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April 26, 2021

Why Programs for Managing Colicky Crying Fail to Prevent Abusive Head Trauma and Suggestions for Improvement

Author Affiliations
  • 1Centre for Healthcare Ethics, Karolinska Institutet, Stockholm, Sweden
  • 2Department of Community Medicine and Rehabilitation, Division of Forensic Medicine, Umeå University, Umeå, Sweden
JAMA Pediatr. 2021;175(7):671-672. doi:10.1001/jamapediatrics.2021.0455

It is sometimes difficult to isolate the cause of a medical finding, especially when the origins and pathogenesis are unknown and there is only a statistical association between empirical phenomena. In 1965, the English epidemiologist Austin Bradford Hill presented 9 criteria to indicate possible causality.1 The eighth criterion states that if a preventive program has a significant effect on a certain condition, there might be a causal relationship between the intervention and the condition it is intended to prevent.

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    1 Comment for this article
    wedish findings does not support that ‘do not shake’ prevention program is associated with a decrease in incidence of infant abuse diagnosis
    Ulf Hogberg, MD, PhD | Uppsala University, Sweden
    Thanks for an interesting view point. We have reported an increased incidence of infant abuse diagnosis in Sweden, and that the diagnosis infant abuse is strongly associated with diagnoses of subdural hemorrhage, rib fractures and retinal hemorrhage.(1) Regarding the implementation of preventive programs on the dangers of shaking and the incidence of infant abuse we commented: “In Stockholm, cases of infant abuse began to rise steeply, concomitant with the establishment of a child protection team and the introduction of a ‘mental vaccination’ against shaking programme in 2008–2010 (…). Further, population surveys showed that Swedish parents reported shaking their children in 18% in 2006, while after an information campaign against shaking, parental reporting of shaking was reduced to almost nil by 2011.” (1) Thus, the Swedish findings does not support that ‘do not shake’ prevention program is associated with a decrease in incidence of infant abuse diagnosis.
    1 Högberg, U, Lampa E, Högberg G, Aspelin P, Serenius F, Thiblin I. Infant abuse diagnosis associated with abuse with abusive head trauma criteria: incidence increase due to over diagnosis? Eur J Publ Health 2018.April 17 1-6 Doi:10.1093/eurpub/cky062