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Hospitals teach parents when to put that baby down

Courtesy photo
As part of an effort to teach adults about infant crying associated with shaken baby syndrome, volunteers in several Canadian provinces and states, including West Virginia, are knitting purple infant caps to distribute to new babies this fall (clickforbabies.org).

A baby was recently brought to CAMC Women and Children's Hospital with a head injury. It looked like shaken baby syndrome.

It was, said Dr. Joan Phillips. The dad confessed. He had about every risk factor doctors have identified. He was young. He was unemployed and was looking after three children, all under age 3, while the mom went to work.

The baby survived. Foster parents say he is doing well. "Cognitively down the road, is he going to be able to read and count in first grade? We don't know," Phillips said.

Between 2006 and 2009 about one in every 2,000 infants in West Virginia was injured or killed when a caregiver lost patience and shook them, according to Dr. James McJunkin, another CAMC pediatrician. He and colleagues Charles J. Mullett of WVU and Ed Pino at Marshall University found the rate of shaken babies has more than doubled compared to 1999 through 2005.

Of the 95 cases they found, 12.5 percent of the babies died, and 35.5 percent lived but with poor outcomes. Babies who survive may suffer loss of sight, seizure problems, developmental delays and mobility problems throughout life.

The peak time of injury is about eight weeks, right about the same time many babies develop what used to be called colic -- long, inconsolable spells of unexplained crying.

"It was an eye-opener," Phillips said of the research.

Members of the West Virginia Academy of Pediatrics have organized efforts at four hospitals to teach adults about crying and how to avoid losing their cool and injuring a baby. Nurses at each hospital talk to new parents about the Period of PURPLE Crying.

Purple crying?

"PURPLE" is an acronym to help people remember the characteristics of this particular type of crying:

• Peak -- Crying often peaks at about two months old.

• Unexpected -- Crying may start and stop for no apparent reason.

• Resists soothing -- Babies may keep crying no matter what you do.

• Pain-like face -- Babies look like they're in pain, even when nothing is wrong.

• Long-lasting -- Babies may cry five hours a day or more.

• Evenings -- Babies tend to cry more during late afternoons or evenings.

The hospitals -- CAMC, Cabell Huntington, Ruby Memorial and Davis Memorial -- send parents home with a DVD and booklet they can review and share with others. Then in a few weeks, parents get another reminder from primary care doctors, and Right from the Start and Birth to Three programs.

"The idea is to understand the crying and that it is a trigger to shaking a baby," Phillips said.

Many babies have long bouts of crying. It's a phase that has been observed in all cultures and even in other animals, Phillips said. "You're not doing anything wrong. You're not a bad parent." And, it will pass.

Once you understand that, then you make a plan. Phillips makes it sound like any other emergency plan, like knowing how to get out of a building in case of a fire.

"In the moment it is very difficult to think," Phillips said. So ask yourself in advance: Who is the person in my life I can call at 11 p.m. and it's OK? Then when you feel like you're at the end of your rope, call them.

Don't worry about whether it is too late or whether you are disturbing anyone, she said. "Just call them."

Parents should also identify in advance what they will do to calm themselves. Then, if all else fails, and you cannot soothe a baby, put the baby down in a safe place and walk away. Take a shower or put your headphones on for 15 minutes, she said.

"A baby has never died from crying, but they have from shaking," Phillips said. "It's OK to put the baby down in a safe place and walk away. We're not taught that."

Extended family

Friends and family can help, too. And they, along with other child care providers, need to know about the risks of shaking babies.

"For the first few weeks, we shower these parents with attention and casseroles and then we assume mom's recovered and everything's fine," Phillips said. But that's when both the crying and the injuries peak.

Stick close to friends or co-workers, Phillips suggests. "It's not just 'How are you? Call if you need me.' Stay connected enough that you can sense when somebody is at the end of their rope."

In British Columbia, knitters started another aspect of the campaign -- making purple caps to give to newborns in hospitals. The effort has spread to a dozen states and provinces, including West Virginia. Clickforbabies.org offers patterns, instructions, contacts and yarn suggestions. Hospitals collect the caps all summer and give them to babies during cold weather. The only real rules are that each cap must be at least half purple and have no pom-poms or other choking hazards. They particularly need boy friendly caps.

It's a wonderful grassroots effort, Phillips said, because volunteers in their knitting clubs or other groups learn about preventing shaken baby syndrome and spread that knowledge in their communities. Then a cap goes home on a baby as a visible reminder to parents and family.

In West Virginia, the four hospitals spreading the Purple crying message account for about 20,000 births a year, about a third of the births in the state. Greenbrier Valley Medical Center, which also collects purple caps, and St. Joseph's Hospital in Buckhannon were already offering their own education efforts for new parents. Wheeling Hospital is interested in joining, and two other hospitals have inquired, Phillips said.

Because of these efforts, within a few years, Phillips hopes McJunkin and his colleagues will be able to measure a drop in the number of babies who suffer abusive head trauma. In New York, a similar campaign led to a 47 percent drop in shaken baby syndrome over five years.

Miller, the Gazette's editorial page editor, can be reached at dawn@wvgazette.com.


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