11.4: Safety

Learning Objectives

1. Identify common causes of nonfatal and fatal injuries among infants and toddlers.
2. Describe car seat safety guidelines and the effectiveness of proper restraint use.
3. Define Abusive Head Trauma and Shaken Baby Syndrome.
4. Explain the characteristics, consequences, and strategies for prevention of Abusive Head Trauma and Shaken Baby Syndrome.

Safety

There are different risks to infant safety. According to the CDC, nonfatal injury rates vary by age group.

• Nonfatal suffocation rates were highest for those less than 1 year of age.
• Rates for fires or burns, and drowning were highest for children 4 years and younger.
• Children 1 to 4 years of age had the highest rates of nonfatal falls and poisoning. Infants should never be left unattended on a high surface, as you never know when they may start rolling over.

And the leading causes of injury death also differed by age group.

• For children less than 1 year of age, two–thirds of injury deaths were due to suffocation.
• Drowning was the leading cause of injury or death for those 1 to 4 years of age.⁶⁶

Car seat safety

Motor vehicle injuries are a leading cause of death among children in the United States. But many of these deaths can be prevented.

• In the United States, 723 children aged 12 years and younger died as occupants in motor vehicle crashes during 2016, and more than 128,000 were injured in 2016.
• One CDC study found that, in a single year, more than 618,000 children aged 0-12 rode in vehicles without using a child safety seat, booster seat, or seat belt at least some of the time.
• Of the children ages 12 years and younger who died in a crash in 2016 (for which restraint use was known), 35% were not buckled up.⁶⁷

Buckling children in age- and size-appropriate car seats, booster seats, and seat belts reduces the risk of serious and fatal injuries:

• Car seat use reduces the risk of injury in a crash by 71-82% for children when compared to seat belt use alone.
• Booster seat use reduces the risk of serious injury by 45% for children aged 4–8 years compared to seat belt use alone.
• For older children and adults, seat belt use reduces the risk of death and serious injury by approximately half.⁶⁸

Figure \(\PageIndex{1}\): The different types of car seats based on age. Image by the CDC is in the public domain.

Shaken Baby Syndrome

Here is a PSA from the Centers for Disease Control (CDC): The crying. The late-night feedings. The diaper changes. The exhaustion. If you’ve ever been around a baby who won’t stop crying, you know there’s potential to get frustrated. Focus on calming yourself and understand that you may not be able to calm your baby. It’s not your fault or your baby’s.⁴⁶

It’s normal for healthy babies to cry, and some babies cry much more than others. And they cannot always be consoled, and caregivers can feel pushed to the limit. When caregivers lose control and shake a baby, it can have devastating effects.

Shaken Baby Syndrome (SBS) is a severe form of physical child abuse. SBS may be caused from vigorously shaking an infant by the shoulders, arms, or legs. The “whiplash” effect can cause intracranial (within the brain) or intraocular (within the eyes) bleeding. Often, there is no obvious external head trauma. Still, children with SBS may display some outward signs:

• Change in sleeping pattern or inability to be awakened
• Confused, restless, or agitated state
• Convulsions or seizures
• Loss of energy or motivation
• Slurred speech
• Uncontrollable crying
• Inability to be consoled
• Inability to nurse or eat

SBS can result in death, mental retardation or developmental delays, paralysis, severe motor dysfunction, spasticity, blindness, and seizures.

Who’s at Risk?

Small children are especially vulnerable to this type of abuse. Their heads are large in comparison to their bodies, and their neck muscles are weak. Children under one year of age are at the highest risk, but SBS has been reported in children up to five years of age. Shaking often occurs in response to a baby crying or having a toilet-training accident. The perpetrator tends to be male and is often the biological father, the mother’s boyfriend, or partner. Caregivers are responsible for about 9%-21% of cases. The explanation typically provided by the caregiver—”I was playing with the baby”—does not begin to account for the severity of trauma. Many times, there is also a history of child abuse.

Can It Be Prevented?

SBS is completely preventable. However, it is not known whether educational efforts will effectively prevent this type of abuse. Home visitation programs are shown to prevent child abuse in general. Because the child’s father or the mother’s partner often causes SBS, they should be included in home visitation programs. Home visits bring community resources to families in their homes. Health professionals provide information, healthcare, psychological support, and other services that can help people to be more effective parents and caregivers.

The Bottom Line

• Shaking a baby can cause death or permanent brain damage. It can result in lifelong disability.
• Healthy strategies for dealing with a crying baby include:
  • finding the reason for the crying
  • checking for signs of illness or discomfort, such as diaper rash, teething, or tight clothing;
  • feeding or burping;
  • soothing the baby by rubbing its back; gently rocking; offering a pacifier;
  • singing or talking;
  • taking a walk using a stroller or driving in a properly secured car seat;
  • or calling the doctor if sickness is suspected
• All babies cry. Caregivers often feel overwhelmed by a crying baby. Calling a friend, relative, or neighbor for support or assistance lets the caregiver take a break from the situation. If immediate support is not available, the caregiver could place the baby in a crib (making sure the baby is safe), close the door, and check on the baby every five minutes.⁴⁷

Figure \(\PageIndex{2}\): Medical professionals caring for an infant. Image by the U.S. Air Force is in the public domain.

Abusive Head Trauma

Shaken baby syndrome is a form of abusive head trauma (AHT), a severe form of physical child abuse that results in injury to the brain of a child. This is important to note because:

• Abusive head trauma is a leading cause of physical child abuse deaths in children under 5 in the United States.
• Abusive head trauma accounts for approximately one-third of all child maltreatment deaths.
• The most common trigger for abusive head trauma is inconsolable crying.
• Babies less than one year old are at greatest risk of injury from abusive head trauma.⁴⁹

References, Contributors and Attributions

46. Coping with Crying 3 PSA by the CDC is in the public domain

47. Shaken Baby Syndrome by the CDC is in the public domain

49. Preventing Abusive Head Trauma in Children by the CDC is in the public domain

66. Protect the Ones You Love: Child Injuries are Preventable by the CDC is in the public domain

67. Child Passenger Safety: Get the Facts by the CDC is in the public domain

68. Child Passenger Safety: Get the Facts by the CDC is in the public domain