More Effective Strategies Needed to Prevent Abusive Head Trauma

When parents feel exhausted, stressed, and frustrated by their inconsolable infant, they may reach a flash point and injure their baby. Devastating head injuries can result from forceful shaking and blunt impact. A largescale, multifaceted educational prevention program attempted to teach 405,060 mothers of newborns the dangers of this scenario. Unfortunately, the intervention did not seem to reduce rates of abusive head trauma (AHT), formerly known as shaken baby syndrome.

While the research findings reported in JAMA Pediatrics are disappointing, Joanne N. Wood, MD, MSHP, of the division of Pediatrics and PolicyLab at The Children’s Hospital of Philadelphia, encouraged investigators to continue to build evidence to design better intervention strategies.

“We have made progress in understanding AHT prevention, but we still have much to learn,” Dr. Wood wrote. “… the high costs of AHT to children, families, and society demand that we must not give up.”

Each year, about 30 infants per 100,000 children under age 1 are injured from AHT, resulting in at least 80 deaths each year, according to statistics reported by the American Academy of Pediatrics. Injuries seen in infants with AHT may include bleeding over the surface of the brain, brain swelling, and bleeding on the back surface of the eyes.

The Period of PURPLE Crying intervention, developed by the National Center on Shaken Baby Syndrome, taught mothers of newborns in hospital maternity wards in North Carolina about these perils and how to respond to normal crying. They received teaching from a nurse, read a booklet, viewed a video, and brought home educational materials. During primary care office visits within the child’s first month of life, staff reinforced these educational messages. Yet investigators who evaluated the intervention over a three-year study period, including principal investigator Adam Zolotor, MD, DrPH, of the North Carolina Institute of Medicine, did not find a reduction in AHT rates after implementation of the program.

In Dr. Wood’s commentary, she discussed some of the challenges in AHT prevention that could be considered in future projects. For example, she pointed out that male caregivers are the most frequent perpetrators of AHT, yet prevention programs often focus on mothers in maternity wards. Perhaps more effective strategies are needed that target fathers, stepfathers, and male partners. In addition, Dr. Wood called for a closer look at policies and programs that are designed to reduce family stress.

“Each year over 1,500 children die from child maltreatment in the United States and many more are injured,” Dr. Wood said. “Research focusing on the development, implementation and dissemination of effective interventions for supporting families and promoting safe, nurturing relationships is desperately needed.”

For more information, read Dr. Wood’s editorial here.