It’s the end of the day and you’re looking forward to sitting down and relaxing, if only for just a minute, when it begins … the crying.

She doesn’t want to feed. She doesn’t need to be changed, and none of your regular tricks for soothing her are working. She just keeps crying. You are at your wits’ end, but the screaming continues.

You have entered: “The Period of PURPLE Crying.”

Infant crying typically starts to increase when your baby is 2 weeks old and usually ends by 5 months of age. All babies go through this period of crying as part of normal infant development, but some babies cry more than others.

Infant crying can be very stressful for parents and other caregivers, and it’s one of the most common aggravating factors leading to shaken baby syndrome. Young infants are particularly susceptible to brain injury after shaking, which often results in brain swelling and bleeding. This can result in blindness, learning difficulties and in the worse case, death. These injuries can be prevented by learning coping strategies to deal with infant crying.

The Period of PURPLE Crying is a program developed by the National Center on Shaken Baby Syndrome. Each of the letters in the word PURPLE stands for a characteristic of normal infant crying:

• P stands for “Peak.” This is the peak of the crying pattern that increases gradually from birth, peaking in the second month of life then improving thereafter.
• U stands for “Unexpected.” The crying occurs unexpectedly with out any clear precipitating event.
• R stands for “Resists soothing”. The crying may not stop no matter what you do to calm the baby.
• P stands for “Pain”.  The infant looks like she is in pain even though she is not.
• L stands for “Long.” These episodes can last for hours.
• E stands for “Evening”. Most commonly the crying episodes occur in the late afternoon or evening when the caregiver is most exhausted.

Inconsolable crying can be extremely frustrating for caregivers. The period of PURPLE Crying program provides three “action steps” that can help reduce some of the stress of dealing with these episodes.

1. Keep walking, talking and comforting your baby, even if she does not seem soothed by this.
2. If it is safe to do so, put the baby down in a safe place, such as their bassinet, and walk away for a few minutes to collect yourself. Breathe! Then return to your baby to check on them.
3. Most importantly, never shake or hurt your baby.

These steps may not calm your baby every time (remember, the crying is resistant), but they may help reduce your baby’s crying as well as help you stay calm so you and your baby can safely make it through this challenging period.

Your OHSU and Doernbecher physicians and nurses are here to help. Please call if you are feeling frustrated with infant crying.

Ruth White, Ph.D.
Student, OHSU School of Medicine

Carrie Phillipi, M.D., Ph.D.
Associate Professor of Pediatrics
OHSU Doernbecher Children’s Hospital
Director, OHSU Mother-Baby Unit

Thomas Valvano, M.D.
Medical Director, Suspected Child Abuse and Neglect Program
OHSU Doernbecher Children’s Hospital

Resources:

• Period of PURPLE Crying Shaken Baby Syndrome Prevention Program
• The Whiplash shaken infant syndrome: what has been learned?
• Shaken baby syndrome: Rotational cranial injuries—technical report

Editor’s note: Noelle Crombia with The Oregonian recently interviewed Dr. Phillipi about the Period of Purple Crying. You can view the article here.