1. Shaken Baby Syndrome Prevention for middle school students
Discussion
Today we are going to discuss shaken baby syndrome prevention. In 2006, a Wisconsin state law was passed requiring people to learn about Shaken Baby Syndrome and how to prevent it. Middle school students were chosen as one of the groups who must learn this information. Other groups are high school students, new parents, and child care providers.
Why do you think you were chosen to be part of this group?
Possible responses
We are old enough to be able to understand and carry the message forward.
We are starting to baby sit for our family and for other families that we know.
It is an important topic that is in the news and we should know what is happening around us.
Some day we will be parents.
We might become child care providers some day.

2. Let’s see what we know so far
Pre test
Provide students with a copy of the pre test. Ask them to answer the questions as best they can. Allow approximately 10 minutes for the activity.
After the students complete the pre test, you make discuss their responses or you may ask them to keep their test in front of them so that they can add notes as they participate in the class.
Note
The post test is identical to the pre test. You may want to print them front-to-back.

3. Shaken Baby Syndrome (SBS) What is it?
Narrative
Shaken Baby Syndrome is a term used to describe the serious injuries that can result if a baby is violently shaken.
Violent shaking causes a baby’s head to whip back and forth. This motion can cause blood vessels in the brain and eyes to tear and bleed.
Compared to adults and older children, babies have fragile and undeveloped brains. Babies’ heads are heavy and their neck muscles are weak; this is why their heads require support whenever you pick them up or carry them.
Half of SBS victims are less than 6 months old.
Older babies and young children are also at high risk because their skulls are further developed, and their soft spot is fused closed. If the baby’s brain is bruised by shaking, there is no way for the skull to expand to allow for the swelling.
SBS is a medical term used to describe the injuries that can result if a baby is violently shaken.
Violent shaking is one of the most devastating forms of child abuse.

4. Elijah’s Story
Video
Inform the students that the video that they will see is a true story. It is a story about what can happen to a baby and to his whole family if he is shaken.
Note: Elijah’s Story runs for approximately 18 minutes.

5. What happens when a baby is shaken?
Activity
For this activity you will need:
a doll or stuffed animal about 22” long. A well loved stuffed animal with a floppy head will work well.
A clear, plastic, covered bowl of jello with a small amount of room at the top for air OR an egg in a small, clear, plastic container.
A timer that can measure seconds.
Discuss some of the falling accidents that occur with babies. Include falling from a couch, a bed or a changing table.
Ask for a volunteer to come up and hold the “baby”. Discuss the size of the baby in comparison to the student. Point out that the baby’s head is very large in proportion to the rest of his body. Discuss the way that a baby’s head should be supported when holding him. Ask the student to drop the baby from the height of a chair and then from the height of a changing table. Discuss whether this would be harmful to a baby.
Explain that the bowl of jello represents the baby’s brain inside of the skull. The plastic bowl is the hard skull. The jello is the delicate brain tissue. When baby’s are born, there is space between the skull and the brain so that the brain isn’t damaged during the birthing process, and that’s what the air space within the bowl represents. The large skull also allows room for the baby’s brain to grow.
Next, have the student drop the jello from the same 2 heights. The jello will show some damage, but it will be minimal.
Ask the student to shake the baby as hard as he can for 10 seconds. Ask if he is tired or if he could continue. He will likely say that he could shake for a longer time. Point out that it only takes one or two seconds of shaking to seriously harm a baby.
Now, ask the same student to shake the bowl of jello using the same amount of strength and for the same amount of time. The jello will separate from the bowl and will lose it’s consistency.
Discuss how easily someone the size of the student or larger can cause significant harm to a baby’s brain.
Note: Baby Think it Over, if already available in your school, is a good resource. There is also a demonstration doll that can be purchased from the National Shaken Baby Organization that has been developed for this purpose. We recommend that you use these more costly options if they are readily available to you, but a soft- body store item or an item brought in by a student of the correct size will be just as effective.

6. Shaken Baby Syndrome What is it?
Narrative
This image shows how an infant’s head moves when she is shaken.
The shaking has its most serious effects on the brain because different parts of the brain move at different speeds and in different directions. The brain not only moves back and forth but it also moves from side to side. The brain inside the skull moves faster than the skull much like the jello moved inside the hard bowl. This can cause tearing of the different layers of the brain resulting in damage to the brain cells.
The most common injuries of SBS are:
bleeding in the space between the brain and the skull
swelling of the brain
bleeding in the retinas in the back of the eyes

7. Signs that a baby has been shaken
Broken bones
Unusual crying
Sleepiness
Vomiting or refusing
to eat
Pale or bluish skin
Not breathing
Unconscious
Narrative
When a baby is shaken, the most serious effect is on the brain, but sometimes bones in the ribs, arms or legs will also be broken. Many babies have injuries to their brains without having broken bones. Sometimes there will be bruising to the baby’s head but most often there won’t be any external signs that the baby was shaken. Most of the damage will be to the baby’s brain.
Other signs that a baby has been shaken are:
Crying that sound different from the baby’s usual cry, often a high pitched cry, or crying at times that the baby is usually calm
Sleepiness when the baby is usually awake
Vomiting or refusing to eat
Pale or bluish skin
Not breathing or having a hard time breathing
Unconsciousness
In most cases there won’t be external signs on the head that the baby was shaken. Please remember that these are important signs to watch for in a baby, but they do not necessarily mean that the baby has been shaken. Even Doctors often have a hard time diagnosing SBS. Other illnesses can also cause many of these symptoms. If you notice any of these signs or anything else that seems unusual, contact a responsible adult immediately.

