Tag Archives: abusive head trauma

Straight, No Chaser: Learning the Risks and Signs of Abusive Head Trauma

shaken baby syndrome never_shake_bear

This part of the conversation is not about spanking. It’s not even about abuse. It’s about learning who is most likely to cause harm to your child, intended or not, and what places your child most at risk. This Straight, No Chaser takes an additional look at Abusive Head Trauma (AHT)/Shaken Baby Syndrome and provides you with information to better understand the risks and the signs that your child may be suffering.

Abusive head trauma is 100% preventable but not predictable. You’d do well to heighten your sensitivity about what places a child at risk for this most devastating consequence of child abuse, and you’d do very well to understand the connection of risk for AHT to stress. Finding ways to alleviate the parent or caregiver’s stress at the critical moments when a baby is crying will significantly reduce the risk to a child. You must develop the discipline not to strike a child when you’re angry – in any part of the body. Parents and other caregivers should be aware of their own behaviors that may feed into punitive activities that can injure a child. It’s important to tell any and everyone caring for a baby or young child to never shake him or her.

SBS Statistics

Beyond the key component of a caretaker’s inability to manage their own stress, the following list includes conditions and situations that have been shown to increase the risk of a child being exposed to AHT. That said, anyone has the potential to harm a baby if he or she isn’t able to handle stressful situations well, has poor impulse control, or has a tendency toward aggressive behavior.

shaken baby physicalabuse

  • Children with special needs
  • Children with multiple siblings
  • Children with conditions that promote crying, like colic or gastroesophageal reflux disease (GERD, reflux)
  • Boys are more likely to be victims of AHT than girls.
  • Children whose families live at or below the poverty level are at an increased risk for AHT and other components of child abuse.
  • The perpetrators in about 70% of cases are males, typically either the baby’s father or the mother’s boyfriend. These males are often someone in their early twenties.
  • Substance abuse often plays a role in AHT.

Shaken baby head trauma

Unfortunately, children don’t always exhibit definitive symptoms. Sometimes this is the case because they aren’t brought in for evaluation immediately after, or perhaps the history given to the physician didn’t include the components of shaking or other activities. Children may look normal after an abusive episode and may not have problems noticed until they enter the school system. At this time, it is significantly more difficult to trace the symptoms back to a single causative episode of abuse. It is much more likely that the child’s intelligence level will be interpreted as being “what it is.” Please don’t ever deem that a child’s head injury is insignificant or fail to obtain a medical clearance evaluation after any injury. Alternatively, different types of interactions with a child such as bouncing a baby on a knee or tossing the baby up in the air will not cause these injuries.

shaken baby child abuse

Here are the symptoms of AHT. Of course, ongoing and/or severe episodes can increase the severity of symptoms. Mild symptoms include the following:

  • altered consciousness
  • an inability to lift the head
  • an inability to focus the eyes or track movement
  • blue color (due to lack of oxygen)
  • decreased appetite
  • difficulty breathing
  • irritability
  • lessened or lack of smiling and verbalizing/vocalizing
  • lethargy
  • poor sucking or swallowing
  • rigidity
  • seizures
  • unequal pupil size
  • vomiting

More severe immediate injuries may include the following:

  • brain swelling
  • bruises around the head, neck, or chest
  • hemorrhages in the retinas of the eyes
  • rib and long bone (bones in the arms and legs) fractures
  • skull fractures
  • subdural hematomas (blood collections pressing on the surface of the brain)

SHAKEN BABY 1

Recall that 1 in 4 cases of AHT results in death. Even when death doesn’t occur, other long-term effects may include the following:

  • cerebral palsy
  • developmental delays
  • hearing loss
  • impaired intellect
  • partial or total blindness
  • problems with memory and attention
  • seizures
  • severe mental retardation
  • speech and learning difficulties

What makes AHT so devastating is that it often involves a total brain injury in a developing brain, meaning there will be incredibly widespread manifestations. For example, a child whose vision is severely impaired won’t be able to learn through observation, which decreases the child’s overall ability to learn. The development of language, vision, balance, and motor coordination, are particularly likely to be affected in any child who has AHT.

