PURPLE Program and Its Research
The Period of PURPLE CryingÂ® provides educational information about the properties of normal infant crying that are uniformly frustrating to caregivers, and appropriate action steps that caregivers need to know. Inconsolable infant crying is the number one trigger that precedes a shaking event.
The program is presented in two components that reinforce each other: (1) an 11-page booklet (“Did you know your infant would cry like this?”) and (2) a 10-minute DVD.
The letters in the word PURPLE describe the properties of normal infant crying that are frustrating:
P for Peak of Crying – Crying peaks at around 2 months, then decreases at around 3 to 5 months;
U for Unexpected – Crying comes and goes unexpectedly, for no apparent reason;
R for Resists Soothing – Crying continues despite all soothing efforts by caregivers;
P for Pain-like Face – Infants look like they are in pain, even when they are not;
L for Long Lasting – Crying can last as much as 5 hours a day, or more;
E for Evening – Crying occurs more in the late afternoon and evening.
The behavioural component – three action steps – guides caregivers on how to respond to crying in order to reduce crying as much as possible and to prevent shaking and abuse. These action steps are:
1. Carry, comfort, walk and talk with the infant. This encourages caregivers to increase contact with their infant, reduce some of the fussing and attend to their infant’s needs.
2. If the crying is too frustrating, it is okay to walk away. The infant may be put in a safe place so that the caregiver can take a few minutes to calm down and then go back and check on the infant again.
3. Never shake or hurt an infant.
The educational information and action steps are brief, memorable and easy to transmit.
Research Completed. From 2003-2007, research was conducted to test the Period of PURPLE Crying program through randomized controlled trials in Vancouver, British Columbia and Seattle, Washington. The hypothesis of the research was that the intervention materials could change parents’ knowledge, attitudes and behaviours about early infant crying, especially inconsolable crying and shaken baby syndrome. In Vancouver, BC the materials were delivered via public health nurse home visits and in Seattle, WA the materials were delivered via maternity wards, pediatricians’ offices and prenatal classes. The participants were randomly assigned to either an intervention arm where they received the Period of PURPLE Crying materials (a 10-minute DVD and 11-page booklet) or to a control arm where they received comparable information about general infant safety. Over 4,400 parents participated in the studies. Additionally, 25 parent focus groups were conducted to develop the materials.
Vancouver, British Columbia, Canada Trial in the Canadian Medical Association Journal
The following article describing the randomized controlled trial of the Period of PURPLE Crying materials in Vancouver, B.C., Canada has been published in the March 2009 edition of the Canadian Medical Association Journal.
Article Title: Do educational materials change knowledge and behaviors regarding crying and shaken baby syndrome in mothers of newborns when delivered by public health home visitor nurses? A randomized controlled trial.
Authors and Investigators: Ronald G. Barr, MDCM, FRCPC, Marilyn Barr, BIS, SSW, Takeo Fujiwara, MD, PhD, MPH, Jocelyn Conway, BA, Nicole Catherine, M. Sc., Rollin Brant, PhD.
Click here to read the full article on the CMAJ website.
Seattle, Washington, USA Trial in Pediatrics
The following article describing the randomized controlled trial of the Period of PURPLE Crying materials in Seattle, WA has been published in the March 2009 issue of Pediatrics.
Article Title: Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken baby syndrome in mothers of newborn infants: a randomized controlled trial.
Authors and Investigators: Barr RG, Rivara FP, Barr M, Cummings P, Taylor J, Lengua LJ, Meredith-Benitz E.