No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Infant abusive head trauma prevention: acceptability of the Period of PURPLE Crying® program in far North Queensland, Australia
Abstract
A study examined the appropriateness and likelihood of usage of the north American Period of PURPLE Crying® intervention program in far north Queensland, to educate families about the risk of infant abusive head trauma (AHT)/shaken baby syndrome.
A mixed-method cross-sectional study with a questionnaire and semi-structured interview was conducted with 33 health professionals in far north Queensland (FNQ) to gauge their opinions of the Period of PURPLE Crying program's educational materials.
Seventy per cent of participants were aware of infant AHT; 87.8% agreed the program would be appropriate for far north Queensland populations; 90% agreed that new parents/carers could learn new strategies to deal with inconsolable crying, and that men would be particularly advantaged.
In their present form, the educational materials of the Period of PURPLE Crying are appropriate for use. As such, the researchers intend to undertake a pilot implementation in FNQ.
... The most common initiatives found in literature are those aimed at raising parents and caregivers awareness on AHT, summing up to 25 studies describing 12 initiatives. These initiatives were chiefly developed in the United States (Altman et al., 2011;Barr et al., 2015;Barr, Rivara, et al., 2009;Bechtel et al., 2011;Deyo et al., 2008;Dias et al., 2005;Hennink-Kaminski & Dougall, 2009;Keenan & Leventhal, 2010;Meškauskas et al., 2009;Morrill et al., 2015;Reese et al., 2014;Runyan et al., 2009;Shanahan et al., 2014) but also present in Canada Goulet et al., 2009;Stewart et al., 2011), Australia (Foley et al., 2013;Stephens, Kaltner, & Liley, 2014.;Tolliday et al., 2010), Japan (Fujiwara, 2015;Fujiwara et al., 2012), Turkey (Foley et al., 2013;Taşar et al., 2015), France (Simonnet et al., 2014), Colombia (Monsalve-Quintero & Alvarado-Romero, 2010), Puerto Rico (Rodriguez et al., 2011), Greece, Brazil, and Hungary (Foley et al., 2013). ...
... This program was replicated in upstate New York, also yielding a significant reduction of 75% in the number of AHT cases after program implementation (Altman et al., 2011), indicating the effectiveness of this initiative in the prevention of this form of abuse. Based on the promising results of studies by Dias et al. (2005) and Altman et al. (2011), several other initiatives seeking to raise awareness of AHT were developed, with emphasis on the program The Period of PURPLE Crying Barr et al., 2015;Barr, Rivara, et al., 2009;Fujiwara, 2015;Fujiwara et al., 2012;Hennink-Kaminski & Dougall, 2009;Reese et al., 2014;Runyan et al., 2009;Shanahan, Nocera, Zolotor, Sellers, & Runyan, 2011;Stephens et al., 2014;Stewart et al., 2011). The development of this initiative was the starting point for the creation of a set of preventive materials entitled, The Period of PURPLE Crying (PURPLE; Runyan et al., 2009). ...
... Finally, the effectiveness of The Period of PURPLE Crying program was studied in four different countries: United States (Reese et al., 2014;Shanahan et al., 2014), Canada (Barr et al., 2015;Stewart et al., 2011), Australia (Stephens et al., 2014), and Japan (Fujiwara, 2015). In Canada and in one of the studies conducted in the United States, the three stages of the program were evaluated, observing an increase in nurses' knowledge of the infant's crying pattern and nurses' knowledge of AHT (Stewart et al., 2011), with a reduction in the number of visits by new parents to the pediatric emergency department with complaints regarding infant crying within the program's coverage area (Barr et al., 2015). ...
