The Shaken Baby Prevention Project (SBPP) commenced in 2001 as a collaborative endeavour by health and child protection professionals across Western Sydney. The project aims to develop a targeted education strategy to disseminate information to parents, carers, perinatal health educators and other stakeholders, about the impact of infant shaking and positive and safe strategies to respond to a crying baby.

A three minute animated multi-language film, 'Shaking Your Baby is Just Not the Deal', and accompanying information leaflet and poster were collaboratively developed and trialled. Research was undertaken at The Children's Hospital at Westmead (CHW) and Westmead Hospital (WH) to evaluate the effectiveness of the package, with very positive outcomes. In 2007, a web-based e-learning strategy was developed to allow universal access to the material.

To reduce non-accidental brain injury (NABI) caused by shaking a baby, through the use of an education strategy, including a short film that can be shown to new and prospective parents, carers and extended family to inform them about the dangers of shaking a baby and to suggest safe strategies to respond to a crying baby. 

Non-accidental brain injury (NABI) as a result of shaking, can lead to death and long term disability, impacting at an individual, family and community level across many cultures and socio-economic groups. Suffering an inflicted brain injury at an early age places surviving children at risk of significant impairment in their development. Mild to severe impairments can occur across physical, cognitive, social, emotional and behavioural functioning, contributing to problems with long-term adjustment and adaptive functioning of the child. (Duhaime 1996).  NABI resulting from 'shaking' or 'shaking with impact' is a preventable form of child abuse (Showers 2001). Parental behaviours, environmental factors and child characteristics contribute towards a shaking event (Wyszynski 1999).  The SBPP developed a Child Protection Perspective Model (Figure 1) to illustrate some of the complex contributing and precipitating factors leading to shaking.

In the late 1990s there was increased recognition of the high incidence and serious impact of NABI in literature and at international child protection conferences. Australian and international prevention projects and relevant literature in the areas of child protection, health promotion, communication and marketing were reviewed. There were no ongoing Australian-based prevention programs. A file review (Piper et al 2000), of children presenting with NABI from 1995 – 1999 identified that 39 children aged less than four years were treated for inflicted head injury. A 2004 review (2000 – 2003) identified 29 children from 18 days to 30 months treated for NABI. In five cases, the perpetrator admitted to shaking the infant.

In the research, (Becker, 1998) perpetrator accounts identify inconsolable crying as one of the commonly cited reasons for aggression towards children. Therefore, the project team partnered with a community reference group, including consumer representatives, a specialist men’s education program, an anti-violence agency and an indigenous health representative to develop an appropriate intervention strategy.

The SBPP is a primary prevention project relating to three NSW Health Strategic Directions, 'Make prevention everybody’s business'; 'Strengthen primary health and continuing care in the community' and 'Build regional and other partnerships for health'. 

The prevention of death or long-term disability in infants and children due to shaking will have a significant impact on children, families and the community and is in line with NSW Health increased focus on early intervention.

The project teamwork across agencies in Western Sydney, including NSW Health, NSW DoCS and non-government agencies, has extended to a pilot project at Sydney Children's Hospital and the Royal Hospital for Women. Positive response to the project is evidenced by invitations to present at workshops and conferences and the purchase and cultural adaptation of project resources. 

The SBPP developed an educational package comprising a video/DVD film, pamphlet and poster (see figure 2).

We trialled the package in an appropriate clinical setting to determine whether the package affected carers:

1. Understanding of baby's crying
2. Knowledge of the adverse effects of shaking
3. Range of possible responses to baby’s crying

In 2005 the CHW pilot of video/DVD and pre and post questionnaires occurred. The questionnaire was subsequently redesigned and, during 2006 – 2007 administered pre and post viewing of the film to 116 parents and carers of newborn babies in the post-natal unit of Westmead Hospital.

51 of the initial participant group completed a three-month follow-up standardised telephone interview to determine retention of the key learning messages. Following analysis of the research, we developed an e-learning package utilising the CHW website (figure 3), aiming to increase accessibility of the film for both professionals and carers  http://www.chw.edu.au/parents/kidshealth/crying_baby.

The e-learning strategy also has a research component that continues to provide data about the effectiveness of this resource. 335 people have participated in the e-learning package and evaluation since August 2007.

In response to feedback at national and international child protection conferences and research participants, the film was updated in 2008 to ensure clarity of the key messages and cultural applicability.

The project has been continuously reviewed and evaluated at each stage of implementation. The research data indicates that the resource is acceptable to all carers regardless of age, gender or cultural background and is effective in maintaining engagement and promoting the key learning messages. This preliminary data indicated that the resource is effective in changing knowledge (see tables one to six).

This project is a culturally relevant resource and there has been a huge demand for the subtitled film in over 20 community languages. The project has generated interest in using resources in a universal education strategy in Western Sydney Area Health Service - Westmead, Blacktown and Nepean Hospitals and Tresillian, Sydney Children’s Hospital and Royal Hospital for Women in South Eastern Sydney/Illawarra Area Health Service, Western Australia, Queensland and the United Kingdom. 

SBPP continues to develop statewide, national and international collaborations. Project team members are regularly invited to present at seminars, workshops and conferences, engaging a broad range of health practitioners in the process of primary prevention. We are currently working on strategies to target universal dissemination of shaken baby prevention materials in the Child Health Record book given to parents.

During 2007, Child Protection Week SBPP held a Seminar for professionals where the e-learning strategy was launched in combination with a series of expert lectures. This also included an inaugural meeting of the Shaken Baby Prevention Alliance. A business card containing directions to the website and film is being developed and its effectiveness will be evaluated.

This project has wide applicability across a broad range of hospital and community health settings. The SBPP has identified a number of clinical areas within the Hospital where the project can disseminate and further develop the intervention strategies, such as the Emergency Department, Grace Centre for Newborn Care, Feeding and Refugee Outpatient Clinics and the Social Work Department. This program would also be applicable to mental health settings, such as drug and alcohol services, early childhood and all antenatal and postnatal clinics. It would also be relevant to educational and health settings for young people, including adolescent parents and babysitters.

• Becker, JC et al, (1998), Shaken baby syndrome: report on four pairs of twins Child Abuse & Neglect, Volume 22, Issue 9, 931-937.
• Duhaime, AC et al, (1996), Long-Term Outcome in Infants with the Shaking-Impact Syndrome, Paediatric Neurosurgery, Vol.10, pp. 211-221.
• Ghahreman A et al, (2005), Nonaccidental head injuries in children: a Sydney experience, J Neurosurg, Sep; 103 (3 Suppl):213-8.
• Piper, A et al, (2000), "Inflicted Head Injury in Childhood- A 5 Year review", Child Protection Unit, The Children’s Hospital at Westmead, Sydney, NSW. (Poster)
• Showers, J, (2001), ‘Preventing Shaken Baby Syndrome’ in The Shaken Baby Syndrome: A Multidisciplinary Approach, ed. S Lazoritz, V Palusci, The Haworth Press Inc, New York.
• Wyszynski, M, (1999), Shaken Baby Syndrome: Identification, Intervention, and Prevention, Clinical Excellence for Nurse Practitioners, Vol 3 No 5 262-267.

Co-ordinator, Service Improvement Unit
The Children's Hospital at Westmead
Phone: 02 9845 2093