Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers
Preventing abusive head trauma resulting from a failure of normal interaction between infants and their caregivers
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DOI：
10.1073/pnas.1121267109
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发表时间：
2012-10-16
影响因子：
11.1
通讯作者：
Barr, Ronald G.
中科院分区：
文献类型：
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作者：
Barr, Ronald G.
虐待造成的头部创伤，包括摇晃婴儿综合征，是一种毁灭性的和潜在致命的婴儿身体虐待形式，最早在20世纪70年代初被认识到。人们较少认识到的是，在出生后的头几个月里，本来正常的婴儿在早期哭闹的增加是虐待的触发因素。在某种程度上，这是因为婴儿哭泣，特别是长时间的无法安抚的哭泣，在临床上被解释为婴儿、婴儿的照顾者或他们之间的相互作用有问题。在这里，我们回顾了另一种发展解释，即早期哭闹的增加是正常婴儿的典型行为发展，通常并不反映任何错误或异常。我们还回顾了表明这种正常哭泣模式是虐待性头部创伤（AHT）最常见的触发因素的证据。总之，这些研究结果表明，AHT的概念化是一个失败的结果，否则常见的，反复的，发育正常的婴儿-照顾者的互动。它们还意味着，通过公共卫生初级普遍预防战略，旨在改变照顾者和社会对婴儿正常发育和婴儿早期哭闹增加的意义的知识和行为，有机会预防AHT和其他形式的婴儿虐待。如果有效的话，可能会对国家和国际防止虐待婴儿产生重要影响。
Head trauma from abuse, including shaken baby syndrome, is a devastating and potentially lethal form of infant physical abuse first recognized in the early 1970s. What has been less recognized is the role of the early increase in crying in otherwise normal infants in the first few months of life as a trigger for the abuse. In part, this is because infant crying, especially prolonged unsoothable crying, has been interpreted clinically as something wrong with the infant, the infant's caregiver, or the interactions between them. Here, we review an alternative developmental interpretation, namely, that the early increase in crying is a typical behavioral development in normal infants and usually does not reflect anything wrong or abnormal. We also review evidence indicating that this normal crying pattern is the most common trigger for abusive head trauma (AHT). Together, these findings point to a conceptualization of AHT as the consequence of a failure in an otherwise common, iterative, and developmentally normal infant-caregiver interaction. They also imply that there is a window of opportunity for prevention of AHT, and potentially other forms of infant abuse, through a public health primary universal prevention strategy aimed at changing knowledge and behaviors of caregivers and society in general concerning normal development of infants and the significance of early increased infant crying. If effective, there may be important implications for prevention of infant abuse nationally and internationally.