Current State-Specific Legislation

The National Center on Shaken Baby Syndrome is now hosting a section on our website that lists the current laws in every state of the United States of America related to Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT). Laws include any SBS/AHT education required to be given to families of new babies, SBS/AHT education required of childcare providers, SBS/AHT education required to be taught in schools, etc.

Click this button to find the current legislation related to SBS/AHT in your state.  Find SBS/AHT Legislation in Your State

Please click on a state to see the legislation related to shaken baby syndrome specific to that state.

Twentieth International Conference on Shaken Baby Syndrome / Abusive Head Trauma

Loews Vanderbilt Hotel - Nashville, TN

September 20, 21, and 22, 2026

The National Center on Shaken Baby Syndrome is pleased to announce our twentieth biennial conference will be in Nashville on September 20, 21 and 22, 2026. The conference will bring together the world's experts to present the newest research and best practices in prevention, diagnosis, treatment, investigation, prosecution, or rehabilitation of victims of shaken baby syndrome/abusive head trauma. Return to this page and follow our social media channels for the latest updates on the conference. Click this link for information on the Loews Vanderbilt Hotel.

Nineteenth International Conference on Shaken Baby Syndrome/Abusive Head Trauma

The Nineteenth International Conference on Shaken Baby Syndrome/Abusive Head Trauma was held on September 15, 16, 17, 2024, at the Little America Hotel in Salt Lake City, Utah. More than 400 people from 11 countries participated in over 60 sessions focusing on family/victim support, investigative techniques, legal and trial experiences, prevention programs from around the world, the latest research from experts in the field, and shared experiences from parents and survivors.

We were honored to have the conference kick off with a keynote presentation by Dr. Lori Frasier, “Deconstructing a Diagnosis of Abusive Head Trauma.”

Some of the other highlights of the 3-day event included:

• Marilyn Barr received the Lifetime Achievement Award. She founded the National Center on Shaken Baby Syndrome and has worked tirelessly as an advocate since. A special piece of art was commissioned and painted for Marilyn by Sabine Witte, a survivor.
• A three-part series was presented over the course of 3 hours detailing the process of a successful conviction in Boise, Idaho. Speakers included Dr. Lori Frasier, Dr. Gina Bertocci, Dr. Derrick Dauplaise, Jason Pietrzak, Daniel Dinger, and Tessie Buttram.
• Debbie Eappen and Sameer Sabir were keynote speakers addressing “Media: Fact or Fiction, Friend of Foe.“ This was an in-depth presentation on their experiences with the media during their cases and ways they were further victimized.
• Special family-oriented sessions included music therapy, caring for the caregiver, and the benefits of animal therapy.

We are so grateful for the incredible speakers who presented at this conference, sharing their experiences, research, and knowledge. The survey feedback was the highest we have ever achieved! 

Our twentieth conference will be held in Nashville, Tennessee, on September 21, 21 & 22, 2026, at the Loews Vanderbilt Hotel.

The National Center on Shaken Baby Syndrome (NCSBS) celebrates Shaken Baby Awareness Day in Kansas

The NCSBS’ Executive Director is traveling to Topeka to participate in a festival sharing governor’s proclamation of shaken baby awareness day in honor of Mireya Keck, victim of shaken baby syndrome who passed away in January

Topeka, Kansas – October 7, 2024 – Kansas Governor Laura Kelly proclaimed October 9, 2024 as Shaken Baby Syndrome Awareness Day in Kansas, and National Center on Shaken Baby Syndrome (NCSBS) Executive Director Danielle Vazquez will be in Topeka to celebrate with the family of the young girl for whom the proclamation honors, Mireya Keck, who passed away this past January from the injuries she sustained when she was shaken at just seven (7) weeks old.

“It is an honor to be in Kansas to recognize Shaken Baby Syndrome Awareness Day at the Miracle Mireya Butterfly Family Festival,” says Vazquez. “We’ve had the pleasure of getting to know Mireya’s mother, Kathy, over the last few months learning about her drive to prevent shaken baby syndrome/abusive head trauma in Kansas and support families through the Miracle Mireya Foundation. We already have strong prevention partners in Kansas including the Kansas Children’s Service League and several hospitals and medical centers. Now with the Miracle Mireya Foundation getting started with Kathy’s direction, we are excited about the renewed focus on the safety of Kansas’ children. The steps taken now will benefit children well into the future.”

