George Lithco Parent of "Skipper" Lithco, a victim of SBS

George Lithco and his wife, Peggy Whalen are the parents of George "Skipper" Lithco, an eleven-month-old boy who was shaken by his home day care provider. The Skipper Initiative was formed by family and friends to promote awareness and education about SBS prevention efforts, and includes the family of Dale Anderson, Jr., a seventeen-month-old boy who was also shaken by his home day care provider a few months later. Please visit www.SkipperVigil.com for more information about the Skipper Initiative.

Preface to the Skipper Initiative

After learning about a highly successful shaken baby syndrome prevention effort at Children’s Hospital of Buffalo, Assemblyman Sam Hoyt introduced a bill requiring all New York hospitals to provide SBS information to all new parents regarding the causes and consequences of shaken baby syndrome and how it can be prevented.

On July 25, 2001, the New York State Legislature sent the bill to Governor George Pataki. It was signed into law by the Governor as Section 2803-j of the Public Health Law and became effective October 6, 2001. The law provides that SBS information must now be added to an already existing general information brochure received by all new parents.

The law reads as follows:
1-c. The informational leaflet shall also include a description of the dangers of shaking infants and young children. The description shall include information of the effect of shaking infants and young children, appropriate ways to manage the causes of shaking infants and young children, and discussion on how to reduce the risks of shaking infants and young children.

Assemblyman Hoyt, whose district includes portions of Buffalo, New York, first sponsored the bill in 1998 and then again in 2001 after becoming aware of a program developed at Children’s Hospital of Buffalo by Mark Dias, M.D. Dr. Dias’ hospital program presents education to new parents about the dangers of shaken baby syndrome through the use of Portrait of Promise, an 11- minute video, an SBS educational brochure and a 5 to 10 minute discussion with a nurse on staff.

The Dias program seeks to ensure that parents of newborn children actually receive the information they need to protect their child against shaking injuries at a time when they are most receptive to the information. During the post-delivery stay in the hospital, a maternity nurse introduces the videotape, provides the SBS brochure and returns to answer questions and obtain an acknowledgment/evaluation form signed by the parents. To provide information on the retention of the materials, the Project collects information from follow up calls to the parents six months after discharge.

Evaluation of the Dias program continues, but the interim results indicate that it has significantly reduced SBS injuries in western New York. In its initial year, the incidence of shaken baby syndrome presenting at Children’s Hospital of Buffalo was reduced from an average of one every six weeks to one in a year.

The program was subsequently extended by Dr. Dias and Dr. Linda Barthauer, of Strong Children’s Hospital, as the Upstate New York SBS Prevention Project, to seventeen counties in western New York with grant assistance from New York State’s William B. Hoyt Memorial Children and Family Trust Fund.

The two year evaluation report on the Project reported a reduction of more than 60% in the area served by the Project. The Project has received a great deal of press, including an article in the New York Times on May 29, 2001, reporting on the remarkable success of this prevention program.

Still Room to Improve

While the statute adopted by New York does require that hospitals provide information about SBS to new parents, it does not require the implementation of the Dias program. To satisfy the letter of the law, hospitals need merely provide a brochure to prospective parents who are making arrangements for delivering at the hospital. In contrast, an essential element in the effectiveness of the Dias program seems to be that it actively engages the parents in the hospital with a powerful video presentation at a time when they are most receptive to information.

Skipper Initiative Responds

Earlier that year, responding to the shaking deaths of five young children in the Hudson Valley area over a nine-month period, a group of parents and friends formed the Skipper Initiative to increase awareness about shaken baby syndrome and to educate parents and caregivers about how it can be prevented. One of the first initiatives was a letter-writing campaign to state legislators, urging adoption of the SBS bill as a first step for New York State.

Some hospitals in the Hudson Valley are doing more than the law requires. For instance, Vassar Hospital has been working with the Skipper Initiative and the Child Abuse Prevention Center of Poughkeepsie, to implement the Dias program in Dutchess County. In 2000, three counties in the Albany region formed a collaboration to implement the program at seven maternity hospitals, and Westchester County is planning to initiate the program county-wide in January.

There are significant challenges that remain. While Dr. Dias estimated that the cost of extending the program state-wide would only be $1.2 million, the prospects of funding is uncertain at a time when New York state faces serious budget shortfalls as a result of the World Trade Center tragedy.

Hospitals also have limited resources to implement new programs. However, the Skipper Initiative is working with Dr. Dias to demonstrate to the state legislature that full funding for prevention will still cost less that the medical and consequent costs of shaking injuries.

Dr. David Corwin, a Utah researcher replicating the Dias program in cooperation with the National Center on Shaken Baby Syndrome, helped that project receive funding from insurance companies and the State Medicaid program by analogizing the prevention program to a “vaccination” against shaking injuries. Although the hospital-based program developed by Dr. Dias appears to be a very effective intervention, it is prospective in nature. Seven hundred babies are born on an average day in New York State, and they remain at risk for three to four years. Parents of children who were born before these prevention efforts started also need to be educated. Instead of waiting for parents of those children born before the hospital programs are established to seek out prevention information, methods must be found to push that information.

By working with the state, local departments of health and professional groups, the Skipper Initiative will work to educate day care providers, pediatricians, parenting educators and similar groups, not only about the dangers of shaking infants, but ways that they can become partners with parents by educating them about how to prevent injuries to their children. For instance, when Governor Pataki announced in June that the state would mail all day care providers information about the Back to Sleep campaign to reduce SIDS deaths in day care settings, the Skipper Initiative requested that the mailing also include information on preventing SBS injuries and increasing awareness, similar to the mailing the state of Michigan sent to 22,000 licensed day care providers following a number of SBS deaths involving day care providers.

The Skipper Initiative is encouraging New York State to incorporate information about shaking injuries and prevention into the initial training required to become a licensed day care provider in New York. We are also urging parents to bring up the topic with pediatricians during their regular pediatric checkups if the pediatrician doesn’t bring it up first.

Experience shows that SBS is a very difficult topic to broach with parents in most settings. A positive, proactive approach that gives parents information they need so that they may best protect their child by educating others about shaking injuries seems to result in greater receptivity than messages directed simply at preventing parents from shaking.

Information Resources

For more information regarding the New York law, visit the New York Legislation web site at public.leginfo.state.ny.us and reference bill number A2208-A for the year 2002. The full text, sponsor information, voting breakdown and summary are available at this site.

For more information about Utah’s hospital based prevention program, and the Period of PURPLE Crying® materials currently being used, please email Julie Price at jprice@dontshake.org