No parent holds a new baby and thinks that within a year they will have seriously injured or even killed that child. Or that the violence could be sparked by something as common as a baby's cry.
But each year, more than 4,000 young children are hospitalized because they've been seriously injured, usually by a parent, and about 300 die. Babies under age 1 are the most likely victims, according to a study in the journal Pediatrics.
"We'd like the number to be 20, or 10 or zero," says John Leventhal, a professor of pediatrics at the Yale's medical school and lead author of the study. "Figuring out how to do that is one of the challenges we face as a nation."
He's one of a number of researchers around the country who are trying to do just that.
Leventhal points to successful public health campaigns to reduce the risk of SIDS, or sudden infant death syndrome, by telling new parents they should put babies to sleep on their backs. Those efforts have halved the death rate from SIDS, to about 50 per 100,000 births. That's now less than the number of babies hospitalized for abuse — 58 per 100,000.
In this study, head trauma, also known as shaken baby syndrome, was the cause of hospitalization just half the time. That, the authors say, suggests that public health efforts shouldn't focus on shaken baby syndrome alone. Other forms of violence included bruises, broken bones and burns.
State and national organizations track child abuse, but this study is the first to look at the seriousness of injuries and hospitalizations.
Fathers, stepfathers, and boyfriends tend to be the most likely attackers, Leventhal says. That's partly because they often don't have much experience taking care of children. "They're feeling overwhelmed, the baby's crying. Bingo, something terrible happens."
At Yale-New Haven Hospital, where Leventhal works, new parents are told that any parent can get overwhelmed by a baby's cries. "If they feel like they're about to lose it, they need to step away, take five, take a break. Put the baby in a safe place. Call a friend, call a doctor."
Other researchers are testing outreach programs to see what techniques work best at getting that message across. But because serious child abuse is relatively rare, it takes studies with lots of families to figure that out.
"One of the challenges is not just to reach the moms but to reach the fathers," Leventhal says. "Figuring out how to reach them is critical."