The free family festival is expected to draw hundreds to Gage Park in Topeka where they can find hours of entertainment from dozens of organizations and community groups who will be there to support the Miracle Mireya Foundation. Several area food and beverage trucks will also be at the festival to serve those attending. 

While the festival serves to bring awareness to shaken baby syndrome (SBS) and honor Mireya’s life, why the butterfly theme?

“Mireya loved butterflies,” says Kathy Keck, Mireya’s mother and the founder of the Miracle Mireya Foundation. “Our daughter Josie was still born in 2013, and we started seeing butterflies everywhere.  After Mireya entered our lives whenever a butterfly would appear, we’d tell her it was her sister watching over her.  Also, Mireya’s life story is the perfect example of the life cycle of butterfly going from a caterpillar to a beautiful butterfly and her life emulates the concept of the butterfly effect.”

In the spirit of the event, festival attendees can expect to be offered a butterfly-themed item before they leave. “We’ve asked all the organizations who are participating to bring something butterfly-themed that they can share with those who attend the festival,” says Keck. “And the first one hundred children who arrive will get a free pair of butterfly wings.”

The festival will also include an auction with proceeds directly benefiting the foundation and their mission to prevent SBS, support families of children with disabilities and spread joy through acts of kindness. Donations to the foundation are encouraged, and attendees will have options to donate at the event. Donations can also be made on their website at stopshakenbaby.com.

“All the donations received at the festival will help us in our efforts to honor Mireya’s life through SBS prevention and helping families with disabilities,” says Keck. “We’re just getting started, and we have a lot of work to do. Shaken baby syndrome is devastating to babies and their families, but it’s absolutely preventable. Mireya was a miracle. She lived eight years after suffering what one neurologist said was one of the worst cases of shaken baby that had survived. We want to do our part to make sure no other families need a miracle to see their babies live for eight years.”

Download the Press Release PDF

SBS/AHT Conference Approved for Medical Examiner and Legal Continuing Education Hours

The Nineteenth International Conference on SBS/AHT is approved for continuing education hours for both medical examiners and legal professionals (registered in Utah).

Approved for Fifteen (15) ABMDI Continuing Education Credit Hours: This program is Approved by the American Board of Medicolegal Death Investigators Inc. for fifteen (15) continuing education credit hours.

Approved for Eighteen (18) Continuing Legal Education Hours for Utah Attorneys: Utah State Board of CONTINUING LEGAL EDUCATION Utah has approved this conference for eighteen (18) CLE credits for attorneys licensed in Utah.

Click this button to register for the conference.  Register for the Conference

Title: Abusive Head Trauma Prevention: The Role a Public Health System Can Play

Authors: Sue Ewy, MS, RN, PHN, and Shantel Wakley, BS
Minnesota Department of Health (MDH) and National Center on Shaken Baby Syndrome (NCSBS)

Background Evidence

What is shaken baby syndrome/abusive head trauma (SBS/AHT)? The Center for Disease Control and Prevention defines shaken baby syndrome as a preventable, severe form of physical child abuse resulting from violently shaking an infant by the shoulders, arms, or legs¹⁴. SBS/AHT may result from both shaking alone and shaking with impact so the term abusive head trauma (AHT) is used more inclusively.  

Abusive Head Trauma (AHT) is the leading cause of infant mortality due to physical abuse causing death in more than 25% of AHT cases¹. Approximately 1,200-1,400 clinically recognized cases occur each year in the United States¹⁵. Around 32-38 cases per 100,000 children less than 1-year-old suffer from AHT each year, and because 30-40% of cases are missed at medical institutions, the actual incidence is unknown despite these prior estimations¹⁶. Likely the known incidence is just the tip of the iceberg.

The evidence that shaking a baby is an extremely dangerous caregiving behavior is compelling and increasing. 

A study conducted by Dr. T. Berry Brazelton on healthy newborns in his Philadelphia practice found that all infants experience a normal phase of increased crying starting at 2 weeks, peaking at 2 months and decreasing in months 3-5². Many replications of Dr. Brazelton’s study found that regardless of whether the babies were born pre- or full-term and despite the vast differences in caregiving behaviors and even species, all the subjects studied showed an age-related crying or distress pattern. This led the NCSBS to hypothesize that this increased crying may be a trigger for AHT.

Two studies were then published showing the relationship between this crying curve and the age-related incidence of AHT^3,4. A study conducted on 273 hospitalized AHT cases in California from 1996 to 2000 showed that when plotting the number of cases by age the shape of the curve is very similar to the crying curve in Dr. Brazelton’s study.

