For more information—as well as radio PSAs and broadcast-quality 

video that includes B-Roll, full-screen tips, and downloadable 

scenarios—please visit: www.cdc.gov/TraumaticBrainInjury.

“Helping all people live to their full potential”

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention
“Preventing Shaken Baby Syndrome: A Guide for Health Departments and Community-Based Organizations” is a publication of the 

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. See www.cdc.gov/injury.
Table of ConTenTs

Summary: Shaken Baby Syndrome is a Preventable Public Health Problem 1

The Facts: What You Need to Know About Shaken Baby Syndrome 3

Focusing on Prevention 4 

Understanding the Consequences 4 

Learning What to Look For 6 

Getting Started: Working Towards Success 9

Building a Framework for Prevention 9 

Learning About and from Existing Programs 10

Getting the Message Out: The Right Message, Right Person, Right Time 15

Creating Effective Messages 15 

Working with the Media 19

Strength in Numbers: Building Partnerships to Prevent SBS 21 

Collaborating with other Organizations and the Business Community 21 

Initiating Partnerships 21 

Working Together: Roles of Health Departments and Community-Based Organizations 23 

Identifying Potential Partners 26

Taking Public Health Solutions to the Next Level: Impacting Policy 29 

Policy is an Effective Public Health Intervention 29 

Your Agency/Organization’s Role in Impacting Policy 31

Resources 35

Appendix A: State Initiatives on SBS 43 

Appendix B: Prevention Tips for Parents and Caregivers 50 

Appendix C: A Partnership Planning Tool 52

Appendix D: Educational Resources 54
1

Shaken Baby Syndrome is a 

Preventable Public Health Problem

Summary
Preventing Shaken Baby Syndrome

2
The Facts

3

THE FACTS:

What You need to Know 

about shaken baby syndrome

Understanding the facts helps build awareness, and ultimately affects how we take action. 

Using your contact with parents and other community members to promote the facts, risk 

factors and triggers, and ways to prevent sbs is the first step in addressing it as a public health 

problem that can be prevented, and not just a crime to be punished. 

sbs, a form of abusive head trauma (aHT) and inflicted traumatic 

brain injury (ITbI), is a preventable and severe form of physical 

child abuse. It results from violently shaking an infant by the 

shoulders, arms, or legs. sbs may result from both shaking alone 

or from impact (with or without shaking).1

 The resulting whiplash 

effect can cause bleeding within the brain or the eyes.2

The american academy of Pediatrics (aaP) and the Centers 

for Disease Control and Prevention (CDC) report that 

maltreatment causes a high rate of injury and death among 

infants.4,5 sbs can cause death, mental retardation or 

developmental delays, cerebral palsy, severe motor 

dysfunction, blindness, and/or seizures.

■ sbs is a leading cause of child abuse 

deaths in the United states. nearly all 

victims of sbs suffer serious health 

consequences and at least one of every 

four babies who are violently shaken 

dies from this form of child maltreatment.

■ babies (newborn to 4 months) are at 

greatest risk of injury from shaking.

■ Inconsolable crying is a primary 

trigger for shaking a baby. 

1

Carbaugh sf. Understanding shaken baby syndrome. adv neonatal Care 2004;4(2):105–16. 

2Centers for Disease Control and Prevention, national Center for Injury Prevention and Control, Division of Violence Prevention. shaken baby syndrome Tip sheet [online]. [cited 2010 

March 1.] available from URl: http://www.cdc.gov/healthmarketing/entertainment_education/tips/shaken_baby.htm.

3

Carbaugh sf. Understanding shaken baby syndrome. adv neonatal Care 2004;4(2):105–116.

4

Centers for Disease Control and Prevention. nonfatal Maltreatment of Infants [online]. [cited 2010 March 1.] available from URl: www.cdc.gov/mmwr/preview/mmwrhtml/mm5713a2.htm. 

5american academy of Pediatrics Committee on Child abuse and neglect. shaken baby syndrome: Rotational cranial injuries—technical report. Pediatrics 2001; 108(1):206–10 [online]. 

[cited 2010 March 1.] available from URl: aappolicy.aappublications.org/cgi/reprint/pediatrics;108/1/206.pdf.
Preventing Shaken Baby Syndrome

4

Research shows that shaking most often occurs in response to a baby crying or other factors that can 

trigger the person caring for the baby to become frustrated or angry. 

The fact is that crying—including long bouts of inconsolable crying—is normal developmental behavior 

in infants. The problem is not the crying, it’s how caregivers respond to it. Picking up a baby and 

shaking, throwing, hitting, or hurting him or her is never an appropriate response.

everyone, from caregivers to bystanders, can do something to prevent sbs. Giving parents and 

caregivers tools that can help them cope if they find themselves becoming frustrated while caring 

for a baby are important components of any sbs prevention program (see appendix b: Prevention Tips 

for Parents and Caregivers).

as a public health professional, you play a key role in reinforcing prevention through helping people 

understand the dangers of violently shaking a baby, the risk factors and the triggers for it, and ways 

to lessen the load on stressed-out parents and 

caregivers, all of which may help to reduce the 

number of cases of sbs. 

UnDeRsTanDInG THe ConseQUenCes

It is important to understand that sbs is the result 

of violent shaking that leads to a brain injury, which 

is much like an adult may sustain in repeated car 

crashes. The forceful shaking that causes sbs is 

child abuse; it does not happen in normal play. 

Claims of perpetrators that the highly traumatic 

internal injuries characterized by sbs resulted from 

“playing with the baby” are false. While jogging an infant on your knee or tossing him or her in the air 

can be very risky, the injuries that result from sbs are not caused by these types of activities. 
5The FactsThe Facts
Preventing Shaken Baby Syndrome

6

SBS Signs and Symptoms

6Carbaugh sf. Understanding shaken baby syndrome. adv neonatal Care 2004;4(2):105–16. 

7

Miehl nJ. shaken baby syndrome. J forensic nurs 2005;1(3):111–7. 

8Carbaugh sf. Understanding shaken baby syndrome. adv neonatal Care 2004:4(2): 105–16. 
7The Facts

Factors that Put an Infant at Risk

The following factors increase an infant’s risk of being shaken,9,10,11 particularly when combined with a 

parent or caregiver who’s not prepared to cope with caring for a baby:

■ being less than 1 year of age, 

• babies less than 1 year of age are at the greatest risk, but sbs has been reported in children 

up to 5 years of age.

• babies (especially babies ages 2 to 4 months) are particularly at risk of injury from shaking, 

because they are small in relation to the size of adults who may pick them up and shake them, 

and they tend to cry more frequently and longer than older babies.

■ Infant prematurity or disability,

■ being one of a multiple birth,

■ Inconsolable and/or frequent crying,

■ Prior physical abuse or prior shaking, and

■ Most sbs victims are male.

Factors that Can Increase Parents’ or Caregivers’ Risk for Harming a Baby

Most sbs perpetrators are parents and their partners, with the majority of the perpetrators being the 

male parent or partner. The following factors increase a parent’s or caregiver’s risk of shaking a baby, 

particularly when combined with not being prepared to cope with caring for a baby.12

■ frustration or anger resulting from an infant’s crying,

■ being tired,

■ Having limited anger management or coping skills,

■ limited social support,

■ Young parental age,

■ Unstable family environment,

9Hoffman, JM. a case of shaken baby syndrome after discharge from the newborn intensive care unit. adv neonatal Care 2005;5(3): 135–46. 

10black Da, Heyman Re, smith slep aM. Risk factors for child physical abuse. aggress Violent behav 2001;6(2–3): 121–88.

11Keenan HT, Runyan DK, Marshall sW, nocera Ma, Merten Df, sinal sH. a population-based study of inflicted traumatic brain injury in young children. JaMa 2003;290(5):621–6. 

12Miehl nJ. shaken baby syndrome. J forensic nurs 2005;1(3):111–7.
Preventing Shaken Baby Syndrome

8

■ low socioeconomic status,

■ Unrealistic expectations about child development and child-rearing,

■ Rigid attitudes and impulsivity,

■ feelings of inadequacy, isolation, or depression,

■ being a victim or witness to intimate partner violence, or

■ negative childhood experiences, including neglect or abuse.

