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Law aims to protect children from SBS by Heather Woolwine Public Relations Imagine an egg inside a glass jar. Someone picks up the jar and shakes it for a few seconds. In a short time, the egg’s thin protective membrane would burst and the yoke would be mixed from slamming into the jar walls.   When a person shakes a baby, the result is similar in terms of what can happen to the brain. It could happen to any family and with deadly consequences.   Shaken baby syndrome (SBS) is the leading cause of head injury in small children in the United States. To combat the syndrome, some states have passed legislation requiring hospitals to provide patients with education materials concerning the dangers of shaking a child, how to prevent it from happening, and how to communicate with other caregivers so children are fully protected from SBS’s devastation.   Gale Horinbein, MUSC social worker and SBS Prevention Project coordinator, has seen firsthand the way young lives are forever affected from one devastating mistake.   “This is just something that I feel very strongly about, and the statistics from other states and hospitals suggest that an educational, one-on-one approach to providing this information can dramatically reduce the number of head injuries that are related to shaken baby syndrome,” she said. “It really wasn’t a question of if we should do it, but how we were going to make it happen.”   Horinbein has spent much of her personal time writing a proposal for a grant to fund the first year of the project. Her proposal was funded in May 2006. Horinbein believes it may be the only SBS inpatient education program in South Carolina.   Meanwhile, she has found a supporter in Sue Rex, state superintendent of education's Jim Rex’s wife. In fact, Sue was instrumental in getting ETV to air a special on shaken baby syndrome that aired in April. The panel for this TV special included  the bill’s sponsor in the state legislature, Sen. Gregg Ryberg (R-Aiken), and Horinbein and Oscar Lovelace, M.D.  Ryberg was also instrumental in getting legislation to the state house where the House of Representatives passed a bill that would require all hospitals to provide SBS education to parents prior to discharge from the hospital.   The SBS bill passed the Senate and became law in early June. It will go into effect statewide Jan. 1.   Deborah West, R.N., nurse educator, and June Stovall, R.N., nurse manager for Postpartum, Newborn and Special Care nurseries, implemented the program in late May on 5 East. The goal of the project is to educate every parent of every child born at MUSC about SBS before the family leaves the hospital. Participation currently is voluntary, and the project is administered via intimate discussion with an emphasis on reaching both mother and father, as men are more often the perpetrators of SBS.   “One benefit of the way we are delivering the information is by doing so separately from all of the other information that parents receive, so hopefully we are able to emphasize the importance of understanding and preventing shaken baby syndrome,” Horinbein said. In addition to printed materials and discussion, patients may also view a video depicting the stories of three children who were victims of SBS. Hispanic patients may view a Spanish version and can attain materials in their primary language. What happens? Young babies (6 months or less) are most vulnerable to the effects of SBS because of weak neck muscles, a large head to body ratio, and an undeveloped brain. Toddlers and other young children can suffer from SBS, too. No matter what age, shaking a child is child abuse, and people who do it may find themselves facing criminal charges and arrest.   When a baby is shaken, the child’s head whips back and forth, unsupported, and causes the brain to slam against the skull repeatedly. In a few seconds, the sudden impact can prompt bleeding in the brain, spinal cord injuries or damage to the retina. Shaken children can suffer a variety of horrible outcomes, including severe brain damage, blindness, paralysis, seizures, fractures or death.   Horinbein and others who support SBS awareness also strive to educate parents about choosing an appropriate caregiver for their child. Project materials recommend that parents openly discuss SBS with potential caregivers before leaving a child in someone else’s care. Specifically, parents should determine a caregiver’s knowledge about SBS and provide needed information. Caregivers should be familiar with what can happen if a baby or small child is shaken. Parents can further prevent SBS by offering a phone number so the caregiver can call if he or she becomes frustrated, and to secure an additional contact in case parents cannot be reached. If the caregiver continues to be unsuccessful, parents should assure caregivers that placing a child in a safe place such as a crib, leaving the room, and then checking on the child periodically is acceptable.   Any adult who has cared for a child can relate to becoming frustrated when a child is continually crying or distressed. Crying is an infant’s way of communicating that he is hungry, tired, needs to be held, is uncomfortable, has something in his eye, is feeling pain, needs burping, or is sick. Responding to the basic needs of a small child or infant will not spoil him. If feeding, changing a diaper, burping, or holding a child won’t stop his crying, parents and caregivers are encouraged to try taking a walk with him and checking his comfort level. If there are signs that a child may be sick, call a health care provider for advice. Sometimes nothing works, and a child simply will not stop fussing. Never does this indicate that a baby is angry or disrespectful, or that a parent is failing. When the situation escalates beyond simple frustration, Horinbein said it’s the time to take a step back.   “Place the baby in a safe place and leave the room momentarily. Take a few minutes to watch a little TV or call a friend to vent, or request that they relieve you, because things are getting to be too much,” she said. “It’s also a good idea to talk to a pediatrician about colic and see if that may be something the child is dealing with, as one of its major symptoms is persistent and unexplained crying.”   Previous studies have suggested that about a half of parents and adolescents are not aware of the dangers of violent infant shaking.   “We believe parents are their child’s best protectors. By educating parents, they can then be advocates to teach those who care for their children about the dangers of SBS,” Horinbein said.   Parents and caregivers may also call a hotline that provides support and tries to deter violence toward children at 800-422-4453.   For more information about the project, contact Horinbein at 792-2975, or e-mail horinbeg@musc.edu. Shaken baby syndrome signs and symptoms can include: Lethargy or decreased muscle tone Extreme irritability Decreased appetite, poor feeding or vomiting for no reason No smiling or vocalization Poor or no sucking or swallowing Rigidity or posturing Difficulty breathing Seizures Larger than usual head or forehead soft spot bulges Inability to lift head Inability to focus or track movement with eyes or unequal pupils Facts about shaken baby syndrome Shaking an infant can cause bleeding in the child's brain and eyes, and massive brain swelling. The injuries of shaken baby syndrome occur when a child is violently shaken. Every day handling of a baby, playful acts or minor household accidents do not cause the forces necessary to create these injuries. Shaking injuries are not caused by: bouncing a baby on your knee; tossing a baby in the air; jogging or bicycling with a baby; falling off furniture; sudden stops in a car or driving over bumps. For information, visit http://www.dontshake.com     Friday, June 15, 2007 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.