Thesis (Ph.D.)--Marquette University, 2009. / Marilyn Frenn, Maureen O'Brien, Ardene Brown, Advisors.

The purpose of this essay is to establish applicable law regarding the questions outlined in the paper about medical evidence in cases of child abuse in the form of shaken baby syndrome. In order to answer the essay's research questions about this, the essay has applied a legal-judicial method based on a hierarchical order of legislation, legislative history, case law, and doctrine. In the analysis, the conclusions are that medical expertise is generally valued highly by the courts while at the same it is being considered with caution in the individual case. Mostly, by the diagnosis of shaken baby syndrome, is considered resting on an uncertain scientific basis, the legal assessment of the question of liability has been affected so that the evidentiary requirement "beyond reasonable doubt" is not to be considered met in recent case law. The essay also addresses the discussion on an international scientific level regarding the diagnosis of shaken baby syndrome.

Background: Child maltreatment is a serious health concern in the United States (U.S.) affecting as many as one in four children throughout their lifetime (Finkelhor, Turner, Ormond, & Hamby, 2013). In 2013, a reported 678, 932 victims of child maltreatment were reported to Child Protective Services (CPS), and of those cases 1,520 were fatal (CDC, 2015a). Out of all the various types of child maltreatment, Shaken Baby Syndrome (SBS) is the leading cause of child abuse deaths in the U.S. (CDC, n.d.). While current research has focused on validating the effectiveness of educational interventions, very few studies have analyzed the efficacy of individualized, patient-centered action plans. Such data would be beneficial to assess the usefulness of action plans in preparing caregivers for coping with an inconsolable infant at home. Purpose: To enhance caregiver knowledge about SBS and to provide parents with the skills and resources necessary to cope effectively and efficiently at home when unable to console their infant. Methods: This study utilized a quasi-experimental pre-test/post-test design. Participants were recruited from the Franciscan Women’s Health Associates located at St. Joseph Medical Center in Tacoma, Washington and were members of the Centering prenatal groups. The entirety of the study was completed during these groups including the pre-test, intervention, action plan, and post-test. Data was analyzed through the utilization of descriptive statistics as well as a paired t test. Results: Overall, results revealed that participant (n=26) knowledge significantly improved after the educational intervention (p=0.000) with a mean score of 87.56% on the pre-test and a mean score of 95.38% on the post-test. In addition, a majority of participants (57.5%) found both the action plan and the education to be extremely useful. Discussion: The results of this study were consistent with current evidence indicating that education on SBS, the dangers of shaking, and healthy coping mechanisms significantly impacts caregiver knowledge. In addition, a majority of participants viewed the action plans favorably identifying that they would be beneficial if they felt frustrated. Future research is warranted to gather more information on the long-term outcomes of educational interventions as well as individualized action plans.

Bakgrund: Shaken Baby Syndrom är en allvarlig form av barnmisshandel. Förekomsten är vanligare bland barn under ett år och barnets skrik anses vara den enskilt största orsaken. BVC-sjuksköterskorna har ett ansvar i att arbeta förebyggande mot Shaken Baby Syndrom. Att som BVC-sjuksköterska möta en familj där barnet utsatts för skakvåld väcker mycket känslor och ställer höga krav på professionalitet. Syfte: Syftet med denna studie var att belysa BVC-sjuksköterskors erfarenheter av att möta en familj, där barnet utsatts för Shaken Baby Syndrom. Metod: Data analyserades med kvalitativ innehållsanalys med induktiv ansats. Fem intervjuer genomfördes med BVC-sjuksköterskor. Resultat: Ur analysen av datamaterialet framträdde fyra kategorier; lyhörd för varningssignaler, tillämpa beprövad kunskap, egna insatser otillräckliga och kollegial avlastning med totalt 11 underkategorier. Konklusion: Resultaten av denna studie kan bidra till att utveckla och förbättra BVC-sjuksköterskors komplexa arbetssituation i mötet med familjen. Det kan också bidra till att BVC-sjuksköterskor lättare upptäcker varningssignaler och får en större insikt i betydelsen av att arbeta förebyggande och därmed minskar förekomsten av Shaken Baby Syndrom. / Background: Shaken Baby Syndrome is a serious form of child abuse. The occurrence is more frequent among children younger than one year, and the baby's cries are considered the largest single cause. Child health care nurses have a responsibility to work to prevent Shaken Baby Syndrome. Meeting a family where the child has being abused evokes a lot of emotions and requires a high level of professionalism.Aim: The aim of the study was to highlight child health care nurses’ experiences of meeting a family, where the child is a victim of Shaken Baby Syndrome.Method: The data were analyzed using qualitative content analysis technique with an inductive approach. Five interviews with child health care nurses’ were performed.Result: Four categories emerged from the analysis; perceptive to warning signs, application of proven knowledge, own efforts inadequate and collegiate relief, with 11 subcategories.Conclusion: The results of this study may contribute to develop and improve how child health care nurses handle their complex interaction with families. It can also contribute to a deeper understanding and awareness of warning signs. Preventive work is essential to decrease the prevalence of Shaken Baby Syndrome.

