INTRODUCTION:

Babies are such delightful and mysterious creatures. The first activities we do with our babies are hold them, touch them, look into their eyes and talk to them like we have known them forever. Your love and attention help your baby adjust to his or her new environment. Each stage of development is crucial and the role parents and caretakers play is so important.¹

Shaken baby syndrome (SBS) is caused by forcefully/happily repetitive shaking the baby, with or without blunt trauma, resulting in head trauma. It's also known as inflicted traumatic brain injury or head trauma. Infants from birth to age1 year, especially those ages 2 to 4 months, are at greatest risk of injury from shaking. Infants are especially vulnerable to head injuries caused by shaking because they have a very large head-to-body ratio and weak neck muscles and ligaments. An infant's head accounts for 12% of total body weight. This weight, accompanied by undeveloped neck muscles and ligaments, makes infants susceptible to acceleration/ deceleration injuries.²

Shaken baby syndrome describes the serious injuries that can occur when a very young child is severely shaken, causing the brain to move back and forth inside the skull. The syndrome usually originates when a parent or other caregiver shakes a baby out of anger or frustration, often because the baby would not stop crying.³

Shaken baby syndrome (SBS) causes the subdural hematoma, retinal bleeding and, disadvantageous for the prognosis, diffuse brain damage caused by powerful shaking of the infant. The clinical symptoms include irritability, difficulty with drinking, apathy, cerebral cramp attacks, apnoea, temperature regulation disorders and vomiting due to cranial pressure. Milder symptoms of SBS are often not diagnosed and the number of unregistered cases is probably much greater.^4,5

The injurious mechanism is considered to be caused by rotational forces which force tissue layers in the brain against each other and also lead to rupture of bridging veins between the skull and the brain. The prognosis is poor and approximately 25% of infants die of SBS within days or weeks. Approximately 75% of survivors suffer from long term damage with physical handicaps, limitations in hearing, visual disturbances up to blindness and mental disorders or combinations of these conditions.⁶

Had injuries are the leading cause of traumatic death of child abuse fatalities. Homicide is the leading cause of injury-related deaths in infants younger than four years. Serious injuries in infants, particularly those that result in death, are rarely accidental unless there is another clear explanation, such as trauma from a motor vehicle crash. when uncomplicated documented that 80% of deaths from head trauma in infants and children younger than two years were the result of non accidental trauma. shaken baby syndrome is unlikely to be an isolated event. Evidence of prior child abuse is common’⁷.

The damage can be even greater when a shaking episode ends with an impact (hitting a wall or a crib mattress, for example), because the forces of acceleration and deceleration associated with an impact are so strong. After the shaking, swelling in the brain can cause enormous pressure within the skull, compressing blood vessels and increasing overall injury to its delicate structure.⁸

Normal interaction with a child, like bouncing the baby on a knee, will not cause these injuries, although it's important to never shake a baby under any circumstances because gentle shaking can rapidly escalate. The more serious the child's neurological injury, the more severe the symptoms and the shorter the period of time between the shaking and the appearance of symptoms. From the time of the shaking these children do not look or act as usual they may not eat or sleep or play normally.⁹Babies who are shaken may be brought to medical attention by a caregiver who offers no history of injury, a vague account of events or an explanation that is not consistent with the physical findings. Unless the physician is aware of the possibility of abuse and knowledgeable about the signs of Shaken Baby syndrome, the cause of these children's symptoms can be missed. The outcome for infants who suffer brain damage from shaking can range from no apparent effects to permanent disability, including developmental delay, seizures and/or paralysis, blindness and even death. Survivors may have significant delayed effects of neurological injury resulting in a range of impairments seen over the course of the child‘s life, including cognitive deficits and behavioural problem.¹⁰

AIM OF THE STUDY:

The study aimed to improve the knowledge of the mother regarding shaken baby syndrome.

RESEARCH HYPOTHESIS:

H0- There will be no significant association between post test knowledge score among postnatal mothers regarding shaken baby syndrome with their selected demographic variables regarding SBS

H1- There will be significant difference between pre-test and post-test knowledge score among postnatal mothers regarding shaken baby syndrome.

