Period Of PURPLE Crying Research Articles

New Horizons for the Journal: Familiar Landscapes in Child Protection

New Horizons for the Journal: Familiar Landscapes in Child Protection

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

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.

Eight-year outcome of implementation of abusive head trauma prevention.

Low incidence rates and economic recession have hampered interpretation of educational prevention efforts to reduce abusive head trauma (AHT). Our objective was to determine whether the British Columbia experience implementing a province-wide prevention program reduced AHT hospitalization rates. A 3-dose primary, universal education program (the Period of PURPLE Crying) was implemented through maternal and public health units and assessed by retrospective-prospective surveillance. With parents of all newborn infants born between January 2009 and December 2016 (n = 354,477), nurses discussed crying and shaking while delivering a booklet and DVD during maternity admission (dose 1). Public health nurses reinforced Talking Points by telephone and/or home visits post-discharge (dose 2) and community education was instituted annually (dose 3). During admission, program delivery occurred for 90% of mothers. Fathers were present 74.4% of the time. By 2-4 months, 70.9% of mothers and 50.5% of fathers watched the DVD and/or read the booklet. AHT admissions decreased for <12-month-olds from 10.6 (95% CI: 8.3-13.5) to 7.1 (95% CI: 4.8-10.5) or, for <24-month-olds, from 6.7 (95% CI: 5.4-8.3) to 4.4 (95% CI: 3.1-6.2) cases per 100,000 person-years. Relative risk of admission was 0.67 (95% CI: 0.42-1.07, P = 0.090) and 0.65 (95% CI: 0.43-0.99, P = 0.048) respectively. We conclude that the intervention was associated with a 35% reduction in infant AHT admissions that was significant for <24-month-olds. The results are encouraging that, despite a low initial incidence and economic recession, reductions in AHT may be achievable with a system-wide implementation of a comprehensive parental education prevention program.

The impact of an educational intervention on knowledge about infant crying and abusive head trauma.

Infants follow a predictable trajectory of increased early crying. Frustration with crying is reported to be a trigger for abusive head trauma (AHT). To evaluate the impact of postpartum delivery of the educational program, the Period of PURPLE Crying (PURPLE), in a group of first-time mothers. The primary objective was to determine whether there was a change in knowledge about infant crying and shaking after exposure to PURPLE. Factors associated with change in knowledge were also examined. A total of 93 participants were recruited over a four-month period at a tertiary care hospital in Nova Scotia. Pre- and postintervention data were collected. Knowledge about infant crying increased significantly after program delivery (P=0.001). Low baseline crying knowledge was a significant predictor of increased knowledge about infant crying (P≤0.01). There was an insignificant decrease in shaking knowledge (P=0.5), which may have been the consequence of high baseline knowledge. An educational program for new parents appears to be warranted, especially with respect to improving knowledge about infant crying. This may have a positive benefit in AHT prevention. Additional studies are required to evaluate the impact of the program on other caregivers and on rates of AHT.

An evidence-based method for targeting an abusive head trauma prevention media campaign and its evaluation.

A triple-dose abusive head trauma (AHT) prevention program (Period of PURPLE Crying) was implemented. The third dose consisted of an education media campaign. The study objectives were to describe the qualitative and spatial methods developed to target AHT prevention and to evaluate this campaign. A questionnaire on the level of importance of factors, rated on a 7-point Likert scale, was distributed to a panel of experts to determine the best advertising locations. Ranked factors were used to create weights for statistical modeling and mapping within a Geographic Information Systems to determine optimal ad locations. The media campaign was evaluated via a telephone survey of randomly selected households. The survey found locations of new families, high population density, and high percentage of lone parents to be the most important factors for selecting billboard sites. Spatial analysis revealed six areas that ranked highest in our factors. Five billboards, four media posters, and six transit shelters were selected for our advertisements. A population-based telephone survey revealed that 23% of respondents knew the campaign. Nearly half (42%) heard the radio public service announcements, and 9% saw billboards. Extending primary prevention efforts to the public helps to create a cultural change in the way inconsolable crying, the trigger for AHT, is viewed. With the use of ranked factors and Geographic Information Systems, geographic locations with high visibility and specific risk factors for AHT were identified for targeting the campaign, facilitating the likelihood that our message was reaching the population in greatest need.

Effectiveness of public health practices against shaken baby syndrome/abusive head trauma in Japan

ObjectivesPrevious studies have demonstrated the effectiveness of educational materials on infant crying to change caregivers' knowledge and behaviours related to shaken baby syndrome or abusive head trauma (SBS/AHT) using selected samples in randomized controlled trials. This study investigated the impact of public health practices to prevent SBS/AHT in Japan through the use of educational materials. Study designCross-sectional study. MethodsThe intervention was comprised of two parts: (1) the screening of an educational DVD at a prenatal class; and (2) the distribution of a public health pamphlet at a postnatal home visit. Expectant parents watched a DVD (The Period of PURPLE Crying) about the features of infant crying and recommended behaviours (walking away if frustrated in the event of unsoothable crying, sharing information on crying with other caregivers) at a preterm parenting class held at eight months' gestation. A postnatal home-visit service was implemented in which a maternity nurse distributed a pamphlet to explain information about infant crying. Before the four-month health check-up, a self-administered questionnaire was distributed to assess exposure to these public health practices and outcome variables (i.e. infant crying knowledge, walk-away and information-sharing behaviours), and responses were collected at the four-month health check-up (n = 1316). The impacts of these interventions on outcome variables were analysed by comparing those exposed to both interventions, either intervention and neither intervention after adjusting for covariates. ResultsCrying and shaking knowledge were significantly higher among women exposed to the public health practices, with a dose-response relationship (both P < 0.001). Further, walk-away behaviour during periods of unsoothable crying was higher among the intervention group. However, sharing information about infant crying with other caregivers was less likely among the intervention group. ConclusionsThe impact of educational materials in public health practice on knowledge of crying and shaking, and walk-away behaviour in Japan had a dose-response relationship; however, an increase in sharing information with other caregivers was not observed.