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No. of bitstreams: 1 TeseNRLL.pdf: 7812363 bytes, checksum: dd2fc3efde7d3cec4ab57dac3ed313dc (MD5) Previous issue date: 2017-02-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / The present dissertation is composed of a compendium of four scientific papers with the common theme of prevention of abusive head trauma (AHT), a serious type of infant maltreatment. The first article describes a review of the Brazilian and international literature on the main strategies of AHT prevention. A total of 34 articles describing 20 initiatives to prevent AHT were selected, five of which aimed at reducing infant crying, 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. The second article describes the process of elaboration and assessment of validity evidence based on internal structure of the Attitudes towards an Infant Crying Scale, developed for evaluation of parental attitude towards the baby's crying during the first months of life. After exploratory factor analysis, the final version of the scale was composed of 50 items, divided into six components: Consequences of Shaking the Baby, Welfare of the Caregiver, Strategies Targeting the Baby, Strategies Targeting the Caregiver, Beliefs about Baby Care and Characteristics of Infant Crying. The scale appears to be promising with respect to the objective of evaluating the attitude of parents and caregivers about infant crying and in evaluating AHT prevention programs. The third study describes the evaluation of a brief intervention to increase knowledge on AHT among parents of children up to two years old. A total of 254 parents who attended pregnancy or puerperal groups in six municipalities in the State of São Paulo participated in the study. Participants were randomly assigned to one of two conditions: Experimental Group (EG) or a waiting list Control Group (CG). The intervention involved showing an educational video and reading a pamphlet on AHT. To measure parental knowledge, the Attitudes towards the Infant Crying Scale was used. An increase in participants' knowledge about consequences of shaking, caregiver’s wellbeing, caregiver strategies to deal with crying, beliefs about infant care and about characteristics of infant crying were observed in the EG at posttest. Finally, the fourth article describes the evaluation of a training program for Health Care professionals about AHT. The training consisted of a four-unit course (two hours per unit), in which the topics of family violence, child abuse, abusive head trauma and prevention strategies were addressed. A total of 13 professionals from Basic Health Units from a city in the State of São Paulo participated in the study. Participants were randomly divided into two groups: Experimental Group (EG) and a Wait-List Control Group (CG). The experimental design for the EG was pre-test - intervention - post-test - follow-up and for the CG was pre-test 1 - pre-test 2 - post-test - intervention. The Attitudes towards the Infant Crying Scale was used. After training, participants' knowledge about caregiver strategies to deal with crying related to caregiver and to baby and characteristics of infant crying increased for EG participants. The increase in knowledge about caregiver strategies to deal with crying related to caregiver and characteristics of infant crying was maintained at follow-up, suggesting the effectiveness of this training in increasing knowledge on AHT among health professionals. / A presente tese é composta por um compêndio de quatro artigos científicos que têm como temática comum a prevenção do trauma craniano violento (TCV), uma forma grave de maustratos contra bebês. O primeiro artigo descreve uma revisão da literatura nacional e internacional sobre as principais estratégias de prevenção do TCV. Foram selecionados 34 artigos que descreviam 20 iniciativas para prevenção do TCV, sendo que cinco tinham como objetivo reduzir o choro nos primeiros meses de vida, três visavam a regulação emocional do cuidador e 12 visavam aumentar a sensibilização de pais sobre esta forma de maus-tratos. Dentre estas estratégias, a educação parental sobre o choro nos primeiros meses de vida e os riscos de sacudir um bebê se destacou por suas evidências empíricas de efetividade. O segundo artigo descreve o processo de elaboração e investigação das evidências de validade com base na estrutura interna da Escala de Atitudes frente ao Choro do Bebê, desenvolvida para avaliação da atitude de pais frente ao choro do bebê nos primeiros meses de vida. Após análise fatorial exploratória, a escala ficou composta por 50 itens divididos em seis fatores, sendo eles: Consequências de Sacudir o Bebê, Estratégias