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Sadler K, Rajabali F, Zheng A, Jain N, Pike I. Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada. Can J Nurs Res 2024; 56:109-116. [PMID: 38115698 DOI: 10.1177/08445621231222527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND The Period of PURPLE Crying Program® (PURPLE) is a universal parent education program that is delivered by nurses and health care providers to all parents/caregivers of newborns in British Columbia (B.C.). The aim of the program is to reduce the incidence of Traumatic Head Injury -Child Maltreatment (THI-CM), a form of child physical abuse. OBJECTIVE To determine if the PURPLE program had an impact on the rate of physical abuse hospitalizations for children less than or equal to 24 months of age in B.C. since implementation in 2009. METHODS The analysis measured physical abuse hospitalization rates for the period January 1, 1999 to December 31, 2019 and excluded any cases of confirmed Traumatic Head Injury-Child Maltreatment. Data were divided into pre-implementation period January, 1999 to December, 2008, and post-implementation period January, 2009 to December, 2019. Data were obtained from the Discharge Abstract Database and B.C. THI-CM Surveillance System to capture information on infant child abuse. Poisson regression and ANCOVA was applied to model the change in rates pre and post program implementation. RESULTS Physical abuse hospitalization rates decreased by 30% post-implementation period (95% CI: -14%, 57%, p = 0.1561). The decreasing linear trend in the post-implementation period was significantly different than the increasing linear trend in the pre-implementation period (F1,17 = 4.832, p = 0.042). CONCLUSIONS Nurses' role in engaging parents in conversations about PURPLE messages over multiple timepoints within a structured universal program model resulted in a decrease in physical abuse hospitalization rates since the implementation of PURPLE.
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Affiliation(s)
- Karen Sadler
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, BC, Canada
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, BC, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, BC, Canada
| | - Nita Jain
- Child Protection Service Unit, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada
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Caregiver Reports of Infant Distress and Injury in Abused Infants. J Pediatr 2022; 245:190-195.e2. [PMID: 35351533 DOI: 10.1016/j.jpeds.2022.02.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine whether in infants evaluated for physical abuse, medical encounters for infant distress are correlated with physical abuse or a history of sentinel injuries. STUDY DESIGN This retrospective, case-control analysis of infants aged <12 months evaluated for physical abuse identified demographic characteristics, prior injuries, and medical encounters for infant distress. Variables were compared between abused infants and nonabused infants with and without sentinel injuries. A nonparametric recursive classification tree analysis assessed interactions between variables. RESULTS Infant distress was associated with abuse (67.9% vs 44.7%; P = .008; OR, 2.6; 95% CI, 1.3-5.2). Infants with sentinel injuries had higher rates of infant distress (74.1% vs 42.4%; P ≤ .001) and crying (81.5% vs 62.7%; P = .012). Previous falls (32.6% vs 18.1%; P = .03) and nonsentinel injuries (18.2% vs 5.4%; P = .002) also were associated with abuse, although sentinel injuries were the most important predictor of abuse, followed by infant distress. CONCLUSIONS Infants with medical encounters for distress and injury may be at higher risk for abuse and may benefit from intensive educational and support services for their caregivers. Additional research evaluating the most effective interventions for caregivers of fussy infants is needed.
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Elbourne C, Cole E, Marsh S, Rex D, Makin E, Salter R, Brohi K, Edmonds N, Cleeve S, O'Neill B. At risk child: a contemporary analysis of injured children in London and the South East of England: a prospective, multicentre cohort study. BMJ Paediatr Open 2021; 5:e001114. [PMID: 34796283 PMCID: PMC8573663 DOI: 10.1136/bmjpo-2021-001114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Injury is a leading health burden in children yet relatively little is reported about the contemporary risks they face. Current national registry data may under-represent the true burden of injury to children. We aim to analyse contemporary patterns of paediatric trauma and identify current factors putting children at risk of injury. Methods A 3-month prospective multicentre cohort evaluation of injured children across the London Major Trauma System was performed. All children receiving a trauma team activation; meeting National Institute for Health and Care Excellence CT head criteria; or admitted/transferred out due to trauma were included. Data were collected on demographics, mechanism and location of injury, and body region injured. The primary outcome was in-hospital mortality and secondary outcome was safeguarding concerns. Results 659 children were included. Young children were more likely to be injured at home (0-5 years old: 70.8%, n=167 vs adolescents: 15.6%, n=31). Adolescents were more likely to be injured in the street (42.7%, n=85). Head trauma caused over half of injuries in 0-5 years old (51.9%, n=121). Falls were common and increasingly prevalent in younger children, causing 56.6% (n=372) of injuries. In adolescents, penetrating violence caused more than one in five injuries (21.9%, n=50). Most injured children survived (99.8%, n=658), however, one in four (26.1%, n=172) had safeguarding concerns and a quarter of adolescents had police, third sector or external agency involvement (23.2%, n=53). Conclusions This study describes modern-day paediatric trauma and highlights the variance in injury patterns in young children and adolescents. Importantly, it highlights differences in actual rates of injuries compared with those reported from current national registry data. We must understand real risks facing 21st century children to effectively safeguard future generations. The results provide an opportunity to reassess the current approach to injury prevention, child and adolescent safeguarding, and public health campaigns for child safety.
