EVALUATION OF ALL BABIES CRY, A SECOND GENERATION UNIVERSAL ABUSIVE HEAD TRAUMA PREVENTION PROGRAM

Glimpsing the Iceberg: Parent-Child Physical Aggression and Abuse

Despite evidence that parents' physical aggression abuse has long-lasting negative consequences, information about the true population prevalence of aggression and physical abuse is limited. We have even less information about how parental aggression and abuse vary by child age, parent gender, and how that aggression and abuse might be clustered within families. To address these gaps, an anonymous, computer-based assessment was administered to nearly 40,000 parents of more than 60,000 children in the United States Air Force, which included a detailed assessment on up to four minor children of aggression and its impact. The survey was the largest of its type ever conducted in the United States, allowing for stable, crossvalidated estimation of rates of both corporal punishment and physical abuse. Approximately 39% of children experienced corporal punishment, peaking at three years of age, and 7% experienced physical abuse, peaking at age six. About 45% of parents reported perpetrating corporal punishment and 8% abuse; these rates were higher in multi-child families and most often involved more than one child. Parent gender was not associated with physical aggression or abuse.

Engagement Measures in Maltreatment Prevention Studies: A Scoping Review

Prevention services can promote public health by building protective factors and reducing maltreatment risk. Yet, engaging caregivers in prevention services presents a unique set of challenges. Measurement studies are important first steps to increase the knowledge of caregiver engagement in prevention services. The purpose of this scoping review was to investigate how family engagement has been measured and operationalized in the studies of maltreatment prevention/positive parenting programs. The review examined quantitative and mixed methods studies conducted in the U.S., which measured multiple dimensions of client engagement, including behavioral, attitudinal, and relational domains. A total of 88 studies selected from PubMed, CINAHL, ERIC, PsycINFO, Social Work Abstracts, Academic Search Premier, and Web of Science were included in this review. Results indicated that studies examine engagement constructs in all three domains of engagement with a primary focus on behavioral engagement. The attitudinal and relational engagement was mostly assessed through general satisfaction surveys, and a limited number of studies utilized validated measures to assess those constructs. While most studies reported acceptable internal reliabilities, only two studies reported other dimensions of psychometric qualities. Only one validated measure was found, which assessed client perceptions of provider cultural competence. More measurement studies are needed to further incorporate multiple dimensions of engagement into the studies of maltreatment prevention programs, which can inform the effort to develop tailored implementation strategies to fully engage various groups of parents in maltreatment prevention programs.

The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.

The role of household composition of children diagnosed with abusive head trauma

BACKGROUND

To prevent abusive head trauma (AHT), many studies focus on understanding the risk factors. Few studies assess the role of household composition.

OBJECTIVE

To describe the household composition of children diagnosed with AHT and assess the relationships between patient and household characteristics, perpetration, and fatality.

PARTICIPANTS AND SETTING

Children admitted to a large pediatric hospital with AHT between January 1, 2010 and December 31, 2019.

METHODS

The diagnosis of AHT was made at initial hospitalization by a child abuse pediatrician with a multidisciplinary team review. The electronic medical records of identified patients were reviewed to identify demographic information, the number and ages of all of their siblings and the number and relationship to patients of all adults who were reported as being present at the time of AHT and therefore considered to be possible perpetrators. Descriptive statistics were used to characterize the sample. Comparisons were made using Fisher exact tests and Mann-Whitney tests.

RESULTS

Children with AHT who were under 12 months of age and had siblings in the home, particularly siblings under age 5, had greater odds of being injured by a biological parent. Children 12 months or older and children without siblings had greater odds of being injured by a boyfriend or girlfriend of their parent or guardian.

CONCLUSIONS

In cases of AHT, the possible perpetrator differed based on the presence of young siblings living in the home, which has important implications for AHT prevention.

Which Mothers Know That All Babies Cry? A Randomized Controlled Trial of a Child Abuse Prevention Program for Low-Income New Mothers

This study evaluated an intervention for low-income new mothers, half from Spanish-speaking homes, that provides education around infant crying and abusive head trauma (AHT). At enrollment, non-US-born mothers were less likely than US-born mothers to have heard of shaken baby syndrome (60% vs 89%, P ≤ .0001) or to know shaking babies could lead to brain damage or death (48% vs 80%, P < .0001). At follow-up, non-US-born intervention mothers had improved knowledge of the peak of crying (31% vs 4%, P = .009), improved knowledge that shaking a baby could lead to brain damage or death (36% vs 12%, P = .035), and identified more calming strategies for parenting stress compared with non-US-born control mothers (+0.8 [SD = 1.1] vs -0.4 [SD = 1.4]). This study identifies a gap in AHT knowledge at baseline of non-US-born mothers. These mothers had improved knowledge with intervention and are an important population for similar prevention efforts.

Feasibility study of the calm baby gently program: An educational baby book intervention on safe practices related to infant crying

BACKGROUND

Abusive head trauma (AHT) is a preventable form of child abuse.

OBJECTIVE

This project used a mixed method design to assess the feasibility of the Calm Baby Gently educational baby book intervention for promoting safe practices related to infant crying in an effort to prevent AHT.

PARTICIPANTS AND SETTING

Three pediatric practices participated between June 2016 and January 2018, including 1045 caregivers who attended their infant's 2-month well-child visit.

METHODS

Pediatric providers gave the educational baby book to caregivers at the 1-month well-child visit. Caregivers completed a survey at the 2-month well-child visit on their use and satisfaction with the book and responses to infant crying. Thematic analysis of qualitative feedback was performed. Responses to infant crying were compared quantitatively between caregivers who had and had not read the book.

RESULTS

Of the 819 caregivers (78%) who received the book, 92% (754) read it, and 51% (421) had another caregiver read it. Caregivers considered the book approachable, understandable, validating, and helpful for improving knowledge and skills related to infant crying. The book was rated more helpful by caregivers of younger age, male gender, and non-white race. Controlling for age, gender, and race, caregivers who read the book were more confident (p = 0.033) and had more knowledge on how to respond appropriately to infant crying (p = 0.019) than caregivers who had not read it.

CONCLUSIONS

Calm Baby Gently is a feasible and well-received AHT prevention program. Randomized controlled trials are needed to better understand its impact on knowledge, behavior, and AHT rates.

Pediatric Abusive Head Trauma Prevention Initiatives: A Literature Review

Abusive head trauma (AHT) is a serious form of child maltreatment that needs to be prevented. The aim of this study was to summarize the main AHT prevention strategies described in literature, aiming to identify evidence of their efficiency, as well as strengths and limitations. International databases were reviewed from 2005 to 2015 using the key words Shaken Baby Syndrome or abusive head trauma or nonaccidental head trauma or abusive head injury or nonaccidental head injury and prevention. A total of 1,215 articles were found and 34 complete articles were selected for this study. Five initiatives with the main objective of reducing infant crying in the first months of life were found, three aimed at caregiver's emotional regulation and 12 aimed at raising parents and caregivers awareness on AHT. Among them, parental education about infant crying and risks of shaking a baby stands out for its empirical evidence.