To further support the evidence that normal crying and AHT are related they turned to publicly reported AHT cases. They graphed the 591 AHT cases by age regardless of their specified trigger, and the curve was virtually identical to the curve obtained in the California hospital study. Then they looked at the 166 cases that just mentioned frustration with crying as the specified trigger for shaking which was also virtually identical to the crying curve.

These studies found that the most common stimulus for AHT is an infant’s normal increased crying.

The knowledge that shaking a baby is an extremely dangerous caregiving behavior, increased infant crying is a normal part of child development all healthy infants experience, and this increase in inconsolable crying is the most common stimulus for AHT created a pathway for AHT prevention, and are the three lines of evidence the Period of PURPLE Crying program is based on.

The Period of PURPLE Crying

The Period of PURPLE Crying program is an effective, evidence-based prevention program that aims to support caregivers in their understanding of normal early increased infant crying and to reduce the incidence of AHT. Based on over 60 years of research on infant crying, the program teaches and reinforces messages like: 

• “Early increased crying is normal,” 
• “If the crying is too frustrating it is ok to walk away,” and
• “Never shake a baby.”

The PURPLE acronym was developed as a meaningful and memorable way for caregivers to recognize that these aspects of infant crying will happen and are completely normal in healthy infants. We then preface the acronym with the word “period” to remind parents/caregivers that this increase in crying does not go on forever, but only for a particular time period in the infant’s life and will come to an end.

Published Research

The delivery of this effective AHT prevention program has been studied for over 15 years and has shown the program to be highly effective at reducing cases as well as being cost effective. 

2007 – PURPLE Materials

In 2007, the Period of PURPLE Crying program materials were made public. 

2009 – Randomized Controlled Trials^6,7

Two years later, two parallel randomized controlled trials were published in both Canadian Medical Association Journal and in Pediatrics showing a change in knowledge and behavior related to the PURPLE program. 

2013 – Study in NC, USA⁸

In North Carolina in 2013, a study found that shaking as a form of discipline was reduced by 50% with PURPLE intervention. 

2015 – ER & Crying Complaints⁹

In 2015, PURPLE was found to decrease emergency department visits for complaint of crying unrelated to physical illness by 29% in BC, Canada. This reduction in emergency department visits led to a hospital cost savings of 18%. 

2018 – 8-Year Study¹⁰

One of the most important studies to support the program was published in 2018. An 8-year outcome of implementation study revealed the PURPLE program was associated with a 35% reduction in AHT in children under 2 years old. This study was published in the Child Abuse & Neglect Journal and was selected as the article of the year. 

2018 – Parents Use of the Program¹⁰

The same study also found that caregivers having physical materials at home with them to review is a critical component in AHT prevention. The study showed Mother’s use of the program materials more than doubled at home post discharge and 50% of fathers had read and view the materials by the 2-month mark when their infant crying was at its peak. 

2019 – Cost-Effectiveness¹¹

Following the above article, a cost-effectiveness study was published in 2019. This study found that every dollar spent on PURPLE had an associated $54 savings by society. This can be compared to Zero Tolerance where every $1 spent $25 is saved or Child Safety Seat Laws where every $1 spent $42 is saved. 

2021 – Hispanic Mothers¹²

In 2021, a study conducted on a population of Hispanic mothers found that their knowledge of normal infant crying patterns was improved through the delivery of PURPLE. 

2023 – Infant Physical Abuse¹³

The latest study featured was published in December 2023 and found that hospitalization rates for physical abuse in children under 2 years of age decreased by 30% in BC, after PURPLE was universally implemented.

Home Visiting & PURPLE

Home visiting programs that include the following components show positive impacts on their effectiveness:¹⁶

• Focus on improvement of parental expectations of the child and parenthood in general (p=0.016)
• Targeting parental responsiveness or sensitivity to a child’s needs (p<0.001)
• Video-based feedback (p=0.038)

The Period of PURPLE Crying program includes all three components.

Minnesota Family Home Visiting

The map shows the family home visiting programs who utilize the PURPLE materials when educating the families they serve throughout Minnesota.

Minnesota Department of Health's Family Home Visiting (FHV) section encourages local public health agencies who receive funding for family home visiting from MDH to incorporate the Period of PURPLE Crying program into the model that they provide.