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Affiliation(s)
- Ceri Elbourne
- Paediatric Surgery, Barts Health NHS Trust, London, UK
| | - Elaine Cole
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University, London, UK
| | - Stephen Marsh
- Paediatric Surgery, Queen Mary University of London, London, UK
| | - Dean Rex
- Paediatric Surgery, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Erica Makin
- Paediatric Surgery, King's College Hospital, London, UK
| | - Rebecca Salter
- Emergency Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Karim Brohi
- Centre for Trauma Sciences, The Blizard Institute, Queen Mary University, London, UK
- Trauma and Vascular Surgery, Barts Health NHS Trust, London, UK
| | - Naomi Edmonds
- Paediatric Intensive Care, Barts Health NHS Trust, London, UK
| | - Stewart Cleeve
- Paediatric Surgery, Barts Health NHS Trust, London, UK
- Paediatric Surgery, Queen Mary University of London, London, UK
| | - Breda O'Neill
- Paediatric Anaesthesia, Barts Health NHS Trust, London, UK
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Wiley M, Schultheis A, Francis B, Tiyyagura G, Leventhal JM, Rutherford HJV, Mayes LC, Bechtel K. Parents' Perceptions of Infant Crying: A Possible Path to Preventing Abusive Head Trauma. Acad Pediatr 2020; 20:448-454. [PMID: 31629119 DOI: 10.1016/j.acap.2019.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 10/04/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Infant crying can lead to parental frustration and is the most common trigger for abusive head trauma (AHT). We used qualitative methodology with an activating stimulus (an audiotape of an infant crying) to prime the participants to engage in open dialogue for the purpose of understanding their perceptions of infant crying and its association with AHT, with the aim that information from these interviews and the impact of hearing the activating stimulus could be used to inform interventions to prevent AHT that would resonate with parents. METHODS We conducted 25 initial qualitative interviews and 16 subsequent interviews with mothers and fathers of newborns. Before the initial interview, parents listened to a 1-minute audio clip of a crying infant, followed by a preventive message regarding AHT. The transcribed data were analyzed, and themes were developed using the constant comparative method of grounded theory. Data collection and analysis continued past the point of thematic saturation. RESULTS Four themes emerged from the initial interviews: 1) previous experience is helpful to manage infant crying, 2) babies cry for a reason, 3) shaking an infant is incomprehensible to parents, and 4) the role of safety planning to manage frustration with crying. Analysis of the subsequent interviews revealed 2 additional themes: 1) use of supports for infant crying (eg, technology and physician advice) and 2) effects of the audio clip on caregiving practices. CONCLUSION Previous experiences and beliefs about crying affect parents' perceptions of infant crying and AHT. After discharge, parents reported using technology for information and support and thinking about the audio clip when caring for their infant. These experiences, beliefs, and practices may aid in shaping effective prevention strategies to prevent AHT.