Abusive head trauma (AHT) is a serious form of child maltreatment that needs to be prevented. The aim of this study was to summarize the main AHT prevention strategies described in literature, aiming to identify evidence of their efficiency, as well as strengths and limitations. International databases were reviewed from 2005 to 2015 using the key words Shaken Baby Syndrome or abusive head trauma or nonaccidental head trauma or abusive head injury or nonaccidental head injury and prevention. A total of 1,215 articles were found and 34 complete articles were selected for this study. Five initiatives with the main objective of reducing infant crying in the first months of life were found, three aimed at caregiver’s emotional regulation and 12 aimed at raising parents and caregivers awareness on AHT. Among them, parental education about infant crying and risks of shaking a baby stands out for its empirical evidence.
... They also examined whether hospitalization rates for AHT were reduced after implementation, finding that during the period of time when parents received the program, hospital admission rates for AHT were reduced by 35% among infants < 24 months of age (Barr et al. 2018). The intervention is being implemented in rural areas of Queensland, Australia, where a preliminary study showed acceptability among providers (Stephens et al. 2014). In Japan, a small randomized controlled trial was conducted with only the educational materials sent to participants by mail (the video and in-person component were not included); still results were promising with the intervention group showing higher knowledge and the desired behavioral change of more walking away when crying was unsoothable (Fujiwara et al. 2012). ...
Maltreatment of children continues to be a major public health concern, with high social, economic and health burdens. Rates vary by a number of factors that can be categorized into different levels of the social ecology. Research and theory in this field point to the importance of community-level factors that can contribute to either risk or prevention of child maltreatment. The COVID-19 pandemic context creates additional risks and concerns related to child maltreatment and exacerbates risk factors that existed before: e.g., families and communities are in much worsened states of poverty, unemployment, and food insecurity; losses and grief are affecting mental health; and limitations and safety concerns are affecting in-person child protection work and more. Central to recovery from this pandemic will be the mobilization of community-level resources and the building back up of the social fabric that can support vulnerable children and caregivers. Key to this mobilization will be a better intersectional understanding of structural inequities in the child welfare system and in our communities. Efforts to dismantle structural biases and discrimination are critical to provide safety and support for families and vital for effective child maltreatment prevention. In this context, we discuss the state of the science of community-level prevention of childhood maltreatment, highlighting evidence-based community-level prevention programs and how these types of efforts may be impacted by the current COVID-19 global pandemic.
Infant crying and sleep problems (e.g. frequent night waking, difficulties settling to sleep) each affect up to 30% of infants and often co-exist. They are costly to manage and associated with adverse outcomes including postnatal depression symptoms, early weaning from breast milk, and later child behaviour problems. Preventing such problems could improve these adverse outcomes and reduce costs to families and the health care system. Anticipatory guidance-i.e. providing parents with information about normal infant sleep and cry patterns, ways to encourage self-settling in infants, and ways to develop feeding and settling routines before the onset of problems-could prevent such problems. This paper outlines the protocol for our study which aims to test an anticipatory guidance approach.
750 families from four Local Government Areas in Melbourne, Australia have been randomised to receive the Baby Business program (intervention group) or usual care (control group) offered by health services. The Baby Business program provides parents with information about infant sleep and crying via a DVD and booklet (mailed soon after birth), telephone consultation (at infant age 6-8 weeks) and parent group session (at infant age 12 weeks). All English speaking parents of healthy newborn infants born at > 32 weeks gestation and referred by their maternal and child health nurse at their first post partum home visit (day 7-10 postpartum), are eligible. The primary outcome is parent report of infant night time sleep as a problem at four months of age and secondary outcomes include parent report of infant daytime sleep or crying as a problem, mean duration of infant sleep and crying/24 hours, parental depression symptoms, parent sleep quality and quantity and health service use. Data will be collected at two weeks (baseline), four months and six months of age. An economic evaluation using a cost-consequences approach will, from a societal perspective, compare costs and health outcomes between the intervention and control groups.
To our knowledge this is the first randomised controlled trial of a program which aims to prevent both infant sleeping and crying problems and associated postnatal depression symptoms. If effective, it could offer an important public health prevention approach to these common, distressing problems.
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.
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.