The initial months of a baby’s life are characterized by intense periods of crying, their primary form of communication. While parents often expect some fussiness, unexplained and prolonged crying can lead to significant stress and exhaustion. Understanding that this intense crying is a normal, temporary stage of infant development can help alleviate parental anxiety. Health professionals use a specific framework to educate caregivers on this phase and provide strategies for managing it.
Understanding the PURPLE Cry Phase
The Period of PURPLE Crying is a research-based educational concept developed by the National Center on Shaken Baby Syndrome to explain this stage of increased fussiness in healthy infants. This period is not an illness or a diagnosis, but rather a universal, temporary phase that all babies experience to varying degrees. It is a way to describe the normal developmental crying pattern that often gets mislabeled as “colic,” a term that incorrectly suggests a digestive problem or illness.
This phase typically begins around two weeks of age, with the duration and intensity of crying gradually increasing each week. The crying usually reaches its maximum intensity, or “peak,” when the infant is about two months old. Following this peak, the crying tends to decrease steadily, generally resolving on its own by the time the baby is three to five months old.
Decoding the P.U.R.P.L.E. Acronym
The acronym P.U.R.P.L.E. details the six observable characteristics of this normal, developmental crying, helping parents recognize that the behavior is expected.
Peak of Crying (P)
The crying increases in frequency and duration during the first few weeks, reaching its highest point around the second month.
Unexpected (U)
The crying can start and stop suddenly without any apparent cause. This makes it unpredictable for caregivers who try to decipher the reason.
Resists Soothing (R)
The baby continues to cry despite a caregiver’s best efforts to comfort them. This resistance is a major source of frustration for parents who feel they are failing to meet their baby’s needs.
Pain-like Face (P)
The baby may look as if they are in severe pain, even though no medical evidence suggests they are actually hurting.
Long-lasting (L)
The crying can endure for extended periods, sometimes for five hours a day or more. This sustained crying contributes significantly to caregiver exhaustion and stress levels.
Evening (E)
The inconsolable crying often occurs more frequently in the late afternoon or evening hours, coinciding with the time when caregivers are often tired from the day.
Safe Coping Strategies for Caregivers
Caregivers facing a baby in the PURPLE crying phase should first ensure all basic needs are met, checking for hunger, a wet diaper, or signs of being too hot or cold. After confirming these needs, using comforting techniques such as gentle rocking, swaddling the baby snugly, or introducing white noise can sometimes help calm the infant. Trying motion, like holding the baby while walking or swaying, may also provide a temporary distraction or comfort.
Because of the “Resists soothing” characteristic, no technique is guaranteed to work. The goal shifts to safely managing the caregiver’s own frustration. If the crying becomes overwhelming and a caregiver feels anger or a loss of control, the most important strategy is to take a break. Place the baby safely in a crib or bassinet, exit the room, and take five to ten minutes to calm down before returning. This action is a fundamental component of the PURPLE program, as it directly prevents Shaken Baby Syndrome (SBS) and other forms of abusive head trauma, which are often triggered by frustration over inconsolable crying.
Knowing When Crying Requires Medical Attention
While the PURPLE phase is normal, parents must be aware of signs that indicate the crying may be a symptom of illness or injury requiring immediate medical evaluation. A baby experiencing normal PURPLE crying will still be feeding well and gaining weight; a change in these patterns is a red flag.
Symptoms that warrant a call to the pediatrician include:
- A fever of 100.4°F (38°C) or higher, as this may indicate infection.
- A high-pitched, shrill cry that sounds unlike the baby’s usual cry.
- The baby is less alert or difficult to wake.
- Forceful, projectile vomiting, especially if the vomit is green or yellow.
- Any sign of unusual skin color, such as a blue, pale, or blotchy appearance.
- A bulging soft spot on the head.