Educating parents to prevent abusive head trauma in babies: A review and analysis of the evidence

Project aims

We wanted to see how effective educating parents is in reducing abusive head trauma in babies younger than a year old. To do this, we reviewed the existing literature on this subject and combined the results from relevant studies.

What we did

We systematically reviewed the evidence from randomised controlled trials, considered the gold standard of health study, which investigated the effectiveness of educating parents to try to reduce abusive head trauma. We also looked at other types of studies if they assessed abusive head trauma or shaking of babies. We combined evidence from different studies in a ‘meta-analysis’.

What we found and what this means

We screened 6,157 studies and ended up including 25 relevant studies in our systematic review, with 16 included in our meta-analysis.

In most studies, the intervention aimed to educate parents on the characteristics of crying in babies, and that what they are experiencing is normal and will eventually pass.

For example, one of the interventions called the Period of PURPLE Crying highlights to parents the Peak of crying, that crying is often Unexpected, that the baby may Resist soothing, they may look like they are in Pain even when they aren’t, that crying can be Long-lasting, and that it may be worse in the afternoon or Evening.

No randomised controlled trials measured the number of babies with abusive head trauma as an outcome. From five non-randomised studies which did assess this, we found no evidence of a difference in the number of cases of abusive head trauma between the groups who had the intervention and the groups who didn’t. There was some weak evidence from two studies (one cluster randomised control trial and one cohort study) that the parents in the intervention groups were less likely to report violently shaking their babies.

Our analysis of secondary outcomes demonstrated small improvements in parents’ response to inconsolable crying, and weak evidence that interventions increased walking away from crying infants, a method suggested by most interventions. There were no differences between intervention and control groups in the meta-analysis of parents’ wellbeing outcomes and other responses to crying.

Overall, there is very little evidence that educational programmes are effective at reducing abusive head trauma, and only a small amount of evidence that they improve some parental responses to infant crying.

What next?

More robust evidence on the role of educating parents to prevent abusive head trauma is needed. We are investigating one such intervention, ICON.