The Period of PURPLE Cry
It's a dangerous message without additional understanding of babies.
Posted Jun 23, 2013
The advocates of the period of PURPLE crying (PPC) are committed to bettering the developmental outcomes for infants. They want to help parents avoid acting toward the baby with extreme frustration (e.g., shaking) when the baby cries for long periods. We share that concern with them.
We also share in a commitment to providing parents with information about infants and their development as a way to help parents create healthy child-rearing contexts. This type of information can be a powerful tool. Its value and implication is evidenced in the work surrounding PURPLE crying. It is toward the goal of shared information and commitment to infants’ developmental outcomes that we write today.
We are writing this white paper out of concern that advocates for PPC may do more damage in the long term to babies and their relationships with their parents, unless the information is coupled with an understanding of the role of soothing and parental emotional presence.
Without this understanding, the use of Purple Crying as a foundation may cause an inadvertent promotion of the belief that the crying of an infant can be ignored.
On the contrary, as we will outline below:
1. Crying is an infant's major form of communication.
2. Crying is a critical sign of some kind of need or distress.
This paper will provide the reasoning supporting this statement. We begin with an explanation regarding how PPC can lead to an inadvertent promotion of the idea that crying can be ignored.
First, what does the acronym PURPLE stand for? Here's a definition (with our concerns in italics):
P — Peak of crying: Crying starts at two weeks and can last to five months.
This is consistently true only for some babies in the U.S. It is not universal for babies in the U.S., or for babies around the world.
U — Unexpected: Crying appears for no reason known to the parents.
Parents may not be knowledgeable about infant needs and expectations — and additional information may help parents to understand infants’ crying as related to infants’ needs. The bodies of newborns expect to be breastfed several times an hour, because of their small stomachs and rapid growth that requires the hormones and other thousands of ingredients in breast milk. Babies also expect to be carried and held virtually all the time to optimize their development.
R — Resists soothing: Parents have difficulty soothing the baby once the jag starts.
This is part of the definition of colic. This difficulty does not mean that parents’ soothing is not helpful for infants.
P — Painful fact: The baby often looks like they are in pain “even when they are not.”
There is no direct data that supports the notion that babies are not in pain, but advocates of PURPLE Crying say that it doesn’t make sense that there would be babies in pain all over the world. This view is not supported by convincing research. Further, it does make sense that certain experiences and childcare practices are associated with pain. For example, if U.S. birthing practices are employed (Wagner, 2006), or if U.S. contemporary childrearing mainstream norms are being followed which don’t follow the evolved needs of babies (see below), pain that does not seem to have an immediate, direct cause can result. Moreover, pain is not a surprise if the babies are being fed formula, since it populates the gut with pathogenic bacteria (lots of references here), which are related to colic in babies.
L — Long-lasting: Crying can last five or more hours per day.
Yes, this is part of the definition of colic.
E — Evening: The baby is likely to cry more in late afternoon or evening.
Yes, this is a definitional point.
Our Concern: An Inadvertent, Unintended Outcome
Without addressing the points we raise, introducing a universalistic claim that crying is not communication and does not indicate a need creates a new problem; this claim introduces to parents an acceptance that a baby’s distress can be ignored.
Such a belief, we are compelled to suggest, simply substitutes (in our opinions) one naïve and potentially deleterious assumption for another. If accepted uncritically, the belief that crying means nothing could, and likely would, create unanticipated harms and consequences that might even rival the harms that PURPLE crying advocates are obviously committed to attempting to ameliorate. It is our concern that such beliefs can be extended and expanded in unexpected (or unintended) directions and ways that altogether create a cascade of inadvertent, but nonetheless inappropriate infant neglect, and move the conceptualization of infants in quite the wrong direction.