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Affiliation(s)
| | - Alysse Schultheis
- Yale Child Study Center (A Schultheis, B Francis, HJV Rutherford, and LC Mayes), New Haven, Conn
| | - Brianna Francis
- Yale Child Study Center (A Schultheis, B Francis, HJV Rutherford, and LC Mayes), New Haven, Conn
| | - Gunjan Tiyyagura
- Yale School of Medicine (G Tiyyagura, JM Leventhal, and K Bechtel), New Haven, Conn
| | - John M Leventhal
- Yale School of Medicine (G Tiyyagura, JM Leventhal, and K Bechtel), New Haven, Conn
| | - Helena J V Rutherford
- Yale Child Study Center (A Schultheis, B Francis, HJV Rutherford, and LC Mayes), New Haven, Conn
| | - Linda C Mayes
- Yale Child Study Center (A Schultheis, B Francis, HJV Rutherford, and LC Mayes), New Haven, Conn
| | - Kirsten Bechtel
- Yale School of Medicine (G Tiyyagura, JM Leventhal, and K Bechtel), New Haven, Conn
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The Effects of an Infant Calming Intervention on Mothers' Parenting Self-Efficacy and Satisfaction During the Postpartum Period: A Randomized Controlled Trial. J Perinat Neonatal Nurs 2020; 34:300-310. [PMID: 33079803 DOI: 10.1097/jpn.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The aim of this study was to evaluate the effects of a behavioral infant calming technique to support mothers' parenting self-efficacy and parenting satisfaction. The methods of this randomized controlled trial are based on the CONSORT guidelines. Data were collected during March 1 to May 20, 2019, from 3 postpartum units in 1 university-level hospital in Finland. A total of 250 mothers agreed to participate, of which 120 were randomly allocated to the intervention group and 130 to the control group. All mothers completed a baseline questionnaire before randomization. Mothers in the intervention group were taught the 5 S's infant calming technique. The control group received standard care. Follow-up data were collected 6 to 8 weeks postpartum. The primary outcome measure was the change in parenting self-efficacy and parenting satisfaction scores over the follow-up period. The intervention group showed significantly larger improvements in parenting self-efficacy scores. There were no statistically significant differences in median improvements in parenting satisfaction. The 5 S's infant calming technique is feasible. These study findings may assist midwifery and neonatal nursing staff to support mothers and families during the postpartum period, whether the infants are fussy or not.
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Beaulieu E, Rajabali F, Zheng A, Pike I. The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of Purple crying program in British Columbia, Canada. CHILD ABUSE & NEGLECT 2019; 97:104133. [PMID: 31473380 DOI: 10.1016/j.chiabu.2019.104133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Abusive head trauma (AHT) is a severe form of child abuse causing devastating outcomes for children and families, but its economic costs in Canada has yet to be determined. The Period of PURPLE crying program (PURPLE) is an AHT prevention program implemented in British Columbia for which success in reducing AHT events was recently reported. OBJECTIVE This study estimated the lifetime costs to society of incidental AHT events and compared the benefits and associated costs of AHT before and after the implementation of the PURPLE program. PARTICIPANTS AND SETTING Children aged 0-24 months old with a definite diagnosis of AHT between 2002 and 2014 in British Columbia were included in this study. METHODS An incidence-based cost-of-illness analysis, using the human capital approach was used to quantify the lifetime costs of AHT events according to their severity (least severe, severe and fatal). A cost-effectiveness analysis of the PURPLE program was conducted from both a societal and a health services' perspectives using decision tree models. RESULTS There were sixty-four AHT events between 2002-2014, resulting in a total cost of $354,359,080 to society. The costs associated with fatal, severe and least severe AHT averaged $7,147,548, $6,057,761 and $1,675,099, respectively. The investment of $5 per newborn through the PURPLE program resulted in a $273.52 and $14.49 per child cost avoidance by society and by the healthcare system. CONCLUSIONS This study provides evidence to policymakers and health practitioners that investing upstream in well-developed AHT prevention programs, such as PURPLE, not only promote child safety and health, but also translates into avoided costs to society.
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Affiliation(s)
- Emilie Beaulieu
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; Department of Pediatrics, University of British Columbia, Address: UBC Faculty of Medicine, Rm 2D19 4480 Oak Street, BC Children's Hospital, Vancouver, BC, V6H 3V4, Canada.
