, police officers--and...everybody [who knows the perpetrator] is saying, 'I can't believe it!'"

The Fatal Consequences of a Bad Day

Reflecting on his own tragedy, Lithco says, "If I were hiring a nanny today, we wouldn't have made a different choice. There's nothing about her we missed, other than having a conversation with her in which we gave her permission to say, 'It's a bad day, I just can't do it tonight.' We all have bad days, and we should only do what we're prepared to do. Every parent gets up some mornings and says, 'I just can't do this.'"

According to newspaper accounts, the night Lithco's son, Skipper, was fatally injured, his nanny was also looking after her own grandson and a third child. She was depressed from a recent divorce, and Skipper was cranky from teething. Skipper spit up while being fed, and the nanny picked him up from his high chair and shook him for only a few seconds. She later pleaded guilty to a charge of reckless manslaughter and was sentenced to 3-10 years in prison.

SBS is a type of whiplash that can have devastating consequences. Infants are highly vulnerable to this kind of force because their brains are softer, their neck muscles and ligaments are weak and not fully developed, and their heads are large and heavy in proportion to the rest of their bodies. When a baby is shaken, even only for a moment, it can cause the brain to rattle around inside the skull and pull apart. In educating parents, caregivers, and teenagers about SBS, the extent of the injury is often graphically demonstrated by placing an egg in a jar and shaking the jar for a few moments until the egg cracks and the yolk splashes everywhere.

For those who survive it, the consequences of this kind of injury can be tragic. In addition to acute brain damage that requires constant assistance for the rest of their lives, survivors of SBS often suffer blindness due to retinal hemorrhaging, and paralysis because of damage to the spine.

"In many cases, by the time [I see them]Oetheir fate is largely sealed," explains Dr. Kent Hymel, Director of the Forensic Assessment and Consultation Team at Inova Fairfax Hospital for Children in Virginia. "It's admittedly frustrating that it's too late. I think the most important gains will come if we can figure out ways to prevent it in the first place."

Increasing Awareness

Prevention efforts to save children from situations that result in SBS are increasing nationally thanks to publicity from high-profile cases, such as the death of Matthew Eappen in 1997 after a 19-year-old English au pair shook him. Awareness of the consequences of shaking babies is on the rise, with grassroots prevention efforts and slow steps toward federally regulated preventive measures.

Mark Dias, a pediatric neurosurgeon at Penn State Milton S. Hershey Medical Center, and Associate Professor of Neurosurgery at Pennsylvania State University College of Medicine, is spearheading one SBS prevention program. Dias conducted a study on SBS prevention efforts at 16 hospitals in an eight-county region of western New York State served by the Women and Children's Hospital of Buffalo. Nurse educators trained hospital nurses to distribute pamphlets, talk to new parents, and screen a short video about the dangers of shaking a baby. Parents signed commitment statements, acknowledging they received and understood the education materials. The uniform prevention model paid off dramatically, reducing incidences of abusive head injuries from SBS by 47% at participating hospitals.

Dias's program costs less than $10 per infant and takes less than 15 minutes per family--a stark contrast to the medical costs for SBS survivors, which can amount to anywhere from $300,000 to more than $1 million during the first five years of life. Many states, including Illinois, Minnesota, Missouri, Nebraska, New York, Pennsylvania, and Wisconsin, have adopted the Dias model.

The Children's Trust Fund of Connecticut is promoting a "modified Dias training model," says Executive Director Karen Foley-Schain. "What we found impressive is that, for a relatively small investment up front, the project could net huge gains down the line."

The Children's Trust Fund stepped up its prevention efforts first by holding a community awareness and fundraising campaign that brought 500-700 people together at various venues across the state for dinners and discussions about SBS. The campaign used the money it raised to fund training for about 700 human service providers in Connecticut, from educators to social workers. The Children's Trust Fund is now providing education materials and training for a handful of hospitals in Connecticut, and more are interested.

Foley-Schain says the next phase of Connecticut's project is working with private pediatricians and clinics to give them "really simple, straightforward, powerful information to make a difference."

