ICON is here to help prevent abusive head trauma. This page is for professionals looking for support. ICON is an evidence-based programme consisting of a series of brief ‘touchpoint’ interventions that reinforce the simple message making up the ICON acronym.

ICON was conceived following years of study and research into the prevention of Abusive Head Trauma (AHT). The ICON founder, Dr Suzanne Smith PhD, consolidated the study and research with a visit to the USA and Canada in 2016 (courtesy of the Winston Churchill Memorial Trust Travel Fellowship) to see the prevention programmes in action and to understand more about what makes such programmes a success. 

Research points to persistent crying in babies being a potential trigger for some parents/caregivers to lose control and shake a baby.  It also shows that around 70% of babies who are shaken are shaken by men.  So any prevention programme should include male caregivers and use the best opportunities to reach them as well as support all parents/caregivers with information about crying and how to cope with a crying baby.

Intervention points

The full ICON programme consists of 5 core intervention points that mainly dovetail with existing contacts by professionals.  There are additional intervention points that are available described below as ‘Touchpoint +’.  

The first touchpoint steps the family through the ICON message that is explained in the poster below.  

Touchpoints 2, 3 and 4 are reiterations/reminders of this basic message and an opportunity to discuss in more detail if necessary or appropriate.  We have suggested what might be discussed at these touchpoints below, but it is up to the professional assessment as to what should be discussed as long as the reminder of the basic message is included

Touchpoint 5 is with the GP and again includes a reminder of the ICON message displayed below, giving the leaflet/easy read again as this is when the peak of normal crying is likely to be at its highest, or getting there.  GPs are provided with a questionnaire to structure their conversation and also cover other topics recommended as good practice including post-natal depression and domestic abuse.

It is important to recognise that ICON isn’t just about giving written information.  The value of the conversation is what is important. There is a translation facility on this website (Reachdeck) which will support practitioners to give the information if parents/carers require translation services.  Ideally, as with all interventions, the presence of an interpreter is preferable.

The five core touchpoints are:

Where and when: Hospital/Home based following birth and prior to discharge.  Research shows this is where the message is more likely to reach men.

Who delivers the touchpoint? Midwives, anyone from the midwifery team, maternity unit volunteers.  It is mainly midwives who prefer to deliver this touchpoint when they discharge the mother and baby from hospital or following a home birth. 

Resources: This includes the provision of the leaflet or the easy-read version and a simple script to get the conversation started is also available.  It usually takes midwives about 6 – 8 minutes to deliver this touchpoint.

If the baby was premature and is being discharged from the Neonatal Unit, the Neonatal team should deliver this touchpoint using the ‘premature baby’ ICON leaflet or the easy-read version.

Where and when: Within the first 10 days, post-discharge, at home.

Who delivers the touchpoint? Community Midwife

Resources: This is a reminder of the ICON basic message and no resources are necessarily needed.  The midwife may choose to show the parents/carers the ‘Infant crying is normal’ infographic to help reinforce this point. The normal crying curve is also a good resource to help the discussion.

Where and when: Within the first 14 days, the first visit at home by a Health Visitor.

Who delivers the touchpoint? Health visitor

Resources: This is a reminder of the ICON basic message and no resources are necessarily needed.  The Health Visitor may choose to show the parents/carers the ‘Comfort methods can help’ infographic.  A really useful resource that might be used is the ‘Crying Plan’ which could accompany a discussion exploring how the parent/carers are prepared for the rise in crying that is imminent.

Where and when: Around the 3-week period

Who delivers the touchpoint? Health visiting team

Resources: This isn’t normally a time when Health Visitors are routinely in touch with a family but it is a good time to check in with families that they are coping with the possible increase in crying from their baby and are coping.  Some areas are choosing to raise the topic opportunistically at clinics whilst others are proactively sending text messages to both parents/carers as a reminder.

Where and when: At the routine 6/8 week check at the GP surgery

Who delivers the touchpoint? GP and this is sometimes supported by Practice Nurses.

Resources: This is the time the increase in crying is likely to become noticeable.  A reminder of the ICON basic message, provision of the leaflet or easy easy-read version is useful at this point.  GPs are asked to structure their session using the questionnaire included on the members portal.  Although this is a defined touchpoint, many GP practices are using other opportunities during contact with men and women presenting to the surgery who are caring for babies who are crying a lot, to remind them of the ICON message.

Touchpoints +

These are additional touchpoints supported by ICON resources that many practitioners are including.

Antenatal: This is another good opportunity to engage men in a conversation about normal crying and how to cope with it.  It can be delivered by midwives, health visitors or GPs, practice nurses, nursery staff who are aware a new baby is expected etc.  Describing Barr’s crying curve and explaining the basic message is often well-received at this point.

Schools: ICON resources include a PSHE (Personal, social, health and economic education) lesson plan and materials designed by teachers for 14 – 16-year-olds.  Some of these pupils will have siblings who are babies, may babysit or may soon become or are already parents.  The purpose of this lesson is to enhance the public health messaging around the normal crying behaviour of babies, when and where to seek help and advice and the dangers of shaking a baby.  It can be delivered by teaching staff or health professionals.

Opportunistic: Any professional involved with babies to provide opportunistic support/advice using the free resources available on this website.

Social Media: Following and sharing ICON materials, short animations and films, digital audio products etc… will help reach people, especially men, who won’t always be at appointments with health professionals.  

ICON is now being used extensively throughout the country.  If you want to adopt ICON in your area or place of work, please get in touch and we’ll be in touch to get you started.

Ellis’ Story

Some may find this video distressing. Viewer discretion is advised