Abstract
BACKGROUND: Disciplining a child is a complex, multidimensional aspect of parenting, involving emotional guidance, behavioral correction, and consistent communication. Disciplinary practices applied to children may vary due to social, cultural, and geographic contexts. Among these practices, child shaking and its potentially severe consequences, including traumatic brain injury and long-term neurodevelopmental impairments, are more frequently documented in high-income countries. Although child shaking also occurs in low- and middle-income countries, particularly among infants, where it is primarily triggered by persistent crying, it is rarely reported in formal studies. Moreover, primary caregivers, particularly mothers, may not perceive shaking as a form of punitive discipline, and maternal depression is often associated with their caregiving attitude toward children. Furthermore, notable functional variations are also observed in the parenting practices of low-income urban and rural mothers, often influenced by divergent socioeconomic and environmental factors. OBJECTIVE: This study aims to explore caregivers' use of shaking as a disciplinary practice with young children in lower-income urban and rural communities in Bangladesh and identify the underlying factors associated with this behavior. METHODS: This was a cross-sectional study in which we randomly interviewed 800 caregivers of children (aged <2 y) admitted to the hospitals of the International Centre for Diarrhoeal Disease Research, Bangladesh, in urban Dhaka (n=520, 65%) and rural Matlab (n=280, 35%). We collected detailed information on how they disciplined their young children (index children), with particular emphasis on shaking behavior. The questionnaires also explored perceived causes and common beliefs related to child shaking, in addition to collecting information on sociodemographic characteristics and caregivers' depression. All analyses were conducted using SPSS software. RESULTS: Child shaking was higher in lower-income communities of Dhaka compared to rural Matlab (n=265, 51% vs n=52, 19%; P<.001). Mothers, as the primary caregivers, mostly used shaking as a disciplinary practice with their young children (n=491, 61%). Overall, 27% (n=214) of primary caregivers reported ever shaking a child below 2 years; among these, 62% (n=133) reported shaking at least 3 to 5 times. Crying and fussing were the main triggering factors (Dhaka: n=107, 62% vs Matlab: n=26, 67%) for shaking behavior, particularly in infants aged younger than 6 months. Approximately 56.6% (n=99) of the mothers in Dhaka and 28.2% (n=11) of the mothers in Matlab believed that shaking was either definitely or probably harmless. Maternal depression was significantly correlated (adjusted odds ratio 1.03, 95% CI 1.01-1.04; P=.001) with shaking practices used by mothers. CONCLUSIONS: Shaking young children as a form of discipline is quite prevalent in lower-income communities of Bangladesh, where poverty and other stressors are common. Caregivers are not fully aware of the harmful side effects of infant shaking. Positive parenting programs need to be strengthened to reduce these harmful behaviors toward children to support their developmental potential.