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Assessment of Maternal Knowledge and Confidence About Abusive Head Trauma and Coping With Infant Crying Before and After Infant Safety Education in the Neonatal Intensive Care Unit

Rabbitt, Angela L., DO; Bretl, Deborah, APNP; Parker, Matthew, MD; Yan, Ke, PhD; Zhang, Liyun, MS

The Journal of Perinatal & Neonatal Nursing: October/December 2018 - Volume 32 - Issue 4 - p 373–381
doi: 10.1097/JPN.0000000000000362
Feature Articles

Infants with a history of perinatal illness are at higher risk for abusive head trauma (AHT). Crying is a common trigger for physical abuse, and education on coping with infant crying is an important component of AHT prevention. This study assesses the effects of education in the neonatal intensive care unit (NICU) on mothers' knowledge about AHT and infant crying, self-efficacy in applying the education to infant cares and providing the education to others, and the quality of AHT and infant crying education after discharge. Mothers received a standardized education program about AHT and infant crying and completed a preeducation survey, posteducation survey, and 4- to 5-month follow-up survey. Overall, there was a sustained increase in knowledge (P < .001) and confidence (P < .001). Mothers who received verbal education reported a higher increase in confidence (P = .03). Few received information from healthcare providers about crying (35%) and AHT (20%) after discharge. At follow-up survey, most felt highly confident in their ability to share information about AHT (97%) and calm their infant (95%). Most had shared the education with others (77%). Education on AHT and crying in the NICU can produce sustained increases in mothers' knowledge and confidence, but the effectiveness may be improved by addressing unique barriers to education in this population.

Department of Pediatrics, Medical College of Wisconsin, Milwaukee (Drs Rabbitt, Parker, and Yan and Ms Zhang); and Child Advocacy and Protection Services, Children's Hospital of Wisconsin, Milwaukee (Ms Bretl). Dr Parker is now at the Pediatric Residency Training Program at the University of California, Los Angeles.

Corresponding Author: Angela L. Rabbitt, DO, Children's Hospital of Wisconsin, Child Advocacy—C615, PO Box 1997, Milwaukee, WI 53201 (

The authors thank the Pediatric Translational Research Unit of Children's Hospital of Wisconsin for its substantial assistance in designing data collection methods, obtaining consents from subjects, and distributing surveys. The authors also thank nurses and staff of the Children's Hospital of Wisconsin Neonatal Intensive Care Unit for their educational efforts and study support.

Dr Parker received a stipend from the Wisconsin Medical Society for a Summer Research Fellowship in which he collected data for this study. Dr Rabbitt received a grant from the Child Abuse and Neglect Prevention Board to translate surveys into Spanish.

Disclosure: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Each author has indicated that he or she has met the journal's requirements for Authorship.

Submitted for publication: January 25, 2018; accepted for publication: July 14, 2018.

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