Just as infant formula is useful as an emergency food, it should not be presented to parents as the first choice or baseline, since it is vastly inferior to breastmilk. Similarly, the notion of the period of PURPLE crying is useful in a crisis, but should not be presented to parents as a baseline for infant behavior, since colic is diminished or prevented by nurturing parenting behavior (Barr & Geertsma, 2002), and the type of crying described does not represent the majority of infants, especially around the world.
Address this Concern by Providing the Additional Information
Given the importance of shared information, we respectfully forward the next piece of information that might reduce the potential for these aforementioned unintended consequences — sharing with parents the importance of their role in nurturing and caring for their infants, even if and when infants have crying jags that may not be clearly tied to events understood by parents.
We would like to add information that underscores the element of caring. The importance of caring is a clear thread in all the works associated with PURPLE crying — from the information about soothing to the section on protection. However, parents may not have as clear an idea or sense of infants’ reliance on their guidance and care for optimal development as do researchers and pediatricians. Thus, conveying such information, coupled with information about crying, may help to reduce unintended consequences of a message that may suggest infants’ most powerful communication tool can be ignored.
We would like to suggest, then, a framework for bringing together both:
- The message that an infant may continue crying even when being soothed
- The importance of parents remaining close to assure and soothe the infant even then
This care is essential to infants’ well-being and betterment. We have outlined this below, along with information that may be helpful in supporting the sharing of these things with parents.
Contextualizing Advice to Parents
We write with respect for the work and goals of the advocates of PURPLE. We press for a greater advocacy of the well-being of babies. By focusing on both the potential of crying jags in infants and the physiological needs of infants for care, then the message shared can help build an understanding of crying and an understanding of infants’ needs developmentally, in the manner outlined below.
We propose to frame this in a context similar to that of PURPLE as a way to assure easy access and recall of what is an important message. For those who advocate for the period of PURPLE crying, we suggest adding to PURPLE the acronym CRY (PURPLE CRY) with the following meaning:
C = Calm the baby with touch (perhaps skin-to-skin is needed), gentle movement, and a quiet voice (e.g., singing).
R = Remember the rapid growth that babies are undergoing, which requires your constant support.
Y = Care for yourself to keep yourself calm. Have someone there to help care for your infant when you are overwhelmed; caring for you can help you remain calm and better care for your infant.
CRY as an acronym would help in the following ways:
1. Building parents’ understanding of infant development and their role in early care
Help parents to understand what is occurring in the early months of development and to understand the developmental niche so necessary to support early growth.
Parents may benefit from knowing that every animal evolved with a developmental niche or “nest” for its young, and that the developmental niche for human infants has evolved to provide the care needed by the world's most fragile, immature mammal at birth. Babies are born 9 to 18 months earlier than their completed development, depending on whether you consider mobility or bone development (Trevathan, 2011). Their brain is only 25 percent of the adult size at birth, with much left to develop with help from caregivers. Much of this brain development involves systems connected to survival, as well as later well-being. For example, in representative studies of mammalian brains using rats (who are far more developed at birth and much less social than humans), low maternal nurturing in the first ten days of life (equivalent to the first six months of life in humans) affects gene expression of multiple genes for the rest of life (e.g., influencing control of anxiety; Meaney, 2010).
Table 1 lists the characteristics of the intensive parenting that humans evolved during their evolution (Hewlett & Lamb, 2005); each practice has known effects on physiological health, mental health and even moral development (Narvaez, Panksepp, Schore & Gleason, 2013; Narvaez, Wang et al., 2013). Humans have not evolved away from being social mammals, so it makes no sense to argue that human babies should not be receiving what social mammals require.
Table: Evolved Parenting Practices That Optimize Development of Brain and Body
TOUCH: Held or kept near others constantly
RESPONSIVITY: Prompt responses to fusses and cries
BREASTFEEDING: Nursed frequently (2 to 3 times per hour initially) for 2 to 5 years
ALLOPARENTS: Shared care by adults other than mothers
PLAY: Free play in natural world with multiage playmates
NATURAL CHILDBIRTH: No separation of mom and baby, no induced pain
POSITIVE SOCIAL SUPPORT: Supportive climate with positive emotions dominant
This information can help parents understand that babies need responsiveness and lots of touch and movement to develop self-regulation (e.g., vagus nerve; Porges, 2011), epigenetic controls of anxiety, and the stress response (HPA axis; McEwan, 2003) from the first moments after birth.