The irony of AHT is you’ve seen many cases of it in your casual activities. You simply haven’t associated those cases with a child having been abused. Consider thinking proactively, learn to adjust your stress and the way you interact with children in times of discipline to minimize the risks. Their developing brains will thank you.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

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Comments Off on Straight, No Chaser: Learning the Risks and Signs of Abusive Head Trauma

Filed under Mental Health, Pediatrics/Kids Health, Public Health, Trauma

Straight, No Chaser: Abusive Head Trauma aka Shaken Baby Syndrome

shaking-baby

The discussion regarding the line between parental discipline and child abuse has proven to be a passionate one. Without wading into opinions, let me elaborate and give a concrete example of why the conversation is not limited to your right to discipline. Straight, No Chaser has addressed Post-Traumatic Stress Disorder (PTSD) at length. We have no difficulty appreciating the damage that can occur to veterans, victims of sexual assault and others. Why is it not similarly easy to appreciate that there are emotional and physical consequences to children? After all, PTSD is most often described in adults having fully formed brains. You would be correct to assume that results would be even more pronounced in children, whose brains are still developing.

SBSyndrome

The problem is you actually don’t know the harm you’re inflicting. As the saying goes, you can have your opinions about what you’re doing, but you can’t have your facts; that’s especially true about medical facts. As an example, there’s a relatively common condition called Shaken Baby Syndrome/Abusive Head Trauma (aka Shaken Impact Syndrome or Inflicted Traumatic Brain Injury) that is typically the result of parents getting frustrated at crying babies or angry and disciplining young children. Abusive head trauma (AHT) occurs in kids up to 5 years old, but it occurs most often among babies during the age at which they cry the most, which is 6-8 weeks old. The average age is between 3-8 months.

Here are some of the types of activities that can cause abusive head trauma:

SBS

  • Dropping a child
  • Jerking a child
  • Shaking a child
  • Slapping or otherwise delivering blows to the head
  • Striking the head against a surface
  • Tossing a child
  • Violently grabbing a child

The relevance of AHT to current events is you would be likely to underestimate the force needed to create defined and permanent injury to a child’s developing brain. Now before you think “When I spank my child, I never hit them in the head,” compare that to the following fact:

Head trauma is the single leading cause of death in child abuse cases in the U.S.

The activities mentioned above cause life-threatening injury to the child’s brain, usually to the blood vessels, nerves and even the brain tissue itself, even without direct blows to the head. Furthermore…

About 1 out of every 4 cases of AHT results in the child’s death.

Shaken baby 5SBS SDH

Respectfully, the anatomy of the child’s head is similar to a lawn dart. The disproportionate size of the head relative to the rest of the body lends to its involvement even when it’s not the primary target of spanking. Whenever a child gets injured, there is some risk that the head can be involved, including bleeding within the brain, as displayed in the above two pictures. AHT often causes irreversible damage.

Even when death doesn’t occur, other long-term effects may take hold, including the following:

  • cerebral palsy
  • developmental delays
  • hearing loss
  • impaired intellect
  • partial or total blindness
  • problems with memory and attention
  • seizures
  • severe mental retardation
  • speech and learning difficulties

A separate Straight, No Chaser will discuss AHT in greater detail, including prevention and treatment considerations. In the meantime, realize that unseen consequences do in fact occur to children in the course of spanking. Whatever your views on parenting or child discipline, please never allow a child to be struck by anyone in anger. Despite your intentions, the consequences are real.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2017 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: Abusive Head Trauma aka Shaken Baby Syndrome

Filed under Mental Health, Pediatrics/Kids Health, Public Health, Trauma

Straight, No Chaser: Learning the Risks and Signs of Abusive Head Trauma

shaken baby syndrome never_shake_bear

This part of the conversation is not about spanking. It’s not even about abuse. It’s about learning who is most likely to cause harm to your child, intended or not, and what places your child most at risk. This Straight, No Chaser takes an additional look at Abusive Head Trauma (AHT)/Shaken Baby Syndrome and provides you with information to better understand the risks and the signs that your child may be suffering.

