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Keeping Babies Safe:
Preventing Shaken Baby Syndrome in North Carolina

Baby Crying on Mother's ShoulderIn North Carolina, keeping babies safe from harm is the goal of a new
$7 million, five year statewide shaken baby prevention initiative. Shaken Baby Syndrome is a term used to describe the symptoms resulting from violent shaking of an infant or small child and it is one of the leading causes of death from childhood maltreatment. The state initiative, the largest and most comprehensive in the country, is a collaborative effort between the UNC-Chapel Hill Injury Prevention Research Center, Prevent Child Abuse NC and Duke University’s Center for Child and Family Health. A multi-agency leadership team comprised of experts from state agencies and non-profit organizations, including the North Carolina Healthy Start Foundation, has helped to shape the initiative. Funding is provided by the Centers for Disease Control and Prevention,the Doris Duke Charitable Foundation and The Duke Endowment.

What's all the Fuss?

Crying, especially inconsolable crying, is the most common trigger for shaking and physical abuse of infants. Preliminary data from a baseline survey of parents of children under two years of age in North Carolina (undertaken as part of the state-wide initiative) shows 2,000 of these children were shaken by a parent or caregiver. Almost 1 in 100 parents of children under two report that they or their partner have shaken a child. A little more than one percent of mothers in the survey report that they have seen someone other than their partner shake a child under two years of age in the last year.

Violent shaking of an infant or child can cause the signs and symptoms known as"Shaken Baby Syndrome." Violent shaking can cause the baby's brain to move within the skull and destroy tissue and tear blood vessels that nourish the brain. Pooling blood within the skull can create too much pressure and additional brain damage. The results of shaking are devastating. Immediate consequences can include breathing problems, vomiting, seizures, irritability, loss of consciousness or death and long term consequences can include cognitive or physical disabilities, cerebral palsy, behavioral disorders, seizures or death. Almost 1 in 4 babies with Shaken Baby Syndrome die of their injuries, and about 80% of the survivors are left with permanent brain injury.

Baby looking over Mother's ShoulderKeeping Babies Safe in North Carolina

North Carolina's initiative is based on an intervention program developed by Dr. Ron Barr, a professor of community child health research and a developmental pediatrician at the University of British Columbia, and Marilyn Barr, founder and executive director of the National Center on Shaken Baby Syndrome, called "The Period of PURPLE Crying."

North Carolina's initiative intends to provide every parent of the approximately 125,000 babies born in the state annually with this intervention program. The Period of PURPLE Crying program includes provider-based parent education, a 10-minute video and an 11-page booklet that parents can share with their babies'’ caregivers. The program educates parents and caregivers about normal infant crying, the dangers of shaking and about things they can do when they are feeling overwhelmed by a crying infant. The project will be implemented in several stages. In the first year, 30 hospitals in the state will begin providing the materials and support to new parents.

In addition, an integrated marketing communication campaign is planned to spread the word to the general population of North Carolina. Babies live and thrive in a complex social environment, and changing the way our society understands and responds to crying is imperative. Professional resources such as on-line training modules and train-the-trainer services will be available. For the general public, newspaper, billboard, TV and radio announcements are planned. Trained information specialists at the NC Family Health Resource Line (1-800-367-2229) will be available to provide assistance.

Ongoing research is planned to assess the impact of the initiative in North Carolina.


Each letter in PURPLE describes a normal characteristic of infant crying. The word "Period" reminds parents and caregivers that the crying in temporary and does eventually end.

P Peak Pattern - Crying Peaks at around 2 months of age and then levels off after that
U Unpredictable - Crying for what seems like no reason at all
R Resistant to Soothing - Crying continues even after attempts to soothe
P Pain-like Face - Babies look like they are in pain, though they may not be
L Long Bouts - Crying goes on for 30 minutes or longer
E Evening Cry - Crying happens more in the afternoon or evening

At A Glance

Every year in the U.S.:

  • Approximately 1 in 50 infants is a victim of non-fatal child abuse or neglect
  • A third of these victims are less than one week old when the abuse or neglect occurs
  • 1,200 to 1,400 children a year receive medical treatment after being shaken
  • 25 percent of these children die
  • The vast majority of survivors are left with some form of life-long brain injury

In North Carolina (2003) approximately:

  • 2.6 percent of parents (NC and SC) admitted to shaking a child under 2 years of age
  • 40 children were hospitalized for Shaken Baby Syndrome
  • 10 children die from Shaken Baby Syndrome

Current studies indicate the number of parents admitting to shaking a baby has decreased from 2003 by about 50 percent.

Source: Keenan et. al.  A Population-Based Study of Inflicted Traumatic Brain Injury in Young Children. Jama 2003;290:621-626.


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