Shaken Baby Prevention in Maine: The Period of PURPLE Crying

Shaken Baby Prevention in Maine: The Period of PURPLE Crying

Abusive head trauma in infants and why we CAN afford to prevent it

Abusive head trauma in infants and why we CAN afford to prevent it

Preventing child maltreatment: community approaches

Dodge, Coleman, Introduction: Community-based Prevention of Child Maltreatment. Part 1. The Scientific Basis for the Community Prevention of Child Maltreatment. Daro, The History of Science and Child Abuse Prevention: A Reciprocal Relationship. Part 2. Community Efforts to Prevent Child Maltreatment. Olds, Eckenrode, Henderson, Kitzman, Cole, Luckey, Holmberg, Baca, Preventing Child Abuse and Neglect with Home Visiting by Nurses. Prinz, Toward a Population-Based Paradigm for Parenting Intervention, Prevention of Child Maltreatment, and Promotion of Child Well-Being. Dodge, Murphy, O'Donnell, Christopoulos, Community-Level Prevention of Child Maltreatment: The Durham Family Initiative. Melton, How Strong Communities Restored My Faith in Humanity: Children Can Live in Safety. Runyan, Zolotor, The Period of PURPLE Crying: Keeping Babies Safe in North Carolina. Part 3. Policy and Practice Issues. Ammerman, Putnam, Margolis, Van Ginkel, Quality Improvement in Child Abuse Prevention Programs. Waldfogel, Differential Response. Coleman, Innovations in Child Maltreatment Prevention: Resolving the Tension between Effective Assistance and Violations of Privacy. Lederman, Healing in the Place of Last Resort: The Role of the Dependency Court within Community-based Efforts to Prevent Child Maltreatment. Wald, Preventing Maltreatment or Promoting Positive Development - Where Should a Community Focus Its Resources?: A Policy Perspective.

Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken‐baby syndrome in mothers of newborns: a randomized, controlled trial

. Barr R. G., Rivara F. P., Barr M., Cummings P., Taylor J., Lengua L. J. &amp; Meredith‐Benitz E. ( 2009 ) , 123 , 972 – 980 . DOI: 10.1542/peds.2008‐0908 . Background Infant crying is an important precipitant for shaken‐infant syndrome. Objective To determine if parent education materials [The Period of PURPLE Crying (PURPLE)] change maternal knowledge and behaviour relevant to infant shaking. Methods This study was a randomized, controlled trial conducted in prenatal classes, maternity wards and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included two knowledge scales about crying and the dangers of shaking; three scales about behavioural responses to crying generally and to unsoothable crying, and caregiver self‐talk in response to unsoothable crying; and three questions concerning the behaviours of sharing of information with others about crying, walking away if frustrated and the dangers of shaking. Results The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioural responses to crying generally, responses to unsoothable crying, and for self‐talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviours of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. Conclusions Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviours considered to be important for the prevention of shaking.

Effectiveness of Educational Materials Designed to Change Knowledge and Behaviors Regarding Crying and Shaken-Baby Syndrome in Mothers of Newborns: A Randomized, Controlled Trial

Infant crying is an important precipitant for shaken-infant syndrome. OBJECTIVE. To determine if parent education materials (The Period of PURPLE Crying [PURPLE]) change maternal knowledge and behavior relevant to infant shaking. This study was a randomized, controlled trial conducted in prenatal classes, maternity wards, and pediatric practices. There were 1374 mothers of newborns randomly assigned to the PURPLE intervention and 1364 mothers to the control group. Primary outcomes were measured by telephone 2 months after delivery. These included 2 knowledge scales about crying and the dangers of shaking; 3 scales about behavioral responses to crying generally and to unsoothable crying, and caregiver self-talk in response to unsoothable crying; and 3 questions concerning the behaviors of sharing of information with others about crying, walking away if frustrated, and the dangers of shaking. The mean infant crying knowledge score was greater in the intervention group (69.5) compared with controls (63.3). Mean shaking knowledge was greater for intervention subjects (84.8) compared with controls (83.5). For reported maternal behavioral responses to crying generally, responses to unsoothable crying, and for self-talk responses, mean scores for intervention mothers were similar to those for controls. For the behaviors of information sharing, more intervention mothers reported sharing information about walking away if frustrated and the dangers of shaking, but there was little difference in sharing information about infant crying. Intervention mothers also reported increased infant distress. Use of the PURPLE education materials seem to lead to higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing of information behaviors considered to be important for the prevention of shaking.