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Education About Crying in Normal Infants Is Associated with a Reduction in Pediatric Emergency Room Visits for Crying Complaints

Barr, Ronald G. MDCM, FRCPC*,†,‡; Rajabali, Fahra MSc; Aragon, Melissa MA; Colbourne, Marg MD*; Brant, Rollin PhD‡,§

Journal of Developmental & Behavioral Pediatrics: May 2015 - Volume 36 - Issue 4 - p 252–257
doi: 10.1097/DBP.0000000000000156
Original Article

Objective: The primary aim of this study was to determine whether there was any change in visits of 0- to 5-month old infants to the medical emergency room (MER) of a metropolitan pediatric hospital after province-wide implementation of a public health prevention program that teaches new parents about the properties of early crying in normal infants.

Methods: Free-text descriptions of Presenting Complaint and Final Diagnosis on electronic MER clinic visit files were used to classify infants as cases of infant crying not due to disease. Annual crying case visits as a percent of MER visits were analyzed pre- and post-introduction of the prevention program.

Results: Before the program, crying case visits represented 724 of 20,394 MER visits (3.5%). The age-specific pattern of MER visits for crying peaked at 6 weeks and was similar to the previously reported age-specific pattern of amounts of crying in the community. After program implementation, crying cases were reduced by 29.5% (p < .001). The most significant reductions were for crying visits in the first to third months of life.

Conclusion: The findings imply that improved parental knowledge of the characteristics of normal crying secondary to a public health program may reduce MER use for crying complaints in the early months of life.

*Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada;

Child and Brain Development, Canadian Institute for Advanced Research, Toronto, ON, Canada;

Developmental Neurosciences and Child Health, Child and Family Research Institute, BC Children's Hospital, Vancouver, BC, Canada;

§Department of Statistics, University of British Columbia, Vancouver, BC, Canada.

Address for reprints: Ronald G. Barr, MDCM, FRCPC, Developmental Neuroscience and Child Health, BC Children's and Women's Hospital, F507, 4480 Oak St, Vancouver, BC V6H 3V4, Canada; e-mail:

The study was supported in part by grants from the British Columbia Ministry of Children and Family Development who were the main funders of the implementation and evaluation of the prevention program, from the Child and Brain Development program of the Canadian Institute for Advanced Research (CIFAR) and from a Canada Research Chair in Community Child Health Research to RGB.

Disclosure: The National Center on Shaken Baby Syndrome (NCSBS) and RG Barr jointly registered the trademark for the Period of PURPLE Crying. RG Barr's spouse, M Barr, was the former Executive Director of the NCSBS, a 501(c)3 non-profit organization. Graham Consulting Ltd., an organization that consults and provides grants for child abuse prevention and child development programs, co-owns the trademark with the NCSBS and owns the royalties. RG Barr and M Barr are both uncompensated members of the International Advisory Board of the NCSBS, and sit as two members of the uncompensated Board of Directors of Graham Consulting. The remaining authors declare no conflict of interest.

Received August , 2014

Accepted February , 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.