A new study shows that a pioneering initiative to prevent shaken baby syndrome was associated with a 35-per-cent reduction in the number of children under two admitted to B.C. hospitals with shaking-related injuries.

Recently published online in the journal Child Abuse and Neglect and led by BC Children’s Hospital and the University of British Columbia, the study includes an investigation of the rates of shaken baby syndrome in B.C. and an assessment of the reach and impact of the Period of PURPLE Crying, a public education initiative informed by 50 years of research on infant crying. 

“This study shows that the Period of PURPLE Crying is improving how parents and caregivers cope with uncontrollable crying and is helping to prevent life-changing, life-threatening injuries in babies,” said Marilyn Barr, the co-author of the study and the founding director of Prevent Shaken Baby Syndrome BC, a province-wide program based at BC Children’s Hospital.

Implemented in 2009, the Period of PURPLE Crying consists of in-person teaching from a maternity nurse or midwife, as well as a follow-up from a public health nurse as part of post-birth care. Parents learn that babies go through a normal developmental phase where they may cry for long periods of time and not respond to soothing. Parents also receive coping strategies for this challenging time.

To determine the incidence of shaken baby syndrome in B.C., researchers reviewed hospital admission records from 2007 to 2016. They tracked the number of children admitted to a hospital with abusive head trauma, the medical diagnosis for injuries caused when infants and toddlers are deliberately and violently shaken. 

“Our research found that the Period of PURPLE Crying is associated with a significant reduction in shaken baby syndrome cases in British Columbia,” said Dr. Ron Barr, the study’s lead author. “This is very important, because shaken baby syndrome is a devastating form of child abuse that often results in death or lifelong disability.” 

Dr. Barr is a developmental pediatrician, a professor emeritus at UBC’s Faculty of Medicine and a former investigator at BC Children’s Hospital. Dr. and Ms. Barr were instrumental in establishing the program, and both are members of the International Advisory Board at The National Center on Shaken Baby Syndrome in the United States.

“Fewer babies are being admitted to hospital with traumatic brain injury caused by shaking,” said Dr. Ian Pike, the study’s co-author. “Our next steps are to further evaluate the success of the program and continue to increase awareness of the risks of shaken baby syndrome in B.C.”

Dr. Pike is the current program director for Prevent Shaken Baby Syndrome BC, an investigator and director of the BC Injury Research and Prevention Unit at BC Children’s, and a professor in UBC’s Department of Pediatrics.

“We have heard from countless parents and caregivers about how the information in the Period of PURPLE Crying has helped them understand their baby’s crying and feel less frustrated,” said Ryan Steinbeigle, the executive director of the National Center on Shaken Baby Syndrome. “This new study is further evidence that the program helps families and keeps babies safe.” 


Shaken Baby Syndrome (SBS) is the name given to the collection of signs and symptoms resulting from violently shaking an infant. Typically one in four children who are shaken will die as a result of their injuries. Of those who survive, approximately 80 per cent will suffer from lifelong disabilities such as brain injury, blindness and deafness, fractures, paralysis, cognitive, physical and learning disabilities and cerebral palsy.

The Period of PURPLE Crying is an evidence-based program for preventing shaken baby syndrome. The acronym PURPLE describes a normal developmental phase in babies:

  • Crying Peaks between two and three to five months of age 
  • Crying is Unexpected and Resists soothing
  • Babies look like they are in Pain even when they are not
  • Crying may be Long-lasting and occur more in the Evening

Today in B.C.:

  • PURPLE program materials are available in 12 languages
  • Health authorities distribute approximately 40,000 booklets and other educational materials annually to new parents and caregivers across the province. 
  • Close to 6,000 maternity and public health nurses have completed PURPLE program training, and more than 1,200 nursing, midwifery and community support students have completed the online training. 

Visit dontshake.ca for more information about normal infant crying and tips for parents and caregivers on how to sooth their babies and manage their own frustrations.

This study was funded by B.C.’s Ministry of Children and Family Development with contributions from the Ministry of Health and the Provincial Health Services Authority, Canadian Institutes for Advanced Research and BC Children’s Hospital Foundation.

The Ministry of Children and Family Development also funded the implementation of the Period of PURPLE Crying in BC. They continue to provide financial support to Prevent Shaken Baby Syndrome BC, which coordinates the program across BC.

B.C.’s PURPLE program is affiliated with The National Center on Shaken Baby Syndrome, a U.S.-based public charity that has implemented the program in the Yukon, Ontario, 18 American states and six countries outside of North America.