The PURPLE program is embedded into the MN Maternal Early Childhood Sustained Home-Visiting (MECSH) model of FHV and is an approved Maternal, Infant, and Early Childhood Home Visiting evidence-based, FHV model. PURPLE materials are included in the "Crying and Settling" module within the MN MECSH curriculum. 

Program Delivery in Minnesota

The Period of PURPLE Crying program uses a three dose exposure approach to create a cultural change in the way society views normal infant crying.

MDH encourages all family home visiting grantees to incorporate the Period of PURPLE Crying program into the family home visiting that they provide.

MDH guidance suggests family home visiting grantees who implement the program provide both dose one and dose two to every family in the first few months after the birth of an infant. This ensures families receive the critical information before their infant's crying starts to naturally increase, and then a reinforcement of the information around the peak of their infant's crying.

. 

In the MN MECSH Model, home visitors are working toward providing dose one in week two and dose two in week eight of the curriculum to meet model fidelity. Family home visiting nurses have the capacity to deliver additional education at their discretion as appropriate through the infant's first year of life, reinforcing the key messages to any family. 

All MECSH home visitors are required, and supervisors are encouraged to complete the PURPLE Crying training from the NCSBS as well as refresh their training at least every two years. 

Local programs are encouraged to work with their local hospitals and medical clinics to coordinate public education and media campaigns.

Contact Information

If you are interested in learning more about the Period of PURPLE Crying program, or how your organization could implement it as your AHT prevention education contact the National Center on Shaken Baby Syndrome at or call 801-447-9360 x 1

If you are interested in learning more about the Minnesota Department of Health’s efforts of delivering this program through their Family Home Visiting program contact the MDH at 

The Period of PURPLE Crying is a registered trademark and all content is copyright protected. All rights reserved, Ronald G. Barr, MDCM and the National Center on Shaken Baby Syndrome (2004-2024).

The Period of PURPLE Crying can only be delivered to families as the App+Booklet package. Altering the program materials, referring parents to our website page intended for providers, only showing the videos to families without providing the App+Booklet package, or adding any of the PURPLE information onto websites, flyers, handouts, or other resources created is a violation of the program Fidelity and Copyright.

References

1. 1. Narang, S. K., Fingarson, A. D., Lukefahr, J. M., & COUNCIL ON CHILD ABUSE AND NEGLECT (2020). Abusive Head Trauma in Infants and Children. Pediatrics, 145(4), 1-7.
2. 2. Brazelton, T.B. (1962, April). Crying in Infancy. Pediatrics, 29(4), 579-88.
3. 3. Lee, C., Barr, R. G., Catherine, N., & Wicks, A. (2007, August). Age-related incidence of publicly reported shaken baby syndrome cases: is crying a trigger for shaking? Journal of Developmental & Behavioral Pediatrics, 28(4), 288-93.
4. 4. Barr, R.G., Trent, R.B., & Cross, J. (2006, January). Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: convergent evidence for crying as a trigger to shaking. Child Abuse & Neglect, 30(1), 7-16.
5. 5. Stirling, J., Gavril, A., Brennan, B., Sege, R. D., Dubowitz, H., & American Academy of Pediatrics, Council on Child Abuse and Neglect. (2024). The pediatrician’s role in preventing child maltreatment: Clinical report. Pediatrics, 154(2), e2024067608.
6. 6. Barr, R. G., Barr, M., Fujiwara, T., Conway, J., Catherine, N., & Brant, R. (2009). Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial. Canadian Medical Association Journal, 180(7), 727-733.
7. 7. Barr, R. G., Rivara, F. P., Barr, M., Cummings, P., Taylor, J., Lengua, L. J., & Meredith-Benitz, E. (2009). Effectiveness of Educational Materials Designed to Change Knowledge and Behaviors Regarding Crying and Shaken-Baby Syndrome in Mothers of Newborns: A Randomized, Controlled Trial. Pediatrics, 123(3), 972-980.
8. 8. Reese, L. S., Heiden, E. O., Kim, K. Q., & Yang, J. (2014). Evaluation of Period of PURPLE Crying, an Abusive Head Trauma Prevention Program. JOGNN, 752-761.
9. 9. Barr, R. G., Rajabali, F., Aragon, M., Colbourne, M., & Brant, R. (2015). Education About Crying in Normal Infants is Associated with a Reduction in Pediatric Emergency Room Visits for Crying Complaints. Journal of Developmental & Behavioral Pediatrics, 36(4), 252-257. 
10. 10. Barr, R.G., Barr, M., Rajabali, F., Humphreys, C., Pike, I., Brant, R., Singahl, A. (2018, October). Eight-year outcome of implementation of abusive head trauma prevention. Child Abuse & Neglect, 84, 106-14.
11. 11. Beaulieu, E., Rajabali, F., Zheng, A., Pike, I. (2019). The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of PURPLE Crying.
12. 12. Jalloul, R.J., Vigil, A., Chen, H.Y., et al. (2021). Effectiveness of Educational Materials Designed to Improve Knowledge Regarding Crying and Shaken Baby Syndrome in Moths of Hispanic Population. Hispanic Health Care International. 2022;20(3):179-183.
13. 13. Sadler, K., Rajabali, F., Zheng, A., et al. (2023). Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada. Canadian Journal of Nursing Research. 2023;0(0). 
14. 14. (2010, March). Shaken Baby Syndrome Tip Sheet. Retrieved from CDC: CDC_5965_DS1.
15. 15. Keenen, H. T., Runyan, D.K., Marshall, S .W., Nocera, M. A., Merten, D. F., & Sinal, S. H. (2003). A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children. Journal of the American Medical Association, 290(5), 621-26. 
16. 16. Jenny, C., Hymel, K. P., Titzen, A., Reinart, S. E., & Hay, T. C. (1999). Analysis of missed cases of abusive head trauma. Journal of the American Medical Association, 281(7), 621-626.