MATERIALS AND METHODS:

Research design:

A quantitative approach and pre experimental research design were used to assess the effect of STP on knowledge regarding SBS among the post natal mothers in the postnatal word SCB MCH. Cuttack .

Study population:

The study population was all the postnatal mothers of postnatal ward in SCB MCH,cuttack .The population of the study was 50.

Inclusion criteria:

The study includes: postnatal women who are

· Admitted in the postnatal ward.

· Present during data collection

· willing to participate in the study

· Who can read ,write and speak Oriya

Exclusion criteria:

The study includes:

The postnatal mother who has high risk health problems

Who has a sick child.

Sampling Technique:

In this study non probability Purposive sampling technique was used to select the samples.

Methods of data collection:

Data was collected by self structured questionnaire methods for the mothers who met the inclusion criteria.the data was collected before and after stractured teaching program. total 50 nos. of mothers were there during data collection.

Data analysis:

The data collected in this study were analyzed by using descriptive and inferential statistics. Frequency and percentage of distribution of demographic characteristics of postnatal mothers. Frequency and percentage distribution mean, SD, mean difference and paired ‘t’ test were used to analyze the effectiveness of STP regarding SBS.Chi square test was used to find out the association between the post test score with demographic variables.

Criterion Measures:

Sl. No	Category	Percentage	Marks
1	Excellent	>70	>21
2	Good	51-70	15-21
3	Average	30-50	9-14
4	Below Average	<30	<9

Maximum score =30

Minimum score =0

FINDING:

The analysis of the data is done in accordance with the objectives of the study .the data was organized and presented under the following section:

Table. 1 Comparison between difference of pre test and post test knowledge scores of postnatal mothers regarding shaken baby syndrome

Area	‘t’ Value Calculating value	‘t’ value Table value	Level of significance
Introduction and incidence	12.69	2.02	Highly significant
Causes and Risk factor	9.62	2.02	Highly significant
Sign and symptoms and diagnosis	12.13	2.02	Highly significant
Complication	6.51	2.02	Highly significant
Management andprevention	8.91	2.02	Highly significant
Over All	19.6

(df = 49), (Table value= 2.02), (P≤ 0.05)

Paired ‘t’ test is calculated to assess the significant difference between pre and post test knowledge scores which shows highly significant difference between area wise score values of pre test and post test knowledge scores. Hence, the statistical hypothesis is accepted.

The obtained post test mean value 17.52 is higher than the pre test mean value 8.3. and the over all paired’ test value is 19.6 at 5% level of significance which is highly significant. The calculated value is higher than tabulated ‘t’ value. Hence, null hypothesis is rejected and statistical hypothesis is accepted. It is inferred that postnatal mothers have significantly higher knowledge after implementation of structured teaching program.

Table-2 shows no Association between post test knowledge scores of the postnatal mothers on Shaken Baby Syndrome with selected demographic variables

Demographic variables	Chi square value (χ2)	Level of significance
Age of mother	0.57	Not significant
Education	0.09	Not significant
Occupation	0.12	Not significant
Types of family	0.72	Not significant
No of child present in family	0.04	Not Significant
Income of family	0.92	Not significant
Residence	0.4	Not Significant
Previous knowledge	0.34	Not Significant

(P≤0.05), (df=1), (Table value=3.84)

DISCUSSION:

A pre-experimental design was conducted on postnatal women to assess the effectiveness of structure teaching programme on knowledge regarding SBS The postnatal women were selected SCB MCH, Cuttack Odisha. The data was collected from 50 Postnatal women by purposive sampling technique by using closed ended multiple-choice questionnaire and analyzed by using descriptive and inferential statistic.