Similarly, the Wisconsin Children's Trust Fund has been working with maternity wards in hospitals statewide. It helped push legislation through the state legislature this year that mandates hospitals to adopt a Dias-like model to distribute information about SBS to new parents. The legislation also requires the state Department of Health and Family Services to create a registry of documented SBS cases in the state; all licensed child care providers, as well as middle and high school students, to receive information about SBS; and home visitation programs to include SBS information in their curriculum materials.

The Wisconsin Children's Trust Fund is planning to hire a coordinator to work specifically on its expanding SBS prevention efforts. Executive Director MaryAnn Snyder says her organization is also developing more ideas for SBS prevention materials, including "caregiver instruction pads" for babysitters and day care providers, prescription pads for pediatricians that are imprinted with warnings to parents about shaking their babies, and more materials geared to young fathers and the parents of toddlers, not just newborns.

Washington State has focused on research that shows many SBS perpetrators are in their early 20s. An eight-minute video called Have a Plan for Teens, featuring real-life teens talking about parenting, babysitting, stress, frustration, and the dangers of SBS, is being distributed to schools, teen parents, caregivers, birthing hospitals, and childbirth education classes.

The video--produced through a partnership between the Children's Protection Program at Children's Hospital and Regional Medical Center, the Washington Council for Prevention of Child Abuse and Neglect (WCPCAN), the Conscious Fathering Program of Parent Trust for Washington Children, and the state chapter of the National Shaken Baby Coalition--can be previewed and ordered through WCPCAN's website.

Also, Washington's Department of Health is now distributing SBS information to new parents, along with immunization information. Earlier this year, the state began selling license plates that say, "Keep Kids Safe," and feature the handprints of a Washington infant who died from SBS. Fifteen percent of the proceeds from the license plate sales will go to SBS prevention efforts, and the rest will go to child abuse prevention programs, says WCPCAN spokesperson Chris Jamieson.

Finding Solace in Advocacy

After the death of his son, Lithco and his wife Peggy Whalen founded the Skipper Initiative to increase awareness about SBS and promote prevention efforts. Their advocacy efforts focus on teaching parents and caregivers to identify situations in which they are vulnerable, and how to manage these situations.

Demonizing SBS perpetrators is unproductive, according to the philosophy of the Skipper Initiative and similar programs. "We are trying to reach 'good' people who could do a 'bad' thing if they aren't prepared to cope," Lithco says.

The Skipper Initiative has found much success in its efforts to target parents, caregivers, and high school students who regularly serve as babysitters, in addition to pursuing state and national legislation to standardize prevention. "There's a great pressure for child care, but yet, on average, it's certainly one of the worst paying jobs in the United States," Lithco says. "Taking care of four or five kids for $8 an hour is a lot of stress and a lot of responsibility for not a lot of money and frequently not a lot of training."

The challenge in sending an effective message, he explains, is to make people want to learn the information, instead of forcing it on them. "Even if you know shaking is dangerous, if you haven't spoken to the other child care providers, you haven't protected your child. If you can get that information out to parents to talk to child care providers, then parents feel a lot more comfortable, and you're doing a greater service to your children."

He adds that people have to be able to relate to the circumstances that facilitate shaking, instead of removing themselves from the scenario and thinking this is not relevant to them. "If you get the message to them, and they don't listen to it, you've lost it. If you give it to them and they say, 'Oh, SBS is terrible, don't do it. If someone does it, we should lock them up and throw away the key because they're animals,' well at three o'clock in the morning they are no better off than the person who didn't get the message.

"If someone says, 'Oh shaken baby, crying baby, I can understand that, I can relate to that, and now I understand what I need to do about it,' then protection has been achieved."

Today, the Lithcos take solace in their efforts to prevent Skipper's tragedy from harming another family. They also find joy in the life of their second son, John, who will never know his older brother. John is almost 4, and the Lithcos have yet to trust him to a babysitter. Most likely, John will not have a babysitter until he is at least 5, the age at which a child's skull and bone structures usually solidify, making the child no longer susceptible to SBS.

Ann Blake is a Contributing Editor, and Jennifer Michael is Managing Editor, Children's Voice.

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