Diagnosing SBS

Health care providers may be alerted to a possible sbs injury by any of the following:13

■ any infant or young child who presents with a history that is not plausible or consistent with the 

presenting signs and symptoms,

■ The presence of a new adult partner in the home,

■ a history of delay in seeking medical attention,

■ a previous history or suspicion of abuse,

■ The absence of a primary caregiver at the onset of injury or illness,

■ Physical evidence of multiple injuries at varying stages of healing, or

■ Unexplained changes in neurologic status, unexplained shock, and/or cardiovascular collapse. 

There are a number of diagnostic tools that health care providers can use to assess the possibility of 

sbs in injured babies. In addition to a thorough history and physical exam, including ophthalmologic 

examination, physicians may use computerized tomography, magnetic resonance imaging, skeletal 

surveys, and other medical tests to diagnose sbs. 

13Miehl nJ. shaken baby syndrome. J forensic nurs 2005;1(3):111–7.
9Getting Started

GETTING STARTED:

Working Towards Success 

Knowing what needs to be done and prioritizing where to start can often be a challenging task. Start 

by using a prevention model, rooted in behavioral science, as a practical tool to create an effective 

strategy. The model can guide decisions to identify your organization’s role in the issue, align activities 

with your mission, and leverage your reach to the community to maximize impact. 

BUILDING A FRAMEWORK FOR PREVENTION 

Prevention requires understanding the factors that influence violence. CDC uses a four-level socialecological model to better understand violence and the effect of potential prevention strategies.14

This model considers the complex interplay between individual, relationship, community, and societal 

factors and is more likely to sustain prevention efforts over time than any single intervention. 

The model serves as a practical 

framework to build your strategy. 

The activities, messages, partnership, 

and policy suggestions outlined in 

this guide already build upon each 

of the four levels of the framework. 

Additionally, you can also use the 

model as a reference or guide to 

assess ways to use resources and 

reach audiences at various levels. 

14Dahlberg LL, Krug EG. Violence a global public health problem. In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, eds. World Report on Violence and Health. Geneva, 

Switzerland: World Health Organization; 2002:1–56.
Preventing Shaken Baby Syndrome

10
11Getting Started

Many of these programs strive to raise awareness about sbs, educate parents and other caregivers 

about the serious effects of sbs-related injuries, and inform them about infant crying behavior and 

safe ways to reduce and prevent sbs injuries. These strategies address the multiple levels of the 

prevention model. examples of common prevention strategies include: 

■ Coordinated hospital-based primary prevention programs targeting parents of newborns, 

■ Home visits for new parents (home visits bring community resources to families in their homes; 

health professionals provide information, health care, psychological support, and other services 

that can help people to be more effective parents and caregivers),

■ anticipatory guidance at well-baby visits in pediatric practice and/or health clinics,

■ school prevention programs for junior high and high school students providing students with 

an understanding of child maltreatment issues, anger management techniques, and child care 

skills. for example, the national Center on shaken baby syndrome offers a school-based 

program for junior and senior high school students, which teaches students about the “medical 

aspects of shaking injuries, combined with basic anger management and child care skills. The 

program reaches young adults as potential caregivers 

and future parents. Teaching students how frustration 

can lead to shaking helps them understand the 

importance of appropriate coping skills,”15

■ Programs targeting males, especially new fathers, 

with information and resources for providing safe and 

nurturing care for their new infants and safe strategies 

for coping with frustration caused by crying babies,16

■ Professional education and trainings for doctors, nurses, 

social workers, and others providing family services, and

■ educational print and video materials provided at the 

time of delivery, as well as at pediatric offices and 

prenatal classes.

This is Important

When possible, it is important to use 

evidence-based practice as the 

foundation for any intervention. evidencebased practice, as defined by the Institute 

of Medicine (IoM), is a combination of 

three factors: 

1. best research evidence

2. best clinical experience, and 

3. Consistency with patient values.17

15national Center for shaken baby syndrome [online]. [cited 2010 March 1.] available from URl: www.dontshake.com/audience.aspx?categoryID=10&Pagename=schoolbased.htm.

16national Center for shaken baby syndrome, Dads 101 [online]. [cited 2010 March 1.] available from URl: www.dontshake.com/audience.aspx?categoryID=10&Pagename=Dads101.htm.

17Committee on Quality of Health Care in america, Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. (2001). national academy 

Press: Washington, DC 
Preventing Shaken Baby Syndrome

12

example program

Upstate New York Shaken Baby Syndrome Education Program

The California evidencebased Clearinghouse for 

Child Welfare (CebC) has 

designated the Upstate new 

York shaken baby syndrome 

education Program as 

having Promising Research 

Evidence.

18 Developed by Dr. Mark s. Dias and 

colleagues, this hospital-based, parent education 

program provides information to parents at the time 

of birth about the effects of violent shaking, as well as 

alternatives for responding to crying infants. as part 

of this intervention, nurses were asked to have both 

parents read a pamphlet, view a video titled Portrait 

of Promise: Preventing Shaken Baby Syndrome, and 

sign a commitment statement to indicate that they 

received and understood the information before 

their baby was discharged from the hospital.

findings from follow-up telephone surveys with 

parents 7 months after the birth suggest that 

more than 95 percent of the parents remembered 

receiving the information. In addition, after 5 years, 

this effort resulted in significantly decreased 

incidence of abusive head trauma among children 

ages 36 months and younger.19 The program, which 

began in December 1998, has been adopted by 

many states and hospitals across the nation. 

as part of CDC-funded research, Dr. Dias is 

replicating a revised version of the program in 

Pennsylvania. The components of this 

evaluation include:

1) Time series analysis of reported cases in 

Pennsylvania to examine the trends in sbs 

cases before, during, and after the program 

is introduced, and comparing results,

2) Time series analysis of hospital discharge data 

in Pennsylvania and surrounding states,

3) Randomized trial in 31 counties in central 

Pennsylvania to evaluate the effectiveness of 

providing additional information at pediatric 

well visits, and

4) an economic analysis to examine program 

costs and benefits.

18California evidence-based Clearinghouse for Child Welfare [online]. [cited 2010 March 1.] available from URl: www.cachildwelfareclearinghouse.org/scientific-rating-scale.

php#rating3. 

19Dias Ms, smith K, deGuehery K, Mazur P, li V, shaffer Ml. Preventing abusive head trauma among infants and young children: a hospital-based, parent education program. 

Pediatrics 2005;115(4):e470–7.
13Getting Started

example program

Period of PURPLE Crying®

The CebC has designated the Period of PURPle 

Crying© program as having Promising Research 

Evidence. This program was developed by Dr. Ronald 

Barr and colleagues at the national Center on shaken 

baby syndrome (nCsbs). Two randomized controlled 

trials of the program showed increases in knowledge 

about crying and sbs and “walk away behavior when 

the mother was frustrated.”20

as part of CDC-funded research, Dr. Desmond K. 

Runyan is testing the program in north Carolina. 

The state-wide program will educate parents about 

normal infant crying patterns, how to respond to 

crying, and the dangers of shaking. The information 

will be disseminated in a manner designed to reach 

every new parent three times. nurses will educate 

parents of every newborn at all 86 hospitals/birthing 

centers in north Carolina, using discussion, a video, 

and a booklet about infant crying. In addition:

■ County health departments, pediatricians, 

and family physicians will provide a dose of 

the intervention in prenatal classes and/or at 

2-week well-child checks; and

■ The nCsbs and the University of north 

Carolina school of Journalism and Mass 

Communications will develop a statewide 

media campaign that addresses social 

norms about shaking and reinforces 

program messages directly and through 

family and friends.

Period of PURPLE Crying®

P - Peak Pattern

Crying peaks around 2 months, then decreases.

U - Unpredictable

Crying for long periods can come and go for 

no reason.

R - Resistant to soothing 

The baby may keep crying for long periods.

