Over 5% of parents reported having smothered, slapped, or shaken their baby

Doctors and other health-care professionals should be more aware of the association between infant crying and potentially abusive parental behaviour, conclude authors of a research letter in this week’s issue of THE LANCET.

Child abuse and neglect are important causes of child illness and death. An estimated 6 young infants per 100,000 die from the effects of child abuse each year; non-fatal infant morbidity could be up to 2000 times greater than this annual death rate. Sijmen A Reijneveld (University of Groningen, and TNO Prevention and Health) and colleagues assessed potentially detrimental parental actions induced by infant crying in 3259 infants aged 1–6 months, in the Netherlands.

Over 5% of parents reported having smothered, slapped, or shaken their baby (by age 6 months) at least once because of its crying. The risks of detrimental actions were highest for parents from non-industrialised countries, those with either no job or a job with short working hours, and those who judged their infant’s crying to be excessive.

Professor Reijneveld comments: “Clinicians and other health-care providers working with parents of infants should be aware of the risks for young children associated with their crying, especially if parents report a history of what they regard to be excessive crying and they are in a social position that could put pressure on the family situation. The actual duration of crying at a given moment seems to be less relevant than the parents’ perception of the crying of their infant in the long term. Furthermore, our results show that the number of infants implicated is substantial, highlighting an urgent need to teach carers of infants how to cope adequately with infant crying, including telling parents that the average 1-month-old baby cries 1•5 h per day, asking questions about crying during routine well-baby visits, and providing additional support services and follow-up for those at risk”.

In an accompanying commentary (p 1295), Clare Sheridan (Loma Linda University Children’s Hospital, USA) states: “It is the parents’ or caretakers’ abnormal response to an infant crying that leads to abuse. We need to study, hold accountable, and offer psychological treatment to the caretakers, not blame the infants as the agents of their own maltreatment… We must encourage clinicians to tell parents that they have a normal infant if they cry, not a child that needs correction”.

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