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Hot Topic 2: Post Natal Education Program Impact on Abusive Head Trauma

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Review:
(R. Miller) Abusive head trauma is the leading cause of death related to physical abuse. There are numerous prevention programs and projects nationally. However, there is little supporting data to determine the effectiveness of these programs. The purpose of this paper is to assess the effect of statewide abusive head trauma (AHT) education for parents on AHT hospitalization rates in one state and on parents’ self-reported knowledge gains and parenting behaviors. The study determined the intervention (parent education on AHT) did not reduce the AHT hospitalization rates, but parents reported gains in knowledge.

Title:
Association of a Postnatal Parent Education Program for Abusive Head Trauma With Subsequent Pediatric Abusive Head Trauma Hospitalization Rates

JAMA Pediatr. 2017;171(3):223-229. doi:10.1001/jamapediatrics.2016.4218 Published online January 30, 2017.

Authors:
Mark S. Dias, MD; Carroll M. Rottmund, BSN, RN; Kelly M. Cappos, BSN, RN; Marie E. Reed, MEd, BSN, RN; MingWang, PhD; Christina Stetter, BS; Michele L. Shaffer, PhD; Christopher S. Hollenbeak, PhD; Ian M. Paul, MD, MSc; CindyW. Christian, MD; Rachel P. Berger,MD, MPH; Joanne Klevens, MD, PhD

Author Affiliations:
Department of Neurosurgery, Penn State University College of Medicine, Penn State Children’s Hospital, Hershey, Pennsylvania (Dias, Rottmund, Cappos, Reed); Department of Pediatrics, Penn State University College of Medicine, Penn State Children’s Hospital, Hershey, Pennsylvania (Dias, Hollenbeak, Paul); Department of Public Health Sciences, Penn State University College of Medicine, Penn State Children’s Hospital, Hershey, Pennsylvania (Wang, Stetter, Shaffer, Hollenbeak, Paul); Department of Pediatrics, University of Washington, Seattle (Shaffer); Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington (Shaffer); Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia (Christian); Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Berger); Division of Violence Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia (Klevens).

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WHY THIS ARTICLE IS RELEVANT OR IMPORTANT:
There have been previous studies suggesting a postnatal parental educational intervention may reduce the incidence of abusive head trauma (AHT) of infants and young children.

VERY BRIEF REVIEW:
Background: Abusive head trauma continues to be the leading cause of death associated with physical abuse. In 1998, universal post-natal parent education was implemented. The education provided information regarding infant crying, reducing care giver frustration, and the dangers of shaking. There was a reduction of the hospitalization rates for AHT during this time. Several states have mandated the education based on the previous success.

Methods:
Data was collected from maternity units and birthing centers throughout one state from the parents of 1,593,834 infants born on these units from January 1, 2003, to December 31, 2013. Parental behavior and knowledge were assessed through immediate (n = 16,111) and 7-month postintervention (n = 146) parent surveys in a per protocol analysis of evaluable parents. Parents read a brochure, viewed an 8-minute video about infant crying and AHT, asked questions of the nurse, and signed a commitment statement affirming their participation. Educational posters were displayed on each unit. Data was analyzed to determine changes in AHT hospitalization rates before and during the intervention in six states. Secondary outcomes included self-reported knowledge gains and changes in parenting practices.

Results:
A total of 1,180,291 parents (74.1%) of children ranging in age from 0 to 23 months signed a commitment statement. Incidence rate ratios for hospitalization for AHT increased from 24.1 (95%CI, 22.1-26.3) to 26.6 (95%CI, 24.9-28.4) per 100000 children aged 0 to 23 months during the intervention period. A total of 16,111 parents (21.5%men, 78.5%women) completed the postnatal survey. Despite an overall 74.1%adherence with the intervention, only 20.6%of parents saw the brochure and video and only 5.7%were exposed to the entire intervention. Among the respondents answering individual questions on the postnatal surveys, 10 958 mothers (91.0%) and 2950 fathers (88.6%) reported learning a lot about understanding infant crying as normal; 11023 mothers (92.2%) and 2923 fathers (88.9%), calming their infant, 11 396 mothers (94.6%) and 3035 fathers (91.9%), calming themselves; 10 060 mothers (85.1%) and 2688 fathers (83.4%), selecting other infant caregivers; and 11 435 mothers (94.8%) and 3201 fathers (95.8%), that the information would decrease the likelihood of shaking an infant. Among the 143 respondents completing the 7-month survey, 109 (76.2%) reported remembering the information while their child was crying.

Conclusion:
Even though there was widespread distribution of the education, and parents reported the intervention provided significant educational value, this statewide AHT prevention program failed to reduce rates of hospitalization for AHT.

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