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Do Educational Materials Change Knowledge and Behaviour About Crying and Shaken Baby Syndrome? A Randomized Controlled Trial

NCJ Number
Canadian Medical Association Journal Volume: 180 Issue: 7 Dated: 2009 Pages: 727-733
Ronald G. Barr; Marilyn Barr; Takeo Fujiwara; Jocelyn Conway; Nicole Catherine; Rollin Brant
Date Published
7 pages

Since shaken baby syndrome often occurs after shaking in response to crying bouts, this study examined whether the use of the educational materials from the Period of PURPLE Crying program would change maternal knowledge and behavior related to shaking.


The study performed a randomized controlled trial in which 1,279 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 the child. At 5 weeks, the mothers completed a diary to record their behavior and their infant 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 PURPLE materials than among mothers who received the control materials (58.4 points) (difference 5.4 points, 95 percent confidence interval 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 percent v. 38.5 percent, difference 13.0 percent, 95 percent CI 6.9 percent to 19.2 percent), the dangers of shaking (49.3 percent v. 36.4 percent, difference 12.9 percent, 95 percent CI 6.8 percent to 19.0 percent), and infant crying (67.6 percent v. 60.0 percent, difference 7.6 percent, 95 percent CI 1.7 percent to 13.5 percent). 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 percent CI 1.1 to 2.6). The study concludes that the receipt of the Period of PURPLE Crying materials led to higher maternal scores for knowledge about infant crying and for some behaviors considered to be important for the prevention of shaking. 2 tables, 1 figure, and 46 references (publisher abstract modified)