P - Pain-like look on face

l - long bouts of Crying Crying can go on 

for hours.

e - evening Crying 

Baby cries more in the afternoon and evening.

source: national Center on shaken baby syndrome

20national Center on shaken baby syndrome. Randomized Controlled Trials on the effectiveness of the PURPle Materials: Parallel studies in the state of Washington (Usa) and the 

province of british Columbia (Canada) [online]. [cited 2010 March 1.] available from URl: http://www.dontshake.org/sbs.php?topnavID=4&subnavID=32&subnav_1=172&navID=176.
Preventing Shaken Baby Syndrome

14

Period of PURPLE Crying® (continued)

The multi-level evaluation strategy for the project 

includes:

1) active surveillance of traumatic brain injuries in 

all Pediatric Intensive Care Units,

2) anonymous surveys of parents on discipline 

practices before and after the intervention,

3) Time series analysis to examine the trends 

in abusive head trauma cases before, during, 

and after the program is introduced and 

comparing results,

4) Process evaluation of the delivery of the messages,

5) nested case-control study of abusive head trauma 

cases, compared to other hospitalized children 

with brain injury and the entire cohort of children 

under age 2, and

6) an economic analysis to examine program costs 

and benefits.

Reviews and ratings used to determine the research 

evidence for other interventions related to child 

welfare are located on Web sites, such as the 

national MCH Center for Child Death Review, 

www.childdeathreview.org, the RanD Promising 

Practices network on Children, families and 

Communities, www.promisingpractices.net, and the 

California evidence-based Clearinghouse for Child 

Welfare, www.cachildwelfareclearinghouse.org.
15Getting the Message Out

GETTInG 

the MESSAGE OUT:

The Right Message, Right Person, Right Time 

CReaTInG effeCTIVe MessaGes 

Prevention messages are often drowned out in the thousands of messages seen and heard by people 

every day. That’s why it is important to focus your message to make sure it reaches the right audience 

for the right results. since all ideas and words do not resonate with all audiences, it is important to 

tailor specific messages to each audience to make them effective. 

Using messages to communicate about sbs prevention can range from developing a complex 

campaign to using a few appropriate messages in your existing programs and activities. no matter the 

size of your effort, using the example messages below consistently with the right audiences can help 

reframe sbs as a preventable public health problem, and can be used to address each of the four 

levels of the prevention framework. 

To prevent child maltreatment, it is important to focus on making people aware of what to normally 

expect as a child develops, how to support parents, and steps they can take in different situations.21

because crying is one of the primary triggers for shaking a baby, messages that teach how to cope 

with crying may be most effective. Messages should also be specific and focus on awareness and 

action. It is important to make people not only aware of sbs and their role in preventing it, but also 

21Wrisley b. Reframing the issue: a new child maltreatment prevention message. n C Med J 2005;66(5):367–9.
Preventing Shaken Baby Syndrome

16

give them specific and feasible actions for prevention. 

Messages should also match activity goals and can be 

used to:

■ Increase awareness of sbs in a particular audience. 

■ Help make an audience more open to participating 

in programs or taking specific action for prevention. 

■ Help support policies.

■ Help decisionmakers, such as policymakers, 

partners, or organizational leadership, understand 

sbs as a preventable issue that needs their support. 

Health communication tools are available 

to help you plan, design, implement, 

and evaluate an sbs prevention communication 

campaign. below are some examples:

■ Adding Power To Our Voices: A Framing Guide 

for Communicating About Injury (www.cdc.gov/

injury)

■ CDCynergy: Violence Prevention Edition 

(www.cdc.gov/ncipc/dvp/CDCynergy/ 

CDCynergy.htm)

■ National Cancer Institute’s Making Health 

Communication Programs Work, (www.cancer.

gov/pinkbook) 

The example messages below can help guide you in 

addressing key audiences with the power to prevent 

sbs: parents, caregivers, bystanders, and health care 

providers. 

Example Messages for Parents and Other Caregivers:

1) Crying is normal for babies.

a) Crying is one way babies communicate. 

b) excessive crying is a normal phase in infant development.

■ babies cry most between 2 and 4 months.

■ Prolonged, inconsolable crying generally lessens when babies are around 5 months old.22

■ Most babies who cry a great deal are healthy and stop crying spontaneously. 

c) You are not a bad parent if your baby continues to cry after you have done all you can to 

 calm him or her.

d) Remember, this will get better.

22st. James-Roberts, I. effective services for managing infant crying disorders and their impact on the social and emotional development of young children. In: Tremblay 

Re, barr RG, Peters RDeV, eds. encyclopedia on early Childhood Development [online]. 2004:1–6. available from URl: http://www.child-encyclopedia.com/pages/PDf/ 

stJames-RobertanGxp.pdf.
17Getting the Message Out

2) When a baby cries, there are steps you can 

take to try to comfort him or her.

a) Check for signs of illness or discomfort 

like a dirty diaper, diaper rash, teething, 

fever, or tight clothing.

b) assess whether s/he is hungry or needs 

to be burped.

c) Rub his/her back, gently rocking him/her; 

offer a pacifier; sing or talk; take a walk 

using a stroller or a drive in a properlysecured car seat.

d) Call the doctor if you think the child is ill.

e) Remember you are not a bad parent or 

caregiver if your baby continues to cry after you 

have done all you can to calm him or her.

3) When you feel frustrated, angry, or stressed while caring for your baby, take a break.

a) Call a friend, relative, neighbor, or a parent helpline for support. 

b) Put your baby in a crib on his or her back, make sure the baby is safe, and then walk away 

for a bit, checking on him or her every 5 to 10 minutes.

c) Remember, this will get better.

4) be aware of signs of frustration and anger in yourself and others caring for your baby:

a) see a health care professional if you have anger management or other behavioral concerns.

b) ensure others caring for your baby see a health care professional if they easily become angry 

or frustrated around your baby.
Preventing Shaken Baby Syndrome

18

Focusing on Positive Parenting

Example Messages for Bystanders 

1) Crying is normal for babies.

a) excessive crying is a normal phase in 

infant development. 

b) sometimes babies cry for no apparent 

reason.

c) It is not always possible to console a 

crying infant.

Many parents feel pressured on some level, 

by others, to make their baby stop crying (CDC 

2007 Healthstyles Survey). bystanders are people 

who are not caring for an infant, but who may be 

affected by an infant’s crying or other behaviors. 

2) support parents and other caregivers of babies.

a) as appropriate, offer to provide child care so that parents get needed breaks.

b) be sensitive and supportive in situations in which parents or caregivers are trying to calm a 

crying baby.

c) Communicate to the parent or caregiver that you understand that it is difficult to care for a crying 

baby and offer to help (this may include giving the parent a helping hand or a break, sharing 

a parent support helpline number, or just acknowledging that parenting can be difficult and 

exhausting at times).

23Miehl nJ. shaken baby syndrome. J forensic nurs 2005;1(3):111–7.
19Getting the Message Out

“Crying Curve”

Infant crying begins to increase 

around 2 to 3 weeks of age, and 

peaks around 6 to 8 weeks of age. 

as illustrated below, it then tapers off 

when the baby is 3 to 4 months old.

Hours of fussing 

per 24 Hours

5

4

3

2

1

age in Weeks

2 3 4 5 6 7 8 9 10 11 12

Upper Quartile

Lower Quartile

Median

Source: Crying in Infancy, T. berry brazelton. Reproduced 

with permission from Pediatrics, Vol. 29, Pages 579-588, 

Copyright © april 1962 by the aaP

Example Messages for Health Care Providers

1) Remind parents and caregivers that crying is normal 

for babies.

a) explain to parents that excessive crying is a normal 

phase of infant development.

b) share the Crying Curve with parents. 