Title: How Do You Start a Conversation about Abusive Head Trauma: The Importance of a Multi-Faceted Approach

Three Lines of Evidence

1.  Shaking a Baby is Dangerous

What is shaken baby syndrome/abusive head trauma (SBS/AHT)? The Center for Disease Control and Prevention defines shaken baby syndrome as a preventable, severe form of physical child abuse resulting from violently shaking an infant by the shoulders, arms, or legs¹⁴. SBS/AHT may result from both shaking alone and shaking with impact so the term abusive head trauma (AHT) is used more inclusively.  

Abusive Head Trauma (AHT) is the leading cause of infant mortality due to physical abuse causing death in more than 25% of AHT cases¹. Approximately 1,200-1,400 clinically recognized cases occur each year in the United States¹⁵. Around 32-38 cases per 100,000 children less than 1-year-old suffer from AHT each year, and because 30-40% of cases are missed at medical institutions, the actual incidence is unknown despite these prior estimations¹⁶. Likely the known incidence is just the tip of the iceberg.

The evidence that shaking a baby is an extremely dangerous caregiving behavior is compelling and increasing. 

2.  Early Increased Infant Crying is Normal

A study conducted by Dr. T. Berry Brazelton on healthy newborns in his Philadelphia practice found that all infants experience a normal phase of increased crying starting at 2 weeks, peaking at 2 months and decreasing in months 3-5². Many replications of Dr. Brazelton’s study found that regardless of whether the babies were born pre- or full-term and despite the vast differences in caregiving behaviors and even species, all the subjects studied showed an age-related crying or distress pattern. This led the NCSBS to hypothesize that this increased crying may be a trigger for AHT.

3.  Crying as the Stimulus for AHT

Two studies were then published showing the relationship between this crying curve and the age-related incidence of AHT^3,4. A study conducted on 273 hospitalized AHT cases in California from 1996 to 2000 showed that when plotting the number of cases by age the shape of the curve is very similar to the crying curve in Dr. Brazelton’s study.

To further support the evidence that normal crying and AHT are related they turned to publicly reported AHT cases. They graphed the 591 AHT cases by age regardless of their specified trigger, and the curve was virtually identical to the curve obtained in the California hospital study. Then they looked at the 166 cases that just mentioned frustration with crying as the specified trigger for shaking which was also virtually identical to the crying curve.

These studies found that the most common stimulus for AHT is an infant’s normal increased crying.

The knowledge that shaking a baby is an extremely dangerous caregiving behavior, increased infant crying is a normal part of child development all healthy infants experience, and this increase in inconsolable crying is the most common stimulus for AHT created a pathway for AHT prevention, and are the three lines of evidence the Period of PURPLE Crying program is based on.

Who has a Role in Prevention?

