When Stacey Nee delivered her second child, nurses talked to her about breastfeeding, safe sleeping practices, and postpartum depression, but she took note of what they did not mention: the potentially angry emotions, even dangerous actions, that can be stirred by a chronically crying baby.
The omission was particularly jarring to Nee, who works at the Children’s Trust in Boston, an agency that helped implement a 2006 state law calling on maternity wards to train parents, before discharge, about the dangers of shaken-baby syndrome.
“Nobody talked to me about this,” said Nee, who remembers, at most, receiving a brochure on the topic at the hospital two years ago.
Her experience reflects fears among many child-protection specialists that the state’s once-robust prevention efforts around this issue have weakened, relegated to pamphlets or a topic only faintly touched upon as part of stress-reduction advice given to new moms.
The evaporation of state funds is one major cause. But some also wonder if recent publicity over some highly contested, shaken-baby prosecutions in Massachusetts has raised questions about the diagnosis, and undermined the prevention message.
Others say warnings about mishandling infants are being crowded out by other new initiatives in the past decade, such as safe sleeping practices, postpartum depression, and even stronger promotion of breastfeeding.
Raising the idea that parents — or anyone they assign to care for their child — could be angered to the point of violence is also a downer in the feel-good environment of a maternity ward, and even mothers who told the Globe about their lack of training on the subject declined to name the hospital, for fear of pointing blame toward an institution that helped create their family.
“It’s a difficult conversation, but you have to have it,” said Geri Wilson, nurse manager of the mother-baby unit at Winchester Hospital, which requires new parents to sign documents attesting that they have been exposed to shaken-baby syndrome education.
Amid an alarming cluster of about 80 child deaths or injuries linked to this form of child abuse from 2001 to 2004, state lawmakers passed a prevention bill and approved a total of about $1 million over three years to fund it. This jump-started a prevention campaign once considered among the most aggressive in the country.
But the money has since dried up, and the Department of Public Health, in charge of coordinating the state law, no longer has a staffer devoted to it. The syndrome, also referred to as abusive head trauma, maims or kills some 1,000 babies a year nationally, according to the American Academy of Pediatrics.
Some nonprofits also detect diminished interest in the topic, symbolized by the educational pamphlets, videos, and other materials that sit unused in boxes in their offices.
Massachusetts Citizens for Children, a nonprofit child-abuse prevention group, distributed a total of about 80,000 of its prevention brochures to hospitals and groups in 2008 and 2009, but annual requests have since dropped by more than half, said Jetta Bernier, its executive director.
No state statistics are available to detect trends in the number of injuries or deaths related to this syndrome, though there is some evidence that fatalities nationwide have declined, and some researchers credit prevention efforts that have evolved in a number of states.
Still, even at the height of the Massachusetts prevention campaign in 2009, Boston Children’s Hospital and Massachusetts General Hospital reported nine infants suffering from shaken-baby syndrome in the first three months.
Massachusetts continues to have its share of cases, though some prosecutions have been vigorously challenged by defense attorneys and their medical experts who sometimes put forth possible natural causes for the brain injuries.
A segment of the legal and medical community, working nationwide, says doctors are often too quick to cite abuse when accidents or medical disorders might explain bleeding in the brain.
Still, some child advocates, relying on private funds to maintain prevention efforts, insist this form of child abuse is likely underdiagnosed, and worry these controversies may be sending a confusing message to the public.
“With more doubts that are being raised, people are beginning to think this is not a real issue,” said Suzin Bartley, the executive director of Children’s Trust, which is soon to launch a new app as part of its ongoing prevention work.
Some hospitals’ nurses, with firsthand exposure to victims of this type of abuse, say they are not allowing a small number of legal cases affect their commitment to prevention.
“We’re so confident in the validity of shaken-baby. It’s part of our DNA,” said Ginny Combs, nurse manager of the mother-baby unit at Boston Medical Center. But some nurse managers acknowledge that abusive head trauma may not always be explicitly discussed during a new mother’s typical 48-hour hospital stay.
Newborn education has evolved over the decades, they say, requiring many subjects — including conventional ones about bathing, car safety, and diapering — to be crammed into a new mother’s discharge plan.
New parents are often exhausted by the delivery process, and are more receptive to learning about shaken-baby syndrome in the months before — or after — the baby’s birth, rather than while they are in the hospital.
A major push, they say, is around making sure new mothers are aware of their own emotional well-being, and how they can stop a crisis from developing. “Moms really need to figure out how to care for themselves best,” said Kathleen Gordon, associate chief of maternal child and ambulatory nursing at Newton-Wellesley Hospital.
Dr. Katherine Economy, attending physician in maternal fetal medicine at Brigham and Women’s, also said education for new mothers is focusing more on “emotional support,” including knowing how and when to call for help when feeling overwhelmed.
Many who work in the child-protection field, however, worry that prevention around abusive head trauma is becoming too subtle, as nurses shy away from possibly insulting parents by raising issues of potential violence.
They also note that the vast majority of the people accused of perpetrating this abuse are males. After giving birth, one of a mother’s key decisions is picking the safest caretakers for her babies, they say.
The Massachusetts Society for the Prevention of Cruelty to Children sponsors a program for first-time teenage mothers, and works hard to involve the father or boyfriend in the child-abuse prevention training. It uses a doll with a transparent head, which allows participants to see what happens to the brain when vigorous shaking occurs.
RuthEmely Rivera, a staffer who conducts home visits out of the agency’s Lawrence office, said she finds “the dads react differently than the moms,” often finding this hands-on training helpful to understanding the delicacy of an infant’s head.
Child protection specialists worry that prevention training is only emphasized by political leaders after high-profile tragic deaths, with little attention paid to the many cases that never make the news.
A pediatrician in the Boston area said she had always understood abusive head trauma from textbooks, but then, within the past few years, personally encountered an infant with massive brain swelling, which was later diagnosed by specialists as child abuse. The issue — and the importance of prevention — was no longer academic.
In September, this doctor — who asked to be nameless to protect her patient’s and family’s privacy — gave birth to her second child and was given training about how to care for her baby, and for herself.
Nothing was said about abusive head trauma while she was in the hospital, though she later found, tucked within thick piles of papers in her discharge packet, a brochure entitled, “All Babies Cry,” which referred to the dangers of shaking an infant.
She thought to herself: “If you thought this was important, you’d say this to me.”