Preventing Abusive Head Trauma in Children

It’s not just a crime, it’s a public health issue.

What Is Abusive Head Trauma?

Abusive head trauma (AHT), which includes shaken baby syndrome, is a preventable and severe form of physical child abuse that results in an injury to the brain of an infant or child.  AHT is most common in children under age five, with children under one year of age at most risk. It is caused by violent shaking and/or with blunt impact.³ The resulting injury can cause bleeding around the brain or on the inside back layer of the eyes.

Nearly all victims of AHT suffer serious, long-term health consequences such as vision problems, developmental delays, physical disabilities, and hearing loss. At least one of every four babies who experience AHT dies from this form of child abuse.³

Research shows that AHT often happens when a parent or caregiver becomes angry or frustrated because of a child’s crying. The caregiver then shakes the child and/or hits or slams the child’s head into something in an effort to stop the crying.

Crying—including long bouts of inconsolable crying—is normal behavior in infants. Shaking, throwing, hitting, or hurting a baby is never the right response to crying.

How Can Abusive Head Trauma Be Prevented?

You can play a key role in preventing AHT by understanding the dangers of violently shaking or hitting a baby’s head into something, knowing the risk factors and the triggers for abuse, and finding ways to support parents and caregivers in your community. CDC’s technical package for preventing child abuse and neglect [PDF 3.90MB] identifies a number of strategies to help states and communities prioritize prevention activities based on the best available evidence.

If you are a parent or caregiver

• Understand that infant crying is worse in the first few months of life, but it will get better as the child grows.
• Try calming a crying baby by rocking gently, offering a pacifier, singing or talking softly, taking a walk with a stroller, or going for a drive in the car.
• If the baby won’t stop crying, check for signs of illness and call the doctor if you suspect the child is sick.
• If you are getting upset or losing control, focus on calming yourself down. Put the baby in a safe place and walk away to calm down, checking on the baby every 5 to 10 minutes.
• Call a friend, relative, neighbor, or parent helpline for support.
• Never leave your baby with a person who is easily irritated or has a temper or history of violence.

If you are a friend, family member, or observer of a parent or caregiver

• Be aware of new parents in your family and community who may need help or support.
• Provide support by offering to give a parent or caregiver a break when needed.
• Let the parent know that dealing with a crying baby can be very frustrating—especially when they are tired or stressed, but infant crying is normal and it will pass.
• Encourage parents and caregivers to take a calming break if needed while the baby is safe in the crib.
• Be sensitive and supportive in situations when parents are trying to calm a crying baby.
• Be supportive of work policies (e.g., paid family leave) that make it easier for working parents to stay with their infants during the period of increased infant crying (i.e., between 4-20 weeks of age).⁵

Where Can I Find Additional Resources on Abusive Head Trauma?

Pediatric Abusive Head Trauma: Recommended Definitions for Public Health Surveillance and Research[PDF 1.6MB]
This publication improves the quality and consistency of data collected on abusive head trauma in children. It provides a definition of abusive head trauma and presents recommended data elements for use by individuals and organizations. The document is designed to aid in the collection of surveillance data and is intended to promote and improve consistency of abusive head trauma surveillance for public health purposes.

CDC/Medscape Expert Commentary. Shaken Baby Syndrome: Making the Diagnosis (Video)
(Free login required through Medscape to view the video)
Video provides expert commentary on shaken baby syndrome, the diagnostic indicators used to identify infants who have been shaken, and ways to prevent this tragic form of child abuse. The video is part of a collaboration between CDC and Medscape, designed to deliver CDC guidance directly to healthcare professionals.

Preventing Child Abuse & Neglect: A Technical Package for Policy, Norm, and Programmatic Activities [PDF 3.69MB]
CDC’s technical package for preventing child abuse and neglect identifies a number of strategies to help states and communities prioritize prevention activities based on the best available evidence. These strategies range from a focus on individuals, families, and relationships, to broader community and societal change.

Preventing Shaken Baby Syndrome: Guide for Health Departments and Community Based Organizations [PDF 2.46MB]
This guide can help your organization identify your role and take action to protect infants from shaken baby syndrome, also known as abusive head trauma. The guide offers information on building a framework for prevention, getting the message out, building partnerships, and impacting policy. Together with local and national partners, your organization can make a difference in prevention.

Journalists’ Guide to Shaken Baby Syndrome: A Preventable Tragedy [PDF 733KB]
This guide gives journalists and other media professionals access to the pertinent background and resources needed to effectively cover the story of shaken baby syndrome as a public health issue. The guide provides tips for parents and caregivers on coping with a crying baby, reinforces that crying is a normal part of infant development, and educates parents and caregivers on ways to calm down when frustrated or pushed to the limit by a crying baby.

Downloadable PSAs

Radio PSAs focused on parents and caregivers (in English and Spanish)

• Coping with Crying 1 PSA (:30)
• Coping with Crying 2 PSA (:30)
• Coping with Crying 3 PSA (:30) 
• Coping with Crying 4 PSA (:30)
• Qué hacer cuando el bebé llora 2 PSA (:30) (Coping with Crying 2)
• Qué hacer cuando el bebé llora 3 PSA (:30) (Coping with Crying 3)

References

1. Klevens J, Leeb R, Child maltreatment fatalities in children under five: Findings from the National Violent Death Reporting System. Child Abuse Negl. 2010; 34(4):262-266.
2. Palusci VJ, Covington, TM. Child Maltreatment Deaths in the U.S. National Child Death Review Case Reporting System. Child Abuse Negl. 2014; 38:25-36.
3. Barr RG, Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers. Proc Natl Acad Sci. 2012;109(Suppl2):17294-17301.
4. Keenan HT, Runyan DK, Marshall SW, Nocera MA, Merten DF, Sinal SH.  A population-based study of inflicted traumatic brain injury in young children. JAMA. 2003; 290:621–626.
5. Klevens J.,Luo F, Xu L, Peterson C, Latzman N. Paid family leave’s impact on hospital admissions for pediatric abusive head trauma. Inj Prev. Published online first: February 11, 2016. doi injuryprev2015-041702.