2) support parents and other caregivers of babies.

a) During routine pediatric visits, be sure to ask parents 

how they are coping with parenthood and their feelings 

of stress. 

b) assure them that it is normal to feel frustrated at long 

bouts of crying and a sudden decrease in sleep, but that 

things will get better. 

c) Give parents the number to a local helpline or other 

resource for help. 

d) Talk with them about the steps they can take when 

feeling frustrated with a crying baby, such as putting 

the baby safely in a crib on his or her back, making 

sure that he or she is safe, walking away and calling 

for help or a friend, while checking on the baby every 

5 to 10 minutes. 

e) let parents know what to check for when their baby is 

crying: signs of illness, fever or other behavior that is 

unusual, or discomfort like a dirty diaper, diaper rash, 

teething, or tight clothing, or whether he or she is hungry 

or needs to be burped.
Preventing Shaken Baby Syndrome

20

WoRKInG WITH THe MeDIa

Messages through the media can have wide reach to 

multiple audiences. The media can also uniquely help to 

reframe sbs as a public health problem, rather than just 

a criminal investigation. CDC has created a companion 

guide for the media on reporting on sbs. You can share 

this guide with local media or use it to develop messages 

when you speak to journalists. The guide, “a Journalist’s 

Guide to shaken baby syndrome: a Preventable 

Tragedy,” as well as radio public service announcements 

(in english and spanish) and broadcast-quality video that 

includes b-roll, full-screen tips, and downloadable scenarios, are available at: www.cdc.gov/Injury.
21Strength in numbers

STREnGTH in nUMBERS:

building Partnerships to Prevent sbs 

CollaboRaTInG WITH oTHeR oRGanIZaTIons anD THe bUsIness CoMMUnITY 

Partnerships and collaborations can be critical elements for achieving success. They can be 

instrumental in expanding your reach to new audiences, augmenting resources, adding outreach 

channels, facilitating message dissemination within the community, and offering referral sources for 

your program. for example, when your partners collaborate to deliver the same prevention messages 

through communication channels used by your target audience, it extends the messages’ reach and 

frequency. effective messages that are delivered to the same audience through multiple channels are 

more likely to be remembered and move the audience to take the desired action. 

InITIaTInG PaRTneRsHIPs

While every situation and partnership is unique, here are some general steps often used to build 

partnerships:

1) Assess your current situation. Planning your prevention effort should involve a careful analysis 

of your organizational resources and needs, including staff, funding, facilities, technology, and 

expertise. This information will help clarify when a potential collaboration with another organization 

can support your program goals. 

2) Identify potential partners. The relationship should be mutually beneficial. Identify organizations 

that support your mission of preventing injuries and improving health and safety for new parents 

and their babies. Determine how collaboration will mutually support short- and long-term goals. first 

consider those with which you have successfully partnered in the past. Then consider new partners, 

such as the media and business communities. These organizations can help you reach new parents 

with key information and resources and strengthen your advocacy for prevention efforts, or perhaps 
Preventing Shaken Baby Syndrome

22

combine resources with you and other organizations to develop a collaborative prevention effort in 

the community supported by a range of like-minded civic groups. for example, an employer’s “lunch 

and learn” program for new parents in a business setting, or building relationships with human 

resource or employee assistance professionals in large corporations may lead to other opportunities 

to build community support for parents. 

3) Develop your “pitch.” after strategically selecting groups with which you might work, develop 

your “pitch,” or selling points, and your “ask,” that is, what you want the organization or individual to 

do as part of the collaboration. for example, you may want to ask them to join you in incorporating 

sbs prevention messages and parent support activities into their ongoing communication activities 

with parents, caregivers, and other relevant audiences. This will vary based on the resources, needs, 

and priorities of each organization. In addition, showcase the benefits that your potential partners will 

gain by collaborating. be sure to highlight benefits that are most relevant to their values and mission. 

4) Make contact. Whenever possible, deliver your partnership proposal in person. Consider bringing 

at least one other person, because different communication styles and demeanors can influence an 

encounter. However, make sure that your team speaks with one voice, based on the messages you 

develop. Delivering mixed messages creates confusion and weakens your credibility. 

5) Establish the partnership. being credible and offering incentives are important, but these may not 

be enough. Use your passion to make potential partners believe they should be involved. Describe 

how your programs and services can make a difference. share information about the emotional 

and financial burdens caused by sbs. Underscore how your community will benefit from your 

collaborative efforts, how others are getting involved, and how even seemingly small contributions 

can help prevent injury and death. Confirm how the proposed partnership is mutually beneficial. be 

specific about what you are asking the organization to do.

6) Give thanks. never forget the power of the phrase “thank you.” acknowledge partnership 

agreements promptly. look for creative ways to convey your gratitude to partners often and thank 

them publicly.
23Strength in numbers

WoRKInG ToGeTHeR: Roles of HealTH DePaRTMenTs anD CoMMUnITYbaseD oRGanIZaTIons

Roles for Health Departments in Preventing SBS
Preventing Shaken Baby Syndrome

24

Roles for CBOs in Preventing SBS

Cbos are uniquely positioned to incorporate consistent prevention messages and interventions into 

their ongoing community programs to address all four levels of the prevention framework. for example, 

individual-, relationship- and community-level strategies can be directed to new parents, caregivers, health 

care workers, social workers, and others who provide services to families in existing programs, such as:

■ Prenatal classes,

■ Parenting classes,

■ Postnatal support programs,

■ stress management classes,

■ Mentoring activities,

■ Home visitation programs,

■ Training for babysitters and child care providers,

■ Mental health programs, and

■ Training programs for health care providers and social workers.

other sbs prevention activities for Cbos include: 

■ forging partnerships with state and local health departments,

■ Referring new parents to organizations for information and support,

■ adding information about sbs prevention to existing, regular communications with other 

community organizations through Web sites, newsletters, and regular mailings,

■ advocating with policymakers and funding bodies for effective policies and resources to support 

parents in providing safe, stable, nurturing relationships for their infants (see Taking Public Health 

Solutions to the Next Level: Impacting Policy), and

■ Working with the media by providing consistent and appropriate messages (see section on 

Creating Effective Messages and CDC’s “a Journalists Guide to shaken baby syndrome: 

a Preventable Tragedy”).
25Strength in Numbers
Preventing Shaken Baby Syndrome

26

IDenTIfYInG PoTenTIal PaRTneRs

There are many diverse groups you could consider approaching for support, just as there are a 

variety of ways they might be able to work with you. The chart below offers examples of both:

Type of Organization

Civic and service organizations

Potential Collaborative Activities to Support SBS Education

■ Help identify local programs that might incorporate crying and coping 

 education and messages and promote those programs. 

■ Disseminate sbs prevention materials to their own members, as appropriate.

■ Disseminate information through existing channels, such as newsletters, flyers, 

 and Web sites.

■ Provide community forums where sbs information can be shared.

Local hospitals ■ 

■ 

■ 

■ 

■ 

Provide crying and coping education materials and messages to new parents.

offer training courses to new and expectant parents. 

sponsor health and wellness fairs incorporating crying and coping 

education information.

Incorporate sbs education in health care employee training.

Publish messages about crying behavior and coping in hospital wellness 

publications that are distributed to the public.

Faith-based organizations ■ 

■ 

Include crying behavior and coping messages in newsletters, marriage/parent 

education classes, daycare facilities, etc.

Distribute sbs prevention information at community health fairs and other 

appropriate forums.

Government programs that 

serve families and children, 

such as Women, Infants, and 

Children (WIC)

■ 

■ 

■ 

■ 

Include messages and education materials in outreach to new and young parents.

Display crying and coping information on bulletin boards and include it as part 

of regular communication with clients.

Put inserts into mailings and/or other types of regular statements.

Incorporate crying and coping messages in trainings, job preparation classes, 

maternity classes, work/life balance sessions, etc.

Large employers ■ 

■

■ 

Post information on bulletin boards and Web sites. 

offer information at employee brown bag lunches and 

for parents.

Include messages on pay stubs.

other employee activities 
27Strength in numbers

Type of Organization

Large employers 

(continued)

Potential Collaborative Activities to Support SBS Education

■ Include crying and coping messages in employee health fairs and other forums.

■ ask employee assistance programs to incorporate messages and education materials into their 

 counseling for new parents, and to direct new parents to resources that address “new baby” stress.

