European Journal of Pediatrics

, Volume 178, Issue 2, pp 139–146 | Cite as

Do we get the message through? Difficulties in the prevention of abusive head trauma

  • Oliver BertholdEmail author
  • Andreas Witt
  • Vera Clemens
  • Elmar Brähler
  • Paul L. Plener
  • Jörg M. Fegert
Original Article


Many programs aim to prevent abusive head trauma throughout the USA, Europe, and in many other regions of the world. Most of these programs inform mothers shortly after delivery about the dangers of abusive head trauma. Effectiveness of these programs usually is measured by the increase of knowledge on abusive head trauma. Recent research showed, however that for effective primary prevention, a much broader approach might be necessary. But so far, there is no data that reports the knowledge on key messages on abusive head trauma in the general public as a baseline. We conducted a representative population-based survey on abusive head trauma knowledge in Germany. Whereas the dangers are generally well known, a majority might be ambivalent towards the recommendation to leave a crying infant alone for a few minutes when the caregiver becomes too stressed or frustrated. Furthermore, a majority prefers being informed on abusive head trauma before birth.

Conclusion: Future preventive programs should focus on educating adolescents (potential baby sitters) and young adults when they do not yet have children of their own.

What is known:

• Most programs for primary prevention of abusive head trauma (AHT) focus on mothers shortly after delivery

• There are no analyses so far of the quality of education programs in the general public, as educating mothers might not be sufficient to reduce incidence rates

What is new:

• Our study is the first population-based survey to measure the knowledge on AHT in a representative population sample and to provide the data base for targeted prevention programs.

• The introduction of broader prevention programs might be necessary.


Child abuse Shaken baby syndrome Prevention Abusive head trauma Maltreatment 



Abusive head trauma


Nationales Zentrum Frühe Hilfen (national centre for early interventions, Germany)


Shaken baby syndrome


Standard deviation


Authors’ Contributions

OB contributed to the conception and design of the study, data analysis, interpretation of findings, and drafting the article.

AW and VC contributed to the data processing and interpretation.

EB, PLP, JMF contributed to study conception, design, data collection, and critical revision of the results.

All authors revised the manuscript and finally approved the version submitted.

Compliance with ethical standards

The study was conducted in accordance with the Declaration of Helsinki and fulfilled the ethical guidelines of the International Code of Marketing and Social Research Practice of the International Chamber of Commerce and of the European Society of Opinion and Marketing Research. The study was approved by the Ethics Committee of the Medical Department of the University of Leipzig. No. 132/18-EK of April 3rd, 2018.

Conflict of interest

The authors declare that they have no conflict of interest.

PLP has received research funding from the Bundesinstitut für Arzneimittel und Medizinprodukte, BMBF (Federal Ministry of Education and Research), VW-Foundation, Baden-Württemberg Stiftung, Lundbeck, Servier. Professor Plener holds no stocks of pharmaceutical companies.

JMF: Within the last 5 years, JMF received research funding from the European Union (EU), German Research Foundation (DFG), the German Federal Ministry of Health (BMG), the German Federal Ministry of Education and Research (BMBF), the German Federal Ministry of Family Affairs, Senior Citizens, Women, and Youth (BMFSFJ), several state ministries of social affairs, State Foundation Baden-Württemberg, Volkswagen Foundation, European Academy, Pontifical Gregorian University, RAZ, CJD, Caritas, Diocese of Rottenburg-Stuttgart. He received travel grants, honoraria, and sponsoring for conferences and medical educational purposes from the German Research Foundation (DFG), the American Academy of Child and Adolescent Psychiatry (AACAP), the National Institute of (Mental) Health (NIMH/NIH), the European Union (EU), Pro Helvetica, Janssen-Cilag (J&J), Shire, several universities, professional associations, and German federal and state ministries. He conducted clinical trials for Janssen-Cilag, Lundbeck, the German Federal Ministry of Education and Research (BMBF), and Servier. He is in steering committees and DSMB for Lundbeck, Servier. Every grant and honorarium has to be declared to the law office of the University hospital Ulm. Potential conflicts of interests have to be declared to German Society for Child and Adolescent Psychiatry and Psychotherapy (DGKJP) and American Academy of Child and Adolescent Psychiatry (AACAP) annually, because of commission membership. He has no stocks, no interests in pharmaceutical companies and is majority owner of the 3Li institute.

Informed consent

Participants were informed about the study and informed consent was obtained. In the case of minors, participants gave informed assent with informed consent being provided by their caregivers. Responses were anonymized.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Child and Adolescent Psychiatry/PsychotherapyUniversity of UlmUlmGermany
  2. 2.Child Abuse ClinicDRK Kliniken Berlin | WestendBerlinGermany
  3. 3.Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center of Johannes Gutenberg University of MainzMainzGermany
  4. 4.Department of Medical Psychology and Medical SociologyUniversity of LeipzigLeipzigGermany
  5. 5.Department of Child and Adolescent PsychiatryMedical University of ViennaViennaAustria

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