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Original Investigation
March 2017

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

Author Affiliations
  • 1Department of Neurosurgery, Penn State University College of Medicine, Penn State Children’s Hospital, Hershey, Pennsylvania
  • 2Department of Pediatrics, Penn State University College of Medicine, Penn State Children’s Hospital, Hershey, Pennsylvania
  • 3Department of Public Health Sciences, Penn State University College of Medicine, Penn State Children’s Hospital, Hershey, Pennsylvania
  • 4Department of Pediatrics, University of Washington, Seattle
  • 5Children’s Core for Biomedical Statistics, Seattle Children’s Research Institute, Seattle, Washington
  • 6Department of Pediatrics, University of Pennsylvania School of Medicine, Children’s Hospital of Philadelphia, Philadelphia
  • 7Department of Pediatrics, University of Pittsburgh School of Medicine, Children’s Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 8Division of Violence Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
JAMA Pediatr. 2017;171(3):223-229. doi:10.1001/jamapediatrics.2016.4218
Key Points

Question  Does universal parental education about infant crying and the dangers of violent infant shaking during the immediate postnatal period reduce hospitalization rates for abusive head trauma?

Findings  In this prospective comparative study, a statewide abusive head trauma intervention was not associated with a significant reduction in the overall hospitalization rates for abusive head trauma among infants aged 0 to 23 months compared with 5 other states lacking such a statewide intervention, although parents did report significant knowledge gains from the intervention.

Meaning  Other or additional types of interventions may be needed to reduce hospitalization rates for abusive head trauma of infants and young children.

Abstract

Importance  Studies suggest that a postnatal parental intervention may reduce the incidence of abusive head trauma (AHT) of infants and young children.

Objective  To assess the effect of statewide universal AHT education for parents on AHT hospitalization rates in Pennsylvania and on parents’ self-reported knowledge gains and parenting behaviors.

Design, Setting, and Participants  Changes in AHT hospitalization rates in Pennsylvania before and during the intervention were compared with those in 5 other states lacking universal parental AHT education during the same period. Data were collected from maternity units and birthing centers throughout Pennsylvania 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.

Interventions  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.

Main Outcomes and Measures  Changes in AHT hospitalization rates before and during the intervention in Pennsylvania and 5 other 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 in Pennsylvania from 24.1 (95% CI, 22.1-26.3) to 26.6 (95% CI, 24.9-28.4) per 100 000 children aged 0 to 23 months during the intervention period; changes in Pennsylvania were not significantly different from aggregate changes in the 5 other states, from 22.4 (95% CI, 21.2-23.6) to 22.0 (95% CI, 21.2-22.8) per 100 000 children aged 0 to 23 months. 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; 11 023 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.

Conclusions and Relevance  This intervention was not associated with a reduction in pediatric AHT hospitalization rates but was associated with self-reported gains in parental knowledge that were retained for 7 months.

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