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UNC, Duke lead first statewide shaken baby prevention research project in US

January 17, 2008

CHAPEL HILL - Child abuse prevention experts from the University of North Carolina at Chapel Hill Injury Prevention Research Center and School of Medicine and Duke University Medical Center will undertake a $7 million statewide shaken baby prevention project.

The project, the largest and most comprehensive in the country, is funded by the Centers for Disease Control and Prevention, the Doris Duke Charitable Foundation and The Duke Endowment and is led by a broad coalition of stakeholders from the National Center for Shaken Baby Syndrome, University of British Columbia and state and county agencies, service providers and non-profit organizations.

State Sen. William Purcell and the North Carolina Child Fatality Task Force announced the project Jan. 15, 2008, in the legislative building in Raleigh. It is designed to reach the parents of every baby born each year in North Carolina with the goal of significantly reducing the number of deaths and serious injuries that occur when frustrated caregivers shake crying babies.

"In a baseline survey of parents of children younger than 2 years old in North Carolina, we found that more than 2,000 of these children are shaken, to a greater or lesser extent, by a caregiver each year and that serious injuries result for some," said Dr. Desmond Runyan, a professor of social medicine and pediatrics at UNC and principal investigator for the project.

"However, only about 40 of these children are admitted to a hospital intensive care unit. Of those, 10 die and the other 27 suffer serious long-term health problems such as mental retardation, blindness, or cerebral palsy as a result," Runyan said. "A lot more children are shaken who are not hospitalized but may have mental retardation or learning disabilities later. This shows the need for, and potential benefits of, preventing shaking."

"As a pediatrician and a long-standing member of the N.C. Child Fatality Task Force, I know how devastating shaking a baby can be - to the infant and to the family. This project will share very important information that all parents can use about normal infant crying and how to manage that crying safely," said Purcell, a retired pediatrician from Laurinburg, N.C., who has been actively involved with shaken baby prevention efforts for more than 10 years.

Previous research has shown that shaking babies is both common and a leading cause of infant mortality. Nationally, an estimated 1,200 to 1,400 children a year receive medical treatment after being shaken. An estimated 25 percent of these children die and 80 percent of survivors are left with some form of life-long brain injury.

Preliminary, unadjusted data from the baseline survey shows that almost one in 100 parents of children under 2 reported that they or their partner has shaken a child. Also, 1.3 percent of mothers in the survey reported having seen somebody other than their partner shake a child under 2 within the last year.

Jennipher Dickens' son Christopher was shaken in 2006, when he was 7 weeks old, by another family member and now has permanent brain damage.

"Too many people in this state and all across the country have never heard of shaken baby syndrome and are unaware that shaking a baby is harmful," said Dickens, of Windsor, N.C., who spoke at today's announcement.

"Because he was shaken in a moment of anger and frustration, Christopher will suffer for the rest of his life. No baby should ever have to go through that pain and suffering.

"That's why this program is so important. All parents and caregivers need to be educated on the fact that crying is normal, and should be taught healthy ways of coping with crying so they will know how to deal with frustration when the situation arises," Dickens said. She created Stop Shaken Baby Syndrome Inc. (www.stopsbs.net) to promote prevention.

North Carolina's project plans to provide every parent of the approximately 125,000 babies born in the state annually with an intervention program called "The Period of PURPLE Crying," which was developed by Dr. Ron Barr, a professor of community child health research and a developmental pediatrician at the University of British Columbia, and Marilyn Barr, founder and executive director of the National Center on Shaken Baby Syndrome. Both Dr. Barr and Marilyn Barr are collaborating with the North Carolina project.

Dr. Barr created the concept of "The Period of PURPLE Crying" to help describe the characteristics of crying in healthy infants. "PURPLE" describes normal infant crying - it Peaks at 2 months of age and ends at 4 or 5 months, and often earlier; is Unexpected; Resists soothing; the child appears to be in Pain; it is Long lasting (2-5 hours); and occurs more in the Evening. The word "Period" lets parents know that this experience of increased, frustrating crying is temporary and eventually does come to an end.

The program includes hospital and health care provider-based parent education, a 10-minute video and an 11-page booklet that parents can share with other caregivers of their baby, such as family members and babysitters. The program educates parents and caregivers about the hazards of shaking and gives them alternatives to use when they feel they need a respite from a crying baby, such as handing off the baby to another caregiver or going to another room while leaving the baby in its crib with the rails up for periods of no longer than 15 minutes.

The co-principal investigator on the CDC research grant is Dr. Adam Zolotor of the UNC department of family medicine. In addition, Heidi Hennink-Kaminski and Elizabeth Dougall of the UNC School of Journalism and Mass Communication will work with the National Center on Shaken Baby Syndrome to develop a statewide media campaign to address social norms about shaking and reinforce program messages through caregivers, family, and friends.

The Center for Child and Family Health - a collaborative effort involving Duke University Medical Center, North Carolina Central University and the UNC School of Medicine focused on improving the standards of care for abused and traumatized children - will lead the implementation of the project. Dr. Robert Murphy, the center's executive director and an associate professor of psychiatry at Duke and Margaret Samuels, center deputy director and Period of Purple Crying program manager, lead a statewide leadership team with Runyan that will foster the effort in more than 90 hospitals where children are born, as well as in community settings across the state.

"Our goal with this program is to protect those most vulnerable in our community by increasing awareness, especially among new parents, about proper childcare and the dangers of shaking," Murphy said. "We hope these efforts will protect the long-term health and well-being of our newest generation."

University of North Carolina at Chapel Hill