PURPLE Crying Research Articles

Designing and Testing a Shaken Baby Syndrome Prevention Program—The Period of PURPLE Crying: Keeping Babies Safe in North Carolina

Each year infants die or are permanently disabled at the hands of their caregivers by abusive head trauma, more commonly known as Shaken Baby Syndrome (SBS). Current medical research confirms the central role of infant crying in triggering shaking by caregivers; anecdotally, inconsolable crying is the most common explanation given by abusers. Although SBS prevention efforts have been initiated, most remain unevaluated. This article provides an overview of a 5-year, evidence-based SBS-prevention program called The Period of PURPLE Crying: Keeping Babies Safe in North Carolina from a social marketing perspective. The project includes three components: (1) in-hospital education for parents of every newborn at all 86 hospitals/birthing centers in North Carolina; (2) reinforcement in community settings such as prenatal visits to health departments or well-child care visits to primary care providers; and (3) a media campaign.

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. & 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.

Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial.

Shaken baby syndrome often occurs after shaking in response to crying bouts. We questioned whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behaviour related to shaking. We performed a randomized controlled trial in which 1279 mothers received materials from the Period of PURPLE Crying program or control materials during a home visit by a nurse by 2 weeks after the birth of their child. At 5 weeks, the mothers completed a diary to record their behaviour and their infants' behaviour. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behaviour. The mean score (range 0-100 points) for knowledge about infant crying was greater among mothers who received the PURPLE materials (63.8 points) than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95% confidence interval [CI] 4.1 to 6.5 points). The mean scores were similar for both groups for shaking knowledge and reported maternal responses to crying, inconsolable crying and self-talk responses. Compared with mothers who received control materials, mothers who received the PURPLE materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%, difference 13.0%, 95% CI 6.9% to 19.2%), the dangers of shaking (49.3% v. 36.4%, difference 12.9%, 95% CI 6.8% to 19.0%), and infant crying (67.6% v. 60.0%, difference 7.6%, 95% CI 1.7% to 13.5%). Walking away during inconsolable crying was significantly higher among mothers who received the PURPLE materials than among those who received control materials (0.067 v. 0.039 events per day, rate ratio 1.7, 95% CI 1.1 to 2.6). The receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some 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.

Question From the Clinician

Question From the Clinician