Period of PURPLE Crying®
Period of PURPLE Crying® is an educational program designed for parents and caregivers of children ages 0–2 years. Period of PURPLE Crying aims to prevent shaken baby syndrome/abusive head trauma by increasing family and community understanding about the period of increased crying in early infancy that can lead to shaking or abuse. PURPLE is an acronym describing the features of normal infant crying: (P) Peak of crying in month two, (U) Unexpected, (R) Resists soothing, (P) Pain-like face, (L) Long lasting, and (E) Evening crying.
Providers can deliver Period of PURPLE Crying to families in one, two, or three phases (doses). In Doses 1 and 2, providers deliver educational materials directly to parents and caregivers. Dose 3 is a community-wide public education campaign. Program implementation requires Dose 1 and recommends Doses 2 and 3. The program focuses on the same key messages in all three doses. The key messages: (1) explain that early increased crying is normal, (2) provide ways to comfort a crying baby, (3) discuss actions steps, (4) explain why crying is frustrating and how to cope with the frustration, (5) describe how shaking a baby is dangerous, and (6) ask parents to share what they have learned with others.
In Dose 1, providers give parents and caregivers educational program materials within 2 weeks of a baby’s birth. Materials include a 10-page booklet and video. After sharing the information with parents, the program recommends that providers answer questions and ask parents to repeat back the key program messages.
In the optional Dose 2, providers in the community reinforce the prevention strategies described in Dose 1. Providers typically deliver Dose 2 in pediatrician and family practice physicians’ offices, public health programs, or home visiting programs. Providers remind caregivers about key program messages and share resources including posters, flyers, postcards, and reinforcement information cards. If a family did not receive Dose 1, then providers will give them program materials and resources from Dose 1 before providing Dose 2.
In the optional Dose 3, organizations, such as public health departments, implement a public education campaign using print and digital media content. Dose 3 is designed to remind parents and caregivers about key program messages and reach those that did not receive Dose 1 or 2. Dose 3 intends to increase community awareness and support a cultural change in public understanding about the normal period of increased crying in early infancy.
Period of PURPLE Crying does not currently meet criteria to receive a rating because no studies of the program that achieved a rating of moderate or high on design and execution demonstrated a favorable effect on a target outcome.
Date Last Reviewed (Handbook Version 2.0): Jul 2025
Date Program or Service Description Last Updated: Jul 2025
Date Originally Reviewed (Handbook Version 2.0): Jul 2025
Sources
The following sources informed the program or service description, target population, and program or service delivery and implementation information: the program or service manual, the program or service developer’s website, the California Evidence-Based Clearinghouse for Child Welfare, and the studies reviewed.
This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, download the Handbook of Standards and Procedures, Version 2.0
Target Population
Period of PURPLE Crying is designed to serve parents and caregivers of children ages 0–2 years.
Dosage
Providers deliver Period of PURPLE Crying to families in one, two, or three doses. Providers typically deliver Dose 1 to parents and caregivers within the first 2 weeks of birth, though it can also be delivered prenatally. In Dose 1, providers give parents and caregivers educational materials and a 10- or 16-minute video to watch with or without the provider. Providers can discuss key program messages with parents and caregivers and answer questions. Dose 2 and Dose 3 are optional. Dose 2 typically occurs during the three months post-birth. Dose 3 timing is dependent on the organization’s capacity to implement a public education campaign, not the timing of any one infant’s birth.
Location/Delivery Setting
Recommended Locations/Delivery Settings
Providers can deliver Period of PURPLE Crying at hospitals, in the home, in clinical settings, and in community settings.
Education, Certifications and Training
Period of PURPLE Crying does not have any formal education requirements. Providers can include nurses, home visitors, doctors, public health professionals, and laypersons. Providers complete a 1-hour online training. The training has 5 lessons: (1) the Period of PURPLE Crying video, (2) the Period of PURPLE Crying booklet, (3) the Crying, Soothing, and Coping video, (4) evidence and rationale for the Period of PURPLE Crying presentation, and (5) how to access the Period of PURPLE Crying program app. The training includes a 10-question assessment and implementation protocol review. Partnering organizations must sign a fidelity agreement before they can implement the program. A train-the-trainer webinar and onsite training options are also available.
Program or Service Documentation
Book/Manual/Available documentation used for review
- Noble, J., & York, A. (2018). Period of PURPLE Crying® program guidebook for program implementation and management. National Center on Shaken Baby Syndrome.
- National Center on Shaken Baby Syndrome. (2022). Period of PURPLE Crying® [Booklet].
- National Center on Shaken Baby Syndrome. (2022). Period of PURPLE Crying® [Video].
Available languages
The Period of PURPLE Crying manual is available in English. The Period of PURPLE Crying Booklet is available in English, Arabic, French, Haitian Creole, Somali, and Spanish. Other Period of Purple Crying materials are available in English and Spanish.