para Bem-Estar do Cuidador, Estratégias para lidar com Choro relacionadas ao Bebê, Estratégias para lidar com o Choro relacionadas ao Cuidador, Crenças sobre o Cuidado do Bebê e Características do Choro do Bebê. A escala parece ser um instrumento promissor para avaliar a atitude de pais e cuidadores sobre o choro do bebê nos primeiros meses de vida e para ser utilizado na avaliação de programas de prevenção do TCV. O terceiro estudo que compõe a presente tese descreve a avaliação da eficácia de uma intervenção breve para o aumento de conhecimento sobre o TCV entre pais de crianças com até dois anos. Participaram do estudo 254 pais de crianças com até dois anos que frequentavam grupos de gestantes ou de puerpério em seis municípios do Estado de São Paulo. Os participantes foram divididos aleatoriamente em dois grupos: Experimental (GE) e Controle de Espera (GC), sendo que o delineamento experimental para o GE foi pré-teste – intervenção - pós-teste - follow-up e para o GC foi préteste 1 – pré-teste 2 – intervenção. A intervenção consistiu na exibição de um vídeo educativo e leitura de um panfleto sobre a SBS. Para avaliação do conhecimento foi utilizado a Escala de Atitudes Frente ao Choro do Bebê. Foi observado aumento do conhecimento dos participantes sobre as consequências de se sacudir o bebê, o bem-estar do cuidador, as estratégias para lidar com o choro do bebê relacionadas ao cuidador, as crenças sobre o cuidado do bebê e as características do choro do bebê nos primeiros meses de vida. Este aumento do conhecimento foi mantido após um mês da intervenção, sugerindo sua efetividade. Por fim, o quarto artigo descreve a avaliação de um curso de capacitação a profissionais da Atenção Básica em Saúde sobre o TCV. A capacitação consistiu em um curso de quatro módulos com duas horas de duração cada, em que foram abordadas as temáticas da violência intrafamiliar, maus-tratos infantis, trauma craniano violento e estratégias de prevenção. Participaram do estudo 13 profissionais de Unidades Básicas de Saúde de um município do Estado de São Paulo. Os participantes foram divididos aleatoriamente em dois grupos: Grupo Experimental (GE) e Grupo Controle de Espera (GC), de modo que o delineamento para o GE foi pré-teste – intervenção – pós-teste – follow-up e para o GC foi pré-teste 1 – pré-teste 2 - pós-teste – intervenção. Para avaliação do conhecimento dos profissionais foi utilizado a Escala de Atitudes Frente ao Choro do Bebê. Ao final da avaliação, foi observado aumento do conhecimento dos participantes sobre as estratégias para lidar com o choro do bebê relacionadas ao bebê e ao cuidador e as características do choro do bebê nos primeiros meses de vida. Foi observada a manutenção do aumento de conhecimento sobre as estratégias para lidar com o choro relacionadas ao cuidador e as características do choro do bebê, sugerindo a efetividade da capacitação em aumentar o conhecimento dos profissionais sobre o TCV. / FAPESP: 2012/25234-1 / FAPESP: 2014/15300-2

Shaken baby syndrome (SBS) is one of the most violent forms of physical child abuse. In 2007, the State of Ohio enacted a health education mandate known as Claire's law. Claire's law requires all birthing hospitals to provide SBS education to mothers prior to their discharge. This law is the result of public demand and advocacy initiatives; however, it was not clear how the mandate was developed or whether or not the mandate and subsequent educational programs have had an impact on efforts to prevent SBS. The purpose of this qualitative case study was to explore the state of Ohio's processes involved in creating legislation to mandate SBS education. Data were collected through document reviews and interviews with SBS workgroup members (n = 5). The precede-proceed program planning model provided the conceptual framework to examine the participatory process involved in the development of the mandate from its beginning. The findings of the study showed that SBS workgroup members believed mandated education would affect SBS incidence and would ensure that mothers receive SBS education in Ohio hospitals during their birth experience. The findings also demonstrated a lack of a formal program planning methodology and no public inclusion in the development of the mandate or its required health education component. The state of Ohio has an additional means to ensure widespread education on SBS through the creation of this mandate. Statutory requirements provide opportunities for health professionals to educate the public on the effects of shaking a baby, resulting in a key implication for social change. Legislation focused on health education should be multifaceted and include varying layers of intervention.

