The Period of PURPLE Crying® Program

Shaken Baby Syndrome or Abusive Head Trauma (SBS/AHT) are terms used to describe the constellation of signs and symptoms resulting from violent shaking or shaking with impact to the head of an infant or small child. Among shaken infants, mortality rates range from 15% to 38% with a median of 20% to 25%. 1 2

In 2007, Prevent Shaken Baby Syndrome BC, a program of BC Children’s Hospital, developed a shaken baby syndrome and infant abuse prevention program called the Period of PURPLE Crying. The program title describes the time in a newborn’s life when he or she cries more than any other time in infancy. It begins at about two weeks of age and continues until they are about three to four months old. PURPLE stands as an acronym for “Peak of crying/Unexpected/Resists soothing/Pain-like face/Long-lasting/Evening.” It’s a normal part of every infant’s development and all babies go through this period.

The program has three aims:

  1. To change the way parents and caregivers are educated about normal infant crying.
  2. To improve awareness around the dangers of shaking infants.
  3. To reduce the incidence of SBS/AHT and infant abuse in British Columbia.

Delivery

Since February 2009, the Period of PURPLE Crying Program® has been delivered to parents of BC’s 45,000 annual births at all 48 birthing hospitals and 110 public health units.

The public education campaign was launched through various media and every year the program hosts a province-wide grassroots campaign called CLICK for Babies where purple newborn caps are collected and distributed with the program during the months of November and December. 3

To date, more than 5,800 maternity and public health nurses, as well as 5,200 community personnel (health practitioners, early childhood educators, childcare providers, First Nations support, foster parents, and health care students) across the province have completed the PURPLE program training and are administering the program. 13 post-secondary institutions have incorporated the program into their curriculum and/or course assignments.

Materials

Parents of newborns receive crying education as well as an informational package which includes a 10-minute crying film, a 17-minute research-based soothing film and a 10-page booklet.

As of 2017, the crying film and booklet is offered in 11 languages: English, French (Canadian), Punjabi, Cantonese, Spanish (Mexican), Korean, Vietnamese, Japanese, Portuguese (Brazilian), Somali, and Arabic.

Evaluation

The Period of PURPLE Crying Program® is currently being evaluated through quality improvement process measures as well as active and passive surveillance.

Quality improvement measures include: public health nurse administrative forms (February 2009 to September 2011), maternity nurse surveys (September 2009 to March 2014), parent surveys when their infants are 2-4 months of age (January 2010 and ongoing) and public health nurse surveys (October 2012 and ongoing).

For active and passive surveillance, incidence rates of shaken baby syndrome and other forms of physical abuse in 0-2 year olds are collected from the Neurosurgery Department at BC Children’s Hospital (completed), Child Protective Services, the BC Coroners Office, as well as Canadian Institute for Health Information and compared pre-/post-PURPLE program implementation.

  1. Ludwig S, Warman M. Shaken baby syndrome: A review of 20 cases. Ann Emerg Med. 1984;13:104–107.
  2. Alexander R, Sato Y, Smith W, Bennett T. Incidence of trauma with cranial injuries ascribed to shaking. Am J Dis Child. 1990;144:724–726.
  3. Christian CW, Block R. Abusive head trauma in infants and children. Pediatrics. 2009;123(5):1409-1411.