Abusive head trauma is 100% preventable but not predictable. You’d do well to heighten your sensitivity about what places a child at risk for this most devastating consequence of child abuse, and you’d do very well to understand the connection of risk for AHT to stress. Finding ways to alleviate the parent or caregiver’s stress at the critical moments when a baby is crying will significantly reduce the risk to a child. You must develop the discipline not to strike a child when you’re angry – in any part of the body. Parents and other caregivers should be aware of their own behaviors that may feed into punitive activities that can injure a child. It’s important to tell any and everyone caring for a baby or young child to never shake him or her.

SBS Statistics

Beyond the key component of a caretaker’s inability to manage their own stress, the following list includes conditions and situations that have been shown to increase the risk of a child being exposed to AHT. That said, anyone has the potential to harm a baby if he or she isn’t able to handle stressful situations well, has poor impulse control, or has a tendency toward aggressive behavior.

shaken baby physicalabuse

  • Children with special needs
  • Children with multiple siblings
  • Children with conditions that promote crying, like colic or gastroesophageal reflux disease (GERD, reflux)
  • Boys are more likely to be victims of AHT than girls.
  • Children whose families live at or below the poverty level are at an increased risk for AHT and other components of child abuse.
  • The perpetrators in about 70% of cases are males, typically either the baby’s father or the mother’s boyfriend. These males are often someone in their early twenties.
  • Substance abuse often plays a role in AHT.

Shaken baby head trauma

Unfortunately, children don’t always exhibit definitive symptoms. Sometimes this is the case because they aren’t brought in for evaluation immediately after, or perhaps the history given to the physician didn’t include the components of shaking or other activities. Children may look normal after an abusive episode and may not have problems noticed until they enter the school system. At this time, it is significantly more difficult to trace the symptoms back to a single causative episode of abuse. It is much more likely that the child’s intelligence level will be interpreted as being “what it is.” Please don’t ever deem that a child’s head injury is insignificant or fail to obtain a medical clearance evaluation after any injury. Alternatively, different types of interactions with a child such as bouncing a baby on a knee or tossing the baby up in the air will not cause these injuries.

shaken baby child abuse

Here are the symptoms of AHT. Of course, ongoing and/or severe episodes can increase the severity of symptoms. Mild symptoms include the following:

  • altered consciousness
  • an inability to lift the head
  • an inability to focus the eyes or track movement
  • blue color (due to lack of oxygen)
  • decreased appetite
  • difficulty breathing
  • irritability
  • lessened or lack of smiling and verbalizing/vocalizing
  • lethargy
  • poor sucking or swallowing
  • rigidity
  • seizures
  • unequal pupil size
  • vomiting

More severe immediate injuries may include the following:

  • brain swelling
  • bruises around the head, neck, or chest
  • hemorrhages in the retinas of the eyes
  • rib and long bone (bones in the arms and legs) fractures
  • skull fractures
  • subdural hematomas (blood collections pressing on the surface of the brain)

SHAKEN BABY 1

Recall that 1 in 4 cases of AHT results in death. Even when death doesn’t occur, other long-term effects may include the following:

  • cerebral palsy
  • developmental delays
  • hearing loss
  • impaired intellect
  • partial or total blindness
  • problems with memory and attention
  • seizures
  • severe mental retardation
  • speech and learning difficulties

What makes AHT so devastating is that it often involves a total brain injury in a developing brain, meaning there will be incredibly widespread manifestations. For example, a child whose vision is severely impaired won’t be able to learn through observation, which decreases the child’s overall ability to learn. The development of language, vision, balance, and motor coordination, are particularly likely to be affected in any child who has AHT.