Other supporting materials
Period of PURPLE Crying® Implementation Protocol
Period of PURPLE Crying® FAQs for Professionals
Period of PURPLE Crying® FAQs for Parents
Period of PURPLE Crying® Fidelity Agreement
Period of PURPLE Crying® Online Training
For More Information
Website: https://dontshake.org/purple-crying
Phone: (801) 447-9360
Email: purple@dontshake.org
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Period of PURPLE Crying® |
|---|---|
| Identified in Search | 16 |
| Eligible for Review | 5 |
| Rated High | 2 |
| Rated Moderate | 0 |
| Rated Low | 3 |
| Reviewed Only for Risk of Harm | 0 |
| Outcome | Effect Size
|
95% Confidence Interval
|
Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
|---|---|---|---|---|---|---|
| Adult well-being: Parent/caregiver mental or emotional health | 0.00 | [-0.06, 0.06] | 0 | 2 (2) | 3806 |
Favorable:
0 No Effect: 2 Unfavorable: 0 |
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention condition and a negative number favors the comparison condition. A range of comparison conditions, including no intervention, minimal intervention, placebo or attention, treatment as usual, and head-to-head comparison conditions are eligible for review (see Section 4.1.7 of the Handbook Version 2.0). Different types of comparison conditions may affect the magnitude of the effect sizes across studies. For example, an intervention compared to a no treatment comparison condition may produce a larger effect size than the same intervention compared to another intervention because the other intervention may itself be effective. The effect sizes shown may be derived from samples that overlap across studies. See the Individual Study Findings table for information about the specific comparison conditions used in each study and the Studies Reviewed section for information about any overlapping samples. The effect sizes presented here are provided for informational purposes only and are not used in determining a program or service rating. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.
| Outcome | Effect Size
|
Implied Percentile Effect
|
Months after treatment when outcome measured
|
Number of Participants | |
|---|---|---|---|---|---|
| Adult well-being: Parent/caregiver mental or emotional health | |||||
| Study 15336 - PURPLE vs. Control (Barr, 2009) | |||||
| Baby’s Day Diary: Frustration Level | 0.00 | 0 | 4 | 2738 | |
| Study 15588 - PURPLE vs. Control (Barr, 2009) | |||||
| Baby's Day Diary: Frustration Level | Null | not calculated | 1 | 1068 | |
*p <.05
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention condition and a negative number favors the comparison condition. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Version 2.0, Sections 6.4 and 6.5 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by study authors in response to author queries to assign study ratings and calculate effect sizes (see Section 8.4.2 in the Handbook of Standards and Procedures, Version 2.0). The Prevention Services Clearinghouse typically relies on study-reported p-values to form the basis of the assessment of statistical significance for a finding, but will perform its own statistical test of a finding using any available information in study documents or author queries, as needed (see Section 6.3 in the Handbook of Standards and Procedures, Version 2.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents. Effect sizes for some outcomes were not able to be calculated by the Prevention Services Clearinghouse.
Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.
Full citations for the studies shown in the table are available in the "Studies Reviewed" section.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Demographic Characteristics
|
Populations of Interest*
|
Household Socioeconomic Status
|
||
| Study 15336 - PURPLE vs. Control | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Washington, USA | 2004 |
15% 18-24 years; 26% 25-29 years; 35% 30-34 years; 24% 35-54 years
100% Female
|
100% Mothers |
30% >$101,000 Annual Family Income 34% $61,000 - $100,000 Annual Family Income 36% $0 - $60,000 Annual Family Income |
||
| Study 15588 - PURPLE vs. Control | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Vancouver, BC, Canada | 2005 |
8% <25 years; 23% 25-30 years; 37% 30-35 years; 29% >35 years
100% Women
|
100% Mothers; 57% First-time parents | -- | ||
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated High
Study 15336Barr, R. G., Rivara, F. P., Barr, M., Cummings, P., Taylor, J., Lengua, L. J., & Meredith-Benitz, E. (2009). Effectiveness of educational materials designed to change knowledge and behaviors regarding crying and shaken baby syndrome in mothers of newborns: A randomized, controlled trial. Pediatrics, 123(3), 972-980. https://doi.org/10.1542/peds.2008-0908
This study was conducted in a usual care or practice setting (Handbook Version 2.0, Section 7.2.2)Study 15588
Barr, R. G., Barr, M., Fujiwara, T., Conway, J., Catherine, N., & Brant, R. (2009). Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial. Canadian Medical Association Journal, 180(7), 727-733. https://doi.org/10.1503/cmaj.081419
This study was conducted in a usual care or practice setting (Handbook Version 2.0, Section 7.2.2)Studies Rated Low