| | - Fahra Rajabali
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada
| | - Alex Zheng
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada
| | - Ian Pike
- BC Injury Research and Prevention Unit, BC Children's Hospital Research Institute, Address: F508, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; Department of Pediatrics, University of British Columbia, Address: UBC Faculty of Medicine, Rm 2D19 4480 Oak Street, BC Children's Hospital, Vancouver, BC, V6H 3V4, Canada
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Bamber D, Powell C, Long J, Garratt R, Brown J, Rudge S, Morris T, Bhupendra Jaicim N, Plachcinski R, Dyson S, Boyle EM, Turney N, Chessman J, St James-Roberts I. Parental and health professional evaluations of a support service for parents of excessively crying infants. BMC Health Serv Res 2019; 19:592. [PMID: 31438940 PMCID: PMC6704568 DOI: 10.1186/s12913-019-4430-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 08/13/2019] [Indexed: 11/24/2022] Open
Abstract
Background The ‘Surviving Crying’ study was designed to develop and provisionally evaluate a support service for parents of excessively crying babies, including its suitability for use in the United Kingdom (UK) National Health Service (NHS). The resulting service includes three materials: a website, a printed booklet, and a Cognitive Behaviour Therapy (CBT) programme delivered to parents by a qualified professional. This study aimed to measure whether parents used the materials and to obtain parents’ and NHS professionals’ evaluations of whether they are fit for purpose. Parents were asked about participating in a randomised controlled trial (RCT) to evaluate the materials fully in health service use. Methods Participants were 57 parents with babies they judged to be crying excessively and 96 NHS Health Visitors (HVs). Parental use and parents’ and HVs’ ratings of the Surviving Crying materials were measured. Results Thirty four parents reported using the website, 24 the printed booklet and 24 the CBT sessions. Parents mostly accessed the website on mobile phones or tablets and use was substantial. All the parents and almost all HVs who provided data judged the materials to be helpful for parents and suitable for NHS use. If offered a waiting list control group, 85% of parents said they would have been willing to take part in a full RCT evaluation of the Surviving Crying package. Discussion and conclusions The findings identify the need for materials to support parents of excessively crying babies within national health services in the UK. The Surviving Crying support package appears suitable for this purpose and a full community-level RCT of the package is feasible and likely to be worthwhile. Limitations to the study and barriers to delivery of the services were identified, indicating improvements needed in future research. Trial registration Study Registration no. ISRCTN84975637.
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Affiliation(s)
- Deborah Bamber
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Charlotte Powell
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jaqui Long
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Rosie Garratt
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Jayne Brown
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - Sally Rudge
- Counseling Psychologist and CBT Practitioner, Leicester, UK
| | - Tom Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | | | | | - Sue Dyson
- School of Health and Education, Middlesex University, London, UK
| | - Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | | | - Ian St James-Roberts
- Thomas Coram Research Unit, UCL Institute of Education, University College London, London, WC1H OAL, UK.
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Jones S, Tyson S, Young M, Gittins M, Davis N. Patterns of moderate and severe injury in children after the introduction of major trauma networks. Arch Dis Child 2019; 104:366-371. [PMID: 30470686 PMCID: PMC6530074 DOI: 10.1136/archdischild-2018-315636] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/27/2018] [Accepted: 09/29/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To describe the demographics, mechanisms, presentation, injury patterns and outcomes for children with traumatic injuries. SETTING Data collected from the UK's Trauma and Audit Research Network. DESIGN AND PATIENTS The demographics, mechanisms of injury and outcomes were described for children with moderate and severe injuries admitted to the Major Trauma Network in England between 2012 and 2017. RESULTS Data regarding 9851 children were collected. Most (69%) were male. The median age was 6.4 (SD 5.2) years, but infants aged 0.1 year (36.5 days) were the most frequently injured of all ages (0-15 years); 447 (36.0%) of injuries in infants aged <1 year were from suspected child abuse. Most injuries occurred in the home, from falls <2 m, after school hours, at weekends and during the summer. The majority of injuries were of moderate severity (median Injury Severity Score 9.0, SD 8.7). The limbs and pelvis, followed by the head, were the most frequently and most severely injured body parts. Ninety-two per cent were discharged home and 72.8% made a 'good recovery' according to the Glasgow Outcome Scale. 3.1% of children died, their median age was 7.0 years (SD 5.8), but infants were the most commonly fatally injured group. CONCLUSIONS A common age of injury and mortality was infants aged <1 year. Accident prevention strategies need to focus on the prevention of non-accidental injuries in infants. Trauma services need to be organised to accommodate peak presentation times, which are after school, weekends and the summer.