The irony of AHT is you’ve seen many cases of it in your casual activities. You simply haven’t associated those cases with a child having been abused. Consider thinking proactively, learn to adjust your stress and the way you interact with children in times of discipline to minimize the risks. Their developing brains will thank you.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: Learning the Risks and Signs of Abusive Head Trauma

Filed under Mental Health, Pediatrics/Kids Health, Public Health, Trauma

Straight, No Chaser: Abusive Head Trauma aka Shaken Baby Syndrome

shaking-baby

The discussion regarding the line between parental discipline and child abuse has proven to be a passionate one. Without wading into opinions, let me elaborate and give a concrete example of why the conversation is not limited to your right to discipline. Straight, No Chaser has addressed Post-Traumatic Stress Disorder (PTSD) at length. We have no difficulty appreciating the damage that can occur to veterans, victims of sexual assault and others. Why is it not similarly easy to appreciate that there are emotional and physical consequences to children? After all, PTSD is most often described in adults having fully formed brains. You would be correct to assume that results would be even more pronounced in children, whose brains are still developing.

SBSyndrome

The problem is you actually don’t know the harm you’re inflicting. As the saying goes, you can have your opinions about what you’re doing, but you can’t have your facts; that’s especially true about medical facts. As an example, there’s a relatively common condition called Shaken Baby Syndrome/Abusive Head Trauma (aka Shaken Impact Syndrome or Inflicted Traumatic Brain Injury) that is typically the result of parents getting frustrated at crying babies or angry and disciplining young children. Abusive head trauma (AHT) occurs in kids up to 5 years old, but it occurs most often among babies during the age at which they cry the most, which is 6-8 weeks old. The average age is between 3-8 months.

Here are some of the types of activities that can cause abusive head trauma:

SBS

  • Dropping a child
  • Jerking a child
  • Shaking a child
  • Slapping or otherwise delivering blows to the head
  • Striking the head against a surface
  • Tossing a child
  • Violently grabbing a child

The relevance of AHT to current events is you would be likely to underestimate the force needed to create defined and permanent injury to a child’s developing brain. Now before you think “When I spank my child, I never hit them in the head,” compare that to the following fact:

Head trauma is the single leading cause of death in child abuse cases in the U.S.

The activities mentioned above cause life-threatening injury to the child’s brain, usually to the blood vessels, nerves and even the brain tissue itself, even without direct blows to the head. Furthermore…

About 1 out of every 4 cases of AHT results in the child’s death.

Shaken baby 5SBS SDH

Respectfully, the anatomy of the child’s head is similar to a lawn dart. The disproportionate size of the head relative to the rest of the body lends to its involvement even when it’s not the primary target of spanking. Whenever a child gets injured, there is some risk that the head can be involved, including bleeding within the brain, as displayed in the above two pictures. AHT often causes irreversible damage.

Even when death doesn’t occur, other long-term effects may take hold, including the following:

  • cerebral palsy
  • developmental delays
  • hearing loss
  • impaired intellect
  • partial or total blindness
  • problems with memory and attention
  • seizures
  • severe mental retardation
  • speech and learning difficulties

A separate Straight, No Chaser will discuss AHT in greater detail, including prevention and treatment considerations. In the meantime, realize that unseen consequences do in fact occur to children in the course of spanking. Whatever your views on parenting or child discipline, please never allow a child to be struck by anyone in anger. Despite your intentions, the consequences are real.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.

Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: Abusive Head Trauma aka Shaken Baby Syndrome

Filed under Mental Health, Pediatrics/Kids Health, Public Health, Trauma

Straight, No Chaser: The Evidence on the Effectiveness of Corporal Punishment (Spanking)

spanking 1

Although we make exceptions, Straight, No Chaser is not in the opinion business. The primary goal of this blog is to provide you with factual and easily understandable information covering medicine, health care, public health and other relevant areas. We want to empower you with information and advice that allows you to be a better decision maker when it comes to matters of your health and wellbeing.

