Not long ago, Kathleen Todd-Seymour, a pediatric registered nurse who runs an agency called Mother & Child Postpartum Care, arrived at a client's home to find the mother waiting at the door, her infant crying in her arms and the mother close to tears herself. The baby had been crying for hours. ''I don't know what to do with him," she said.
''Have you tried to swaddle?" Todd-Seymour asked.
''But it's not sleep time," said the mother, clearly frustrated.
Todd-Seymour tells that story as a reminder of how easy it is for even the most loving parents and caregivers to slip into that dangerous zone that can lead to shaken baby syndrome, which is responsible for two to four infant deaths a year in Massachusetts and about 1,500 nationwide.
''Swaddling isn't just about sleep," Todd-Seymour told the mother. ''It's about calming a baby."
She might have added: and a parent.
Working on the theory that a parent or caregiver who knows how to soothe a baby is less likely to reach a point of frustration that could lead to fatal shaking or debilitating injury, Massachusetts Citizens for Children is sponsoring two daylong seminars for child-care professionals with UCLA pediatrician Harvey Karp -- the author of the best-selling ''The Happiest Baby on the Block" and ''The Happiest Toddler on the Block," which have been made into DVDs. Today's session is at the Days Inn in Chicopee, and tomorrow's is at the Bentley College Conference Center in Waltham.
Jetta Bernier, executive director of Massachusetts Citizens for Children, hopes Karp's soothing methods will be incorporated into a $675,000 statewide initiative to train health care providers in child abuse prevention. The initiative, whose approval is anticipated in the legislature, would include in-hospital presentations to parents of newborns. It is modeled on a shaken baby syndrome prevention initiative that MCC runs in Worcester and Hampden counties. If it is adopted, Massachusetts will be the first state to incorporate Karp's methods in a child abuse prevention plan.
''From a public health perspective, when you have something that is as preventable as this is, it's a no-brainer," said Sally Fogerty, associate commissioner for the state Department of Public Health.
The act of shaking a baby can tear fragile blood vessels that link the brain to the skull. Among victims of shaken baby syndrome, about 25 percent die; others suffer moderate to severe brain damage that may not surface for years, as well as blindness or seizure disorders.
Shaken baby syndrome was not widely known until 1997, when British au pair Louise Woodward was convicted of involuntary manslaughter in the death of 8-month-old Matthew Eappen of Newton. In February, Ann Power, a Reading day care provider, was convicted in the 2003 shaking death of 3-month-old MacKenzie Rose Corrigan.
Karp bases his techniques on the theory that babies could benefit from another three months in the womb. ''I tell parents to think of the first three months of life as a fourth trimester," he said. ''Babies are born with a calming reflex, but we typically don't know how to trigger it. By combining a series of strategies, we mimic the environment of the womb."
In utero, a baby is accustomed to a ''whooshing sound that is louder than a vacuum," he said. ''So when we put the baby in a quiet room at birth and tiptoe around, it's like sensory deprivation." Not that a baby needs a screaming toddler or a blaring TV. Karp recommends using a white noise machine, literally running the vacuum, or making a loud ''shushing" noise in the baby's ear.
Similarly, lying on a soft, motionless bed is disorienting and unnatural for a newborn who is accustomed to a ''rhythmic, hypnotic, entrancing movement." He recommends a swinging motion that resembles a shiver: Place the baby on your knees and make fast, tiny movements back and forth.
Babies have a startle reflex, called the Moro reflex, said Todd-Seymour, one of three certified Karp soothing specialists in Massachusetts. Their arms startle involuntarily, waking them up: ''If they are swaddled too loosely or not at all, they startle themselves awake over and over."
Many parents and caregivers are skeptical when they see how firmly she wraps a baby. ''I tell them, 'Try it your way on your night, and I'll do it my way on my night.' It doesn't take long for them to come around," she said, adding that the typical baby in a Karp swaddle will sleep an hour longer at night. Even when a baby is awake, swaddling provides a sense of security.
Another benefit to the Karp technique is that it strengthens the parent-child relationship, said Bernier. ''If you see from the start that you can soothe your baby, it gives you a sense of competence that carries over into the rest of your parenting." That empowerment is particularly important for teen parents and for fathers. Men are responsible for 80 percent of shaken baby syndrome cases, Bernier said.
Jason Rashkin of Waltham is one dad who's a believer. He and his wife, Allison, hired Todd-Seymour before their son Noah was born. She sent them a copy of Karp's DVD, but they didn't have time to watch it. The first night Noah was home ''was rough," Jason said. ''He was hard to soothe. We were up all night."
The next morning, while his wife and baby slept, he watched the video.
''I didn't think it would work, but it was like a magic bullet, especially putting him on my knee," Rashkin says. ''We haven't had another night like that."
For more information on the MCC seminars, call 617-742-8555, ext. 3.
Barbara Meltz can be reached at firstname.lastname@example.org.
The typical baby cries one to two hours a day; 15 percent cry for more than three hours.
If nothing works to calm your baby, place her safely in the crib to cry it out while you calm yourself.
That's always better than yelling, or hitting or shaking the baby.
For free, 24-hour help, call the Massachusetts Parental Stress Line, 800-632-8188.
When the crying wont stop
When your baby seems inconsolable, run through this checklist: