Related Experiment Video
Updated: Aug 23, 2025
Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Educational interventions to prevent paediatric abusive head trauma in babies younger than one year old: A systematic
Lauren J Scott1, Rebecca Wilson1, Philippa Davies1
1Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Insights
Educational programs to prevent abusive head trauma (AHT) in infants show little to no effectiveness. While some interventions may slightly improve parental responses to crying, they do not significantly reduce AHT incidence.
Area of Science:
- Pediatrics
- Public Health
- Child Development
Background:
- Paediatric abusive head trauma (AHT) is a severe form of child maltreatment resulting from violent shaking or blunt impact.
- Primary prevention strategies, including educational and behavioral programs, aim to modify parent-infant interactions to reduce AHT incidence.
- This systematic review evaluates the efficacy of these interventions in preventing AHT in infants.
Approach:
- A comprehensive search of multiple databases (Embase, MEDLINE, PsycINFO, Cochrane, CINAHL) and trial registries was conducted up to September 2021.
- Included studies were randomized controlled trials (RCTs) and non-randomized studies (NRSs) focusing on interventions with messaging about infant shaking dangers.
- Meta-analyses were performed on combinable studies, with evidence certainty assessed using the GRADE framework.
Key Points:
- Meta-analyses of five NRSs found no significant effect of interventions on AHT rates (OR 0.95, 95% CI 0.80-1.13).
- One cluster-RCT indicated a reduction in self-reported shaking (OR 0.11, 95% CI 0.02-0.53), but a cohort study did not show this effect.
- Secondary outcomes showed marginal improvements in parental responses to crying, such as increased 'walking away' (IRR 1.52, 95% CI 0.94-2.45), but no effects on parental mental wellbeing.
Conclusions:
- Low-certainty evidence suggests educational programs are ineffective in preventing abusive head trauma (AHT).
- Interventions demonstrate minimal to no impact on parental mental wellbeing or most responses to infant crying.
- Further research may be needed to identify effective strategies for AHT prevention.
Background:
Paediatric abusive head trauma (AHT) occurs in young children due to violent shaking or blunt impact. Educational and behavioural programmes modifying parent/infant interactions may aid primary prevention. This systematic review aims to assess the effectiveness of such interventions to prevent AHT in infants.
Methods:
We searched Embase, MEDLINE, PsycINFO, The Cochrane library, CINAHL databases and trial registries to September 2021, for studies assessing the effectiveness of educational and behavioural interventions in preventing AHT. Eligible interventions had to include messaging about avoiding or dangers of infant shaking. Randomised controlled trials (RCTs) reporting results for primary (AHT, infant shaking) or secondary outcomes (including parental responses to infant crying, mental wellbeing), and non-randomised studies (NRSs) reporting primary outcomes were included. Evidence from combinable studies was synthesised using random-effects meta-analyses. Certainty of evidence was assessed using GRADE framework. PROSPERO registration CRD42020195644.
Findings:
Of 25 identified studies, 16 were included in meta-analyses. Five NRSs reported results for AHT, of which four were meta-analysed (summary odds ratio [OR] 0.95, 95 % confidence intervals [CI] 0.80-1.13). Two studies assessed self-reported shaking (one cluster-RCT, OR 0.11, 95 % CI 0.02-0.53; one cohort study, OR 0.36, 95 % CI 0.20-0.64, not pooled). Meta-analyses of secondary outcomes demonstrated marginal improvements in parental response to inconsolable crying (summary mean difference 1.58, 95 % CI 0.11-3.06, on a 100-point scale) and weak evidence that interventions increased walking away from crying infants (summary incidence rate ratio 1.52, 95 % CI 0.94-2.45). No intervention effects were found in meta-analyses of parental mental wellbeing or other responses to crying.
Interpretation:
Low certainty evidence suggests that educational programmes for AHT prevention are not effective in preventing AHT. There is low to moderate certainty evidence that educational interventions have no effect or only marginally improve some parental responses to infant crying.