To that end, this series on child abuse has generated a lot of passionate responses without necessarily much in the way of contrary factual information. I would suggest that’s because there isn’t any. The rebuttals to the challenge to learn a better way in preventing damage to children – either through outright child abuse or corporal punishment that has unintended consequences – has been emotional and has either made readers incredibly defensive or (we hope) reflective about what we’re actually doing.

We’ve heard it all this week.

  • “No one is going to tell me how to raise my child!”
  • “My parents spanked me, and I turned out fine!”
  • “I discipline my child so the police won’t have to!”
  • “Any striking a child should be a crime.”
  • “Children are the only people you can legally hit in this country!”
  • “You can’t even get away with hitting a dog like you can a child!”

It bears repeating: the point of Straight, No Chaser has never been to dictate your actions but to give you accurate information that empowers you to make better decisions. Regarding parenting, spanking and child abuse, we have provided you with several posts, including the following:

Straight, No Chaser: The Physical Signs of Child Abuse

Straight, No Chaser: The Emotional Signs of Child Abuse

Straight, No Chaser: Abusive Head Trauma aka Shaken Baby Syndrome

Straight, No Chaser: Learning the Risks and Signs of Abusive Head Trauma

In this final post of the series, we press our advantage of being factual; we review the public health landscape and bring you up to date on the latest facts and evidence on the questions at hand.

To the question: “Isn’t corporal punishment a regional and cultural phenomenon?”spanking at school

Facts:

  • Affluent families at the upper end of the socioeconomic scale spank children the least.
  • Middle-class parents tend to administer corporal punishment in greater numbers than the affluent.
  • Lower-class parents tend to do so with still greater frequency.
  • African-American families are more likely to practice corporal punishment than white families.
  • Corporal punishment in public schools have in fact been outlawed in most of the country outside of the South (see above graphic. It is concerning and worth study to analyze whether it is more than a correlation that states with the highest rates of students obtaining advanced educational degrees are found in those states that do not allow corporal punishment in schools).

To the assumption: I have the right to raise my child as I see fit.

Spanking slap

The line between permitted corporal punishment and punishment legally defined as abuse varies by state and is intentionally not clear. Laws typically allow “reasonable force” and “non-excessive corporal punishment.” In other words, you have the opportunity to discipline your children using your discretion. That said, if you are discovered to have crossed a line of “reasonable force” as determined by those in the system designed to review cases and protect children from abuse, you will be prosecuted. This is exactly what is unfolding in the case of Adrian Peterson, football player for the Minnesota Vikings.

Your well-intentioned spanking that turns into child abuse is not like a parking ticket; you shouldn’t expect to get a warning. Mandatory reporting laws require that persons witnessing certain visible injuries along with reports by a child of abuse to report it to the local Child Protective Services (CPS) or equivalent agency charged with the protection of the child. Such agencies operate on definitions of child abuse provided by each state’s health department. These definitions are often very different from the exceptions provided in the criminal code and often include ability of these entities to act decisively without further engaging the legal system.

To the belief: Physically disciplining my child will make them better.

spanking cartoon

 

The data on this question represent over 60 years and approximately 90 research studies, including summary analysis of all the data collected. In other words, this is the stuff of scientific review, not opinions.

Let me begin by sharing evidence that the above assumption is correct. This evidence is pretty much limited to one consideration. Corporal punishment does appear to reduce the short-term risk of repeating certain undesirable behaviors.