 1.  Lived Experiences

Sharing lived experiences in child abuse prevention is vital as it provides a deep, personal perspective that statistics alone cannot convey. Caregivers of children who have suffered abusive head trauma, for instance, can offer unique insights into the challenges of recognizing early signs of abuse, the emotional toll on families, and the importance of vigilant caregiving and community support. Their voices bring authenticity to prevention efforts, helping to drive home the real-life impact of abuse and the need for informed, compassionate interventions.

Meet Ainhoa (presented by her mother Vanessa)

Ainhoa was born healthy in 2005 after an uncomplicated pregnancy. She was developing like any other baby. She was a very happy baby, breastfed and slept through the night at 6 weeks old. Until one fateful night in May 2006. She was unresponsive and taken to hospital. Her care team stated she had experienced a tremendous lack of oxygen for a long time. 

This deprivation caused severe disabilities. Once she was transferred to the academic hospital in Utrecht, I was told they suspected child maltreatment, specifically shaken baby syndrome. 

During the investigation, the perpetrator denied all accusations and I believed him. I looked for my own explanation and began to investigate alternative theories. I  thought it was due to her receiving vaccinations. Because I believed the perpetrator, it took several months before I was able to get her home with me. Then it happened again. 

At the end of March 2007, Ainhoa was abused again. This incident included bruises and cuts and I understood what had happened. There wasn’t any doubt.

Ainhoa and I had to enter a whole new reality . A road that is a never-ending discovery of the consequences of my girl being shaken. As life-altering and devastating this was to her, it has also led us to beautiful things. Ainhoa's has an amazing new father and two little sisters. 

With everything that Ainhoa goes through, she gives me strength to stand up. Our family and I fight every day for her, and we strive to find new paths to combat child maltreatment.

She's given me this voice. I'm her voice, her legs, her arms, her beliefs. I want to make some sense out of this very senseless act to help others. Even if Ainhoa’s story saved one child, that would be an achievement. But we don't stop with one. We continue…

2.  Clinicians

Pediatric healthcare providers (HCPs) can enhance the safety, health, and well-being of their patients by focusing on relational health⁵. Trauma-informed, family-centered pediatric care equips HCPs with the necessary tools to prevent child maltreatment and build resilience. This approach includes anticipatory guidance and consistent, attentive follow-up. When risk factors for child maltreatment are identified, well-researched targeted interventions are available to help prevent future harm. Additionally, familiarity with community resources, along with thorough anticipatory organization and planning, can help healthcare providers effectively support families and children at risk of maltreatment.

3. Justice System Professionals

The justice system plays a pivotal role in the prevention of abusive head trauma (AHT) by enforcing laws that protect children from harm and holding perpetrators accountable. Through collaboration with healthcare providers, child protective services, and community organizations, the justice system ensures that cases of suspected AHT are thoroughly investigated and that children are safeguarded from further abuse. Additionally, the justice system supports prevention efforts by promoting public awareness, implementing policies that encourage early intervention, and providing legal frameworks that facilitate the prosecution of offenders. By prioritizing the protection of vulnerable children and ensuring justice for victims, the justice system contributes significantly to reducing the incidence of AHT.

The Conversation and Approach

The Period of PURPLE Crying program is an effective, evidence-based prevention program that aims to support caregivers in their understanding of normal early increased infant crying and to reduce the incidence of AHT. Based on over 60 years of research on infant crying, the program teaches and reinforces messages like: 

• “Early increased crying is normal,” 
• “If the crying is too frustrating it is ok to walk away,” and
• “Never shake a baby.”

The PURPLE acronym was developed as a meaningful and memorable way for caregivers to recognize that these aspects of infant crying will happen and are completely normal in healthy infants. We then preface the acronym with the word “period” to remind parents/caregivers that this increase in crying does not go on forever, but only for a particular time period in the infant’s life and will come to an end.

Published Research

The delivery of this effective AHT prevention program has been studied for over 15 years and has shown the program to be highly effective at reducing cases as well as being cost effective. 

2007 – PURPLE Materials

In 2007, the Period of PURPLE Crying program materials were made public. 

2009 – Randomized Controlled Trials^6,7

Two years later, two parallel randomized controlled trials were published in both Canadian Medical Association Journal and in Pediatrics showing a change in knowledge and behavior related to the PURPLE program. 

2013 – Study in NC, USA⁸

In North Carolina in 2013, a study found that shaking as a form of discipline was reduced by 50% with PURPLE intervention. 

2015 – ER & Crying Complaints⁹

In 2015, PURPLE was found to decrease emergency department visits for complaint of crying unrelated to physical illness by 29% in BC, Canada. This reduction in emergency department visits led to a hospital cost savings of 18%. 