Elementary schools, Head Start, 

nursery, and daycare programs 

with access to new parents and 

potential parents-to-be

■ 

■ 

■ 

send flyers home with children.

Put information on message boards and in children’s school bags.

sponsor family health fairs that incorporate crying and coping education materials.

Community centers, local 

YMCAs, libraries, support 

groups for parents, and other 

local organizations sponsoring 

children and family activities

■ 

■ 

■ 

Incorporate messages and materials into ongoing classes for new and expectant parents, 

exercise, and stress management classes, etc.

Display posters or other information on bulletin boards.

sponsor family wellness days that incorporate crying and coping messages.

Community and (new) parent 

groups

■ 

■ 

sponsor an event or gathering focused on crying and coping.

organize a forum for new parent groups that incorporates sbs messages.

Local merchants including: 

baby retailers; bulk and big box 

discount retailers; pharmacies; 

grocery stores; gyms; department stores; shoe stores; home 

improvement stores; hair salons/

barber shops/nail salons/day 

spas; coffee shops; bookstores; 

theaters; movie theatres

■ 

■ 

■ 

■ 

■ 

■ 

Insert messages in or on shopping packages.

Display prevention messages on sales slips.

Display brochures, posters, or flyers.

sponsor in-store seminars for new parents as a way to bring them into their facilities for shopping.

Include messages on marquees, screens, or message boards. 

air targeted public service announcements (Psas) in movie theatres (Psas for males during 

movie genres targeted to young adult males and for new mothers during mommy movie days, 

select days at some theaters when babies are welcomed).

Media ■ Develop and air a Psa campaign (radio/TV/Web).

■ Use on-air talent to host events, appear in Psas, and serve as spokespersons.

■ obtain media sponsorships for community events.

■ Provide exclusive stories.

■ Provide ink/air time.

(Please note that partnering with one outlet may preclude work with a competitor and make it hard to pitch stories to other media.)

State and local health 

departments

■ 

■ 

■ 

■ 

Provide appropriate data to define the problem at the local level.

Create and disseminate messages to frame sbs as a preventable, public health issue.

apply the prevention framework to intervention strategies. 

Incorporate sbs prevention messages in programs for and contacts with expectant and new parents.
Preventing Shaken Baby Syndrome

28
TAkInG PUBLIC 

HEALTH SOLUTIOnS 

TO THE nExT LEvEL:

Impacting Policy 

PolICY Is an effeCTIVe PUblIC HealTH InTeRVenTIon 

Policy interventions are important and effective community and societal level strategies for improving 

the public’s health. Policy can be defined many ways, but one definition applicable to public 

health policy intervention describes policy as: “laws, regulations, formal and informal rules and 

understandings that are adopted on a collective basis to guide individual and collective behavior.”24

Public health policy interventions are targeted to influence systems development, organizational 

change, social norms, and individual behavior to promote improvement in the health of a population. 

Policy interventions are particularly valuable because they are systems-based and impact populations 

by changing the context in which individuals take action or make decisions (i.e., making default 

decisions safe and healthy). The effectiveness of a policy intervention, though, depends on the level of 

awareness, education, acceptance, funding, implementation efforts, enforcement, and even programs 

that accompany the creation or passage of the policy. 

24Wallack l. Media advocacy: Promoting health through mass communication. In: Glanz K, lewis fM, Rimer bK, eds. Health behavior and Health 

education: Theory, Research and Practice. san francisco, Calif: Jossey-bass; 1990: 370–386.

29Taking Public Health Solutions to the next Level
Preventing Shaken Baby Syndrome

30

There are different types and levels of policy; each of them plays an important role in improving the 

public’s health.

■ legislative, which is a law, ordinance, or regulation:

• local (city or county),

• state, and

• federal.

■ organizational, which could include the following examples: 

• local education agencies and/or local schools or school districts,

• Private hospital or other health care delivery sites (i.e., physicians’ offices),

• non-governmental organizations,

• Governmental agencies,

• business, industrial, or corporate, and

• Professional associations or accredited organizations.

Examples of SBS Policy Initiatives 

The following are two examples that demonstrate just a few of the multiple levels and types of policy 

changes that have been used in developing sbs prevention initiatives. 

1) Legislation/law at a state level.

“new York passed bill a08314, which requires all child care providers in new York to receive 

training on sbs. It is a mandate that all child day care providers be educated and informed on 

the identification, diagnosis and prevention of sbs. This education is to be added to the training 

providers already receive on early childhood development, nutrition and statues and regulations 

toward safety issues.”25 (see appendix a: State Initiatives on SBS, for a list of examples of state 

legislative initiatives.) 

25national Center on shaken baby syndrome [online]. [cited 2010 March 1.] available from URl: http://www.dontshake.org/sbs.php?topnavID=254&subnavID=318.
31Taking Public Health Solutions to the next Level

This example provides guidance on the agency responsible for implementation. The state health 

department is identified as the agency required to develop and implement an ongoing public 

information and educational campaign to inform child care providers about harmful effects of sbs. 

2) Organizational policy at a local/regional level. 

In response to a doubling of sbs admissions in 2004, the administrative leadership of legacy 

Health authorized a multidisciplinary task force to study the feasibility of implementing a systemwide sbs prevention program. Though not mandated by either state, this oregon and Washington 

hospital system secured grant funding to research, develop, and launch a pilot program. Program 

design was informed both by patient satisfaction data and other patient care quality initiatives. a 

successful system-wide roll- out followed within one year, as did the systematic integration of sbs 

prevention messages throughout the family-centered maternity and pediatric services continuum of 

care procedures. Mandatory skills Day training for all 400 obstetric care registered nurses included 

a 30-minute session on sbs and viewing of a DVD/booklet. 

In 2009, every family from every hospital went home with the Period of PURPLE Crying®

DVD/booklet; 90 percent of those families had both seen the DVD and received sbs prevention 

education from a nurse either at a discharge class or during one-to-one education at the bedside. 

YoUR aGenCY/oRGanIZaTIon’s Role In IMPaCTInG PolICY 

While the two examples above do a good job of illustrating the potential for policy interventions used 

to prevent sbs at the state government and local organizational levels, it should be noted that neither 

of them have been rigorously evaluated to determine their effectiveness in preventing sbs. as a 

matter of fact, there are no current examples of evidence-based policy interventions for prevention of 

sbs. However, an educational approach has been shown to be effective in preventing sbs and there 

are a few evidence-informed prevention programs available (see section, Getting Started: Working 

Towards Success). These are important factors to consider when thinking about activities to include in 

a policy plan or intervention to prevent sbs. 
Preventing Shaken Baby Syndrome

32
33Taking Public Health Solutions to the next Level

Examples of Activities that Impact Policy

Depending on the environment of the community and the role of the agency, an organization or 

program could engage in any or all of these activities to affect public health through policy.

1) Collecting, analyzing, summarizing, and interpreting data and other scientific-based information 

 relevant to the frequency and seriousness of sbs and its prevention,

2) Proactively disseminating data linked to possible solutions and making sure the data gets into 

 the hands of decisionmakers or those who can influence decisionmakers,

3) Packaging, presenting, or promoting data and information in ways that resonate with the 

 audience and can be used to inform decisionmaking (i.e., cannot assume that data or information 

 can stand alone),

4) Utilizing media and partners to help convey important messages to policymakers and the public, 

5) Reviewing and/or drafting potential policies or legislation,

6) building coalition networks that are able to advocate for policy changes, educating the public, 

 and implementing programs that impact prevention of sbs (see section, Strength in Numbers: 

 Building Partnerships to Prevent SBS),

7) Identifying and analyzing existing sbs-related policies in your community or state and working 

 to enhance them,

8) engaging in awareness efforts and implementation of existing policies that support prevention 

 of sbs,

9) Conducting a cost-benefit analysis related to the burden of sbs and predicting how a 

 science-based prevention effort will impact the cost for an organization or society,

10) evaluating existing/new policies, including an assessment of effectiveness and cost 

 effectiveness, and

11) Meeting with policymakers to inform or educate on the burden of sbs and what works to 

 prevent sbs.

