The NCSBS is hosting a 2-day International Symposium on Shaken Baby Syndrome/Abusive Head Trauma on September 16th and 17th, 2019 in Sydney. The symposium will feature presentations on the latest medical diagnosis and treatment of SBS/AHT cases, multidisciplinary approaches, prevention efforts from around the world, and investigative procedures. Learn more about the symposium at: https://www.dontshake.org/2019-sydney

2019 Australia Symposium

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The implementation of the Period of PURPLE Crying prevention program is linked to a thirty-five percent reduction in hospitalizations with injuries related to shaken baby syndrome/abusive head trauma (SBS/AHT) according to a new study published in Child Abuse and Neglect.

“We know that the most common reason a child is shaken is because a parent or caregiver becomes frustrated with their baby’s crying,” said Ms. Marilyn Barr, co-author of the study and founding director of the National Center on Shaken Baby Syndrome (NCSBS). “This study shows that the Period of PURPLE Crying is improving how parents and caregivers cope with uncontrollable crying and is helping to prevent life-changing, life-threatening injuries in newborns.”

The Period of PURPLE Crying program approaches SBS/AHT prevention by educating parents about increased crying between 2 weeks of age and 4-5 months of age as part of their infant’s normal development and the dangers of shaking an infant when frustrated with crying. Parents receive the program materials (booklet and DVD or booklet and mobile app) in a maternity delivery setting, usually in hospitals, and take the materials home with them. The Period of PURPLE Crying is a program of the NCSBS headquartered in Farmington, Utah.

The study compared SBS/AHT hospitalization rates prior to the PURPLE program being implemented in British Columbia (BC), Canada to SBS/AHT hospitalization rates after the program was implemented in 2009. In the eight years following the program’s implementation and despite the great recession, which has been shown to be a contributor to increased SBS/AHT, the rate of SBS/AHT hospitalizations for children less than two years of age fell from 6.7 cases to 4.4 cases per 100,000, a 35 percent decrease. Similarly, SBS/AHT hospitalizations for children less than one year old fell from 10.6 cases to 7.1 cases per 100,000, a reduction of 33 percent.

“Our research found that the Period of PURPLE Crying is associated with a significant reduction in shaken baby syndrome cases in British Columbia,” said Dr. Ronald Barr, the study’s lead author. “Our next steps are to further evaluate the success of the program and continue to increase awareness of the risks of shaken baby syndrome in BC.”

The study also found that 27 percent of mothers reviewed the PURPLE program materials in the maternity hospital, and 71 percent of mothers reviewed the materials in the 2-4 months following the delivery. Fifty percent of fathers also reviewed the materials in the 2-4 months following delivery. This finding is particularly important in showing the PURPLE program’s use later when the infant’s normal increased crying and parents’ frustration with the crying likely transpired. The increase in viewing after delivery suggests that having the materials at home benefited parents when the increased crying occurred.

Previous research on the Period of PURPLE Crying program showed that the program increased parents’ understanding of normal infant crying and influenced positive behaviors related to crying such as taking a break when their infant’s crying becomes too frustrating and sharing information about crying with other caregivers.

“We have heard from countless parents and caregivers about how the information in the Period of PURPLE Crying has helped them understand their baby’s crying and feel less frustrated,” says Ryan Steinbeigle, NCSBS Executive Director. “This new study is further evidence that the program helps families and keeps babies safe.”

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The Society for Pediatric Radiology recently published the most comprehensive and complete consensus statement confirming the medical diagnosis of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT). In part, the statement reads "There is no controversy concerning the medical validity of the existence of AHT" and "AHT is a scientifically non-controversial medical diagnosis broadly recognized and managed throughout the world."

The statement addresses many of the misconceptions and falsities about the SBS/AHT diagnosis that are widely spread in the courtroom and media including that SBS/AHT is diagnosed quickly with little investigation, that SBS/AHT is diagnosed based on a "triad" of injuries, the misconception that using the term Abusive Head Trauma means that the medical community no longer believes that shaking alone doesn't cause injury.

When there is an SBS/AHT case, we often hear that there is a rush to judgment in determining that the baby suffered from SBS/AHT, that doctors were anxious to find a culprit for the baby's injuries. This couldn't be further from the truth. Abuse is the last diagnosis that a doctor would want to make. The truth is that SBS/AHT diagnoses are "made by a multidisciplinary team of pediatricians and pediatric subspecialty physicians, social workers and other professionals based on consideration of all the facts and evidence" only after "considering all the information acquired via clinical history, physical examination, and laboratory and imaging data." This isn't a diagnosis made by one individual attending physician. SBS/AHT is diagnosed by a team who carefully considers all the alternatives.

A common misconception that is often perpetuated in the courtroom and media is that when an infant presents at the hospital with a "triad" of injuries (subdural hematoma, retinal hemorrhages, brain swelling) that SBS/AHT is the only diagnosis that is considered. Knowing that SBS/AHT is diagnosed only after careful investigation, the consensus statement points out the "triad" as a "straw man" argument that "ignores the fact that the AHT diagnosis typically is made only after careful consideration of all historical, clinical and laboratory findings as well as radiologic investigations by the collaboration of a multidisciplinary team" and that the "triad" is used in the legal arena and media "to create the appearance of a 'medical controversy' where there is none."

The recommendation by the American Academy of Pediatrics to use the term Abusive Head Trauma was intended to be more inclusive of the fact that SBS injuries could be caused by more mechanisms in addition to shaking. The consensus statement sums this up by stating "The etiology of injury is multifactorial (shaking, shaking and impact, impact, etc.) so that the current best and most inclusive term is AHT."

This consensus statement is one of the most important documents published confirming the SBS/AHT diagnosis. This statement is jointly published by fifteen (15) multidisciplinary authors and is supported by the SPR Child Abuse Imaging Committee and endorsed by the boards of directors of the Society for Pediatric Radiology (SPR), European Society of Paediatric Radiology (ESPR), American Society of Pediatric Neuroradiology (ASPNR), American Academy of Pediatrics (AAP), European Society of Neuroradiology (ESNR), The American Professional Society on the Abuse of Children (APSAC), Swedish Paediatric Society, Norwegian Pediatric Association and Japanese Pediatric Society.

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