Now to the avalanche of evidence to the contrary:

  • Several very prominent past and current behavioral psychologists view corporal punishment as a form of abuse. This view is based in the notion that when children are beaten during their first years of life, it physiologically creates negative and irreversible brain damage and psychologically, it negatively restructures when the brain learns. (e.g. violence as a means of problem solving is “good” or “necessary”)
  • The child psychology literature reports that children who receive corporal punishment are more likely to be angry as adults and are more likely to use spanking as a form of discipline, approve of striking a spouse, and experience marital discord.

spanking is contagious

  • The child psychology literature reports that older children who receive corporal punishment may resort to more physical aggression, substance abuse, crime and violence.
  • The American Academy of Pediatrics (AAP) in an official policy statement states that “Corporal punishment is of limited effectiveness and has potentially deleterious side effects.” In particular, the AAP believes that any corporal punishment methods other than open-hand spanking on the buttocks or extremities “are unacceptable” and “should never be used.”
  • Both the child psychology literature and the AAP report spanking has been associated with higher rates of physical aggression, more substance abuse, and increased risk of crime and violence when compared with older children and adolescents.
  • 2012 research published in the AAP medical journal Pediatrics showed an association between harsh corporal punishment by parents and increased risk of a wide range of mental illness. Even more convincingly, this research pointedly excluded subjects who had received a formal designation of “abuse.”
  • It was previously mentioned that corporal punishment was associated with less long-term compliance. However, corporal punishment was linked with nine other negative outcomes, including increased rates of aggression, delinquency, mental health problems, problems in relationships with their parents, and likelihood of being physically abused. Depression in adolescence is also another negative outcome of corporal punishment in adolescence because of the harsh punishments.

spanking worse methods

  • The AAP also argues that a problem with the use of corporal punishment is that, if punishments are to maintain their efficacy, the amount of force required may have to be increased over successive punishments, a principal supported by behavioral psychology. They assert: “The only way to maintain the initial effect of spanking is to systematically increase the intensity with which it is delivered, which can quickly escalate into abuse.” Additionally, the Academy noted that: “Parents who spank their children are more likely to use other unacceptable forms of corporal punishment.” In other words, the subset of those committing child abuse is likely to come from those spanking their children.

What does this mean in terms of the role of spanking in disciplining children? Well, you’re their parents, so you retain the ultimate decision in what you do within your homes, but here’s some perspectives to let you know where the standard of care has moved.

spanking worldwide stoppage

  • A 1996 AAP Consensus Conference concluded that spanking should never be used under 2 years of age because of the risks of abusive head trauma. The conference suggest that spanking may be effective for preschoolers when combined with verbal correction, and it concluded that it should not be used in older children and adolescents. Of course, these findings are nearly twenty years old, so the next update is likely to be even more conservative.
  • The National Association of Social Workers “opposes the use of physical punishment in homes, schools, and all other institutions where children are cared for and educated.”
  • 38 countries around the world have banned corporal punishment. The US has not.

On another level, this is largely about cognitive dissonance. No one is suggesting you’re a bad parent because you’re engaged in behaviors that have been passed on for generations and appear to have built strength and character. Just as different treatments for diseases evolve over time, open your mind to at least thinking through the facts presented to you to determine if you still think this is the best course of action for your children. Of course, your reading this blog suggests that you are that open-minded.

To the concern: Of course you’re thinking “So what’s the better way to discipline children?”

That’s the topic for another blog down the road, but here is what we do know from child and behavioral psychology:

spanking alternatives

  • Human behavior is better modified by positive reinforcement than negative reinforcement or punishment.
  • Human behavior is better modified by both positive reinforcement and negative reinforcement than by punishment.

Let’s make sure your behaviors reflect your desire to teach your children rather than express your anger.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

Comments Off on Straight, No Chaser: The Evidence on the Effectiveness of Corporal Punishment (Spanking)

Filed under Mental Health, Pediatrics/Kids Health, Public Health, Trauma

Straight, No Chaser: Learning the Risks and Signs of Abusive Head Trauma

shaken baby syndrome never_shake_bear

This part of the conversation is not about spanking. It’s not even about abuse. It’s about learning who is most likely to cause harm to your child, intended or not, and what places your child most at risk. This Straight, No Chaser takes an additional look at Abusive Head Trauma (AHT)/Shaken Baby Syndrome and provides you with information to better understand the risks and the signs that your child may be suffering.