35Resources

CDC ResoURCes

National Center for Injury Prevention and Control

Violence prevention is a major focus of the national Center for Injury Prevention and Control (Injury 

Center). as the lead federal agency for injury prevention and control, CDC’s Injury Center works closely 

with other federal agencies; national, state, and local organizations; state and local health departments; 

and research institutions. 

www.cdc.gov/Injury

National Center on Birth Defects and Developmental Disabilities

The national Center on birth Defects and Developmental Disabilities promotes the health of babies, 

children, and adults, and enhances the potential for full, productive living by providing positive 

parenting tips and information on developmental milestones and screening. 

www.cdc.gov/ncbddd/child/default.htm

Administration for Children and Families 

The administration for Children and families, within the Department of Health and Human services, is 

responsible for federal programs that promote the economic and social well-being of families, children, 

individuals, and communities. 

www.acf.hhs.gov

Administration for Children and Families, Children’s Bureau

The Children’s bureau is designed for professionals concerned with child abuse and neglect, child 

welfare, and adoption. 

www.cbexpress.acf.hhs.gov
Preventing Shaken Baby Syndrome

36

The Child Welfare Information Gateway 

The Child Welfare Information Gateway (a merger of the former national Clearinghouse on Child abuse and 

neglect Information and national adoption Information Clearinghouse) provides access to information and 

resources to help protect children and strengthen families. 

www.childwelfare.gov

FRIENDS National Resource Center 

fRIenDs national Resource Center is a federally mandated Training and Technical assistance Provider for 

agencies working to prevent child abuse. 

www.friendsnrc.org

American Academy of Pediatrics

The american academy of Pediatrics (aaP) and its member pediatricians dedicate their efforts and resources to 

the health, safety, and well-being of infants, children, adolescents, and young adults. The aaP has approximately 

60,000 members in the United states, Canada, and latin america. The aaP develops guidelines on a variety of 

pediatric health issues and distributes a wide range of patient education materials. 

www.aap.org

American Professional Society on the Abuse of Children

The american Professional society on the abuse of Children (aPsaC) is a nonprofit national organization focused 

on meeting the needs of professionals engaged in all aspects of services for maltreated children and their families. 

especially important to aPsaC is the dissemination of state-of-the-art practice in all professional disciplines related 

to child abuse and neglect. 

www.apsac.org/mc/page.do
37Resources

The California Evidence-Based Clearinghouse for Child Welfare

The California evidence-based Clearinghouse for Child Welfare (CebC) identifies and disseminates information 

about evidence-based practices relevant to child welfare. The CebC provides guidance to statewide agencies, 

counties, public and private organizations, and individuals. This guidance is provided in a simple, straightforward 

format, reducing the user’s need to conduct literature searches, review extensive literature, or to understand and 

critique research methodology. 

www.cachildwelfareclearinghouse.org

Children’s Safety Network National Injury and Violence Prevention Resource Center

The Children’s safety network provides resources and technical assistance to maternal and child health agencies 

and organizations seeking to reduce unintentional injuries and violence toward children and adolescents. This is 

one of four Children’s safety network Resource Centers funded by the Maternal and Child Health bureau of the 

U.s. Department of Health and Human services. 

www.childrenssafetynetwork.org

Childhelp® USA

Childhelp® is a national nonprofit organization dedicated to helping victims of child abuse and neglect. Childhelp’s 

approach focuses on prevention, intervention, and treatment. The Childhelp national Child abuse Hotline, 

1-800-4-a-CHIlD, operates 24 hours a day, seven days a week, and receives calls from throughout the United 

states, Canada, the U.s. Virgin Islands, Puerto Rico, and Guam. Childhelp’s programs and services also include 

residential treatment services (villages); children’s advocacy centers; therapeutic foster care; group homes; child 

abuse prevention, education, and training; and the national Day of Hope®, part of national Child abuse Prevention 

Month every april. 

www.childhelp.org

Child Welfare League of America 

The Child Welfare league of america is an association of nearly 800 public and private nonprofit agencies that 

assist more than 3.5 million abused and neglected children and their families each year with a range of services. 

www.cwla.org
Preventing Shaken Baby Syndrome

38

Circle of Parents 

Circle of Parents provides a friendly, supportive environment led by parents and other caregivers. It is a place 

where anyone in a parenting role can openly discuss the successes and challenges of raising children. 

www.circleofparents.org

FrameWorks Institute

for several years, the frameWorks Institute has conducted communications research on how people think about 

children’s issues in general, and child development and parenting in particular. 

www.frameworksinstitute.org

The International Society for Prevention of Child Abuse and Neglect

The International society for Prevention of Child abuse and neglect’s (IsPCan) mission is to prevent cruelty to 

children in every nation, in every form: physical abuse, sexual abuse, neglect, street children, child fatalities, child 

prostitution, children of war, emotional abuse and child labor. IsPCan is committed to increasing public awareness 

of all forms of violence against children, developing activities to prevent such violence, and promoting the rights of 

children in all regions of the world. 

www.ispcan.org

National Alliance of Children’s Trust and Prevention Funds

The national alliance of Children’s Trust and Prevention funds is a membership organization that provides 

training, technical assistance, and peer consulting opportunities to state Children’s Trust and Prevention funds to 

strengthen efforts to prevent child abuse. 

www.msu.edu/user/nactpf/

National Center on Shaken Baby Syndrome

The national Center on shaken baby syndrome has a mission to educate and train parents and professionals, 

and to conduct research that will prevent shaking and abuse of infants in the United states. It provides help to 

professionals and parents looking for information, ideas, and answers to questions about sbs. 

www.dontshake.org
39Resources

The National Children’s Advocacy Center Child Abuse Library Online

The Child abuse library online of the national Children’s advocacy Center is one of the largest professional 

collections of published knowledge, educational materials, and resources related to child maltreatment in the 

United states. It provides training, online services, and annotated bibliographies to organizations and individuals, 

and offers resource packages to decisionmakers and researchers. 

www.nationalcac.org 

National Exchange Club 

The national exchange Club (neC) foundation is committed to making a difference in the lives of children, families, 

and our communities through its national project to prevent child abuse. The neC foundation’s most successful 

method of countering abuse is by working directly with parents through the parent aide program. The foundation 

coordinates a nationwide network of nearly 100 exchange Club Child abuse Prevention Centers that use the parent 

aide program and provide support to families at risk for abuse. 

www.preventchildabuse.com

National Indian Child Welfare Association

The national Indian Child Welfare association (nICWa) addresses the issues of child abuse and neglect through 

training, research, public policy, and grassroots community development. nICWa improves the lives of american 

Indian children and families by helping tribes and other service providers implement activities that are culturally 

competent, community-based, and focused on the strengths and assets of families. 

www.nicwa.org 

National Maternal and Child Health Center for Child Death Review: Keeping Kids Alive

This organization promotes, supports, and enhances child death review methodology and activities at the state, 

community, and national levels. It builds public and private partnerships to incorporate Child Death Review (CDR) 

findings into efforts that improve child health. building on the extensive knowledge of current CDR programs, the 

Center actively involves states in its service development. 

www.childdeathreview.org/state.htm
Preventing Shaken Baby Syndrome

40

National MCH Center for Child Death Review

The national Center for Child Death Review is a resource center for state and local Child Death Review programs, 

funded by the Maternal and Child Health bureau. It promotes, supports, and enhances child death review 

methodology and activities at the state, community and national levels. 

www.childdeathreview.org

National Scientific Council on the Developing Child

The national scientific Council on the Developing Child is a multi-disciplinary collaboration comprising leading 

scholars in neuroscience, early childhood development, pediatrics, and economics. 

www.developingchild.net

Parents Anonymous® Inc. 

