What does PURPLE crying mean?

PURPLE crying is a way of describing the normal, hard-to-soothe crying of the first months of life. The Period of PURPLE Crying is a shaken baby syndrome prevention programme from the National Center on Shaken Baby Syndrome (NCSBS), available since 2007. Each letter describes one feature of that crying:

Letter	Stands for	What the NCSBS says it means
P	Peak of crying	Your baby may cry more each week, the most in month 2, then less in months 3 to 5
U	Unexpected	Crying can come and go and you don't know why
R	Resists soothing	Your baby may not stop crying no matter what you try
P	Pain-like face	A crying baby may look like they are in pain, even when they are not
L	Long lasting	Crying can last as much as 5 hours a day, or more
E	Evening	Your baby may cry more in the late afternoon and evening

"Period", in the NCSBS's words, "means that the crying has a beginning and an end." Its parent guidance says the phase "will come to an end by about four to five months, and often earlier".

In the UK, NHS trusts such as Mid Yorks teach the same idea as ICON: Infant crying is normal, Comforting methods can help, it's OK to walk away, and Never, ever shake a baby.

The normal crying curve

The NHS says the amount babies cry "tends to increase when they're around 2 weeks old and then gradually reduces at around 3 months old", and that afternoon and evening are the most common times for crying that cannot be comforted. The Mid Yorks NHS trust's ICON page describes a peak "at about 6-8 weeks", after which babies "start to cry less and less each week."

The research is more nuanced. A 2017 meta-analysis led by Dieter Wolke at the University of Warwick pooled 28 crying-diary studies covering 8,690 babies. Average fussing and crying was 117 to 133 minutes a day across the first 6 weeks, falling to 68 minutes by 10 to 12 weeks. But the authors found "no statistical evidence for a universal crying peak at 6 weeks of age across studies". The drop after 8 to 9 weeks is the reliable part, so your baby's crying may level off rather than rise to a sharp peak.

PURPLE crying vs colic

PURPLE crying is not a diagnosis; it describes normal crying. Colic is a label for crying at the long end of that range, and Wolke's review found it in 11% of babies by 8 to 9 weeks. What helps, and which remedies have no evidence, is covered in colic and excessive crying.

How to cope when the crying won't stop

Make a plan before you need it, using these steps from the NHS, the American Academy of Pediatrics (AAP) and the PURPLE programme.

Check the basics. The NHS lists hunger, a dirty or wet nappy, tiredness, wanting a cuddle, wind, being too hot or cold, boredom and overstimulation as the commonest reasons.
Try comfort, without expecting it to work every time. Hold or carry your baby, rock, walk, sing or try a warm bath. The PURPLE parent guidance is frank: what works on some days "does not work on other days."
Put your baby down safely and walk away. The NHS says to put your baby in their cot or pram, make sure they are safe, close the door, go to another room and calm down, with a time limit "for example, 10 minutes". The AAP suggests about 10 to 15 minutes in a cot without blankets or soft toys, and not picking your baby up again until you have calmed down. The PURPLE guidance says plainly: "It will not hurt the baby to let them cry", while checking on them about every 10 to 15 minutes.
Call someone. A friend, your health visitor or GP. In the UK the Cry-sis helpline is free on 0800 448 0737, 9am to 10pm, seven days a week. In the US, the Childhelp National Child Abuse Hotline, (800) 422-4453, describes itself as a safe space for "anyone concerned about or affected by child abuse"; it is not connected to 911.
Tell everyone who looks after your baby. The AAP says anyone caring for your children "should know about the dangers of shaking or striking a baby's head."

If you are finding it hard to cope day after day, raise it: see postnatal depression vs the baby blues and the support routes for the UK and US. For putting your baby down safely, see safe sleep.

What is shaken baby syndrome?

Shaken baby syndrome is a form of abusive head trauma (AHT), a serious brain injury caused by violent shaking, impact, or both. The AAP explains why babies are so vulnerable: they "are not yet able to fully support their heavy heads." The NHS: "No matter how frustrated you feel, you must never shake your baby. Shaking moves their head violently and can cause brain damage."

The US Centers for Disease Control and Prevention (CDC) says babies under one are at greatest risk, that it "often happens when a parent or caregiver becomes angry or frustrated because of a child's crying", and that "as many as one of every four babies who experience abusive head trauma dies". Nearly all babies who experience it have serious long-term effects, which the CDC lists as including vision problems, developmental delays, physical disabilities and hearing loss.

Signs of shaken baby syndrome

The AAP lists irritability, lethargy (trouble staying awake), trouble breathing, vomiting, seizures, decreased alertness and coma. It adds that young babies who cannot yet pull to standing rarely bruise, so "even a small bruise could be the first sign of abuse" and should be checked by a doctor (see bruises on a baby).

When to call 999 or 911

Call 999 in the UK, 911 in the US, or your local emergency number if your baby:

has a fit (seizure)
is unresponsive, floppy or not waking as easily as usual
has difficulty breathing, or is breathing very fast
has blue, grey, pale or blotchy skin, lips or tongue (on brown and black skin this may be easier to see on the palms or soles)
is being violently sick a lot

These NHS 999 signs overlap with the AAP's signs of abusive head trauma. If you think a baby may have been shaken, get medical help and tell the call handler or doctor what happened.

The NHS says constant crying you cannot console, or a cry that does not sound like your baby's normal cry, can be a sign of illness. Contact your GP or NHS 111 if your baby has signs of being unwell, such as a high temperature or not being interested in feeding. More in when to call a doctor or emergency services, and see infant CPR.

Frequently asked questions

At what age does PURPLE crying stop?

The National Center on Shaken Baby Syndrome says the period ends by about four to five months, and often earlier. The NHS says crying gradually reduces from around 3 months, and a meta-analysis found average daily crying falls clearly after 8 to 9 weeks. If you are worried about the crying, talk to your health visitor or GP.

What is the difference between PURPLE crying and colic?

PURPLE crying describes the normal pattern most babies go through. Colic is a label for crying at the long end of that pattern. A 2017 review found colic in 17% to 25% of babies in the first 6 weeks, falling to 0.6% by 10 to 12 weeks.

What is shaken baby syndrome also known as?

Shaken baby syndrome is a form of abusive head trauma, often shortened to AHT. The AAP and CDC both write "abusive head trauma, including shaken baby syndrome", because the injury can come from violent shaking, blunt impact, or both. It is a form of child abuse.

What are the symptoms of shaken baby syndrome?

The AAP lists irritability, trouble staying awake, trouble breathing, vomiting, seizures, decreased alertness and coma. It also says even a small bruise on a baby who cannot yet pull to standing should be checked by a doctor. Call 999 or 911 for any emergency sign.

PURPLE Crying and Shaken Baby Syndrome