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Affiliation(s)
- Samantha Jones
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK,Department of Trauma and Orthopaedics, Manchester Foundation Trust, Royal Manchester Children’s Hospital, Manchester, UK,Research, Manchester Academic Health Science Centre, Manchester, UK
| | - Sarah Tyson
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK,Research, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael Young
- Research, Manchester Academic Health Science Centre, Manchester, UK,Faculty of Biology, Medicine and Health, Trauma and Audit Research Network, University of Manchester, Manchester, UK
| | - Matthew Gittins
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK,Research, Manchester Academic Health Science Centre, Manchester, UK
| | - Naomi Davis
- Department of Trauma and Orthopaedics, Manchester Foundation Trust, Royal Manchester Children’s Hospital, Manchester, UK,Research, Manchester Academic Health Science Centre, Manchester, UK
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Lopes NRL, Williams LCDA. Pediatric Abusive Head Trauma Prevention Initiatives: A Literature Review. TRAUMA, VIOLENCE & ABUSE 2018; 19:555-566. [PMID: 27821497 DOI: 10.1177/1524838016675479] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
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.
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Barr RG, Barr M, Rajabali F, Humphreys C, Pike I, Brant R, Hlady J, Colbourne M, Fujiwara T, Singhal A. Eight-year outcome of implementation of abusive head trauma prevention. CHILD ABUSE & NEGLECT 2018; 84:106-114. [PMID: 30077049 DOI: 10.1016/j.chiabu.2018.07.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 06/08/2023]
Abstract
Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2-4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3-13.5) to 7.1 (95% CI: 4.8-10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4-8.3) to 4.4 (95% CI: 3.1-6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42-1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.
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Affiliation(s)
- Ronald G Barr
- Department of Pediatrics, University of British Columbia; Canadian Institute for Advanced Research; British Columbia Children's Hospital Research Institute, Canada.
| | - Marilyn Barr
- National Center on Shaken Baby Syndrome, United States
| | - Fahra Rajabali
- British Columbia Children's Hospital Research Institute, Canada
| | | | - Ian Pike
- Department of Pediatrics, University of British Columbia; British Columbia Children's Hospital Research Institute, Canada
| | - Rollin Brant
- British Columbia Children's Hospital Research Institute; Department of Statistics, University of British Columbia, Canada
| | - Jean Hlady
- Department of Pediatrics, University of British Columbia, Canada
| | | | - Takeo Fujiwara
- Global Health Promotion, Tokyo Medical and Dental University, Japan
| | - Ash Singhal
- Department of Neurosurgery, University of British Columbia, Canada
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11
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Harrold J, Langevin M, Barrowman N, Sprague AE, Fell DB, Moreau KA, Lacaze-Masmonteil T, Schuh S, Joubert G, Moore A, Solano T, Zemek RL. Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey. CMAJ Open 2018; 6:E423-E429. [PMID: 30266780 PMCID: PMC6182114 DOI: 10.9778/cmajo.20180015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits. METHODS We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services. Parents presenting with a neonate to the emergency department in 5 large academic hospitals in Ontario were surveyed between December 2013 and June 2015. We used descriptive statistics to report survey data and explored correlations between factors. RESULTS A total of 1533 surveys were completed. The most common reasons for presenting were jaundice (441 [28.8%]) and feeding issues (251 [16.4%]). The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department. Although most parents (86.8% [1280/1475]) reported high confidence in caring for a sick or injured child, 42.3% (643/1519) were unsure of the severity, and most (90.4% [578/639]) of these parents felt that the infant required assessment immediately or the same day. Of parents who felt the condition was not serious, 83.2% (198/238) thought that same-day evaluation was required. Nearly half of respondents (44.4% [621/1400]) said they would have gone to their health care provider with a same-day appointment, and 28.1% (344/1225) would have gone to their care provider with a next-day appointment. INTERPRETATION Parents' reported confidence in caring for sick or injured infants does not match the perceived urgency of neonatal conditions, which likely contributes to emergency department overuse. Any system to decrease nonurgent emergency department use by neonates would need to be immediately responsive, providing same-day help.
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Affiliation(s)
- JoAnn Harrold
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont.