2018 – 8-Year Study¹⁰

One of the most important studies to support the program was published in 2018. An 8-year outcome of implementation study revealed the PURPLE program was associated with a 35% reduction in AHT in children under 2 years old. This study was published in the Child Abuse & Neglect Journal and was selected as the article of the year. 

2018 – Parents Use of the Program¹⁰

The same study also found that caregivers having physical materials at home with them to review is a critical component in AHT prevention. The study showed Mother’s use of the program materials more than doubled at home post discharge and 50% of fathers had read and view the materials by the 2-month mark when their infant crying was at its peak. 

2019 – Cost-Effectiveness¹¹

Following the above article, a cost-effectiveness study was published in 2019. This study found that every dollar spent on PURPLE had an associated $54 savings by society. This can be compared to Zero Tolerance where every $1 spent $25 is saved or Child Safety Seat Laws where every $1 spent $42 is saved. 

2021 – Hispanic Mothers¹²

In 2021, a study conducted on a population of Hispanic mothers found that their knowledge of normal infant crying patterns was improved through the delivery of PURPLE. 

2023 – Infant Physical Abuse¹³

The latest study featured was published in December 2023 and found that hospitalization rates for physical abuse in children under 2 years of age decreased by 30% in BC, after PURPLE was universally implemented.

Contact Information

If you are interested in learning more about the Period of PURPLE Crying program, or how your organization could implement it as your AHT prevention education contact the National Center on Shaken Baby Syndrome at or call 801-447-9360 x 1

The Period of PURPLE Crying is a registered trademark and all content is copyright protected. All rights reserved, Ronald G. Barr, MDCM and the National Center on Shaken Baby Syndrome (2004-2024).

The Period of PURPLE Crying can only be delivered to families as the App+Booklet package. Altering the program materials, referring parents to our website page intended for providers, only showing the videos to families without providing the App+Booklet package, or adding any of the PURPLE information onto websites, flyers, handouts, or other resources created is a violation of the program Fidelity and Copyright.

Delivering the PURPLE prevention education through these methods will diminish the research and effectiveness of this program. Please help us continue to deliver this effective program to families by upholding the fidelity of the program delivery model. 

References

1. 1. Narang, S. K., Fingarson, A. D., Lukefahr, J. M., & COUNCIL ON CHILD ABUSE AND NEGLECT (2020). Abusive Head Trauma in Infants and Children. Pediatrics, 145(4), 1-7.
2. 2. Brazelton, T.B. (1962, April). Crying in Infancy. Pediatrics, 29(4), 579-88.
3. 3. Lee, C., Barr, R. G., Catherine, N., & Wicks, A. (2007, August). Age-related incidence of publicly reported shaken baby syndrome cases: is crying a trigger for shaking? Journal of Developmental & Behavioral Pediatrics, 28(4), 288-93.
4. 4. Barr, R.G., Trent, R.B., & Cross, J. (2006, January). Age-related incidence curve of hospitalized Shaken Baby Syndrome cases: convergent evidence for crying as a trigger to shaking. Child Abuse & Neglect, 30(1), 7-16.
5. 5. Stirling, J., Gavril, A., Brennan, B., Sege, R. D., Dubowitz, H., & American Academy of Pediatrics, Council on Child Abuse and Neglect. (2024). The pediatrician’s role in preventing child maltreatment: Clinical report. Pediatrics, 154(2), e2024067608.
6. 6. Barr, R. G., Barr, M., Fujiwara, T., Conway, J., Catherine, N., & Brant, R. (2009). Do educational materials change knowledge and behaviour about crying and shaken baby syndrome? A randomized controlled trial. Canadian Medical Association Journal, 180(7), 727-733.
7. 7. Barr, R. G., Rivara, F. P., Barr, M., Cummings, P., Taylor, J., Lengua, L. J., & Meredith-Benitz, E. (2009). Effectiveness of Educational Materials Designed to Change Knowledge and Behaviors Regarding Crying and Shaken-Baby Syndrome in Mothers of Newborns: A Randomized, Controlled Trial. Pediatrics, 123(3), 972-980.
8. 8. Reese, L. S., Heiden, E. O., Kim, K. Q., & Yang, J. (2014). Evaluation of Period of PURPLE Crying, an Abusive Head Trauma Prevention Program. JOGNN, 752-761.
9. 9. Barr, R. G., Rajabali, F., Aragon, M., Colbourne, M., & Brant, R. (2015). Education About Crying in Normal Infants is Associated with a Reduction in Pediatric Emergency Room Visits for Crying Complaints. Journal of Developmental & Behavioral Pediatrics, 36(4), 252-257. 
10. 10. Barr, R.G., Barr, M., Rajabali, F., Humphreys, C., Pike, I., Brant, R., Singahl, A. (2018, October). Eight-year outcome of implementation of abusive head trauma prevention. Child Abuse & Neglect, 84, 106-14.
11. 11. Beaulieu, E., Rajabali, F., Zheng, A., Pike, I. (2019). The lifetime costs of pediatric abusive head trauma and a cost-effectiveness analysis of the Period of PURPLE Crying.
12. 12. Jalloul, R.J., Vigil, A., Chen, H.Y., et al. (2021). Effectiveness of Educational Materials Designed to Improve Knowledge Regarding Crying and Shaken Baby Syndrome in Moths of Hispanic Population. Hispanic Health Care International. 2022;20(3):179-183.
13. 13. Sadler, K., Rajabali, F., Zheng, A., et al. (2023). Impact of a Parent Education Program Delivered by Nurses and Health Care Providers in Reducing Infant Physical Abuse Hospitalization Rates in British Columbia, Canada. Canadian Journal of Nursing Research. 2023;0(0). 
14. 14. (2010, March). Shaken Baby Syndrome Tip Sheet. Retrieved from CDC: CDC_5965_DS1.
15. 15. Keenen, H. T., Runyan, D.K., Marshall, S .W., Nocera, M. A., Merten, D. F., & Sinal, S. H. (2003). A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children. Journal of the American Medical Association, 290(5), 621-26. 
16. 16. Jenny, C., Hymel, K. P., Titzen, A., Reinart, S. E., & Hay, T. C. (1999). Analysis of missed cases of abusive head trauma. Journal of the American Medical Association, 281(7), 621-626.

