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Shaken Baby Syndrome and a Triple-Dose Strategy for Its Prevention

Stewart, Tanya Charyk MSc; Polgar, Denise; Gilliland, Jason PhD; Tanner, David A. MSc; Girotti, Murray J. MD, FRCSC, FACS; Parry, Neil MD, FRCSC; Fraser, Douglas D. MD, PhD, FRCPC

Journal of Trauma and Acute Care Surgery: December 2011 - Volume 71 - Issue 6 - p 1801-1807
doi: 10.1097/TA.0b013e31823c484a
Original Article

Objectives: Inflicted traumatic brain injury associated with Shaken Baby Syndrome (SBS) is a leading cause of injury mortality and morbidity in infants. A triple-dose SBS prevention program was implemented with the aim to reduce the incidence of SBS. The objectives of this study were to describe the epidemiology of SBS, the triple-dose prevention program, and its evaluation.

Methods: Descriptive and spatial epidemiologic profiles of SBS cases treated at Children's Hospital, London Health Sciences Centre, from 1991 to 2010 were created. Dose 1 (in-hospital education): pre-post impact evaluation of registered nurse training, with a questionnaire developed to assess parents' satisfaction with the program. Dose 2 (public health home visits): process evaluation of additional education given to new parents. Dose 3 (media campaign): a questionnaire developed to rate the importance of factors on a 7-point Likert scale. These factors were used to create weights for statistical modeling and mapping within a geographic information system to target prevention ads.

Results: Forty-three percent of severe infant injuries were intentional. A total of 54 SBS cases were identified. The mean age was 6.7 months (standard deviation, 10.9 months), with 61% of infant males. The mean Injury Severity Score was 26.3 (standard deviation, 5.5) with a 19% mortality rate. Registered nurses learned new information on crying patterns and SBS, with a 47% increase in knowledge posttraining (p < 0.001). Over 10,000 parents were educated in-hospital, a 93% education compliance rate. Nearly all parents (93%) rated the program as useful, citing “what to do when the crying becomes frustrating” as the most important message. Only 6% of families needed to be educated during home visits. Locations of families with a new baby, high population density, and percentage of lone parents were found to be the most important factors for selecting media sites. The spatial analysis revealed six areas needed to be targeted for ad locations.

Conclusions: SBS is a devastating intentional injury that often results in poor outcomes for the child. Implementing a triple-dose prevention program that provides education on crying patterns, coping strategies, and the dangers of shaking is key to SBS prevention. The program increased knowledge. Parents rated the program as useful. The media campaign allowed us to extend the primary prevention beyond new parents to help create a cultural change in the way crying, the primary trigger for SBS, is viewed. Targeting our intervention increased the likelihood that our message was reaching the population in greatest need.

From the Trauma Program (T.C.S., D.P., D.A.T., M.J.G.), London Health Sciences Centre and Children's Hospital; Department of Surgery (T.C.S., M.J.G., N.P.), Schulich School of Medicine & Dentistry; Human Environments Analysis Laboratory (J.G.), Department of Geography, University of Western Ontario; Children's Health Research Institute and Lawson Health Research Institute (J.G., D.D.F.); Division of Critical Care Medicine (N.P.), Schulich School of Medicine & Dentistry, University of Western Ontario; Centre for Critical Illness Research (D.D.F.); and Department of Paediatrics (D.D.F.), Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.

Submitted for publication December 1, 2010.

Accepted for publication October 10, 2011.

Supported by The Children's Health Foundation, whose grant has allowed our team to increase the injury prevention programming for children in Southwestern Ontario. Supported also by the Middlesex-London Health Unit for media campaign and donated media time from 1031 FRESH FM in London, Ontario, Canada.

Presented as a poster at the Eastern Association for the Surgery of Trauma, January 28, 2011, Naples, Florida.

Address for reprints: Tanya Charyk Stewart, MSc, Injury Epidemiologist, Trauma Program, London Health Sciences Centre, London, ON, Canada; email:

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.