Parents anonymous® Inc. is a community of parents, organizations, and volunteers committed to strengthening 

families and building strong communities; achieving meaningful parent leadership and shared leadership; and 

leading the field of child abuse and neglect. 

www.parentsanonymous.org

Prevent Child Abuse America 

Prevent Child abuse america works to prevent abuse and neglect of our nation’s children. Through its chapters 

in 43 states and its voluntary home visitation services provided by Healthy families america® in more than 400 

communities nationwide, Prevent Child abuse america helps provide healthy, safe, and nurturing experiences for 

more than 100,000 families every year. 

www.preventchildabuse.org/index.shtml

Promising Practices Network on Children, Families and Communities

The Promising Practices network (PPn) is a group of individuals and organizations who are dedicated to providing 

quality evidence-based information about what works to improve the lives of children, families, and communities.

www.promisingpractices.net
41Resources

Shaken Baby Alliance

The shaken baby alliance collaborates with community agencies and professionals to provide support for 

victim families (including adoptive and foster parents) of sbs to advocate justice for sbs victims, and to increase 

awareness of the problem. 

www.shakenbaby.com

Zero to Three

The mission of Zero to Three is to support the healthy development and well-being of infants, toddlers, and their 

families. The organization accomplishes this by informing, educating, and supporting adults who influence the lives 

of infants and toddlers. 

www.zerotothree.org

The organizations and resources listed in this guide are additional resources only. 

Their inclusion does not imply endorsement by the U.S. Department of Health and 

Human Services, Centers for Disease Control and Prevention, National Center for 

Injury Prevention and Control.

43Appendix A

APPEnDIx A:

state Initiatives on sbs

Many states have initiated their own sbs programs. following is a list of state initiatives; some were 

compiled by the national association of Children’s Hospitals and Related Institutions (naCHRI) 

and others were located on the respective state’s legislative Web site. as information is continually 

updated, please visit the naCHRI Web site (www.childrenshospitals.net) and state legislative Web sites 

for the most up-to-date legislation.

California requires health facilities and licensed midwives to provide information and instructional 

materials about sbs to parents or guardians of newborns. The law also requires the health department 

to provide instructional materials regarding the medical risks and ways of preventing sbs, if available, 

free of charge to child care providers upon licensure and at the time of a site visit.26

Florida requires hospitals and birthing facilities to provide new parents with sbs brochures.27

Hawaii authorizes hospitals that provide medical care to a newborn to provide each parent of the 

newborn with written educational information, approved by the department of health and provided 

by nonprofit organizations, about the dangerous effects of sbs and the different methods of 

preventing sbs.28

Illinois established an sbs program to educate parents and primary caregivers about sbs and 

provides commitment statements.29

26California state legislature [online]. [cited 2010 March 1.] available from URl: http://www.leginfo.ca.gov/cgi-bin/waisgate?WaIsdocID=26662315299+0+0+0&WaIsaction=

retrieve.

27national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net/aM/Template.

cfm?section=search3&template=/CM/HTMlDisplay.cfm&ContentID=46204.

28Hawaii state legislature [online]. [cited 2010 March 1.] available from URl: http://www.capitol.hawaii.gov/hrscurrent/Vol06_Ch0321-0344/HRs0321/HRs_0321-0033.htm. 

29national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net.aM/Template.

cfm?section=search3&Template=/CM/HTMlDisplay.cfm&ContentID=46204. 
Preventing Shaken Baby Syndrome

44

Indiana requires that the state Department, with the assistance of the Department of Child services, 

establish a program that raises public awareness concerning the causes and nature of childhood 

hazards, including factors that place parents, guardians, and other caregivers at risk for shaking an 

infant, risks associated with shaking an infant, and suggestions for preventing sbs.30

Iowa requires the Department of Health to establish a statewide sbs prevention program to educate 

parents and persons responsible for the care of a child about the dangers to children 3 years old or 

younger caused by shaking babies and infants.31

Massachusetts created a hospital-based program for parents of newborns; education and training 

programs for parents, caregivers, and professionals; support for victims of sbs and their families; and a 

surveillance and data collection program to measure the incidence of sbs.32

Minnesota mandates distribution of sbs information to new parents at hospitals and training for child 

care providers.33

Missouri stipulates that every hospital and birthing center offer all new parents a viewing of an sbs 

video prior to discharge.34

Montana mandates that the Department of Public Health and Human services develop educational 

materials that present readily comprehensible information on sbs and post the materials on the 

department’s Web site in an easily accessible format. The sbs educational materials must be 

distributed by:

■ Childbirth educators and staff of pediatric physicians’ offices and obstetricians’ offices— to an 

expectant parent who uses the educator’s or physician’s services,

■ Hospitals— to each newborn child’s parent before the child is discharged from the facility,

30Indiana General assembly [online] [cited 2009 aug 14] available from URl: http://www.in.gov/legislative/ic/code/title16/ar41/ch40.html.

31The Iowa General legislature 2009 senate Journal archives [online]. [cited 2010 March 1.] available from URl: http://search.legis.state.ia.us/nXT/gateway.

dll?qt=&f=templates&xhitlist_q=shaken+baby&fn=default.htm&xhitlist_d=current-legislation.

32national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net/aM/Template.

cfm?section=search3&template=/CM/HTMlDisplay.cfm&ContentID=46204.

33Ibid.

34Ibid.
45Appendix A

■ service providers under the MIaMI project—to a child’s parent during visits conducted in 

accordance with that project,

■ Child care facilities operating in this state—to each of its employees, and

■ Groups or entities that offer classes for babysitters.35

Nebraska requires that every hospital, birth center, or other medical facility that discharges a newborn 

child request that each maternity patient and father of a newborn child, if available, view a video 

presentation and read printed materials about sbs that are approved by the Department of Health 

and Human services and sign a form indicating they have viewed and read or refused to view or read 

the material.36

In addition, the nebraska Department of Health and Human services shall conduct public awareness 

activities designed to promote the prevention of sudden Infant Death syndrome (sIDs) and sbs.37 In 

addition, the nebraska Department of Health and Human services shall adopt and promulgate rules 

and regulations for mandatory training requirements for providers of child care and school-age-care 

programs. The training requirements for providers of child care programs shall include, but not be 

limited to, information on sIDs, sbs, and child abuse.38

New York requires every hospital and birth center to ask all new parents to view an sbs video and 

sign a form indicating they have viewed or refused to watch the video. The requirements also mandate 

training for child care providers on the identification, diagnosis, and prevention of sbs.39 

The new York state Department of Health shall develop and implement an ongoing public information 

and educational campaign to inform the general public about brain injuries and other harmful effects 

that may result from shaking infants and children under five years of age. The program shall include 

educational and informational materials in print, audio, video, electronic, and other media and public 

35Montana legislature [online]. [cited 2010 March 1.] available from URl: http://data.opi.mt.gov/bills/2009/billhtml/sb0442.htm. 

36nebraska legislature. nebraska Revised statute 71-2103 [online]. [cited 2010 March 1.] available from URl: http://www.legislature.ne.gov/laws/statutes.

php?statute=s7121003000. 

37nebraska legislature. nebraska Revised statute 71-2104 [online]. [cited 2010 March 1.] available from URl: http://www.legislature.ne.gov/laws/statutes.

php?statute=s7121004000.

38nebraska legislature. nebraska Revised statute 43-2606 [online]. [cited 2010 March 1.] available from URl: http://www.legislature.ne.gov/laws/statutes.

php?statute=s4326006000.

39national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net/aM/Template.

cfm?section=search3&template=/CM/HTMlDisplay.cfm&ContentID=46204. 
Preventing Shaken Baby Syndrome

46

service announcements and advertisements. In addition, all schools shall be authorized to include, as 

an integral part of home economics or health education, instruction regarding child development and 

parental skills and responsibility. The commissioner shall promulgate rules and regulations to establish 

a curriculum for instruction regarding child development and parental skills and responsibility for the 

welfare of pupils and the community to be available in school districts. The curriculum may include 

instruction relating to the consequences and prevention of sbs, which may include the viewing of a 

video presentation for students in secondary schools.40

Ohio requires the Director of Health to establish the sbs education program and requires the 

Department of Job and family services to record in the statewide automated child welfare information 

system whether a reported case of child abuse involved sbs.41

Pennsylvania mandates hospitals to provide parents with free educational materials on sbs, including 

a voluntary commitment statement.42

Rhode Island requires the Department of Health to collaborate with the Department of Children, 

Youth, and families and other state agencies serving families and children, the medical community, law 

enforcement, human service providers, and child advocacy organizations to develop and implement a 

comprehensive, statewide initiative to reduce death and disability resulting from sbs.43

South Carolina requires that the Department of Health and environmental Control identify and provide 

videos on the dangers of shaking infants and information on the importance of infant CPR available to 

hospitals, child care facilities, child care providers, and the Department of social services. Hospitals 

must request that the maternity patient, father, or primary caregiver view the video. Child care facilities 

must include this video presentation in the training of the facility’s caregivers. The Department of social 

services shall make the video and information on infant CPR available to adopting parents and shall 

request these parents to view the video.