Pre-Conference NCSBS x NYC OCME Collaboration: Baby Bootcamp for Trauma Investigators

September 14, 2024 : 9:00A - 12:30P

This symposium will provide invaluable training and information for medical, legal, judicial, and law enforcement professionals on the basics of pediatric trauma investigation.

Attendees of this conference will learn:

• The fundamentals of medical findings/injuries commonly associated with sudden, unexplained death in babies and toddlers.
• How the quality of the police investigation impacts the interpretation of the medical findings/injuries in abby and toddler fatality cases
• Medical, legal and law enforcement investigative approaches through case examples.

SPEAKERS

P. Leigh Bishop, Esq.
Director, Babies and Toddlers (BaT) Task Force
NYC Office of Chief Medical Examiner

Cindy W. Christian, MD
Anthony A. Latini Endowed Chair in the Prevention of Child Abuse and Neglect, The Children’s Hospital of Philadelphia
Professor of Pediatrics, University of Pennsylvania Perelman School of Medicine

Detective Michael J. McNelis (Retired)
New York City Police Department Special Victims Division

Vincent J. Palusci, MD, MS, FAAP
Professor of Pediatrics,New York University Grossman School of Medicine

The cost to attend this pre-conference bootcamp is $150 or can be combined as an add-on ticket to the SBS/AHT conference for $125. Register for the bootcamp and conference by clicking this button.

Register Here

Download the Baby Bootcamp for Trauma Investigators Informational Flyer PDF

For any organizations or persons interested in registering an exhibit booth at the Nineteenth International Conference on Shaken Baby Syndrome / Abusive Head Trauma, information on fees, set-up and registration is below.

Exhibit Fees

The rate to exhibit at the conference is $500 for organizations and $250 for nonprofit organizations. This fee can be processed via credit card or check. All payment must be received prior to the conference. This exhibit fee does not include registration to the conference. If interested in attending the keynote presentations, breakout session and access to the breaks, you can register in the above Registration Section.

Exhibit Set-Up

A standard exhibit space includes the following amenities:

• 1 6’ draped table
• 1 electrical outlet (upon request only)
• 2 chairs

Registration

To register, download the Exhibitor Application form, fill out the requested information and return completed form to  or mail to:

National Center on Shaken Baby Syndrome
Attn: Trachelle Hilton-King
1433 N 1075 W
Suite 110
Farmington, UT 84025 

Download Exhibitor Application Form