Abusive head trauma is 100% preventable but not predictable. You’d do well to heighten your sensitivity about what places a child at risk for this most devastating consequence of child abuse, and you’d do very well to understand the connection of risk for AHT to stress. Finding ways to alleviate the parent or caregiver’s stress at the critical moments when a baby is crying will significantly reduce the risk to a child. You must develop the discipline not to strike a child when you’re angry – in any part of the body. Parents and other caregivers should be aware of their own behaviors that may feed into punitive activities that can injure a child. It’s important to tell any and everyone caring for a baby or young child to never shake him or her.

 

SBS Statistics

Beyond the key component of a caretaker’s inability to manage their own stress, the following list includes conditions and situations that have been shown to increase the risk of a child being exposed to AHT. That said, anyone has the potential to harm a baby if he or she isn’t able to handle stressful situations well, has poor impulse control, or has a tendency toward aggressive behavior.

shaken baby physicalabuse

  • Children with special needs
  • Children with multiple siblings
  • Children with conditions that promote crying, like colic or gastroesophageal reflux disease (GERD, reflux)
  • Boys are more likely to be victims of AHT than girls.
  • Children whose families live at or below the poverty level are at an increased risk for AHT and other components of child abuse.
  • The perpetrators in about 70% of cases are males, typically either the baby’s father or the mother’s boyfriend. These males are often someone in their early twenties.
  • Substance abuse often plays a role in AHT.

Shaken baby head trauma

Unfortunately, children don’t always exhibit definitive symptoms. Sometimes this is the case because they aren’t brought in for evaluation immediately after, or perhaps the history given to the physician didn’t include the components of shaking or other activities. Children may look normal after an abusive episode and may not have problems noticed until they enter the school system. At this time, it is significantly more difficult to trace the symptoms back to a single causative episode of abuse. It is much more likely that the child’s intelligence level will be interpreted as being “what it is.” Please don’t ever deem that a child’s head injury is insignificant or fail to obtain a medical clearance evaluation after any injury. Alternatively, different types of interactions with a child such as bouncing a baby on a knee or tossing the baby up in the air will not cause these injuries.

shaken baby child abuse

Here are the symptoms of AHT. Of course, ongoing and/or severe episodes can increase the severity of symptoms. Mild symptoms include the following:

  • altered consciousness
  • an inability to lift the head
  • an inability to focus the eyes or track movement
  • blue color (due to lack of oxygen)
  • decreased appetite
  • difficulty breathing
  • irritability
  • lessened or lack of smiling and verbalizing/vocalizing
  • lethargy
  • poor sucking or swallowing
  • rigidity
  • seizures
  • unequal pupil size
  • vomiting

More severe immediate injuries may include the following:

  • brain swelling
  • bruises around the head, neck, or chest
  • hemorrhages in the retinas of the eyes
  • rib and long bone (bones in the arms and legs) fractures
  • skull fractures
  • subdural hematomas (blood collections pressing on the surface of the brain)

SHAKEN BABY 1

Recall that 1 in 4 cases of AHT results in death. Even when death doesn’t occur, other long-term effects may include the following:

  • cerebral palsy
  • developmental delays
  • hearing loss
  • impaired intellect
  • partial or total blindness
  • problems with memory and attention
  • seizures
  • severe mental retardation
  • speech and learning difficulties

What makes AHT so devastating is that it often involves a total brain injury in a developing brain, meaning there will be incredibly widespread manifestations. For example, a child whose vision is severely impaired won’t be able to learn through observation, which decreases the child’s overall ability to learn. The development of language, vision, balance, and motor coordination, are particularly likely to be affected in any child who has AHT.

