By Hugh Fisher
hfisher@salisburypost.com
The first twelve months of a newborn’s life are the most precious, and can also be the most dangerous.
Dr. Sara Sinal’s talk yesterday at First United Methodist Church focused on ways to identify and prevent infant abuse and death.
The three-hour presentation, sponsored by the Rowan County Board of Social Services, was geared toward parents, law enforcement officers and health professionals alike.
Sandra Wilkes, Rowan County Social Services director, said a focus on preventing infant death was both timely and necessary.
“It is such an easy risk factor to fix,” Wilkes said.
Sinal, a professor at Wake Forest University School of Medicine, is an expert on child abuse and neglect. She works with sick and injured kids at Brenner Children’s Hospital at Wake Forest University Baptist Medical Center.
At one point, she said, talking about the prevention of infant death seemed harsh. “There was a tendency for a while not to ask a lot of questions,” she said.
But today, investigators can, and should, be more willing to find out all the causes of infant death, and to rule out abuse.
She described, in sometimes heart-rending detail, cases where parents had accidentally smothered their infant children by sleeping next to them on couches or beds.
In cases of accidental death, Sinal said, “there is a big debate about whether those people should be prosecuted.”
It is, unfortunately, a very timely discussion in Rowan County: just two days before Sinal’s visit, a Spencer woman’s 2-week-old son was found unresponsive after sleeping in the same bed as his mother. An investigation into the boy’s death is continuing.
The dangers of co-sleeping ó keeping an infant child in the same bed as a parent for sleep or breast-feeding ó were a key point of discussion.
“Co-sleeping was present in 81 percent of infant deaths,” Sinal said, referring to a 2007 study.
While many experts claim co-sleeping can provide valuable psychological benefits, Sinal said the evidence shows that infants 6 months old or younger are at a greater risk of suffocation when they share a parent’s bed.
Suffocation may also be to blame for cases of Sudden Infant Death Syndrome, or SIDS, particularly since studies show a correlation between those infant deaths and a child’s sleeping position.
A key factor, she said, is a child’s sleeping position.
“We are promoting the ‘Back to Sleep’ campaign,” Sinal said. Promotional materials and intervention with parents, particularly in minority communities, are geared toward having parents place their babies on their backs for sleeping.
“A very young infant does not have the strength to push itself up” if it becomes tangled in blankets or pillows, Sinal said.
Among the recommendations Sinal shared, based on a recent American Academy of Pediatricians report, were to limit co-sleeping to times when a baby is actively breast-feeding, and to keep the child in a crib in the parent’s room the remainder of the time.
Those cribs should be free of pillows, blankets and toys; a sleeper with feet can be sufficient to keep a baby warm in a heated home, she said.
A problem, she said, is educating not only parents but other caregivers.
“You’ve got grandparents and others out there telling moms the opposite of what the hospital should be telling them,” Sinal said.
Spotting abuse
Shaking is a chief cause of traumatic brain injury, cerebral palsy and other debilitating conditions, Sinal said.
In a frank and sometimes graphic talk, she related her experience with a baby who had been abused, resulting in lifelong disability.
“The rate … is 25 per 100,000 people, but 25 percent of those babies die,” she said.
“If parents confess to having shaken their children, the cause is often that the baby wouldn’t stop crying.”
Rather than simply emphasizing behavioral change, new efforts focus on helping new parents understand how and why babies cry, and how to respond.
The answer to that need is the PURPLE Crying campaign. Each letter stands for a different fact parents need to remember, including the fact that crying can be unexpected, that it can resist soothing and can make it appear an infant is in pain even when nothing is wrong.
The point is to keep parents from getting so frustrated by unexpected crying that they might lose control of themselves.
“You can carry them, you can comfort them,” Sinal said. “But if it’s too much you can place them in a safe place, walk away and calm yourself.”
Equally important, Sinal said, is for medical professionals to be able to spot abuse, including the telltale signs of shaking.
Sinal said a prime need is for training to help medical professionals recognize small signs of infant abuse that might be hidden or misdiagnosed, especially in cases of repeated abuse by a parent.
She also called for more funding so that a full investigation of the scene can happen whenever a child dies accidentally in the home.
Sgt. Eric Ennis, of the Spencer Police Department, said the talk had increased his awareness of the possibilities that may exist when he sees a child who has been injured or killed.
“As an investigator, it’s going to help me with questioning a parent or caregiver and doing a more thorough investigation,” Ennis said.