Sharing this information may help avoid parents’ belief that crying can be ignored… which may be an unanticipated outcome of the extension of the concept of PURPLE crying.
2. Whether in Pain or Not, Comforting and Soothing is Essential
This information may help deter parents from a belief that crying can be ignored... A potentially unintended consequence of a belief that crying does not indicate pain. Whether in pain, or experiencing some other distress, infants who are crying need assistance to reduce their distress, return their stress response system and the functioning of the HPA axis to a calm state, and train up their vagal nerve for healthful functioning. For this, they need guidance and support. Whether they stop crying or continue to cry, parents’ presence and soothing are essential.
Much of the research outlined in the information about the period of PURPLE crying addresses both what is known and what is not known about why babies cry. Crying, particularly extended periods of crying, does not occur in traditional communities (e.g., nomadic foragers) where adults promptly meet the needs of their infants (Konner, 2005; 2010). Carrying babies and preventing upsets by engaging in soothing behaviors can reduce the intensity of later bouts of crying (Barr & Geertsma, 2002).
Important, then, in a message about crying is the role of responsivity. Extensive research supports how responsivity and synchrony can have a positive impact on both infant development and the parent-infant bond. The quality of responsivity between mother and infant is set by about 4 months of age (e.g., Feldman, 2007).
The effect of physical affection on optimal functioning is well-established; for most mammalian offspring, humans included, losing contact with a caregiver is distressing (e.g., Harlow, 1958). For example, even a few minutes of separation in rats causes lifelong changes in stress response and stress reactivity (e.g., Levine, 2005; Porges, 2011). Even in species less social than ours, physical separation activates painful emotions and influences the dynamics of various emotion-regulating hormones and neuropeptides (Cirulli et al., 2009; Ladd, Owens, & Nemeroff, 1996; Panksepp, 2003; Sanchez, Ladd, & Plotsky, 2001).
So, important to incorporate with the messages forwarded by the Period of PURPLE crying is the importance of soothing and calming. This message, as noted above, is a thread through the material presented. However, it may be important in providing guidance and support to new parents to help make this thread more evident and to note its importance more clearly.
A focus on the importance of soothing and calming can help parents understand that crying is an infant's way to communicate and provides the message that, although perhaps not in pain, they are in need of soothing and care. Helping parents focus on steps for keeping infants calm and soothing infants when they are upset, as well as remaining with infants even if they continue to cry, may be an important step in reducing instances of infant distress. Early steps (prevention) include:
- Breastfeeding (and attending to foods that might be irritating to the baby). If this is impossible, use formula with probiotics.
- Keeping a baby “in arms” — holding the baby and keeping it physically close (rather than setting it down and responding after crying)
- Learning sensitivity to and responding to a baby’s cues (grimace, gestures) well before the baby starts to cry
- Learning how to hold and rock a baby to keep it calm (patiently figuring out what type of rocking the baby needs at that particular time)
Caring for infants — and building a developmental niche that supports the physiological demands of early care — is a big task. Period of PURPLE CRY helps parents build a developmental niche, knowing how important they are for their child’s development, and how important sensitive attention and soothing behavior are.
We hope our message may encourage PPC advocates to add the CRY acronym, thereby emphasizing how important parents are in maintaining the developmental niche and their role in it. We think this more balanced message will prevent the potential dismissal of crying as communication among parents.
Wendy Middlemiss, University of North Texas
Tracy Cassel, Evolutionary Parenting
Kathy Kendall-Tackett, Texas Tech
Helen Stevens, Safe Sleep Space
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