| | - Mélissa Langevin
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Nick Barrowman
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Ann E Sprague
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Deshayne B Fell
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Katherine A Moreau
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Suzanne Schuh
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Gary Joubert
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Andrea Moore
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Tanya Solano
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Roger L Zemek
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
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Powell C, Bamber D, Long J, Garratt R, Brown J, Rudge S, Morris T, Bhupendra Jaicim N, Plachcinski R, Dyson S, Boyle EM, St James-Roberts I. Mental health and well-being in parents of excessively crying infants: Prospective evaluation of a support package. Child Care Health Dev 2018; 44:607-615. [PMID: 29667223 DOI: 10.1111/cch.12566] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/22/2018] [Accepted: 03/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND During the first 4 months of age, approximately 20% of infants cry a lot without an apparent reason. Most research has targeted the crying, but the impact of the crying on parents, and subsequent outcomes, need to receive equal attention. This study reports the findings from a prospective evaluation of a package of materials designed to support the well-being and mental health of parents who judge their infant to be crying excessively. The resulting "Surviving Crying" package comprised a website, printed materials, and programme of Cognitive Behaviour Therapy-based support sessions delivered to parents by a qualified practitioner. It was designed to be suitable for United Kingdom (UK) National Health Service (NHS) use. METHODS Parents were referred to the study by 12 NHS Health Visitor/Community Public Health Nurse teams in one UK East Midlands NHS Trust. Fifty-two of 57 parents of excessively crying babies received the support package and completed the Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder-7 anxiety questionnaire, as well as other measures, before receiving the support package and afterwards. RESULTS Significant reductions in depression and anxiety were found, with numbers of parents meeting clinical criteria for depression or anxiety halving between baseline and outcome. These improvements were not explained by reductions in infant crying. Reductions also occurred in the number of parents reporting the crying to be a large or severe problem (from 28 to 3 parents) or feeling very or extremely frustrated by the crying (from 31 to 1 parent). Other findings included increases in parents' confidence, knowledge of infant crying, and improvements in parents' sleep. CONCLUSIONS The findings suggest that the Surviving Crying package may be effective in supporting the well-being and mental health of parents of excessively crying babies. Further, large-scale controlled trials of the package in NHS settings are warranted.
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Affiliation(s)
- C Powell
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - D Bamber
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - J Long
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - R Garratt
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - J Brown
- Nursing and Midwifery Research Centre, De Montfort University, Leicester, UK
| | - S Rudge
- Counseling Psychologist & CBT Practitioner, Leicester, UK
| | - T Morris
- Leicester Clinical Trials Unit, University of Leicester, Leicester, UK
| | | | | | - S Dyson
- School of Health and Education, Middlesex University, London, UK
| | - E M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - I St James-Roberts
- Thomas Coram Research Unit, UCL Institute of Education, University College London, London, UK
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Huyer G, Chreim S, Michalowski W, Farion KJ. Barriers and enablers to a physician-delivered educational initiative to reduce low-acuity visits to the pediatric emergency department. PLoS One 2018; 13:e0198181. [PMID: 29813114 PMCID: PMC5973597 DOI: 10.1371/journal.pone.0198181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 05/15/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Use of the pediatric emergency department (PED) for low-acuity health issues is a growing problem, contributing to overcrowding, longer waits and higher health system costs. This study examines an educational initiative aimed at reducing low-acuity PED visits. The initiative, implemented at an academic pediatric hospital, saw PED physicians share a pamphlet with caregivers to educate them about appropriate PED use and alternatives. Despite early impacts, the initiative was not sustained. This study analyzes the barriers and enablers to physician participation in the initiative, and offers strategies to improve implementation and sustainability of similar future initiatives. METHODS Forty-two PED physicians were invited to participate in a semi-structured individual interview assessing their views about low-acuity visits, their pamphlet use, barriers and enablers to pamphlet use, and the initiative's potential for reducing low-acuity visits. Suggestions were solicited for improving the initiative and reducing low-acuity visits. Constant comparative method was used during analysis. Codes were developed inductively and iteratively, then grouped according to the Theoretical Domains Framework (TDF). Efforts to ensure study credibility included seeking participant feedback on the findings. RESULTS Twenty-three PED physicians were interviewed (55%). Barriers and enablers for pamphlet use were identified and grouped according to five of the 14 TDF domains: social/professional role and identity; beliefs about consequences; environmental context and resources; social influences; and emotions. CONCLUSIONS The TDF provided an effective approach to identify the key elements influencing physician participation in the educational initiative. This information will help inform behavior change interventions to improve the implementation of similar future initiatives that involve physicians as the primary educators of caregivers.
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Affiliation(s)
- Gregory Huyer
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Wojtek Michalowski
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Ken J. Farion
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Emergency Department, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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15
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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. J Perinat Neonatal Nurs 2018; 32:373-381. [PMID: 30358672 DOI: 10.1097/jpn.0000000000000362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Abstract
Crying conveys evidence about an infant's state and neurological health which, when carefully assessed, can provide diagnostic information for parents and clinicians. When crying is inconsolable or judged to be excessive, it can stress parents, disrupt parenting and, in rare cases, place an infant at risk for abuse. Research has revealed physiological and neural responses to crying that may predispose some adults to maltreat infants. Although this work suggests that parental vulnerabilities contribute to insensitive or aggressive reactions, there is a growing recognition that exposure to large doses of crying may be a challenge for all adults. Support programmes that inform parents about infant crying, enhance parenting, and improve parental wellbeing and coping, are under development with promising initial findings.
