New data indicates that crying is the trigger that prompts parents to shake their babies. In 25% of newborns diagnosed, this procedure is fatal.
Offering strategies to help them better respond to this situation may reduce the incidence of shaken baby syndrome.
What is this?
Shaken Baby Syndrome (SBS) is any form of intentional injury inflicted on an infant or child by violent shaking, with or without impact with a hard surface. This can cause head trauma like hemorrhages in and around the brain, retinal hemorrhages, and fractures. In 25% of newborns diagnosed, this gesture is fatal and causes, in 80% of survivors, irreversible brain damage.
Excessive crying is often seen as the trigger that causes exhausted or frustrated parents to shake their babies. However, there is little data to support this hypothesis. Researchers therefore decided to define a graphic curve representing the number of babies hospitalized in California for SBS according to their age. They then compared this curve to that which represents the "normal distributioncrying” according to age; this curve shows a typical profile of crying during the first months of a baby's life.
Direct link between crying and SBS
The results show a number of properties common to both curves. These begin to rise when infants are two or three weeks old, peak, and then decline almost linearly until about 36 weeks of age. The main difference is when the curves reach their highest point: the number of SBS cases peaks between 10 and 13 weeks while the intensity of uncontrollable crying peaks between five and six weeks.
However, it is important to note that in 35-50% of SBS cases, the infant shows signs of prior abuse and shaking. The difference between the two curves could therefore be attributable to a delay between the cause and its effect.
“The shaking episode that brings the child to the ER could just be the latest in a long series that started days or weeks earlier,” says lead author Dr Ronald G. Barr, of the University of British Columbia.
If crying is the trigger for shaking and abuse, prevention programs should inform parents of the particular characteristics of first crying. A growing body of evidence shows that prolonged, uncontrollable crying canarise, no matter what method you use to try to calm them down. In 95% of cases, this kind of crying is part of normal baby development. People aware of this fact might be less frustrated if they knew the situation was only temporary.
To better inform parents, the National Center on Shaken Baby Syndrome has developed an intervention method called The Period of PURPLE Crying:
- P for crying peak (crying is at its peak);
- U for unexpected (unpredictability of crying);
- R for resistence to soothing;
- P for pain like face (the baby's facial expression suggests pain even though he is not in pain);
- L for long crying boots
- E for evening clustering of crying.
The authors encourage caregivers to follow three steps to prevent SBS. First, they suggest increasing the frequency of contact with the baby: picking him up, walking with him and talking to him more. These behaviors should reduce his crying, but not completely stop it. Second, they recommend placing the newborn in their crib and stepping away for a few minutes to calm down if the crying becomes frustrating. Finally, they insist that you should never shake the baby or himhurt.
Since there are similarities between the SBS incidence curve and the normal crying curve, it is hoped that this kind of educational strategy will help parents and caregivers to better understand and manage excessive crying, and prevent shaken baby syndrome.
by Eve Krakow
Ref: articles by cited authors are available in: Tremblay RE, Barr RG, Peters RDeV, eds. Encyclopedia on Early Childhood Development – Crying. Montreal, Quebec: Center of Excellence for Early Childhood Development. Available on the website: Barr RG. Crying and its importance for the psychosocial development of children. 2006:1-11; St James-Robert I. Effective services to manage infant crying disorders and their impact on the social and emotional development of young children. 2004:1-6. And in: Barr RG, Trent RB, Cross J, Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: Convergent evidence for crying as a trigger to shaking. Child Abuse & Neglect 2006; 30:7-16. National Center on Shaken Baby Syndrome
Krakow E. How to prevent shaken baby syndrome? Bulletin of the Centre of Excellence for Early Childhood Development, 2007;6(2)4. Available on the website or in PDF version.