The injuries happening to children in the household or during leisure time activities constitute the most frequent injury types. The injuries caused by shaking constitute a specific group. The information of lay public in the Czech Republic with regard of the Shaken Baby Syndrome is almost at zero level. The basic precondition to reduce the injury rate consists in identification of risk factors causing the origination of the injury or making the individual vulnerable. The factors include environment, health, behaviour, socio-demographic and social factors. The goal of the thesis consists in mapping children injuries in the household and during leisure time activities. A partial goal consists in mapping the use of protective devices for injury prevention. Another goal of the thesis consists in mapping the information of the parents on the Shaken Baby Syndrome, as well as in mapping the techniques of comforting crying babies and the related parents' feelings. The research method consists in quantitative prospective research; two structured questionnaires are used for data collection. The data collection took place in 2009-14. The first questionnaire is focused on acquisition of information on child injuries in the household and during leisure time activities. The goal of the study consists in analyzing children's injuries in ages from 0 to 18 years. The second questionnaire is focused on the Shaken Baby Syndrome and consists of several partial areas: child crying, techniques of managing and comforting child crying, parents' feelings and level of information on Shaken Baby Syndrome (SBS). Based on the research results, the approach to primary prevention of children's injuries can be improved by increased observation of the child, by increased efficiency of preventive procedures, by increased dispensarization, control or increased efficiency of implemented primary injury prevention.

Abstract {--} Shaken baby syndrome problems and prevention from retrospective nurse point of view The dissertation objective on the theme {\clqq}Shaken baby syndrome problems and prevention from retrospective nurse point of view`` is to process an entire literature and outline the shaken baby syndrome problem. Further to find out the shaken baby syndrome knowledge at nurses and parents by way of analysis and questionnaires evaluation. The third aim of this thesis was to develop the simple educational material for the parents within this work. To meet these objectives the dissertation is divided into theoretical and practical parts. The theoretical one devotes to entire available literature processing related to shaken baby syndrome. The practical part focuses on the quantitative knowledge extent finding out at nurses and parents referring to shaken baby syndrome above all and concentrates on the parents education from nurse side, especially in the field of the baby cry as the main shaken baby syndrome initiator. The data of the quantitative research part have been learned by means of questionnaire disquisition. There were used two kinds of questionnaires, the first for nurses and the second one for parents and home nurses. Both of them were anonymous. The simple developed information material for parents concentrating mainly on correct ways of cry soothing related to shaken baby syndrome is the part of results. Three hypothesises have been set for work needs. Hypothesis 1 {\clqq}There are many sources of the professional literature concerning shaken baby syndrome in the Czech Republic`` hasn´t come true. Hypothesis 2 {\clqq}The parents and health workers knowledge about shaken baby syndrome is wanting`` has come true. Hypothesis 3 {\clqq}Shaken baby syndrome primary prevention doesn´t exist in the Czech Republic`` has also come true. The nurses and parents poor knowledge about the shaken baby syndrome was the important fact found out within research disquisition. With respect to serious consequences of shaken baby syndrome which can be sometime fatal for children there is a need to meet nurses this syndrome and enable them to be familiar with recognition and determination of the shaken baby syndrome risk factors both from the parents and children side. Thus this work could also serve as a source of more information about mentioned problems. The developed information material for parents could have another utilization during their care of child.

Made available in DSpace on 2016-06-02T20:30:55Z (GMT). No. of bitstreams: 1 4979.pdf: 1038551 bytes, checksum: 709a439c826b0d6630ae64c9c4187eb8 (MD5) Previous issue date: 2013-02-07 / Universidade Federal de Sao Carlos / This dissertation is a compendium of four scientific papers. Each paper describes a stage of the study, with the final goal of evaluating the effectiveness of different materials to increase parents knowledge on abusive head trauma. The first paper describes a review of national and international literature, which aimed to give a current overview of abusive head trauma (AHT). According to the review, AHT can be defined as injury to the skull and intracranial contents to a child due to a sudden unintentional impact and/or a violent shaking. It occurs mainly with babies and children under 1 year of age and can result in serious consequences for children's development, including death. Although there are specific signs for this type of abuse, it can be mistaken for common child illnesses or accidental head trauma. Thus, it is essential that health professionals are trained for the correct diagnosis. One of the main factors associated with its occurrence is the baby crying, which highlights the need for intervention with