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Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial

From the Centre for Community Child Health Research (R. Barr, Fujiwara, Catherine), Child and Family Research Institute, University of British Columbia; the Departments of Pediatrics (R. Barr, Fujiwara) and Statistics (Brant), University of British Columbia; Prevent Shaken Baby Syndrome BC (M. Barr, Conway), BC Children's Hospital, Vancouver, BC; and the National Center on Shaken Baby Syndrome (M. Barr), Ogden, USA

Correspondence to: Dr. Ronald G. Barr, Centre for Community Child Health Research, 4480 Oak St., L408, Vancouver BC V6H 3V4; fax 604 875-3589; rbarr{at}cw.bc.ca

Background: 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.

Methods: 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.

Results: 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).

Interpretation: 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. (ClinicalTrials.gov trial register no. NCT00175422.)

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