40The new York state legislature [online]. [cited 2010 March 1.] available from URl: http://public.leginfo.state.ny.us/frmload.cgi?MenU-14272198.

41General assembly of the state of ohio [online]. [cited 2010 March 1.] available from URl: http://www.legislature.state.oh.us/bills.cfm?ID=127_sb_144.

42national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net/aM/Template.

cfm?section=search3&template=/CM/HTMlDisplay.cfm&ContentID=46204. 

43state of Rhode Island office of law Revision [online]. [cited 2010 March 1.] available from URl: http://www.rilin.state.ri.us/Publiclaws/law06/law06547.htm.
47Appendix A

In addition, the Department of Health and environmental Control will establish a protocol for health 

care providers to educate parents or primary caregivers about the dangers of shaking infants and 

young children and review these dangers with parents or caregivers associated with shaking infants at 

well-baby visits.44

Tennessee requires that the departments of health and human services shall jointly develop 

information and instructional materials for distribution, free of charge, to health care facilities, midwives, 

and child care agencies. The information and instructional materials will focus on the risks of shaking 

infants and young children. The Department of Health shall be the lead agency in developing such 

information and instructional materials.

The Department of Health shall provide the information and materials free of charge to health care 

facilities and nurse midwives. Health care facilities will provide the materials free of charge to parents 

or guardians of each newborn, upon discharge from the health care facility. If a home birth is attended 

by a nurse midwife, the nurse midwife shall provide the information and instructional materials to the 

parents or guardians of the newborn. The Department of Human services shall provide the information 

and instructional materials free of charge to child care agencies under the jurisdiction of such 

department upon licensure and at the time of site visits.45

Texas requires licensed daycare facilities to receive education on the identification and prevention 

of sbs.46

Utah requires all daycare centers to receive training on sbs prevention, sIDs prevention, coping with 

crying babies, and brain development.47

44The south Carolina legislature [online]. [cited 2010 March 1.] available from URl: http://www.scstatehouse.gov/cgibin/query.exe?first=DoC&querytext=shaking&category=l

egislation&session=117&conid=4905947&result_pos=0&keyval=1170518.

45Michie’s legal Resources [online]. [cited 2010 March 1.] available from URl: http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.

46national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net/aM/Template.

cfm?section=search3&template=/CM/HTMlDisplay.cfm&ContentID=46204. 

47Ibid.
Preventing Shaken Baby Syndrome

48

Virginia requires information on sbs to be made available to maternity patients by nurse midwives, 

licensed midwives, and hospitals with maternity services.48

Washington mandates that the Council for Children and families conduct a proactive, public 

information and communication outreach campaign regarding the dangers of shaking infants and 

young children, and the causes and prevention of sbs.49

Wisconsin stipulates that all new parents, prior to discharge, receive information and watch a 

videotape on the dangers of sbs. school districts are required to educate grades 5, 8, and 11 on sbs. 

licensed child care providers are trained regarding sbs, and at-risk families receive sbs education 

through the Department of Health and Human services.50

48Virginia General assembly [online]. [cited 2010 March 1.] available from URl: http://leg1.state.va.us/cgi-bin/legp504.exe?051+ful+CHaP0518.

49Washington state legislature [online]. [cited 2010 March 1.] available from URl: http://apps.leg/wa/gov/RCW/default.aspx?cite=43.121.140.

50national association of Children’s Hospitals and Related Institutions [online]. [cited 2010 March 1.] available from URl: http://www.childrenshospitals.net/aM/Template.

cfm?section=search3&template=CM/HTMlDisplay.cfm&ContentID=46204.
49Appendix B
Preventing Shaken Baby Syndrome

50

APPEnDIx B:

Prevention Tips for Parents and Caregivers

■ babies cry a lot in the first few 

months of life and this can be 

frustrating. but it will get better.

■ Remember, you are not a bad parent 

or caregiver if your baby continues 

to cry after you have done all you can 

to calm him or her.

■ You can try to calm your crying 

baby by:

• Rubbing his or her back,

• Gently rocking,

• offering a pacifier,

• singing or talking, or

• Taking a walk using a stroller or a drive with the baby in a properly-secured car seat.

■ If you have tried various ways to calm your baby and he or she won’t stop crying, do the 

following:

• Check for signs of illness or discomfort like diaper rash, teething, or tight clothing.

• Call the doctor if you suspect your child is ill.

• assess whether he/she is hungry or needs to be burped.

■ If you find yourself pushed to the limit by a crying baby, you may need to focus on calming 

yourself. Put your baby in a crib on his or her back, make sure he or she is safe, and then walk 

away for a bit and call a friend, relative, neighbor, or parent helpline for support. Check on him or 

her every 5 to 10 minutes.
51Appendix B

■ Understand that you may not be 

able to calm your baby and that it 

is not your fault, nor your baby’s. It 

is normal for healthy babies to cry 

much more in the first 4 months of 

life. It may help to think of this as 

the Period of PURPLE Crying® as 

identified by the national Center for 

shaken baby syndrome (nCsbs). 

for more information about the 

Period of PURPLE Crying® and 

nCsbs, visit 

www.dontshake.org.

■ Tell everyone who cares for your 

baby about the dangers of shaking 

a baby and what to do if they 

become angry, frustrated, or upset 

when your baby has an episode 

of inconsolable crying or does 

other things that caregivers may 

find annoying, such as interrupting 

television, video games, sleep 

time, etc.

■ be aware of signs of frustration and anger among others caring for your baby. let them know 

that crying is normal and that it will get better.

■ Do not leave your baby in the care of someone you know has anger management issues.

■ see a health care professional if you have anger management or other behavioral concerns.
Preventing Shaken Baby Syndrome

52

APPEnDIx C:

a Partnership Planning Tool

This tool may help you plan your outreach to potential partner organizations and individuals.

Overall Purpose of the Partnership

To identify and collaborate with community-based organizations to raise awareness about Shaken 

Baby Syndrome and to undertake communication and prevention interventions in the community. 

(example)

Brief Description of P Brief Description of Partnership Outreach S artnership Outreach Strategies 

Participating Individuals and Organizations
53Appendix C

Brief Description of Partnership Outreach Strategies 

Major Activities/Desired Outcomes of the Partnership

Needed Resources

Resource Who Provides Details Timing

access to new parents 

Communication 

expertise 

facility/Venue(s) 

funding 

staff 

other 
Preventing Shaken Baby Syndrome

54

APPEnDIx D:

educational Resources

Source: These materials were created and produced by Prevent Child abuse Georgia in collaboration 

with the Georgia Chapter, american academy of Pediatrics. for more information or to order these 

materials, please visit: www.preventchildabusega.org.

Front Back
55Appendix D

Front Back

Front Back
Preventing Shaken Baby Syndrome

56

Certificate
“Preventing Shaken Baby Syndrome: A Guide for Health Departments and Community-Based Organizations” is a publication of the 

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. See www.cdc.gov/injury.
For more information—as well as radio PSAs and broadcast-quality 

video that includes B-Roll, full-screen tips, and downloadable 

scenarios—please visit: www.cdc.gov/TraumaticBrainInjury.

“Helping all people live to their full potential”

U.S. Department of Health and Human Services

Centers for Disease Control and Prevention

Preventing Shaken BaBy Syndrome: A Guide for Health Departments and Community-Based Organizations