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Affiliation(s)
- Debra M Zeifman
- Vassar College, Department of Psychological Science, 124 Raymond Avenue, Mailbox 582, Poughkeepsie, NY 12604 USA
| | - Ian St James-Roberts
- Thomas Coram Research Unit, UCL Institute of Education, University College London, 27/28 Woburn Square, London WC1H 0AA, UK
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Zolotor AJ, Runyan DK, Shanahan M, Durrance CP, Nocera M, Sullivan K, Klevens J, Murphy R, Barr M, Barr RG. Effectiveness of a Statewide Abusive Head Trauma Prevention Program in North Carolina. JAMA Pediatr 2015; 169:1126-31. [PMID: 26501945 PMCID: PMC4687484 DOI: 10.1001/jamapediatrics.2015.2690] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Abusive head trauma (AHT) is a serious condition, with an incidence of approximately 30 cases per 100,000 person-years in the first year of life. OBJECTIVE To assess the effectiveness of a statewide universal AHT prevention program. DESIGN, SETTING, AND PARTICIPANTS In total, 88.29% of parents of newborns (n = 405 060) in North Carolina received the intervention (June 1, 2009, to September 30, 2012). A comparison of preintervention and postintervention was performed using nurse advice line telephone calls regarding infant crying (January 1, 2005, to December 31, 2010). A difference-in-difference analysis compared AHT rates in the prevention program state with those of other states before and after the implementation of the program (January 1, 2000, to December 31, 2011). INTERVENTION The Period of PURPLE Crying intervention, developed by the National Center on Shaken Baby Syndrome, was delivered by nurse-provided education, a DVD, and a booklet, with reinforcement by primary care practices and a media campaign. MAIN OUTCOMES AND MEASURES Changes in proportions of telephone calls for crying concerns to a nurse advice line and in AHT rates per 100,000 infants after the intervention (June 1, 2009, to September 30, 2011) in the first year of life using hospital discharge data for January 1, 2000, to December 31, 2011. RESULTS In the 2 years after implementation of the intervention, parental telephone calls to the nurse advice line for crying declined by 20% for children younger than 3 months (rate ratio, 0.80; 95% CI, 0.73-0.87; P < .001) and by 12% for children 3 to 12 months old (rate ratio, 0.88; 95% CI, 0.78-0.99; P = .03). No reduction in state-level AHT rates was observed, with mean rates of 34.01 person-years before the intervention and 36.04 person-years after the intervention. A difference-in-difference analysis from January 1, 2000, to December 31, 2011, controlling for economic indicators, indicated that the intervention did not have a statistically significant effect on AHT rates (β coefficient, -1.42; 95% CI, -13.31 to 10.45). CONCLUSIONS AND RELEVANCE The Period of PURPLE Crying intervention was associated with a reduction in telephone calls to a nurse advice line. The study found no reduction in AHT rates over time in North Carolina relative to other states. Consequently, while this observational study was feasible and supported the program effectiveness in part, further programmatic efforts and evaluation are needed to demonstrate an effect on AHT rates.
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Affiliation(s)
- Adam J. Zolotor
- Department of Family Medicine, University of North Carolina at Chapel Hill2Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Desmond K. Runyan
- Department of Pediatrics, Kempe Center, University of Colorado, Aurora
| | - Meghan Shanahan
- Injury Prevention Research Center, University of North Carolina at Chapel Hill4Department of Maternal and Child Health, University of North Carolina at Chapel Hill
| | | | - Maryalice Nocera
- Injury Prevention Research Center, University of North Carolina at Chapel Hill
| | - Kelly Sullivan
- Center for Child and Family Health, Durham, North Carolina
| | - Joanne Klevens
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert Murphy
- Center for Child and Family Health, Durham, North Carolina8Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Marilyn Barr
- National Center on Shaken Baby Syndrome, Farmington, Utah
| | - Ronald G. Barr
- Child and Family Research Institute, University of British Columbia, Vancouver, British Columbia, Canada11Canadian Institute for Advanced Research, Toronto, Ontario, Canada
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