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What types of cases does the Child Protection Team at Children’s consult on?
We consult on cases of suspected child abuse and neglect; cases that may involve accidental injury, severe inflicted injury, chronic medical neglect, psychological abuse, domestic violence, sexual abuse and substance abuse.
The make-up of cases that we see generally reflects the national statistics around the distribution of types of child abuse–meaning that roughly 50 to 60 percent of cases we see involve neglect issues, about 20 percent involve some form of serious physical abuse, 10 percent involve sexual abuse and the remainder of cases consist of other types of abuse including more rare conditions like Munchausen syndrome-by-proxy.
What age are the children you see?
Abuse and neglect most frequently happens with younger children - infants through 4 or 5 years of age. However, children of any age are vulnerable to maltreatment by caregivers. At Children’s our team sees children from birth to age 18, and provides services to individuals and young adults that have psychiatric or medical conditions that require their ongoing care into adulthood.
What is shaken baby syndrome?
Shaken baby syndrome (SBS), also known as inflicted traumatic brain injury (ITBI), describes a set of injuries that happen when a child is violently shaken by an adult. These injuries can include bleeding around the brain (called subdural hemorrhage), bleeding in the back of the eyes (called retinal hemorrhage), and, most importantly, injury to the brain itself, both from direct trauma and from a lack of breathing that can occur after a baby is shaken, which leads to poor oxygen flow to the brain. With SBS, children can–but don’t always–have external signs of trauma, such as bruising. Some children may also have fractures.
What types of injuries can result from shaking a baby?
Injuries can range from mild to severe. Some children can initially appear to be mildly injured and can have symptoms of vomiting or sleepiness. Most children have more severe symptoms, including seizures, difficulty breathing or respiratory arrest. Sadly, SBS can also result in the death of a child. Even if the initial presentation seems mild, SBS can have long-term developmental and cognitive effects.
How often is SBS fatal?
SBS is fatal in about 20 percent of children who qualify for the diagnosis. The majority of children who survive are left with major deficits including blindness, seizure disorders, cerebral palsy and intellectual and learning disabilities.
How hard would you have to shake a baby to cause damage?
The type of injury that leads to SBS occurs from a violent act of shaking. It is not a form of handling a child that anyone would construe as normal. It can happen very quickly, but it involves a child being very violently shaken.
Is there a typical demographic associated with SBS?
SBS occurs in every type of family and setting, ranging from families who are poor to families who are well-off, families who have clear risk factors to families who have no apparent risk factors. Its pervasiveness is one of the reasons that a universal prevention strategy is currently being adapted by the state of Massachusetts, where every parent is going to be educated about the risks of SBS and about how to care for a child who’s crying inconsolably.
Legislation was passed by the state in 2006 that requires that birthing hospitals provide education to every parent of a newborn, regardless of whether it is their first, second, third child, etc. This is beginning to happen now in all birthing hospitals across the state.
Children’s is not a birthing hospital, so we are not required by law to provide this education. However, we are providing education for parents of infants and children under the age of 1. We expect that all parents with children coming to us from birthing hospitals will have received this education prior to discharge, but in providing it ourselves, we know we won’t be missing any of these families and will be reinforcing messages around coping with infant crying, normative crying behavior, soothing techniques and coping strategies for parents, some of which include accessing informal social supports, formalized social supports and reaching out to pediatricians.
Have you seen an increase in SBS in the difficult economy?
Unfortunately, there does seem to be an increase, although it’s too soon to tell whether it’s statistically significant. Here at Children’s, over the three-month period beginning in December 2008–a time where we saw an increase in economic hardship–we saw nine cases of SBS. It is typical for us to only see about one case a month, so we essentially saw a threefold increase in that time period compared to last year.
Can you give some tips to help soothe a crying child?
Every child is different, and over the course of development, what helps soothe a crying child may change.
Some of the techniques we suggest include rocking or making shushing noises comparable to those that occur in the womb. For very young infants, swaddling or holding a child close can help. We also suggest running a vacuum, turning on music, or creating a change of environment –taking the child for a ride in the car or for a walk. Sometimes intervening with these simple methods, and doing common sense things like checking to see if baby is wet, hungry or tired will help.
Other times you may try all these things and the baby will continue to cry. It’s important that parents know that crying is normal infant behavior. Once you’ve ruled out sickness, hunger and tiredness, and have attempted soothing techniques, it’s okay to put a baby down in a crib or safe place and take a break, then go back to attempting to soothe and console the child once you’ve taken the opportunity to gather yourself and hopefully take advantage of the supports you have in place.
What should parents always keep in mind?
Take care of yourself, remember to get enough sleep and increase your social supports. Recognize that crying is a normal infant behavior and that it can be extremely stressful. Don’t blame yourself if your child cries; it doesn’t mean you’re a bad parent. Don’t take it personally. Reach out to people when you need help, get the support you need and give yourself permission to take a break. For people with limited social support we suggest calling the Parents Helping Parents stress line - it’s available 24 hours a day. Since crying can happen at all hours, including when typical support systems are not accessible, this can be a great place to turn to.
Can family/friends help prevent abuse?
Family and friends of parents with young children can play an integral role. We suggest that they realize the stress of caring for young children is universal and that every family can benefit from an offer of support in the way of giving a break, coming over and being another pair of hands or giving supportive messages that normalize the stresses of care giving. While these emotions are shared by all parents, they often feel quite guilty about their anxiety and can feel inadequate when they begin to stress over their child’s crying. Hearing from friends and family that it’s normal, that it’s okay, and that people are there to be supportive can be a great stress reducer. |