Study 15337Barr, R. G., Barr, M., Rajabali, F., Humphreys, C., Pike, I., Brant, R., Hlady, J., Colbourne, M., Fujiwara, T., & Singhal, A. (2018). Eight-year outcome of implementation of abusive head trauma prevention. Child Abuse & Neglect, 84, 106-114. https://doi.org/10.1016/j.chiabu.2018.07.004
Sadler, K., Rajabali, F., Zheng, A., Jain, N. & Pike, I. (2023). Impact of a parent education program delivered by nurses and health care providers in reducing infant physical abuse hospitalization rates in British Columbia, Canada. Canadian Journal of Nursing Research, 56(1), 109-116. https://doi.org/10.1177/08445621231222527
This study received a low rating because it did not meet design confound standards.Study 15341
Fujiwara, T., Yamada, F., Okuyama, M., Kamimaki, I., Shikoro, N., & Barr, R. G. (2012). Effectiveness of educational materials designed to change knowledge and behavior about crying and shaken baby syndrome: A replication of a randomized controlled trial in Japan. Child Abuse & Neglect, 36(9), 613-620. https://doi.org/10.1016/j.chiabu.2012.07.003
This study received a low rating because none of the target outcomes met measurement standards.Study 15342
Groisberg, S., Hashmi, S. S., & Girardet, R. (2020). Evaluation of the Period of PURPLE Crying: An abusive head trauma prevention programme. Child Abuse Review, 29(3), 291-300. https://doi.org/10.1002/car.2625
This study received a low rating because baseline equivalence of the intervention and comparison groups was necessary and not demonstrated.Studies Not Eligible for Review
Study 15339
Duzinski, S. V., Guevara, L. M., Barczyk, A. N., Garcia, N. M., Cassel, J. L., & Lawson, K. A. (2018). Effectiveness of a pediatric abusive head trauma prevention program among Spanish-speaking mothers. Hispanic Health Care International, 16(1), 5-10. https://doi.org/10.1177/1540415318756859
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15340
Fujiwara, T. (2015). Effectiveness of public health practices against shaken baby syndrome/abusive head trauma in Japan. Public Health, 129(5), 475-482. https://doi.org/10.1016/j.puhe.2015.01.018
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15343
Jalloul, R. J., Vigil, A., Chen, H.-Y., & Ward, C. (2022). Effectiveness of educational materials designed to improve knowledge regarding crying and shaken baby syndrome in mothers of Hispanic population. Hispanic Health Care International, 20(3), 179-183. https://doi.org/10.1177/15404153211040244
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15344
Lambert, A. W., Wang, C.H., Thompson, C., & Grabowsky, A. (2023). Shaken baby syndrome education for mothers awaiting appointments in rural OB/GYN office. Comprehensive Child and Adolescent Nursing, 46(1), 33-40. https://doi.org/10.1080/24694193.2022.2151665
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15345
Ornstein, A. E., Fitzpatrick, E., Hatchette, J., Woolcott, C. G., & Dodds, L. (2016). The impact of an educational intervention on knowledge about infant crying and abusive head trauma. Paediatrics & Child Health, 21(2), 74-78. https://doi.org/10.1093/pch/21.2.74
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15347
Reese, L. S., Heiden, E. O., Kim, K. Q., & Yang, J. (2014). Evaluation of Period of PURPLE Crying, an abusive head trauma prevention program. Journal of Obstetric, Gynecologic & Neonatal Nursing, 43(6), 752-761. https://doi.org/10.1111/1552-6909.12495
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15348
Shanahan, M. E., Nocera, M., Zolotor, A. J., Sellers, C. J., & Runyan, D. K. (2011). Education on abusive head trauma in North Carolina hospitals. Child Abuse Review, 20(4), 290-297. https://doi.org/10.1002/car.1195
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15349
Stephens, A., Kaltner, M., & Liley, W. (2014). Infant abusive head trauma prevention: Acceptability of the Period of PURPLE Crying program in far North Queensland, Australia. Rural and Remote Health, 14, 2603. https://search.informit.org/doi/10.3316/informit.329021025103748
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15352
Zolotor, A. J., Runyan, D. K., Shanahan, M., Durrance, C. P., Nocera, M., Sullivan, K., Klevens, J., Murphy, R., Barr, M., & Barr, R. G. (2015). Effectiveness of a statewide abusive head trauma prevention program in North Carolina. JAMA Pediatrics, 169(12), 1126-1131. https://doi.org/10.1001/jamapediatrics.2015.2690
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15353
Sadler, K., Rajabali, F., Zheng, A., Jain, N., & Pike, I. (2024). Impact of a parent education program delivered by nurses and health care providers in reducing infant physical abuse hospitalization rates in British Columbia, Canada. Canadian Journal of Nursing Research, 56(1), 109–116. https://doi.org/10.1177/08445621231222527
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)Study 15356
Lee, C., Barr, R. G., Catherine, N., & Wicks, A. (2007). Age-related incidence of publicly reported shaken baby syndrome cases: Is crying a trigger for shaking? Journal of Developmental and Behavioral Pediatrics, 28(4), 288-293. https://doi.org/10.1097/DBP.0b013e3180327b55
This study is ineligible for review because it does not use an eligible study design (Handbook Version 2.0, Section 4.1.5)