Evaluation of the Period of PURPLE Crying: An Abusive Head Trauma Prevention Programme

Abstract

Abusive head trauma (AHT) in infants is thought to be triggered by caregiver frustration with persistent crying. The Period of PURPLE Crying (POPC) is designed to educate parents about normal infant crying, strategies to use when infants cry and the dangers of shaking in an effort to decrease AHT. Studies evaluating the POPC have measured changes in parent knowledge and behaviour regarding infant crying. Our objective was to evaluate the POPC's effect on caregiver frustration with infant crying compared to standard discharge information (SDI). We taught paediatric interns and medical students rotating in the newborn nursery to deliver the POPC and discuss infant crying. New parents were pseudo‐randomised to receive SDI or the POPC plus SDI. Parents were contacted five‐to‐eight weeks after discharge and asked knowledge questions about infant crying as well as the number of times that they were frustrated by their infant's crying in the preceding week. Of 271 parents who consented to participate, 164 (61%) completed the survey. The POPC group answered two of the knowledge questions correctly more often than the control group (score differences: 17%, 95% confidence interval (CI) 3–32% and 21%, 95% CI 7–36%). However, parents reported frustration due to infant crying at similar rates between the control (55/80, 69%) and POPC (60/84, 71%) groups. Our results support previous findings that the POPC improves caregiver knowledge concerning infant crying. The POPC does not appear to affect caregiver frustration with crying.‘Our objective was to evaluate the POPC's effect on caregiver frustration with infant crying compared to standard discharge information’Key Practitioner Messages Instructing new parents about normal infant crying and the dangers of shaking an infant remains an important part of anticipatory guidance. The POPC is not more effective at reducing caregiver frustration with infant crying than standard discharge instructions. Future investigations should specifically aim to include male caregivers as recipients of the programme.