Researchers invited to evaluate a UK program that aims to prevent shaken baby syndrome say the study offers insights that could inform support strategies for Australian parents and carers struggling with the stress of crying babies.
Abusive head trauma (AHT) in infants – more commonly known as shaken baby syndrome – is a leading cause of head injuries in children under 12 months of age, with male caregivers the primary perpetrators.
Almost a quarter of cases result in death, with 80 per cent of survivors suffering lifelong neurological impairment.
In the UK there are 20-24 cases per 100,000 babies per year, while Australian data suggests an annual rate of around 30 cases per 100,000 babies.
Researcher Dr Julie Brose, from The University of Western Australia and the Perron Institute, said AHT most commonly occurred within the first six months of life, with infant crying typically peaking between four and eight weeks of age.
In 2018, the first Clinical Commissioning Group in the UK's National Health Service introduced ICON, a public health initiative aimed at preventing AHT by providing targeted education for new parents.
Delivered by healthcare professionals at five separate touchpoints following the birth of a child, the program aims to normalise crying as part of infant development and provides strategies for parents.
"Importantly, ICON helps parents cope with crying, gives them permission to put their baby down when overwhelmed and reinforces the message to never, ever shake a baby," Dr Brose said.
Dr Brose was part of a team of researchers, led by Dr Mark Lyttle, who evaluated ICON for the UK's National Institute for Health and Care Research to identify whether the program reduced the incidence of AHT, and assess factors influencing the initiative's effectiveness.
The team interviewed healthcare professionals tasked with delivering the program – including midwives, child health nurses, GPs and managers – as well as new parents who had taken part.
In the first of two papers published on the evaluation, the researchers found the program resonated strongly with parents – particularly the reassurance that it was okay to walk away in moments when they may be 'seeing red'.
"Parents really appreciated that reassurance that crying is normal and being given tools to cope," Dr Brose said.
"Overall, we found most parents retained and acted on the messages and strategies provided by the program."
However the paper, published in BMC Public Health, noted ICON was being delivered overwhelmingly to new mothers, who were then expected to pass the information on to their partners.
"This delivery gap meant fathers and other carers were often excluded from direct education," Dr Brose said.
"It also placed added responsibility onto mothers, potentially exacerbating maternal stress at a time when they were already juggling the transition to and demands of motherhood.
"Given fathers and other male caregivers are the primary perpetrators of AHT, any educational prevention program for AHT must engage these carers as well."
In a second paper, published in the journal Child Abuse & Neglect, the researchers reported that healthcare professionals were willing and able to deliver ICON messages to new parents but required training and time to do so.
"Some professionals worried about bombarding new parents with information but overall, despite some challenges in implementation they saw it as a valuable tool – particularly those who had had prior experience with AHT," Dr Brose said.
"One midwife told us: 'It really makes you reflect on how very important it is to get the message across, because that few seconds of anger has resulted in a lifetime's regret'."
Both parents and professionals said improvements could include enhanced training, more tailored approaches to meet diverse family needs and concerns, and an after-hours phone helpline – suggestions the team will include in a raft of recommendations to the NHS.
Dr Brose now hopes to explore how a similar approach could help Australian parents.
"The ICON model demonstrates how structured, multi-touchpoint education can empower families and reduce risk, highlighting a potential pathway for improving infant safety and parental wellbeing in the Australian context," Dr Brose said.
