Editor's note: This article was sponsored by Seattle Children's Hospital.
Caring for a wailing newborn who seems inconsolable is exhausting, frustrating and isolating. That’s been especially true during the pandemic, which has increased fears about exposing infants to disease, squeezed child-care resources, slashed social support and compounded financial insecurities.
With fewer opportunities for social and emotional support or for outside help with child care and household chores, frustration may give way to anger and increase the likelihood of shaking a crying baby. Research shows that rates of child abuse and abusive head trauma — the type of brain injury that happens when an infant is shaken — escalate during economic recessions and natural disasters. During the national recession that began in 2008, Seattle Children’s Hospital and Harborview Medical Center saw the number of such cases more than double, mirroring a trend occurring nationwide.
In response to the increase in abusive head trauma cases locally and nationally, Seattle Children’s established its Period of PURPLE Crying caregiver education program. Christine Baker, coordinator for the Period of PURPLE Crying program, says that when COVID-19 began impacting new parents’ access to social support and child-care resources last year, child abuse researchers feared the worst.
“Last year, at the beginning of the pandemic, we were fearing that there would be a similar effect with rates of child abuse, but it was hard to predict,” she notes. “There is research showing these effects after recessions and natural disasters, but there wasn’t data on the effects of a global pandemic like this one.”
Now, more than a year into the COVID-19 pandemic, research has shown a similar spike in cases of child abuse. According to the Centers for Disease Control and Prevention, the percentage of emergency department visits and hospitalizations related to child abuse and neglect for children and adolescents increased significantly from 2019 to 2020.
“At this moment, we have a combination of isolation and virtual-connection fatigue, particularly for new parents who may be literally stuck at home with an infant,” says Baker. “People are tired of connecting online and they aren’t leaning into the virtual parties and gatherings the way they were a year ago. The supportive ‘We’re all in this together’ messaging is just not there anymore, because people are just over it.”
Reaching caregivers about PURPLE crying
Over the past year, COVID-19 has complicated efforts to educate caregivers about the dangers of abusive head trauma (sometimes called shaken baby syndrome). With more families delaying well-child checkups and community events temporarily curtailed, Period of PURPLE Crying program leaders have fewer opportunities to help new parents learn ways to cope with crying. Getting information to caregivers in the early weeks of parenthood is critical, because it only takes one shaking incident to permanently alter a child’s brain function, says Baker. “A shaken brain will never be the same brain again.”
Shaking causes injury instantly, with effects that can compound over time with repeated episodes. Shaking any part of a baby, even the arms or legs, can cause learning disabilities; behavior disorders; problems with hearing, vision and speech; seizures; cerebral palsy; permanent disability; and even death.
Using the acronym PURPLE (peak of crying, unexpected, resists soothing, pain-like face, long-lasting and evening), the program helps spread the message that a phase of intense crying is developmentally normal, temporary and not the result of genetics, parenting or your child’s personality. While not all babies go through such a phase, many do, crying for as long as five hours in the afternoon or evening during their second and third months. Crying generally tapers off around months four and five, but not before caregivers’ nerves are thoroughly frayed.
Coping tips for caregivers
Knowing that this phase is normal and doesn’t reflect poorly on their child or their parenting can help parents cope, says Baker. Working with families in Pierce and King counties and surrounding areas, Baker counsels caregivers to “just pause.” “We tell parents to ‘take five,’ because taking a pause or a break is so important to keep frustration with crying from escalating. We tell parents to just pause, take a minute, set your baby down gently someplace safe and walk away for a few minutes.”
Parenting isn’t about perfection, says Baker. “It’s about doing what you need to do in the moment and handling a situation in a way that you’ll feel good about tomorrow.” Caregivers should know that periods of intense PURPLE crying are normal for babies, and so are feelings of anger — even fury — for parents.
During tough moments, calling or texting a trusted friend or family member, listening to music, or taking a few deep breaths can keep frustration from escalating to rage — and keep babies safe from unintended outcomes. “A lot of parents don’t feel prepared to deal with the anger they feel, because it’s so unexpected,” says Baker. “They love their baby, they wanted and planned for this baby, and then they feel this anger that can be very isolating. Those are really normal feelings. We help parents expect and plan for that, so when those feelings show up, they know what to do.”
What is the Period of PURPLE crying?
Resources for caregivers