Traumatic Head Injury - Child Maltreatment/Shaken Baby Syndrome (THI-CM/SBS) is a preventable injury that can result in lifelong disability or death in Canada’s youngest and most vulnerable population, with the majority of victims under one year of age.4

Published Article

PURPLE is a recognized international evidence-based injury prevention program. Our research highlights the success of the PURPLE program and universal delivery in BC.

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, 2023)

Key Finding: Nurses’ role in engaging parents in conversations about PURPLE messages over multiple timepoints within a structured universal program model resulted in a 30% decrease in physical abuse hospitalization rates since the implementation of PURPLE

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Mother hovering over her few months old baby
Mother and toddler helps baby who is crying on the sofa

Inequities in Pediatric Abusive Head Trauma According to Neighborhood Social and Material Deprivation: A Population-Level Study in British Columbia, Canada (Child Maltreatment, Volume 25, Issue 3, August 2020)

Key finding: This is the first North American study to assess the role that neighborhood material (education, employment, and income) and social (living alone, single-parent families, and separated/divorced families) deprivation play in the risks and rates of AHT and to emphasize neighbourhood inequities in THI-CM cases. This study highlights that THI-CM follows a social gradient, in which rates increase directly and proportionately with each quintile increase in neighbourhood material and social deprivation.

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The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of PURPLE Crying program in British Columbia, Canada  (Child Abuse and Neglect, Volume 87, November 2019)

Key finding: PURPLE has demonstrated a positive return on investment to society and cost avoidance by the healthcare system. The investment of $5 per newborn through the PURPLE program resulted in a $274 and $14 per child cost avoidance by society and by the healthcare system.

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Mother hovering over her few months old baby
Baby crying on dad's arms

Eight-year outcome of implementation of abusive head trauma prevention (Child Abuse and Neglect, Volume 84, October 2018)

Key Finding: There was a 35% reduction in THI-CM rates per 100,000 Person-Years, BC-wide for infants (ages 0-24 months). Despite a low initial incidence and economic recession, reductions in THI-CM may be achievable with a system-wide implementation of a comprehensive parental education prevention program, such as PURPLE.

Winner of Child Abuse & Neglect Article of the Year Award

Media Coverage: CBC News

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Education about crying in normal infants is associated with a reduction in pediatric emergency room visits for crying complaints (Journal of Developmental & Behavioral Pediatrics, Volume 36, Issue 4 May 2015)

Key Finding: Improved parental knowledge of the characteristics of normal crying can reduce the number of crying complaints that present at emergency in the early months of an infant's life. This study showed a reduction in the number of pediatric emergency department visits at BC Children’s Hospital (BCCH) for crying complaints by 29.5%.

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Baby crying on a bed
Baby crying while behind held

Effectiveness of educational materials designed to change knowledge and behaviours regarding crying and shaken-baby syndrome in mothers of newborns: A randomized, controlled trial (Pediatrics, Volume 123, Issue 3 March 2009)

Key Finding: Use of the PURPLE education materials result in higher scores in knowledge about early infant crying and the dangers of shaking, and in sharing information about behaviours considered to be important for the prevention of shaking.

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Current Research

Current research PSBSBC is engaged in includes:

Does the PURPLE Program have an impact on infant physical abuse rates in BC?

Purpose of study: to determine if physical abuse rates of children ≤ 24-months-old have also decreased in BC due to PURPLE.

What was the impact on (THI-CM/SBS) rates BC  because of COVID19?

Purpose of study: to better understand the burden of COVID 19 and of 0≤2yrs traumatic head injury consequences during the COVID19 pandemic to inform prevention now and in future.

Creating eLearning (VIRTUAL) education to improve improve infant crying and shaken baby syndrome literacy

Purpose of study: to explore a co-creation process utilizing evidence-based injury prevention program core education components and lived experiences related to infant crying, soothing and coping strategies to develop a digital health literacy tool. A CIHR Planning and Dissemination Grant was received to support this work in 2023.

Woman checking her notes from her binder


We use process and outcome evaluations to monitor the success of the program in reducing the incidence of THI-CM cases in BC. Evaluation allows the PSBSBC team to assess the program delivery and efficacy at various levels, including organizational, community, health authority and provincially. 

Process Evaluation


To determine program is delivered with fidelity and meets provider and parent/caregivers needs with the aim to reduce THI-CM/SBS incidence in BC.


Quantitative and qualitative data collection to ensure that the program is being delivered as expected and is responsive to current situations.

Process Measures
  • Provider & parent feedback surveys
  • Delivery, training and knowledge translation metrics

Parent Surveys

Since 2014, over 2,500 surveys have been completed by parents and caregivers on the effectiveness of the program.Some of the positive feedback from parents/caregivers we have heard over the years.

I have learned how patient I should be during this period. :)

I think it's really awesome to let new moms know it's okay to put baby in a safe place and take a minute (or more) to collect your thoughts / patience and baby will be just fine crying for a bit on their own.

The program is wonderful. As first time parents we had never even heard of PURPLE crying. Knowing it was ok and it would pass was helpful.

Public health & primary care nurse surveys

Since 2012, over 1,565 surveys have been completed across all health authorities and communities. Feedback helps shape program resources, delivery, and evaluation methods.

I wish it had been available when I had my own child 11 years ago. It would have been incredibly helpful to normalize the situation. I felt like I was the only one going through it and had immense guilt regarding my frustration, inability to cope, etc. This is a fabulous program and I'm so happy to be able to share it with my clients. Thank you, great work!!!

Like the 1 page hand out we have as mothers receive the booklet from the hospital, it's a nice follow up resource that reviews the same points.

It is nice to have had a program that has been in place for a number of years, it has been consistent and readily available.

Outcome Evaluation


To determine the efficacy of the PURPLE program in reducing the incidence of THI-CM/SBS in BC.

  • A valid and reliable source of THI-CM/SBS data
  • An understanding of the existing incidence of THI-CM/SBS in BC
Review Measures
    • THI-CM/SBS deaths
    • THI-CM/SBS hospitalizations

    Since launching PURPLE in BC in 2009, the rate of THI-CM/SBS in BC has steadily decreased. Ongoing surveillance shows that in BC there has been a decrease of 35% in the average incidence rate of THI-CM/SBS per 100,000 person-years after the program was implemented1.


    1. Barr RG, Barr M, Rajabali F, et al. Eight-year outcome of implementation of abusive head trauma prevention. Child Abuse Negl. 2018; 84:106-114. doi:10.1016/j.chiabu.2018.07.004


    Help us shape the program

    Your opinion on the PURPLE Crying program helps us ensure that we are meeting the needs of parents and caregivers of newborns and the providers that support them in BC. Feedback helps us shape program fidelity, delivery, and outreach. Your opinion matters!  

    Please access either the provider or parent survey using the QR codes below. Surveys take approximately 3-5 minutes. If the QR code does not work use the links below. Survey respondents are anonymous and no personal or identifying information is collected.