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Period of PURPLE Crying

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare Relevance Level:
Medium

See descriptions of 3 levels

Brief Description

The information in this program outline is provided by the program representative and edited by the CEBC staff. The Period of PURPLE Crying program has been rated by the CEBC in the area of: Prevention of Child Abuse and Neglect (Secondary).

  • Type of Maltreatment: Physical Abuse
  • Target Population: All mothers of new infants and society in general in their understanding of early infant crying and shaken baby syndrome.

It is a shaken baby syndrome prevention program that educates parents and caretakers on normal infant crying, the most common trigger for shaking an infant. It was designed to be used primarily in primary prevention settings, but is applicable to secondary prevention as well. The letters in PURPLE stand for the common properties of crying, including unsoothable crying, in infants during the first few months:

  • Peak pattern (crying peaks around 2 months, then decreases)
  • Unpredictable (crying for long periods can come and go for no reason)
  • Resistant to soothing (the baby may keep crying for long periods)
  • Pain-like look on face
  • Long bouts of crying (crying can go on for hours)
  • Evening crying (baby cries more in the afternoon and evening)

The program also contains a public media component aimed at changing cultural attitudes about crying, especially inconsolable crying.

Essential Components

  • Approaches prevention through educating parents and the community about normal infant development, specifically, crying in normal infants, rather than being limited to warnings of the negative consequences of shaking.
  • Uses highly attractive positive messages for caregivers rather than negative warnings about bad consequences.
  • Aims to bring about a cultural change in our understanding of infant crying both for caregivers and the general public.
  • Aims to increase program “penetration rates” to new parents and be widely acceptable to health care professionals and groups disseminating the intervention.
  • Provides a DVD and 11-page booklet, translated into nine languages, to take home to review and share with others.

Child Component

Period of PURPLE Crying was not designed with a child component.

Parent / Caregiver Component

Period of PURPLE Crying was designed with a parent/caregiver component that addresses the following presenting problems and symptoms:

  • Parents of a newborn.

Group Format

Period of PURPLE Crying was not designed to be conducted in a group setting, and has not been tested for use in a group setting.

Delivery Settings

This program is typically conducted in a(n):

  • Birth Family Home
  • Hospital

Homework

This program does not include a homework component.

Languages

Period of PURPLE Crying has materials available in languages other than English:

Cantonese, French, Japanese, Korean, Portuguese, Punjabi, Somali, Spanish, Vietnamese

Close captioning for the hearing impaired is available on the English version.

Resources Needed to Run Program

The typical resources for implementing the program are:

Materials provided by the National Center on Shaken Baby Syndrome and Internet access.

Minimum Provider Qualifications

There are no educational requirements, but the provider must take the training online or in person and be in a position where they have authority to give programs to new parents. The provider should protect the fidelity of the program by complying with the protocol required.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

Onsite training determined by need.

Number of days/hours:

1 to 3 hours depending on need.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Child/Family Well-Being

Show relevant research...

Barr, R. G., Rivara, F. P., Barr, M., Cummings, P., Taylor, J., Lengua, L. J., et al. (2009). Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken baby syndrome in mothers of newborns: a randomized controlled trial. Pediatrics, 123(3), 972-980.

Type of Study: Randomized controlled trial
Number of Participants: 1374 experimental; 1364 control

Population:

  • Age range — Caregivers age 18-5
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Mothers recruited from prenatal classes, maternity wards and pediatric offices.

Location / Institution: Washington State

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Mothers were randomly assigned to receive either the PURPLE crying materials or information on infant safety and safe sleep. Some mothers received materials prenatally and some at pediatric sites. Knowledge was assessed with a baseline interview. Mothers were also given a diary to complete during the fifth week. At two months post-intervention knowledge was assessed. Mothers receiving the PURPLE intervention showed higher knowledge scores about crying and shaking the baby, more positive reported behavioral responses to crying and more likelihood of sharing information with other caregivers about walking away and the dangers of shaking. They also reported more minutes of contact during crying. However rates of picking up the baby, walking away when distressed and daily frustration scores were not different across groups. The intervention group reported longer periods of distress in their babies than the control group. The authors speculate that increased reports of distress may be a result of the focus on crying in the PURPLE materials but suggest that this result needs to be followed up.

Length of post-intervention follow-up: 2 months.

Barr, R. G., Barr, M., Fujiwara, T., Conway, J., Catherine, N., & Brant, R. (2009). Do educational materials change knowledge and behavior about crying and shaken baby syndrome? A randomized controlled trial. Canadian Medical Association Journal, 180(7), 727–733.

Type of Study: Randomized controlled trial
Number of Participants: 1,279 mothers

Population:

  • Age range — 25 years (n=105), 25-30 years (n=291), 30-35 years (n=469), > 35 years (n=374), with an additional 3% missing age variable.
  • Race/Ethnicity — Not Specified
  • Gender — Females
  • Status — Participants were recruited from hospitals in the Greater Vancouver Area, British Columbia, between May 2005 and November 2006, who had an uneventful pregnancy, a healthy singleton infant (> 37 weeks’ gestation), access to a DVD player and who were fluent in English.

Location / Institution: Greater Vancouver Area, British Columbia

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study focused on 1,279 mothers who 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 behavior and their infants’ behavior. Two months after giving birth, the mothers completed a telephone survey to assess their knowledge and behavior. The mean score (range 0-100 points) for knowledge about infant crying was greater among mothers who received the Period of PURPLE Crying materials (63.8 points) than among mothers who received the control materials (58.4 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 Period of PURPLE Crying materials reported sharing information about walking away if frustrated more often (51.5% v. 38.5%), the dangers of shaking (49.3% v. 36.4%), and infant crying (67.6% v. 60.0%). Walking away during inconsolable crying was significantly higher among mothers who received the Period of PURPLE Crying materials than among those who received control materials (0.067 v. 0.039 events per day). Limitations included studying changes for mothers only, although men are the most common perpetrators of shaking. Second, the outcome measures were based on maternal reports, not direct observations. Third, missing data may have resulted in biased estimates unless the data were missing at random. Fourth, the study did not adjust for multiple outcomes, which increases the probability of findings based on chance. Finally, these results may not be generalizable to other populations.

Length of post-intervention follow-up: 6 weeks.

References

Barr, R. G. (2006). Crying behaviour and its importance for psychosocial development in children. In: Tremblay R. E., Barr R. G., Peters R. D., eds. Encyclopedia on Early Childhood Development[online]. Montreal, Quebec: Centre of Excellence for Early Childhood Development, 1-10. Retrieved on August 31, 2009, from: www.dontshake.org/pdf/Crying_Behaviour___CEECD_Encyclopedia.pdf.

Barr, R. G., Trent, R. B., & Cross, J. (2006). Age related incidence curve of hospitalized Shaken Baby Syndrome Cases: Convergent evidence for crying as a trigger to shaking. Child Abuse and Neglect, 30, 7-16.

Lee, C., Barr, R. G., Catherine, N., & Wicks, A. (2007). Age-related incidence of publicly reported Shaken Baby Syndrome cases: Is crying a trigger for shaking? Journal of Developmental and Behavioral Pediatrics, 28(4), 288-293.

Contact Information

Name: Marilyn Barr
Title: Founder and Executive Director
Agency/Affiliation: National Center on Shaken Baby Syndrome
Website: www.dontshake.org
Email:
Phone: (801) 447-9360
Fax: (801) 447-9364

Date Reviewed: June 2011 (originally reviewed in February 2008)