Shaken Baby Syndrome among most tragic forms of child abuse

While most parents don't believe they could ever harm their child, each year, more than 900,000 cases of suspected child abuse are investigated nationally.

Even more alarming, the number of children in the United States who die from neglect or abuse each year in most states ranges from two to three per 100,000, according to estimates from the U.S. Department of Health and Human Service -Administration for Children and Families. This equates to 50 child deaths in Missouri, based on 2007 numbers.

At SSM Cardinal Glennon Children's Medical Center in St. Louis, Timothy Kutz, M.D., director of the Child Protective Division, heads a team of professionals who after evaluation and treatment had reported over 1,000 suspected cases of child abuse and neglect to authorities over the past two years.

Kutz notes that child abuse has occurred throughout the ages. He has reviewed medical references from the 1800s, but he adds that during times of stress -- such as economic hardship -- cases tend to increase, particularly in homes where parents are under stress.

Child abuse can take different forms, including neglect, emotional abuse, sexual abuse and physical abuse. The latter includes "Shaken Baby Syndrome", which can be among the most tragic of cases.

Kutz explains that SBS is a form of head trauma. When someone forcefully shakes a baby to get the infant to stop crying, the child's head rotates uncontrollably because infants' neck muscles are not able to protect against such extreme forces.

Kutz says studies find that most cases of SBS are perpetrated by male caregivers -- usually the father, but sometimes by an unrelated adult, such as the mother's boyfriend. He adds that one step to reduce the risk of abuse is for parents to never leave a child in the care of anyone who has shown aggressive tendencies, such as angry outbursts or hitting other family members or even pets.

It's no surprise to experienced parents, but caring for an infant can be very stressful, Kutz continues. He notes that most babies cry periodically throughout the day --sometimes totaling as much three to five hours.

"New parents sometimes are not prepared for the negative aspects of caring for babies. They think about the positives, but crying is one of the negatives, but of course babies cry to get parents' attention when they are hungry or wet -- but sometimes just to be consoled."

Caregivers who lack skills to console and care for a crying infant -- as well as parents who may not have adequate support from other adults -- are at greatest risk of resorting to shaking or other forms abuse, Dr. Kutz notes. But he emphasizes that shaking an infant can cause permanent physical injuries.

"When we evaluate infants who have been shaken, they have three main sets of injuries: They have bleeding or injury within their heads; they have bleeding within their eyes and also can have broken arms, legs and ribs."

The average age of SBS is between 3 and 8 months, although this type of abuse is occasionally seen in children up to 4 years old.

Kutz notes that, sadly, shaking a baby to get it to stop crying actually has the desired effect initially. He explains that it interferes with how the brain functions, but subsequently can result in severe trauma and permanent disability, such as blindness, mental retardation and death.

How can parents and the public reduce the risk of SBS? Kutz says one step is for parents to recognize their limitations and to seek help. If there are no extended family members -- grandmothers often are the best resource -- mothers may need to call on service agencies, their church or even a fellow neighbor mother to ask for some help.

In some communities, crisis nurseries exist where mothers with nowhere else to turn can drop off an infant for temporary care.

New parents also should learn all they can about techniques to calm a crying baby. These including using white noise such as a fan or vacuum cleaner; swaddling a baby by wrapping it snugly in a blanket for security; and gentle rocking or using a bouncy seat.

Of course for incessant crying, parents should consider whether the baby's needs are being met -- perhaps the infant is hungry or needs to be changed -- and check for a fever. But if a baby then continues to cry and parents feel overwhelmed, Dr. Kutz says it's also OK to for parents give themselves a "time out."

Doctor Kutz explains that a crying baby who apparently cannot be consoled by weary parents can be placed in a safe area for a brief period -- perhaps five to 10 minutes -- while the parent goes to the next room or just outside.

"Put the baby on the floor, in a car seat, or in their crib -- but not up on a table or something elevated where they might fall. Then, get away for five or 10 minutes or whatever the parent feels is a safe interval -- getting away from the situation that's so frustrating."

Foremost, Dr. Kutz emphasis, it's simply never okay to strike or shake an infant. In some families, parents may choose to swat an older child's behind as a way of discipline. Dr. Kutz finds this worrisome as it can lead to additional physical force, but he says infants simply must never be hit or shaken.

Parents also should learn all they can about child growth and development, Dr. Kutz continues, noting that some cases of abuse in toddlers result from parental frustration over issues such as tantrums and toilet training -- their stress reduced by knowing what's reasonable at certain ages.

While parents have a big responsibility, Dr. Kutz encourages neighbors or bystanders who have concerns about potential abuse to get involved.

Hotlines to anonymously report abuse operate 24 hours a day. The National Child Abuse Hotline is 800-4-A-Child (1-800-422-4453). In Missouri, citizens also can call 800-392-3738 (Missouri Division of Family Services); in Illinois, 800-252-2873 (Department of Children and Family Services.). Citizens can call 911 or local law enforcement as well.

Members of the public also can help simply by being more supportive of parents -- recognizing that it's a big job. Dr. Kutz notes that many people have had the experience of seeing a parent trying to manage a crying baby or toddler having a tantrum in a grocery or mall.

"It's sometimes a good idea to walk over; not being confrontational but saying something like, 'Looks like you've got your hands full. Can I help?'"

April is designated as Child Abuse Awareness, making it a good time for parents and the public to learn more. There are many resources online. One good source about parenting, as well as links to more sites with information about prevention child abuse can be found at www.cardinalglennon.com.