• Reference Number: HEY1238/2021
• Departments: Emergency Department, Paediatrics
• Last Updated: 14 May 2021

Introduction

This leaflet provides information on prolonged crying, often referred to as PURPLE crying, in a healthy baby.

Sometimes healthy babies can cry for hours at a time and cannot be soothed. It usually begins within the first few weeks of life but often stops by the time the baby is four to six months old. It is common yet poorly understood, affecting up to one in five babies. It can be exhausting if you have tried everything and nothing seems to comfort your baby.

Causes of a crying baby

Some common reasons for crying are ^[1]:

• Hunger
• Wanting a cuddle
• Tiredness
• Wind
• A dirty or wet nappy
• Being too hot or cold
• Boredom
• Overstimulation (noise, light, handling)
• Hair tourniquet – hair wrapped tightly around a finger or toe (this may cause more sudden onset crying)
• Normal phase of development (with no identifiable cause): See section below on “what is PURPLE crying?”
• More serious illness (see “when to seek help” section)

What is purple crying?

The characteristics of prolonged crying can be explained by the acronym PURPLE, described below ^[2]:

P – Peak crying: Your baby might cry more each week the most in the second month, then less in months three to five.

U – Unexpected: Crying can come and go and you don’t know why

R – Resists soothing: your baby might not stop crying no matter what you try.

P – Pain-like face: a crying baby might look like they are in pain, even when they are not.

L – Long lasting: crying can last as long as five hours a day or more.

E – Evening: your baby might cry more in the late afternoon and evening.

You may also notice your baby’s face becomes flushed, and they may clench their fists, draw their knees up to their tummy, or arch their back. Your baby may appear in a lot of distress but the crying outbursts are not harmful and your baby will continue to feed and gain weight normally. There is no evidence that this has any long-term effects on a baby’s health ^[2].

How to soothe a crying baby

There is no “best” way to comfort your baby. All babies are different and so respond to different methods, so you may have to see what works for you and your baby. The following suggestions may help ^[1]:

Feeding

• If you are breast feeding, monitor how well your baby is latching and if they are having any difficulties. Keep your baby close and have skin to skin contact, which will comfort and calm your baby.
• Try to offer smaller and more frequent feeds, whilst maintaining a sufficient overall volume of milk.
• If bottle feeding, use a “fast flow” teat as holes in bottle teats that are too small may cause your baby to swallow air as they feed.
• Try and keep your baby in a more upright position whilst feeding, and always burp your baby after a feed.

Environment ^[1,3]

• Having some gentle noise or music in the background may help distract your baby.
• Keep a pattern to feeding/settling/sleeping.
• Hold your baby or put them in a sling so they are close to you.
• Massage, rocking, pat your baby.
• Go out for a walk with baby in a pram or go for a drive. Lots of babies like to sleep in prams or cars.
• Try a warm bath as this calms some babies.

Keeping calm

It is normal to find crying stressful to listen to when it continues for a long time. Take the following things into consideration ^[1]:

• For the first few weeks try and keep things as calm as possible – this is your time to get to know your baby, and for your baby to get to know you and the family.
• Get as much help and support as possible from families and friends.
• Be reassured that it is not your fault if your baby is crying for prolonged periods. Try not to compare yourself or your baby to others.
• When the crying becomes frustrating and you’ve tried everything to soothe your baby, it’s important to take a break. If a trusted caregiver is not available to help with the baby for a while, put your baby in a safe place and walk away. Take a few minutes to calm yourself down, then go back and check on the baby.
• Never shake your baby. No matter how frustrated you feel, you must never shake your baby. Shaking moves their head violently and can cause brain damage.
• If you are struggling to cope, do not be ashamed to ask for help. You could contact doctor or health visitor.

When to seek help

If your baby’s crying is continuous and you cannot console or distract them, or the cry does not sound like their normal cry, it could be a sign they are ill. You know your baby best and know what is different or worrying behaviors. Seek help if you are very concerned, from your doctor, 111 or out of hours services ^[1].

Call 999 and ask for an ambulance if your baby:

• Has a weak, high pitched continuous cry
• Seems floppy when you pick them up
• Is under three months old and has a temperature over 38⁰C
• Is between three and six months old and has a high temperature over 39⁰C
• Has a high temperature, but their hands and feet feel cold
• Has a bulging fontanelle (the soft spot on a baby’s head)
• Has had a fit (seizure or convulsion)
• Turns blue, mottled or very pale
• Has difficulty breathing, breathes fast or grunts while breathing, or seems to be working hard to breathe
• Has a spotty purple-red rash anywhere on the body (this could be a sign of meningitis).

References

1. NHS, Soothing a crying Baby, NHS, Available at: Soothing a crying baby – NHS (www.nhs.uk) [Accessed 27/04/2021]

2. Barr, M., What is the Period of PURPLE Crying? The Period of PURPLE Crying, Available at: What is the Period of PURPLE Crying? | PURPLECrying.info [Accessed 27/04/2021]

3. The Royal Children’s Hospital Melbourne, Unsettled or crying babies, The Royal Children’s Hospital Melbourne, Available at: Clinical Practice Guidelines : Unsettled or crying babies (rch.org.au) [Accessed 27/04/2021]