Shaken babies: A life-saving plan

By Martin Johnston

Prevention scheme springs from US, with success rates of up to 75%. Now 13 DHBs have adopted the system.

Julie Herbert and her 12 year old grandson Ryan Herbert. Photo / Chris Gorman
Julie Herbert and her 12 year old grandson Ryan Herbert. Photo / Chris Gorman

A pioneering programme targeting new parents is helping to halt a rising trend in babies injured by being shaken.

The Shaken Baby Prevention Programme, which began in 2010 at the Auckland District Health Board, has won a Health Ministry contract to implement it nationally. It has now been taken up by 13 DHBs.

It is based on a United States prevention scheme which, in one trial, was associated with a 47 per cent reduction in the incidence of shaken babies. Another trial found a 75 per cent reduction.

There has been no increase in the number of shaken baby cases at Starship since the prevention programme began, after a steady increase in the preceding years.

Dr Patrick Kelly, the clinical director of Te Puaruruhau, Starship hospital's child abuse assessment units, said the absence of a reduction in shaken-baby cases "doesn't necessarily mean the programme isn't having an effect".

The programme involves training DHB staff and other health practitioners to provide brief advice to parents and those expecting their first child on how to cope with a crying baby. The information is also included in an ADHB/Child Youth and Family pamphlet and the patients are told of the Starship Foundation Never, ever shake a baby video, available on YouTube. Sometimes the DVD is shown to groups, such as in prisons.

Dr Kelly said: "It's quite affirming for parents to be routinely educated that crying babies are stressful.

"Everyone struggles with it."

Nationally about 20 babies a year, with an average age of 5 months, are admitted to hospital after being shaken or being subjected to violent impact, of whom two to four die. Starship cares for more than half of these cases. It is thought many cases of shaken baby are never detected by authorities.

It is estimated from the known hospital cases that the lifetime costs of each shaken baby exceed $1 million, including health and disability care, education, child protection services, and judicial and incarceration costs.

Among those DHBs that have not taken part is Counties Manukau, which has a comparatively high incidence of injured babies.

The board, whose territory includes the high-deprivation suburbs of South Auckland, said its maternity focus this year was implementing the recommendations of its 2012 external review of maternity care. It used other methods to counter violence and help mothers cope with a crying baby.

But Dr Kelly said: "I'm disappointed they're not implementing the programme, because I think it's a relatively straightforward alteration to a normal conversation that a midwife, GP or other health professional could be having with [parents].

"There will be staff at Counties Manukau who are already having those conversations and it's really just about altering the content a little."

He said Counties Manukau was the source of the largest number of shaken-baby cases from a single DHB coming to Starship.

Nettie Knetsch, the general manager of Kidz First and women's health at Counties Manukau DHB, said it didn't expect to implement the national prevention programme until next year and it would require extra funding.

"All midwives ... are trained in working with the women in their care on coping with crying babies and adjusting to being a new parent."

The DHB's Infant Mental Health Service had developed an education DVD that promoted healthy attachment with a newborn and included calming strategies. It was given to all women giving birth in the DHB's facilities.

"We're planning to review this DVD and look at opportunities of how we integrate the messages in this DVD with the Power to protect pamphlet and the Starship Foundation DVD."

Action's consequences last a lifetime

Ryan Herbert is 12 but still explodes into the tantrums of a 3-year-old.

His toddler temperament results from being shaken as a baby by his mother's new partner - after she and Ryan's father had separated.

Developmentally he is the equivalent of a 3-year-old. His sight is badly impaired, his understandable language is limited to about 50 words, his left side is weak from a stroke, he has botox injections to free up his limbs, he learned to use the toilet only last year, he damages household items unintentionally and sleeps no more than six hours a night.

But he does have something that works for him: music - singing along with songs, playing cymbals and drums and even a bugle his grandfather found. Music has also formed a friendship for Ryan with another disabled boy who attends weekly sessions with him at the Raukatauri Music Therapy Centre.

Ryan's grandmother, Aucklander Julie Herbert, 57, discovered the value of music in calming him down after he came to live with her - and his grandfather and the three of their children then still living at home - four months after Ryan was injured.

"Ryan learns through music," says Mrs Herbert. "That is definitely the way to teach him anything. He is pitch perfect and tells me off if I sing the wrong words.

"He sings along to songs on the radio even though he can't say the words. He's into Queen, Coldplay and Glenn Miller at the moment.

"Ryan was born perfect. He should have had a wonderful life," she says.

But in 2002 when aged 5 months, Ryan was shaken by Craig Campbell Thorburn - the new partner of Mrs Herbert's daughter-in-law - who later pleaded guilty to recklessly causing grievous bodily harm.

He had been throwing Ryan in the air and catching him, but on one occasion failed to catch him and he landed on the floor, according to a Herald court report. When Ryan was apparently lifeless, Thorburn panicked and shook the baby. He was sentenced to two years' prison but served less than a year.

Ryan has mostly been home-schooled, but now attends Albany Junior High, which has a unit for children with special needs.

Mrs Herbert says living with a 12-year-old who is like a toddler has restricted her family's lives.

Ryan took a hammer to nearly every wall in the house after he saw his grandfather doing renovations, he quickly damages new appliances by fiddling with them, and the couple's oldest granddaughter rarely comes to stay as she gets scared of Ryan.

Listing the difficulties of life with Ryan, Mrs Herbert says "Ryan has a tizzy getting in and out of the car - we get reported to the police for manhandling him; when we buy something nice it is trashed in days; since he arrived we have not had a full night's sleep; I have to be careful as Ryan is getting rough with me and can and has hurt me.

"We spent months trying to teach him to draw. Finally he got it - all over the walls and carpet."

Mrs Herbert is speaking out "to let people know that shaken baby does not end with the shaking. It affects everyone close to the child for the rest of that child's life.

"I would like all mothers to be careful when choosing new partners after they have a baby and to put their children before anybody or anything else."

- NZ Herald

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