Preventing Shaken Baby Syndrome

The Duke Endowment believes that educating parents of newborn children can help prevent traumatic brain injury among infants (Shaken Baby Syndrome). A North Carolina education effort, "The Period of PURPLE Crying: Keeping Babies Safe in North Carolina" was supported by a five-year (2008-2012), $2 million grant from The Duke Endowment. This initiative is now closed.


Each year, as many as 1,400 infants in the United States receive medical treatment for inflicted traumatic brain injury, commonly known as Shaken Baby Syndrome. Of those, approximately 25 percent die, and 80 percent of the survivors experience lifelong disabilities from their injuries. A 2003 survey of North Carolina parents with children younger than 2 found that more than 2,000 children were shaken, to some extent, by a caregiver. In North Carolina, about 40 of these children are admitted to intensive care for injuries each year. Of that number, 10 die and 27 suffer lifelong effects from their injuries.

Parents Unaware of Dangers of Shaking Children

Shaken Baby Syndrome most often arises from frustration on the part of the caregiver, but unfortunately, few parents and caregivers are aware of the dangers of shaking children under 2 years of age.


In 2008, The Duke Endowment joined with the Doris Duke Charitable Foundation and the Centers for Disease Control to fund a $7 million statewide launch of "The Period of PURPLE Crying: Keeping Babies Safe in North Carolina," a prevention program developed by Dr. Ron Barr, pediatrician and professor of child health at the University of British Columbia, and his wife, Marilyn Barr, founder and executive director of the National Center on Shaken Baby Syndrome.

The North Carolina project's goal was to educate the parents of each of the approximately 125,000 babies born in the state each year about the causes and dangers of Shaken Baby Syndrome. Project leaders hoped to reduce hospitalization and death from abusive head trauma by 50 percent.

The Period of PURPLE Crying program includeds an 11-page booklet and a DVD that hospital staff or healthcare providers reviewed with new parents before taking their babies home. The "PURPLE" acronym helps parents understand infant crying:

  • P – Peaks at 2 months of age
  • U – is Unexpected
  • R – Resists soothing
  • P – the child appears to be in Pain
  • L – is Long-lasting (from two to five hours)
  • E – usually occurs in the Evening

The Center for Child and Family Health, a partnership between Duke University Medical Center, North Carolina Central University and the University of North Carolina School of Medicine, led the implementation for this project, with an initial goal of reaching more than 80 hospitals across the state. Outreach also included a reinforcement campaign at health departments and pediatricians' offices. The reinforcement campaign placed posters about PURPLE Crying in exam rooms and provided take-home cards with information to all parents or caregivers who brought in infants less than 1 month.

Participating Sites

See original participating hospitals in North Carolina.


Area of Work

  • Prevention and early intervention for at-risk children

Program Area

  • Child & Family Well-Being

Grantmaking Status

This program ran from 2008 to 2012

Areas of Work

  • Prevention and early intervention for at-risk children

    To equip children and families with skills to ensure that children reach developmental milestones to lead successful lives.

  • Out-of-home care for youth

    To drive child welfare systems toward greater accountability for child well-being.

  • Quality and safety of health care

    Improving the quality and safety of health care delivery

  • Access to health care

    Improving health by increasing access to comprehensive care

  • Prevention

    Expanding programs to promote health and prevent disease

  • Academic excellence

    Enhancing academic excellence through program and campus development

  • Educational access and success

    Increasing educational access and supporting a learning environment that promotes achievement

  • Campus and community engagement

    Promoting a culture of service, collaboration and engagement among schools and communities

  • Rural church development

    Building the infrastructure and capacity of United Methodist churches to enhance ministry and mission

  • Clergy leadership

    Strengthening United Methodist churches by improving the quality and effectiveness of church leadership

  • Congregational outreach

    Engaging United Methodist congregations in programs that serve their communities