Belief Statement

Greater Hope Ministries, Inc., believe that preventing, recognizing, responding to, and reporting shaken baby syndrome and abusive head trauma (SBS/AHT) is an important function of keeping children safe, protecting their healthy development, providing quality child care, and educating families.

Prevention

For sexual abuse, it is important to educate children about proper names to call their “private parts” (genitals, buttocks, breast). It is also critical to teach them that these areas are private and 1) it is not OK for other people to have the child see or touch those areas on the other person; 2) nor is it appropriate for other people to ask to see or touch those areas on the child. A child should be taught that this includes anyone — and not just strangers; however, teaching about danger from strangers is also important.

For physical abuse, it is important for caregivers to have appropriate understanding of what their child’s developmental capabilities are as they grow. Additionally, it is recommended to avoid physical punishment. The use of physical punishment poses an increased risk of causing physical injury. Additionally, physical punishment has been identified to have risks including increased prevalence of mental health problems, negative relationships with parents, increased aggression and increased risk of subsequent physical abuse of the child. The alternative age-appropriate methods of discipline can include: timeouts of one minute per year of age, redirection, setting clear limits, offering limited choices, giving clear directions, taking away privileges, teaching alternatives and praising/rewarding good behaviors.

Verbal children also need to understand that if there are concerns, they should tell a trusted adult, and it is OK for them to tell.

Recognition

For physical abuse, it is important to know that bruising on the torso, ears, or neck of a child under 4 years old, or bruising anywhere on a child under 4 months old, should raise concern and prompt further exploration and reporting.

For sexual abuse, often the most important indication is what the child reports as having occurred. Child sexual abuse can include but is not limited to: contact for sexual purposes, molestation, statutory rape, prostitution/human trafficking, exposure/observation of sexual content or sexual behaviors of others, pornography, or incest, as well as other forms of sexual exploitation. Children who have been sexually abused can present with varying degrees of signs and symptoms; however, absence of these should not discount what a child reports as having occurred.

Signs and symptoms may include:

Daytime wetting accidents after previously being able to stay dry
Nighttime bed wetting after previously being able to stay dry
Soiling (stool) accidents after previously achieved continence
Depression
Anxiety
Fear
Sleep disturbance
Appetite changes
Self-esteem problems
Interpersonal relationship problems
Regression of development
Sexualized behavior
Change in school behavior
Blood in urine
Burning with urination
Unexplained genital bruising or oral bruising
Sexually transmitted disease
Pain, bleeding, discharge or lesions of the vagina, penis, anus or mouth
Any of these justifies a conversation with the child’s medical provider, as sexual abuse is only one of the possible causes of some of these findings.

Background 

SBS/AHT is the name given to a form of physical child abuse that occurs when an infant or small child is violently shaken and/or there is trauma to the head. Shaking may last only a few seconds but can result in severe injury or even death.

Procedure/Practice

Recognizing: 

• Children are observed for signs of abusive head trauma including irritability and/or high pitched crying, difficulty staying awake/lethargy or loss of consciousness, difficulty breathing, inability to lift the head, seizures, lack of appetite, vomiting, bruises, poor feeding/sucking, no smiling or vocalization, inability of the eyes to track and/or decreased muscle tone. Bruises may be found on the upper arms, rib cage, or head resulting from gripping or from hitting the head.

Responding to: 

• If SBS/ABT is suspected, staff will
  • Call 911 immediately upon suspecting SBS/AHT and inform the director. 
  • Call the parents/guardians.  
  • If the child has stopped breathing, trained staff will begin pediatric CPR

Reporting: 

• Instances of suspected child maltreatment in child care are reported to Pennsylvania Department of Human Services 215-560-2541 or Childline at 1800-932-0313.
• Instances of suspected child maltreatment in the home are reported to the county Department of Human Services. Phone number: 215-560–2541

Prevention strategies to assist staff* in coping with a crying, fussing, or distraught child
Staff first determine if the child has any physical needs such as being hungry, tired, sick, or in need of a diaper change. If no physical need is identified, staff will attempt one or more of the following strategies

• Rock the child, hold the child close, or walk with the child. 
• Stand up, hold the child close, and repeatedly bend knees. 
• Sing or talk to the child in a soothing voice. 
• Gently rub or stroke the child’s back, chest, or tummy. 
• Offer a pacifier or try to distract the child with a rattle or toy. 
• Take the child for a ride in a stroller.
• Turn on music or white noise.

