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Harvey Karp

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We Can Calm Crying Babies: New Hope in the Fight Against Child Abuse

Posted: 04/26/2012 12:02 pm

One beautiful spring day in 2009, a senior manager at MIT's world famous Media Lab was home with his 6-month-old while his wife was at church. He had cared for his baby before, but that day was very different. His baby's cries made him lose control and he shook his baby so hard it caused a fatal brain hemorrhage.

People tend to think of infant crying and colic as a parenting nuisance. But it is much more serious. In fact, sleep deprivation and blasting the sound of crying babies for hours are used to prepare the Navy elite SEALS to endure torture!

Crying -- and the demoralization and exhaustion it provokes -- trigger a cascade of serious consequences, including marital conflict, postpartum depression, breastfeeding failure, SIDS/suffocation, car accidents, cigarette smoking, maternal obesity... and child abuse.

Almost 580,000 children were reported as abused in 2008, 1,740 of them died of their injuries. In addition to this terrible human cost, the U.S. Centers for Disease Control estimates the financial cost of these abuses at $124 billion/year.

To rally citizens against this scourge, we observe Child Abuse Prevention Month each April. And, to bring national focus on stopping infant shaking -- the #1 cause of child abuse deaths -- the third week of April is designated Shaken Baby Awareness week.

Unfortunately, infant shaking is not rare. Experts estimate that tens of thousands of infants are abused in this way each year. And two recent studies found that rates of Shaken Baby Syndrome (SBS) have increased by as much as 100% during recession.1

* The SBS victims are usually 3-4 months of age.
* On average, one child is killed by SBS every day.
* The main SBS trigger is infant crying. (One study found 89% of SBS victims were brought to a doctor seeking help for severe crying prior to the actual crime.)

Child welfare programs around the country are committed to stopping this terrible abuse. But what is the best way to do so? It would seem logical that all new parents should be taught never to shake their baby; and to put the baby down and take a break if they're feeling upset. One program, in Western New York State, reported a 47% reduction in SBS cases using this type of approach.2 However, a current retest of this approach in the State of Pennsylvania has not yet shown clear benefit.

Another experimental program to prevent SBS, called PURPLE crying, is being evaluated. It also uses a simplistic model, teaching parents that babies normally cry up to 5 hours a day and are often inconsolable, despite holding, feeding and comforting. Unfortunately, in large studies, PURPLE barely raised mother's knowledge that shaking is a danger and it failed to reduce the 2.5 hours of fussing and crying per day that the babies in the study experienced. (That is obviously of great concern since crying is the main trigger for SBS, depression, etc.)

Child welfare leaders are beginning to realize that SBS prevention programs must include showing parents how to effectively and safely calm their babies -- not just teach them never to shake their infants. Adding a baby calming approach may not only stop the vicious cycle of parent frustration leading to child abuse, it may create a virtuous cycle! Quick baby calming may increase parent confidence and nurturing relationships... as well as reduce SBS and other serious problems triggered by infant crying.

Numerous studies have proven that parents can reduce their baby's fussing with swaddling, white noise, rocking, sucking and holding. In fact, a study of the !Kung San tribe in South Africa reported that their parents succeeded at calming baby crying in under 1 minute 95% of the time!

And, last week a new study was spotlighted by the American Academy of Pediatrics (AAP), which showed the simple 5 S's infant calming method, described in the DVD/book "The Happiest Baby on the Block," quickly reduced crying right after infants received shots. (The 5 S's combine the calming effect of swaddling, side/stomach position, shushing, swinging, and sucking.)

In this study, published in the May 2012 issue of Pediatrics, John Harrington, MD, FAAP and associates at Virginia's Children's Hospital of the King's Daughter report the 5 S's are highly effective at stopping crying after multiple vaccine injections in 2- and 4- month-old infants. Infants receiving the 5 S's calmed much faster than those receiving concentrated sucrose water (a proven form of pain relief used in hospitals to lessen pain from circumcision, etc.).

Harrington's study supports a 2011 Penn State report that found the 5 S's helped boost infant sleep and reduce infant obesity at one year of age. Additional studies to evaluate the 5 S's potential to prevent postpartum depression, treat colic, boost sleep and reduce infant (and maternal) obesity are currently underway at Penn State, University of Texas and University of Michigan.

Over 2,600 Happiest Baby educators teach infant calming/sleep techniques. In fact, after the tragic shaking episode, MIT began teaching Happiest Baby classes in order to prevent another case of SBS among their employees.

Over 1,000 of these educators work for state child health and welfare departments, including Colorado, Connecticut, Massachusetts, Minnesota, Pennsylvania and Wyoming. Several child abuse prevention programs recommend The Happiest Baby approach and its referenced in the AAP's abuse prevention initiative, "Practicing Safety."

"Dr. Karp's insights are a key to reducing the anger and frustration that can lead to shaking."
-James Hmurovich, President/CEO, Prevent Child Abuse America

This work supports the important national goal of new, bipartisan legislation currently before Congress, the Protect Our Kids Act, which would call for the development a national strategy to prevent and reduce these deaths. Hopefully, this strategy will include empowering parents to calm their babies with effective, evidence-based techniques, like the 5 S's.

1Huang M, et al. Increased incidence of nonaccidental head trauma in infants associated with the economic recession. J Neurosurg Pediatrics 2011; 8:171-6
Berger, R, et al. Multicenter Analysis Abusive Head Trauma During a Time of Increased Unemployment. Peds 2011;128:637–43).

2Dias MS, et al. Preventing Abusive Head Trauma Among Infants and Young Children: A Hospital-Based, Parent Education Program. Peds 2005;115;e470

 
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