8. What are the long term results?
Even with prompt medical attention
many babies die.
Those who survive may have:
Narrative
Shaking a baby can have extremely serious results.
About one of every four victims of Shaken Baby Syndrome dies.
Many babies who do survivor have life-long disabilities such as:
Blindness
Paralysis
Deafness
Complications from broken bones
Learning disabilities
Coordination problems
Developmental challenges, or
Seizures
Even babies who seem okay when they are released from the hospital may have problems later on, such as learning and attention difficulty in school.
Blindness
Paralysis
Deafness
Learning disabilities
Coordination problems
Developmental disabilities
Seizures

9. given for shaking a baby
The most common reason
given for shaking a baby
is that the baby
wouldn’t
stop
crying.
Narrative
The most common reason given for shaking a baby is that the baby wouldn’t stop crying.
Other stressful times when parents or babysitters have lost control and shaken a baby or young child are:
Toileting training
Sleeping problems
Disobedience

10. All babies cry Crying is normal. Babies cry for many reasons.
ALL babies will have times when they CANNOT stop crying.
Narrative
All babies cry and it can be an irritating sound. This is nature’s way of making sure that infants get their needs met so they can survive. If crying was a pleasant sound it would be easy to ignore.
Babies are completely dependent on their parents and babysitters for survival.
It is normal for babies to cry and babies will cry for many reasons. A baby might cry to let you know he or she is hungry or thirsty, needs a diaper change, needs to be cuddled, doesn’t feel well, or is sleepy. A baby might cry to release tension.
There will also be times when a baby can’t stop crying.
A baby’s crying can be very upsetting. It is important for you to understand what to expect in terms of infant crying, and to plan in advance for how you will handle crying.

11. Babies cry to communicate
Feeling 
Middle Schooler 
2-month-old 
Hunger
“When’s dinner? I’m starved.”
Discomfort
“I’m not wearing these shoes. They’re too tight.”
Over-stimulation
“Leave me alone.”
Under-stimulation
“I’m bored. There’s nothing to do.”
Fatigue
“I’ve had a long day”
“CRY!”
Discussion
You may want to summarize the information on the slide, or you may want to strongly reinforce the message that crying is the infant’s means to get his or her needs met through discussion.
Explain the following to the students
From the moment that they are born, babies communicate by crying as a way of getting their basic needs met by their caregivers. Because they haven’t developed language skills, babies use the tool that they have – they cry.
Review each quote on the slide using this format:
Babies, just like older children, feel hunger. When a middle schooler is hungry, he might say, “When’s dinner? I’m starved.”
How will a 2-month-old communicate hunger to his caregiver?
Click, and then point to the response on the slide and encourage the students to respond with, “cry!”.
Repeat this format for the remaining quotes.
“CRY!”
“CRY!”
“CRY!”
“CRY!”

12. Risk factors for being a victim
Age
Gender (boy or girl)
Greater demands for care, for example pre-maturity, illness, or other special needs
Narrative
Some babies are at greater risk for shaking than others. The main risk factors are:
Age: More than half of SBS victims are under 6 months of age. The size difference between the victim and the perpetrator (Note: depending on the grade level, these may be terms that the students aren’t clear about without an explanation.) can influence how much damage is done. Younger babies have proportionately larger heads and less developed neck muscles and brains than older children and adults. Older babies are also at serious risk from shaking because the soft spot in their skulls has closed and the pressure builds up quickly when the brain swells.
Gender: Sixty percent of victims are boys. It is unknown why this is the case.
Greater demands for care: Anything that makes a baby or young child more difficult to care for, either temporarily or permanently, could make the child more vulnerable to abuse.
For example, pre-term infants (babies who are born before their due dates) are generally more sensitive to changes in their environment. They are also harder to comfort when they cry.
Illness can also make an infant more irritable and difficult to care for. This can be a common illness like an ear infection or a long term situation like a baby who is born with a disability.

13. Soothing an irritable baby
Feed baby slowly and burp baby often.
Make baby as comfortable as possible.
Provide gentle motion or relaxing sound.
Is baby hungry? Thirsty? Bored? Anxious? Sleepy?
Understand that all babies
have times when they cannot stop crying.
Narrative or discussion
Review the information on the slide. If time allows, ask students for additional ways to soothe a baby.
When you are caring for a young child, it is always important to get information from the parent including ways to sooth a baby. For example, does the baby need a “nook” to go to sleep or does the baby fall asleep best if she is put down in her crib?