In addition, the facility: 

• Allows for staff who feel they may lose control to have a short, but relatively immediate break away from the children6.
• Provides support when parents/guardians are trying to calm a crying child and encourage parents to take a calming break if needed.

Prohibited behaviors

Behaviors that are prohibited include (but are not limited to):

• shaking or jerking a child 
• tossing a child into the air or into a crib, chair, or car seat
• pushing a child into walls, doors, or furniture

Strategies to assist staff members understand how to care for infants

Staff reviews and discusses:

For up-to-date resources on IECMHC across all settings, visit Georgetown’s Center of Excellence for Infant and 

Early Childhood Mental Health Consultation. At the Center of Excellence website, you can access resources. How to Care for Infants and Toddlers in Groups, the National Center for Infants, Toddlers and Families, www.zerotothree.org/resources/77-how-to-care-for-infants-and-toddlers-in-groups 

• Including Relationship-Based Care Practices in Infant-Toddler Care: Implications for Practice and Policy, the Network of Infant/Toddler Researchers, pages 7-9, www.acf.hhs.gov/sites/default/files/opre/nitr_inquire_may_2016_070616_b508compliant.pdf 

Strategies to ensure staff members understand the brain development of children up to five years of age

All staff take training on SBS/AHT within first two weeks of employment. Training includes recognizing, responding to, and reporting child abuse, neglect, or maltreatment as well as the brain development of children up to five years of age. Staff review and discuss:

• Brain Development from Birth video, the National Center for Infants, Toddlers and Families, www.zerotothree.org/resources/156-brain-wonders-nurturing-healthy-brain-development-from-birth
• The Science of Early Childhood Development, Center on the Developing Child, developingchild.harvard.edu/resources/inbrief-science-of-ecd/ 

Parent web resources

• The American Academy of Pediatrics: www.healthychildren.org/English/safety-prevention/at-home/Pages/Abusive-Head-Trauma-Shaken-Baby-Syndrome.aspx 
• The National Center on Shaken Baby Syndrome: http://dontshake.org/family-resources
• The Period of Purple Crying: http://purplecrying.info/

References

1. The National Center on Shaken Baby Syndrome, www.dontshake.org
2. Shaken baby syndrome, the Mayo Clinic, www.mayoclinic.org/diseases-conditions/shaken-baby-syndrome/basics/symptoms/con-20034461
3. Pediatric First Aid/CPR/AED, American Red Cross, www.redcross.org/images/MEDIA_CustomProductCatalog/m4240175_Pediatric_ready_reference.pdf
4. Calming Techniques for a Crying Baby, Children’s Hospital Colorado, www.childrenscolorado.org/conditions-and-advice/calm-a-crying-baby/calming-techniques
5. Caring for Our Children, Standard 1.7.0.5: Stress http://cfoc.nrckids.org/StandardView/1.7.0.5

Application 

This policy applies to children up to five years of age and their families, operators, early educators, substitute providers, and uncompensated providers.

Communication 

Staff*

• Within 30 days of adopting this policy, the child care facility shall review the policy with all staff who provide care for children up to five years of age.
• All current staff members and newly hired staff will be trained in SBS/AHT before providing care for children up to five years of age.
• Staff will sign an acknowledgement form that includes the individual’s name, the date the center’s policy was given and explained to the individual, the individual’s signature, and the date the individual signed the acknowledgment
• The child care facility shall keep the signed SBS/AHT staff acknowledgement form in the staff member’s file.

Parents/Guardians

• Within 30 days of adopting this policy, the child care facility shall review the policy with parents/guardians of currently enrolled children up to five years of age. 
• A copy of the policy will be given and explained to the parents/guardians of newly enrolled children up to five years of age on or before the first day the child receives care at the facility. 
• Parents/guardians will sign an acknowledgement form that includes the child’s name, date the child first attended the facility, date the operator’s policy was given and explained to the parent, parent’s name, parent’s signature, and the date the parent signed the acknowledgement
• The child care facility shall keep the signed SBS/AHT parent acknowledgement form in the child’s file. 

* For purposes of this policy, “staff” includes the operator and other administration staff who may be counted in ratio, additional caregivers, substitute providers, and uncompensated providers.