Preventing Abusive Head Trauma

Abusive Head Trauma, often referred to as Shaken Baby Syndrome, can cause catastrophic injuries  including intracranial injuries, retinal haemorrhage and certain long bone fractures and spinal fractures which can lead to brain damage, blindness, learning difficulties and death.

Research suggests that two years after the injury – 24.5% of babies with Abusive Head Trauma have died and 40% will have significant disabilities. Abusive Head Trauma can result when a baby is shaken, thrown, hit or slammed against a surface.

ICON is a nationally coordinated multi-agency programme, designed to support parents by reinforcing the simple evidence based four point message which makes up the ICON acronym:

I= Infant Crying is normal and it will stop.

C= Comfort methods can sometime soothe the baby and the crying will stop.

O= it’s OK to walk away if you have checked the baby is safe and the crying will stop.

N= Never ever shake or hurt a baby.

The Manchester ICON Steering group was set up in April 2018 which included colleagues from Barnardo’s, Population Health, Manchester University Hospitals NHS Foundation Trust (MFT), Manchester Health and Care Commissioning (MHCC) communication team and the designated safeguarding team.  All agencies worked together to ensure the pilot was robustly tested in south Manchester. The work included:

  • Developing ICON ‘touch points’
  • Designing the Manchester ICON leaflet
  • Staff Briefing
  • ICON training for the trainers and professionals package
  • Evaluation

Manchester Pilot

The south Manchester ICON pilot commenced the 1 May 2018 and completed on the 31 August 2018. The pilot focused on all live births due during June 2018 at MFT south Manchester site. There were 70 families who took part in the programme all of which were Manchester residents.

Each family included in the pilot who attended / received the appointments / touch points below received a leaflet and were engaged in a conversation to highlight the ICON message as outlined in table 2 below. This message was reiterated at each subsequent touch point.

Evaluation and findings

Post intervention questionnaires were completed by both parents (via telephone interviews carried out by outreach worker from Children’s Centre during September 2018) and professionals (Community Midwives, Health Visitors and outreach worker carrying out birth registrations), also during September 2018. A total of 23 parent questionnaires and 20 professional’s questionnaires were completed.

Overall the pilot was successful from both parents and professionals perspectives. Parents understood and remembered the message and highlighted the importance for them of the conversation rather than the leaflet alone.

 ‘I have used the mantra, ‘babies cry, I can cope’ myself when baby has cried. It has gone round my head and helped’ 

Professionals found the message flowed well alongside other health messages they were giving e.g. safe sleeping and that the programme fit easily into existing contacts and visits.

‘…very easy at new birth visit in particular but also antenatal visit as it flows well with other info given

‘…easy – fits nicely with bonding, attachment and handling of newborns

Some parents highlighted a belief that the message was more important for first time parents. However it has been noted from Serious Case Reviews and learning reviews that Abusive Head Trauma features more in second, third and fourth babies so it will be important to highlight this within future briefings for staff to ensure this message reaches parents.

‘as a second time dad I didn’t really listen this time round’ 

‘as a second time parent I know about this, but can imagine being a first time parent thinking it would be very useful’ 

The questionnaires revealed that where dads received the message it was well understood. There was however limited opportunities within the touch points to reach dads. The touch point where dads were most likely to have heard the message was at birth registration.

Download a copies of the Pilot ICON Leaflet [PDF] and the ICON Parent Questionnaires Draft Summary of findings [PDF]

Proposal for extending the scheme citywide

Based on the findings of the evaluation of the south Manchester Pilot we propose the following:

  • Expand the ICON programme as a citywide scheme to support all babies born in Manchester
  • Include birth discharge as an additional ‘touch point’. The reasons for this are two-fold: birth discharge provides an additional opportunity to reach both parents- particularly dads / male partners who are more likely to be present at this point than at other visits. We also recognise that currently not all mums are receiving an antenatal visit by a health visitor and this touch points adds an extra opportunity that may be missed.
  • Include all birth registrations as a touch point: The pilot showed this touch point as the one which reached most men. (Birth registrations at Children’s Centre). We therefore would wish to include all birth registration settings within the citywide scheme.
  • Adapt training to emphasise importance of getting the message to those with second and subsequent babies.
  • We propose to launch the full city wide scheme at the three Safeguarding Fora and support safeguarding leads in key agencies to take on responsibility for implementation within their respective organisations.