14. Difficult developmental phases
Narrative
As babies get older and go through the normal learning stages, they also go through stages where they are hard to care for. Some of these stages are:
Crying when they are left with someone new 6 months to 3 years.
Night waking at 7 to 8 months
Exploring or “getting into everything” when they learn to crawl and walk.
The “no, no, no” stage from age 1 to age 3
Toilet training resistance
These are all normal stages that children go through. There is nothing wrong with the child. It’s normal for babies to act this way and it’s also normal for parents or babysitters to get upset during these stages.

15. Who would shake a baby? Anyone, but some people are more at risk:
Late teens and early 20s
Males
Inexperience with babies
People with other risk factors – drug and alcohol use, mental illness, lack of self-control, high stress
Discussion
Ask the students to review the first three points on the slide. Ask for ideas on why people in these groups are more likely to shake a baby. If it isn’t raised by the students, ask them whether they see a relationship between the third point, inexperience with babies, and the first two. Discuss whether this class and other ways to learn about babies might be important for everyone to increase their knowledge about babies.
Discuss the fourth point separately. Relate these risk factors to other educational or personal experiences the students may have had.

16. When a baby can’t stop crying
Try different ways to soothe the baby.
Know that a comforted baby doesn’t always mean a quiet baby.
Know that crying isn’t always a sign that something is wrong.
If at anytime you start feeling tense or frustrated, it is important for you to take a break.
Narrative
When a baby cries you can try different ways to soothe her. Different ideas may work at different times.
Know that a comforted baby doesn’t always mean a quiet baby. Your attempts to calm the baby may not stop the baby from crying. The baby, is still benefiting from your attention. You are building the baby’s trust and security in your relationship.
Keep in mind that sometimes a baby just has to cry. Crying doesn’t necessarily mean that something is wrong.
When you have done everything you can to meet a baby’s needs and the baby keeps crying, you may feel tired, alone, or frustrated. You might feel that you are not doing a good enough job or that the baby is purposely making things hard. This is not the case!
It is normal to have strong feelings in response to inconsolable crying. If at anytime you start feeling tense, frustrated, or angry it is important for you to have a break.

17. Remember the Rule of 10
Lay the baby on his back in his crib or another safe place
Stay feet or more away.
Slowly count to or take deep breaths to calm yourself down.
After minutes, check on the baby
Repeat if necessary.
If you still feel stressed, call someone for help 10
Narrative
Review the information on the slide. You may want to make a copy of this slide to put up in the classroom or to hand out to students.
Never leave a crying child alone for more than 10 minutes without checking on him. 10 10 10

18. It’s okay to ask for help
Have the phone numbers of people who can help when the crying is
too much.
Someone who can come over right away and help
The baby’s doctor, or nurse helpline
Local community resources
Narrative
Not only is it OK to ask for help, sometimes it is the very best thing to do.
Before you agree to babysit, either as a job or for a baby in your family, make sure that you are prepared by getting information from the parents about how to care for the baby and who to contact in case of an emergency.
All parents and babysitters need help at times, and it is important for you to have a plan in place.
Who can come over right away and help? The baby’s parents? Your parent? A neighbor? A friend who has experience taking care of babies?
Can you call the baby’s doctor or nurse helpline?
Are there other local programs that can help you?
Note: Give examples of times that you needed help and how the other person also benefited: a win-win situation. This might be a time when you needed a break from caring for child and how you could help the other person during that time, such as running an errand for a neighbor.

19. My pledge This hand will never harm a baby Signed: Pass the message on
Activity
For this activity you will need:
Pledge cards to distribute to students
Ink pad(s)
I’m going to ask each of you to make this commitment:
This hand will never harm a baby. If you agree, I would sign your pledge card and place your thumb print on your card as part of your personal pledge.
On the back of the card is the Rule of 10. Keep this card in a place where you can find it to remind yourself of your commitment to keeping babies and young children safe from Shaken Baby Syndrome.
Post test
Ask students to complete the post test. (The post test is the same as the pre test and will be printed on the back side.)
When they have completed the test, read off the answers. Ask students to grade their own tests or to grade the test of a classmate. Have them record the number correct on the bottom of each test.
Have students raise their hand if they got more responses correct on the second test. If time allows, facilitate a discussion on how they will use the information they have learned.
Follow up interview
This optional out-of-class activity has two objectives:
Offer students an opportunity to relate the information they have learned
Make the information available to adult members of the community
Provide a copy of the Follow up interview to each student. Ask them to interview someone they know who comes in contact with babies or small children and to return the completed interview form during the next class period. If time permits, facilitate a discussion of their experiences.
Pass the message on

20. This material was developed by the SBS Prevention K12 curriculum team
Susan Abbey – Children’s Trust Fund
Pamela Anderson – Middleton School District
Anne Haverland – Oshkosh School District
Nancy Graese – CESA 11
Nancy Merwin – Cuba City School District
Sue Mokler – Ripon School District
Wendi Schreiter – Wisconsin Shaken Baby Association
Copyright © Children’s Trust Fund of Wisconsin

21. Thanks for your time and your commitment to never harm a baby.
Acknowledgements
National Shaken Baby Association
The Children of Shaken Baby Syndrome
SBS Prevention Network, Alberta Canada
Thanks for your time and your commitment to never harm a baby.
Pass the message on