Highest percentages (40%) of the postnatal women were in the age group20-30 years. Highest percentages (36%) of the postnatal women education qualification were primary. Highest percentages (48%) of the postnatal women were from nuclear family. Highest percentages (38%) of the postnatal women were house wife. Highest percentages (50%) of the family had more then 1 child. Highest percentages (36%) of postnatal mothers were lived in rural area The level of knowledge of the mothers reveals that in pre test, (60%) of the postnatal women had poor knowledge. (30%) of the postnatal women had average knowledge and (5%) of them had good knowledge. Area wise post test highest mean percentage is (73%) with mean for area “causes and high risk of SBS”. The lowest mean percentage in post test is (52%) for area “management andprevention “Further effectiveness varies from 18%.

CONCLUSION:

From the findings of the study can be concluded that structure teaching programme regarding Shaken Baby Syndrome was effective to improve the knowledge of the postnatal women. In pre test before implantation of structure teaching programme, the mothers had POOR knowledge (60%) and after implementation of planned teaching programme the mothers had GOOD knowledge (86%) regarding SBS which shows the effectiveness of structure teaching programme. Highly significant difference found between the pre test and post test knowledge scores of the postnatal women regarding SBS Also there was no significant association between post test knowledge scores of the postnatal women in post test with their demographic variables. Structure teaching programme was effective for all the content area regarding SBS.

RECOMMEDATION:

Structured teaching programs must be conducted in community to educate all postnatal mothers regarding Shaken baby syndrome so as to prevent children suffering from SBS as well as infant mortality rate.

CONFLICT OF INTREST:

None.

ETHICAL CLEARANCE:

The Human Research and Ethics committee of the LJM College and School of Nursing Mancheswar, BBSR, The Medical Superintendent of SCB MCH, Cuttack gave their approval, The Head of the Institution gave the permission and the respondent gave their informed consent to conducted the study.

REFERENCE:

1. Christian CW, Block R; Committee on Child Abuse and Neglect; American Academy of Pediatrics. Abusive head trauma in infants and children. Pediatrics. 2009; 123(5): 1409-1411.

2. Christian C, Endom EE. Child abuse: evaluation and diagnosis of abusive head trauma in infants and children. UpToDate. 2013.

3. Matschke J, Herrmann B, Sperhake J, Kbrber F, Bajanowski T, Glatzel M. Shaken baby syndrome: a common variant of non-accidental head injury in infants. Dtsch Arztebl Int. 2009;106(13):211-217.

4. Balci E, GUn l, Mutlu $ar|i S, et aI. Still an unknown topic: child abuse and "shaken baby syndrome." Ulus Travma Acil Cerrahi Derg. 2011;17(5):430-434.

5. World Health Organization. World Report on Violence and Health. Geneva: WHO; 2002. [Google Scholar]

6. Reece RM, Sege R. Childhood head injury. Arch Pediatr Adolesc Med. 2002; 154:11-15. [PubMed]

7. Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. BM]. 1971; 224:30431. [PMC free article] [PubMed]

8. Bonnier C, Nassogne MC, Saint Martin C, Mesples B, Kadhim H, Sébire G, et a1. Neuroimaging of interaparenchymal lesions pediatricts outcome in shaken baby syndrome. pediatric.2003;112:808-14(Pub Med)

9. Christian CW, Block R, the Committee on Child Abuse and Neglect Abusive head trauma in infants and children. Pediatrics. 2009;123:1409-11. [PubMed] [Google Scholar]

10. International journal of pediatrics and adolescent medicine-Elsevier. 2018;342:256-432

11. International journal of pediatrics-An open Acess journal-Hindawi.2010:678;122-127

12. International Journal of Clinical Pediatrics.2017;305-307.

13. International Journal of Pediatric Research Clinmed International Library.vol-3,2018:356-376.

14. WHO Global IMR In 2018; WHO, 2013?

15. Burden of Mental Illness; Indian Journal Of pediatrica, 2017, Jan-Mar 42(1);14-20

Received on 29.01.2024 Revised on 12.09.2024

Accepted on 31.01.2025 Published on 24.02.2025

Available online from March 17, 2025

Asian J. Nursing Education and Research. 2025;15(1):27-30.

DOI: 10.52711/2349-2996.2025.00006

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