Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Oct 16;109 Suppl 2(Suppl 2):17294-301.
doi: 10.1073/pnas.1121267109. Epub 2012 Oct 8.

Preventing Abusive Head Trauma Resulting From a Failure of Normal Interaction Between Infants and Their Caregivers

Affiliations
Free PMC article
Review

Preventing Abusive Head Trauma Resulting From a Failure of Normal Interaction Between Infants and Their Caregivers

Ronald G Barr. Proc Natl Acad Sci U S A. .
Free PMC article

Abstract

Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.

Conflict of interest statement

Conflict of interest statement: With regard to references to the Period of PURPLE Crying prevention program of the National Center on Shaken Baby Syndrome (NCSBS), the author declares the following: M. Barr is the Executive Director of the NCSBS, a 501(c)3 nonprofit organization. She receives no support other than her salary as Executive Director of the NCSBS. R.G.B. is a member of the International Advisory Board of the NCSBS. He receives no compensation for this role other than travel and lodging expenses for meetings. R.G.B. and M. Barr are married. The NCSBS and R.G.B. jointly hold the registered trademark for the Period of PURPLE Crying (Registration no. 2,962,262). R.G.B. received no financial benefit from Period of PURPLE Crying products sold by the NCSBS through the end of June 2007. In December 2007, the Governing Board of the NCSBS offered a royalty agreement to R.G.B. for a minor share of net profits from the future sale of Period of PURPLE Crying products in recognition of the intellectual property contribution by R.G.B. M. Barr was not involved in the creation of the agreement and was intentionally excluded and uninvolved in terms of the discussions, preparations, and review of the agreement to avoid any perception of a conflict of interest. The agreement was signed on December 22, 2007.

Figures

Fig. 1.
Fig. 1.
Age-specific number of reported cases of SBS in infants from 0 to 18 mo of age from the NCSBS Victim Database entered between January 1, 2003 and August 31, 2004. Diamonds and the solid line represent all cases irrespective of stimulus (n = 591), and squares and the broken line represent the subgroup of cases with crying reported as the stimulus (n = 166). (Reproduced with permission from ref. . Copyright 2007 Lippincott Williams & Wilkins, Inc.)
Fig. 2.
Fig. 2.
Crying amounts and patterns from three North American studies illustrating the age-related crying curve and absence of a secular trend. Triangles represent data from Brazelton (69), circles represent data from Hunziker and Barr (70), and diamonds represent data from Kramer et al. (77). (Reproduced from ref. . Copyright 2005 Elsevier Ltd.)

Similar articles

See all similar articles

Cited by 15 articles

See all "Cited by" articles

Publication types

Feedback