Infant head trauma no more common in military families

NEW YORK (Reuters Health) - Infants in military families have about the same risk of suffering head trauma from violent shaking, known as shaken baby syndrome, as civilian babies, a new study suggests.

Researchers looking at U.S. Department of Defense records found between 26 and 34 out of every 100,000 babies born into military families had substantiated abusive head trauma in the first year of life, similar to civilian rates during the same period.

However, “Within the military there are some children who are particularly at higher risk, including the children of enlisted men,” said Dr. Desmond Runyan, director of the Kempe Center for the Prevention and Treatment of Child Abuse and Neglect at the University of Colorado School of Medicine in Aurora.

Baby boys, as well as those born early or with birth defects, were also at increased risk for shaken baby syndrome. So were infants with young mothers, parents in lower pay grades or mothers in the military.

Babies between two and four months old are at the highest risk of shaken baby syndrome, which can cause seizures and permanent brain damage. One in four children with the condition dies as a result.

In general, shaken baby syndrome is most common among families who are poor, have little social support and are under stress, Runyan and his colleagues said. Inconsolable crying is one of the main triggers for shaking.

“These risk factors for shaken baby syndrome can get magnified a little bit due to the stresses of being in the military,” Runyan told Reuters Health.

Many military families are removed from their extended families, live in lower-quality housing and earn relatively low wages, all of which could make child abuse more likely, he said. On the other hand, being in the military may protect against some forms of abuse, like neglect, since members of the military have to pass an aptitude test, have steady employment and have access to family support programs.

Past studies on the topic have been inconsistent: some showed an increased risk for shaken baby syndrome among military babies, while others failed to show a link.

One issue, Runyan said, is that some of those studies were done on military training bases where there are a lot of young families - so the results may represent the experience of mostly higher-risk infants.

For the new study, the researchers looked at Department of Defense medical records for 676,827 infants born between 1998 and 2005 and linked them to investigative findings from military family advocacy programs confirming cases of abuse.

Of those infants, 230 had substantiated shaken baby syndrome and 73 had probable or possible shaken baby syndrome.

Using U.S. Centers for Disease Control and Prevention criteria for a diagnosis of shaken baby syndrome, the researchers calculated there were 34 substantiated cases in the first year of life for every 100,000 military babies during the study period.

They then did the same analysis with criteria that have been used to study shaken baby syndrome among civilians, which produced a rate of about 26 cases per 100,000 babies. That is similar to the 28 cases per 100,000 infants found in a past study of civilian babies in 2000, the researchers write in Pediatrics.

Gia Gumbs, who led the study at the Naval Health Research Center in San Diego, California, told Reuters Health in an email that studies of civilian families “may underestimate the number of cases” of shaken baby syndrome if they use less sensitive criteria for diagnosis.

The researchers note that higher-risk military families should be provided additional support through screening and prevention programs for shaken baby syndrome, something the military strongly supports, according to the authors.

“The military has been very responsive and active to the concerns raised about shaken baby syndrome in infants,” Runyan said.

SOURCE: Pediatrics, online September 2, 2013