The irony of AHT is you’ve seen many cases of it in your casual activities. You simply haven’t associated those cases with a child having been abused. Consider thinking proactively, learn to adjust your stress and the way you interact with children in times of discipline to minimize the risks. Their developing brains will thank you.

The final Straight, No Chaser in this series will review the landscape and demographic trends on corporal punishment, abuse and consequences.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

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Straight, No Chaser: Abusive Head Trauma aka Shaken Baby Syndrome

shaking-baby

The discussion regarding the line between parental discipline and child abuse has proven to be a passionate one. Without wading into opinions, let me elaborate and give a concrete example of why the conversation is not limited to your right to discipline. Straight, No Chaser has addressed Post-Traumatic Stress Disorder (PTSD) at length. We have no difficulty appreciating the damage that can occur to veterans, victims of sexual assault and others. Why is it not similarly easy to appreciate that there are emotional and physical consequences to children? After all, PTSD is most often described in adults having fully formed brains. You would be correct to assume that results would be even more pronounced in children, whose brains are still developing.

SBSyndrome

The problem is you actually don’t know the harm you’re inflicting. As the saying goes, you can have your opinions about what you’re doing, but you can’t have your facts; that’s especially true about medical facts. As an example, there’s a relatively common condition called Shaken Baby Syndrome/Abusive Head Trauma (aka Shaken Impact Syndrome or Inflicted Traumatic Brain Injury) that is typically the result of parents getting frustrated at crying babies or angry and disciplining young children. Abusive head trauma (AHT) occurs in kids up to 5 years old, but it occurs most often among babies during the age at which they cry the most, which is 6-8 weeks old. The average age is between 3-8 months.

Here are some of the types of activities that can cause abusive head trauma:

SBS

  • Dropping a child
  • Jerking a child
  • Shaking a child
  • Slapping or otherwise delivering blows to the head
  • Striking the head against a surface
  • Tossing a child
  • Violently grabbing a child

The relevance of AHT to current events is you would be likely to underestimate the force needed to create defined and permanent injury to a child’s developing brain. Now before you think “When I spank my child, I never hit them in the head,” compare that to the following fact:

Head trauma is the single leading cause of death in child abuse cases in the U.S.

The activities mentioned above cause life-threatening injury to the child’s brain, usually to the blood vessels, nerves and even the brain tissue itself, even without direct blows to the head. Furthermore…

About 1 out of every 4 cases of AHT results in the child’s death.

Shaken baby 5SBS SDH

Respectfully, the anatomy of the child’s head is similar to a lawn dart. The disproportionate size of the head relative to the rest of the body lends to its involvement even when it’s not the primary target of spanking. Whenever a child gets injured, there is some risk that the head can be involved, including bleeding within the brain, as displayed in the above two pictures. AHT often causes irreversible damage.

Even when death doesn’t occur, other long-term effects may take hold, including the following:

  • cerebral palsy
  • developmental delays
  • hearing loss
  • impaired intellect
  • partial or total blindness
  • problems with memory and attention
  • seizures
  • severe mental retardation
  • speech and learning difficulties

A separate Straight, No Chaser will discuss AHT in greater detail, including prevention and treatment considerations. In the meantime, realize that unseen consequences do in fact occur to children in the course of spanking. Whatever your views on parenting or child discipline, please never allow a child to be struck by anyone in anger. Despite your intentions, the consequences are real.

Thanks for liking and following Straight, No Chaser! This public service provides a sample of 844-SMA-TALK and http://www.SterlingMedicalAdvice.com (SMA). Enjoy some of our favorite posts and frequently asked questions as well as a daily note explaining the benefits of SMA membership. Please share our page with your Friends on WordPress, on Facebook at SterlingMedicalAdvice.com and on Twitter at @asksterlingmd.

Copyright © 2014 · Sterling Initiatives, LLC · Powered by WordPress

1 Comment

Filed under Mental Health, Pediatrics/Kids Health, Public Health, Trauma