parents in order to teach them about child development and safe strategies to deal with the baby. The second paper aimed to investigate the knowledge of newborn parents about some characteristics associated with AHT, such as the pattern of the infant crying in the first months of life, strategies to deal with the crying baby and the consequences of shaking a baby. The results indicated a lack of knowledge about the severity of shaking a baby, as well as a possible Brazilian belief that babies should not be left crying alone. In this sense, there is a need for these issues to be addressed in AHT prevention efforts. The third paper aimed to investigate the belief of Brazilian parents about corporal punishment to infants, and its possible relation with abusive head trauma. As opposed to the international literature, participants of this study did not consider shaking as an appropriate strategy to discipline the baby, agreeing more with this strategy when it aimed to sooth the baby. Furthermore, the results indicated that the caregivers evaluation about the strategy s harm potential seems to influence its adoption in discipline and soothing contexts. Finally, the last paper describes the evaluation of the effectiveness of three different informational materials to increase knowledge of Brazilian parents about this type of abuse. The materials consisted of a video on abusive head trauma, a pamphlet individually read on the AHT, and a video on child safety, unrelated to AHT and used for comparison purposes. The results suggest that reading the pamphlet could be a useful strategy in prevention programs, since it increased participants' knowledge about the severity of shaking a baby, as well as the likelihood of using strategies to distance themselves from the baby when stressed by the crying. Although less significant, the results of the group who watched the video on the AHT also indicated an increase in knowledge about the average number of daily hours of baby crying. It is hoped that the results found in this dissertation will guide future AHT preventive efforts in Brazil. / A presente dissertação foi escrita no formato de um compêndio de quatro textos científicos. Cada artigo descreve uma etapa do estudo, que teve como objetivo avaliar a eficácia de diferentes materiais informativos para aumentar o conhecimento de pais de recém-nascidos sobre o trauma craniano violento pediátrico. O primeiro artigo descreve uma revisão da literatura nacional e internacional, que teve como objetivo traçar um panorama atual do trauma craniano violento (TCV). De acordo com a revisão, o TCV pode ser definido como a lesão ao crânio ou ao conteúdo intracraniano de uma criança devido a um impacto brusco intencional e/ou a uma sacudida violenta. Ocorre principalmente com bebês e crianças menores de 1 ano de idade e pode resultar em consequências graves ao desenvolvimento infantil, incluindo a morte. Apesar de haver sinais específicos para esta forma de maus-tratos, eles podem se confundir com doenças comuns em crianças ou traumas cranianos acidentais. Deste modo, torna-se imprescindível o preparo clínico dos profissionais de saúde para o diagnóstico correto. Um dos principais fatores associados à sua ocorrência é o choro do bebê, destacando a necessidade de intervenção com pais no sentido de ensiná-los sobre desenvolvimento infantil e estratégias seguras para lidar com o bebê. O segundo artigo visou investigar o conhecimento de pais de recém-nascidos sobre algumas características associadas a esta forma de maus-tratos, tais como o padrão do choro do bebê nos primeiros meses de vida, as estratégias para lidar com o choro e as consequências de sacudi-lo. Os resultados indicaram um desconhecimento dos participantes sobre a gravidade de se sacudir um bebê, bem como uma possível crença brasileira de que os bebês não devem ser deixados chorando sozinho. Neste sentido, destaca-se a necessidade dessas questões serem contempladas nas ações de prevenção do TCV. O terceiro artigo objetivou investigar a crença de pais brasileiros sobre a punição corporal em bebês e sua possível relação com o trauma craniano violento. Diferentemente do que aponta a literatura internacional, os participantes do presente estudo não consideraram o sacudir como uma estratégia adequada para disciplinar o bebê, obtendo maior concordância quando avaliada em seu potencial tranquilizador. Além disso, os resultados indicaram que a avaliação que os cuidadores fazem do potencial prejudicial de determinada estratégia parece influenciar sua adoção no cuidado com o bebê, tanto para acalmá-lo, quanto para discipliná-lo. Por fim, o último artigo descreve a avaliação da eficácia de três materiais informativos diferentes para o aumento do conhecimento de pais brasileiros sobre essa forma de maus-tratos. Os materiais consistiram em um vídeo sobre o trauma craniano violento, um panfleto sobre o TCV e um vídeo sobre segurança infantil, que não abordava o TCV e foi utilizado como comparação. Os resultados sugerem que o e leitura individual do panfleto pode ser uma estratégia útil em programas de prevenção, uma vez que a mesma aumentou o conhecimento dos participantes sobre a gravidade de sacudir um bebê, bem como a probabilidade de utilizarem estratégias de se afastar do bebê, quando estressados pelo choro. Apesar de menos expressivos, os resultados do grupo que assistiu ao vídeo sobre o TCV também indicaram um aumento no conhecimento sobre o número médio diário de horas de choro do bebê. Espera-se que os resultados encontrados na presente dissertação possam fornecer embasamento para futuras ações de prevenção dessa forma de maus-tratos.