1. I have no relevant financial relationships with the manufacturers of any commercial products and/or provider of commercial services discussed in this CME activity. I do not intend to discuss an unapproved/investigative use of a commercial product/device in their presentation. Practicing Safety Toolkit: Infant Bundle - Crying Steve Kairys, MD, MPH, FAAP John Stirling, MD, FAAP Practicing Safety Learning Session May 30, 2009

2. The 3 Basic Premises: Parents don’t know enough about child development Lack of knowledge can lead to abuse Pediatricians can make a difference!

6. Myths: What does not cause shaken baby syndrome  Tossing a baby in the air  Bouncing a baby on your knee  Falling off a couch  Jogging with a baby in your backpack  Baby in a bicycle carrier  Falling from a high chair or down stairs  Sudden stops in a car seat

7. Crying is the number one stimulus that results in a baby being shaken, because crying:  Leads to frustration and anger that reaches a threshold  Leads to feelings of inadequacy, guilt, helplessness  Supports beliefs that something is wrong with the baby or that the baby is “bad”

9. Assessment: learn before you teach Green light:  Do parents have realistic expectations?  Do they have a plan?  Does the home environment work?

10. Assessment: learn before you teach Yellow light: complications  Child factors Developmental delays, stressors  Parent factors Stressors  Family factors Multiple caretakers

11. Assessment: learn before you teach Red light: serious complications  Domestic violence  Drug use  Mental illness  Previous hx violence or abuse

12. Temperament?  Activity level  Regularity over time  Approach/withdrawal  Adaptability to new situations  Response threshold  Mood quality (positive/negative)  Distractibility  Persistence (attention span) after Chess & Thomas, 1995

13. Temperament: Interventions  Evaluate “goodness of fit”  Validate parent’s feelings of stress, inadequacy, anger  Ask about support as well as stress  Help parents be aware of temperament Affects feeding, sleeping “Who does he/she remind you of?” Child’s distress = difficulty in adjusting

14. Pearl #1: Don’t take something away from anybody without giving something in return! Corollary: You shouldn’t tell someone what not to do, without telling them what to do.

15. Pearl #2: Ask about them Talk about you (…and don’t assume anything!)

16. Crying: Reasons?  Hungry?  Tired?  Hot or cold?  Needs changing?  Over-tired?  What do the caregivers think?

17. Crying: Interventions  Explain the role of stimulation  Frame the baby’s distress as a difficult adaptation to the world outside the womb  Offer (realistic) hope

18. Crying: Interventions  Hold  Swaddle  Talk or sing to the baby  Walk or rock  Do a handoff  If all else fails:  It’s OK to take a break! BE SPECIFIC!!

19. How About Spoiling? What Grownups Know…

20. How About Spoiling? What Grownups Know…