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Educational materials for new mothers may prevent shaken baby syndrome, CMAJ study shows

March 02, 2009

Educational materials on how to deal with crying newborns lead to increased knowledge about infant crying and behaviours that are important to preventing shaken baby syndrome, found two new studies being published online March 2 in CMAJ (Canadian Medical Association Journal) http://www.cmaj.ca/press/do-barr.pdf and Pediatrics.

The CMAJ study involved 1279 mothers in a randomized controlled trial in Greater Vancouver, BC, Canada who were provided materials from the Period of PURPLE Crying program, an 11-page booklet and DVD developed by the National Center on Shaken Baby Syndrome in Ogden, Utah. Half the participants received the PURPLE materials and the other half received materials with parent safety tips and sleeping position guidelines. Materials were delivered by public health nurses during routine visits within 2 weeks of birth.

Mothers who received the PURPLE materials scored 5% higher in knowledge about crying compared with mothers who received the control materials. The PURPLE recipients walked away 1.7 times more frequently from inconsolable infant crying. They were 13% more likely to warn about the danger of shaking infants and to share advice about walking away if frustrated.

The PURPLE materials indicate that the following behaviours are normal but frustrating for parents and suggest coping mechanisms:

* Peak pattern, where crying increases, peaks during the second month, then declines
* Unexpected timing of prolonged crying
* Resistance to soothing
* Pain-like look on the face
* Long crying bouts
* Evening and late afternoon clustering

To help caregivers deal with a crying infant, the PURPLE materials suggest:

* calming responses (carry, comfort, walk and talk)
* put the baby down in a safe place, then walk away to calm yourself
* NEVER shake a crying baby

The annual rate of inflicted brain injury is estimated at 30 per 100,000 children aged 1 year or younger.

The researchers suggest that additional communication could result in increased awareness about the dangers of shaken baby syndrome. In this study, the nurses did not know which materials they were delivering. "The intervention may have had stronger effects if the nurses had reinforced the messages, or if the messages were reinforced by multiple exposures through prenatal, maternity and postnatal health care providers, media and community support organizations," write Dr. Ronald Barr and coauthors. Dr. Barr is head of community child health at the Child & Family Research Institute and professor of pediatrics in the Faculty of Medicine at the University of British Columbia.

"These findings complement the small number of reports that have reported that practical and contextually relevant materials presented to parents before or shortly after birth can change knowledge and behaviours and perhaps reduce the incidence of shaken baby syndrome," conclude the authors.

Canadian Medical Association Journal