The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis

Abstract

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs’ pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants’ inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents’ knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents’ emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.

Abusive head trauma and crying infant–Public awareness of newborn and infant trauma

“…16 Such prevention programmes could decrease visits to emergency rooms for crying and reduce the incidence of AHT in small samples but failed to demonstrate a significant impact in two state-wide replication trials. 1,23,24 A recently published systematic review and meta-analysis revealed only marginal improvements in parental response to persistent crying and low evidence that educational interventions increase walking away from the crying infant. 18 In summary, up to now, there is no clear evidence that AHT can be reduced by educational programmes.…”

“…18 In summary, up to now, there is no clear evidence that AHT can be reduced by educational programmes. 18,23 However, how the diagnosis of AHT was established in the prevention studies remains questionable. If AHT was concluded on the basis of certain medical findings and not on the basis of a witnessed or admitted event, there may be a risk of false-positive diagnosis.…”

“…Strategies to help parents cope with stressful situations include finding ways to block the sound of crying, break times, safety planning and measures to calm themselves, such as driving, singing or smoking 16 . Such prevention programmes could decrease visits to emergency rooms for crying and reduce the incidence of AHT in small samples but failed to demonstrate a significant impact in two state‐wide replication trials 1,23,24 …”

“…A recently published systematic review and meta‐analysis revealed only marginal improvements in parental response to persistent crying and low evidence that educational interventions increase walking away from the crying infant 18 . In summary, up to now, there is no clear evidence that AHT can be reduced by educational programmes 18,23 . However, how the diagnosis of AHT was established in the prevention studies remains questionable.…”

Examining the Content Validity of the Measure of Psychologically Abusive Behaviors: A Qualitative Approach

“…It is worth noting that these commonly used and recommended measures are older and the limitations noted are expected given how much the literature has evolved. A plethora of measures have been created in response for specific purposes, populations, and psychological IPV subtypes (see Alexander et al, 2022 and Lohmann et al, 2023 for systematic reviews).…”