Nearly a decade after a program to teach parents about the dangers of shaking their crying babies, rates of related hospital admissions have gone down by 35 per cent.
The eight-year study, led by BC Children’s Hospital and the University of British Columbia and released this week, found that less parents were likely to shake their babies when educated that the sudden, unexplained increase in infants crying at the two to five-month mark was normal.
The study, published in research journal Child Abuse and Neglect, looked to a program called the Period of PURPLE Crying, which has been implemented in every B.C. hospital by the study’s lead author Dr. Ron Barr and co-author Dr. Marilyn Barr.
Marilyn, who is the program director of Prevent Shaken Baby Syndrome BC and executive director of the National Centre on Shaken Baby Syndrome, had worked on a similar program down in the U.S.
“They had a program.. and then when we moved here, we felt compelled to do the program in British Columbia,” said Marilyn.
Marilyn felt like her and her husband could make a major difference in reducing shaken baby syndrome because it’s well known in the research field that all babies cry intensely between two and five months of age, but not always relayed to parents.
“Most people don’t know that that’s a well-known developmental stage. Most parents don’t realize that, they just think something is really wrong, or they have a bad baby, or they’re a bad parent,” Marilyn said.
“We felt like if we could calm parents down and make them be able to understand that it’s not their fault – and really importantly, that it does come to an end.”
The program is delivered to brand new parents right in the hospital by maternity nurses. It includes take-home materials for parents to refer to, but most importantly, it included a face-to-face lesson with a nurse.
Maternity nurses would use a pre-planned script to explain to parents that babies cry a lot between two and five months, and that it’s perfectly normal.
“You hear a lot of things when you’re a new parent. You have grandparents, friends, things on the internet, it’s not all correct” fighting for attention,” Marilyn said.
“We wanted to give research-based information and have them hear it from a reliable source at the hospital.”
Period of PURPLE Crying – the name of program – was designed as an easy-to-remember acronym for tired new parents.
- Peak – your baby may cry more each week, the most in month two, then less in months three to five
- Unexpected – crying can come and go and you don’t know why
- Resists soothing – your baby may not stop crying no matter what you try
- Pain-like face – a crying baby may look like they are in pain, even when they are not
- Long lasting – crying can last as much as five hours a day or more
- Evening – your baby may cry more in the late afternoon or evening
The ‘period’ at the end also has a meaning, according to Ron, a developmental paediatrician and a professor emeritus at UBC’s Faculty of Medicine.
“It reminds the parents that even thought it’s not fun now, it’s not going to last forever,” said Ron.
Reduction in shaken baby syndrome not immediate
Prior to kicking off the study, the Barrs were able to get 13 years of “abusive head trauma” data back from health officials. This allowed them to capture a real snapshot of how effective the program really was.
“It didn’t drop immediately to 35 per cent less… but as [the program] became a very common and normal thing, admissions declined rather quickly – over one or two years, and has stayed down 35 per cent less than we had prior,” said Ron.
“That’s a really excellent result. It’s very difficult to change the incidence of maltreatment of any kind.”
Ron said that part of the secret to the program’s success is that parents who are educated typically stop shaking their babies. This makes it easier to tackle in comparison to other, more intentional forms of child abuse.
“It is about stressed-out parents, so it’s a relatively targetable place when you can make a difference as far as child abuse and maltreatment goes,” said Ron.
“In other forms of child abuse… they have many more streams of influences coming which make it much more difficult to change.”
However, Ron hopes that “by getting the mother, father and infant interaction off to a great start in the first three to five months of life, that might actually have some lingering positive effects later on down the line.”
Marilyn said that although logically shaking a baby seems inexplicable, the reasoning can be broken down when taking into account a stressed-out new parent.
“It’s almost this natural reaction,” said Marilyn.
“You can almost imagine the parent shaking them and saying ‘what is wrong with you, why don’t you ever stop crying? What am I doing wrong? Why do you do this?’”
That makes it different than full-on striking a baby.
“When you shake them, it doesn’t seem as abuse [as hitting the baby]. It doesn’t leave marks.”
As well, shaking a baby can produce what temporarily seems like a good consequence.
“If you spank it or slap it, the baby cries more. If you shake it, you stun the brain and quiet it down. It’s the only form of child abuse that, from the parent’s point of view, seems to ‘work.’”
But it comes at a deadly cost.
While a parent may just see their baby quiet down, on the inside the baby’s brain is beginning to swell as it hits against its skull.
It’s the equivalent, Ron said, of getting countless concussions all at once.
“The baby’s brain is damaged because the shaking results in the swelling of the brain, which cuts off blood supply to parts of the brain,” said Ron.
“Those lesions last the whole life of the infant and the effects can be very, very severe.”
Although there’s no real way to reverse the damage that’s already been done by shaking a baby, Ron said the key is to get the infant to a hospital right away.
“If you get the baby to the hospital, they can relieve the pressure on the brain, and taking the blood out of the brain, all of those things make the damage less than it would otherwise be.”