Delivery of the Take 5 Safety Plan for Crying to Caregivers within a Hospital System

Kirsten Bechtel, MD
Julie Gaither, PhD

Abusive head trauma (AHT) is the leading cause of traumatic death in infants in our state and occurs at a rate of 38.8 cases per 100,000 infants in the United States. AHT is often due to caregiver frustration with infant crying, causing them to shake the infant. The Take 5 Safety Plan for Crying is anticipatory guidance that focuses on five specific steps to help caregivers manage their frustration with infant crying and prevent shaking and AHT.

Two studies evaluated the effectiveness of Take 5. In the first study, the delivery of Take 5 as anticipatory guidance led to beneficial changes in parental beliefs about infant crying and the adoption of safe behaviors by caregivers when they become frustrated with an infant’s crying, such as walking away from the infant, doing tasks that help to relieve frustration, and not returning to the infant until calmer. In a recent study, infants whose caregivers received Take 5 were 79% less likely to have suffered AHT.

At present, we are doing several interventions to strengthen the Take 5 message and ensure that it is delivered to all caregivers within our hospital network.

1-We are pairing the Take 5 message with an audiotape of an infant crying to determine if the message is more memorable and more often used by parents at 6 weeks of life compared to it being delivered verbally by a health care provider at newborn hospital discharge 2-We developed a video PSA to determine if the message is more memorable and more often used by parents at 6 weeks of life compared to it being delivered verbally by a health care provider at newborn hospital discharge. 3-We are using a QI process to determine if providers are routinely providing this advice; at present, only 40% of pediatric providers offer this anticipatory guidance to caregivers at well newborn discharge at the York Street Campus of Yale New Haven Health. We would like to raise this rate to 80%.

By strengthening the Take 5 message so that it is memorable to parents and ensuring that all providers deliver Take 5 at newborn hospital discharge, we hope to reduce the rates of AHT in infants born in our hospital system.

1-Abusive head trauma is a leading cause of preventable traumatic death in infants.
2-Abusive head trauma is often due to caregiver frustration with infant crying.
3-The Take 5 Safety Plan for Infant Crying reduces the likelihood of AHT in infants whose caregivers receive this guidance.