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Shaken baby cases on the increase

Specialists link rise to economic stress

By Carey Goldberg
Globe Staff / March 19, 2009
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Cases of the potentially devastating brain injury known as shaken baby syndrome have at least doubled in the last few months, a jump that Massachusetts child abuse specialists say is apparently influenced by families' economic stress.

Child protection teams at Children's Hospital Boston and Massachusetts General Hospital, which consult on many of the state's cases of maltreatment, have seen nine infants with shaken baby syndrome in the last three months, compared with four in the same period last year.

The number of cases of brain trauma has increased statewide, officials say, amid an overall rise in child abuse and neglect reports of 8 percent in the 2008 fiscal year, compared with the previous year.

Research has linked increased family stress, economic crunches in particular, to increased child abuse. Among recent shaken baby cases at Children's, several involved parents who had recently been laid off or faced other stresses such as the utilities being turned off, said Dr. Alice Newton, medical director of the hospital's Child Protection Team.

"This is a tragedy that we need to pay attention to, especially during these really difficult, stressful economic times," said Suzin Bartley, executive director of the Massachusetts Children's Trust Fund, which was created by the Legislature in 2006 to run programs to prevent shaken baby syndrome.

The organization plans to brief legislators today on the latest figures and on its prevention efforts. There is some concern, Bartley said, that the program might not continue to receive its annual $350,000 allocation because the money is no longer listed separately in the state budget.

Broader public education about how to avoid shaken baby syndrome is still badly needed, said Alison Goodwin, spokeswoman for the Department of Children and Families, because it can be very hard to predict which infants are most at risk. She said the majority of cases do not involve clients of the agency, which works with families that have been the subject of previous abuse or neglect reports.

The syndrome occurs when an adult - usually driven to distraction by crying - violently shakes a baby, whose neck muscles are too weak to hold his or her head steady, exposing the fragile brain to potentially overwhelming injury. There are no reliable national figures on how common the syndrome is, but about one in four victims die, and the rest are usually left with severe neurological problems.

The syndrome gained particular attention locally in 1997, when a British au pair, Louise Woodward, was convicted in the shaken baby syndrome death of an 8-month-old Newton boy in her charge, Matthew Eappen.

The state does not have complete data on shaken baby syndrome statewide, but reports of head trauma have increased in recent months, consistent with the increase in shaken baby cases seen at the Boston hospitals, Goodwin said.

Bartley said it seems clear that economic stress is piling on to the usual stress of parenting in dangerous ways.

"You never know what the level of frustration is in an individual family that may be contributing to them feeling totally overwhelmed," she said. "And an inconsolable, incessantly crying baby can send you right over the edge. And if you've got other young children, and you're working odd hours trying to keep a family together, and you don't understand that sometimes babies just cry, then you can be more vulnerable to shaking as a reaction."

The Children's Hospital team has seen an increase of late in the number of abuse cases and in their severity, and also in the number involving very young babies, said Newton. In the last three months, there have been 16 cases of serious physical abuse, predominantly of babies under 3 months old, compared with a dozen cases last winter, Newton said.

Though she has no proof, Newton said, "I think it's a combination of the current economic situation and the deteriorating social infrastructure," such as services for poor families.

Allison Scobie, the program director for child protection at Children's, said the recent cases do coincide with "the collective stress and hopelessness that I think pervades everything."

But "I can't attribute it entirely to the economic situation," she added. "It's just this intense brutality."

About half of the recent cases have been in families with no known risk factors for child abuse, such as previous suspicious child injuries, Newton said. Many of the families are socially isolated, she said, and that can contribute to abuse. Families should try to forge social connections to help support their child-rearing, she said, and anyone who sees an infant with a pattern of bruising or other injuries should report it to authorities.

Just the other night, Newton said, a 6-month-old baby came in to the hospital with multiple fractures and bruises, consistent with inflicted injury. He was "a really sweet baby, who was so easily comforted and just snuggles right into your neck," she said.

"It's just heartbreaking when you see these."

Carey Goldberg can be reached at goldberg@globe.com.

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