HONOLULU, Hawaii (June, 7, 2017) -- It's a memory most soon-to-be parents expectantly anticipate and then treasure for a life time - the moment when their new born baby takes a first breath and lets out an exultant cry. What might surprise new parents in the weeks that follow is just how often and how long crying may occur once baby comes home.

According to the National Center on Shaken Baby Syndrome, between two weeks of age and two months old, babies enter a phase known as the "Period of PURPLE crying", a time where babies cry more than any other time. These bouts can run anywhere between 35 minutes or up to five hours and still be considered within the normal range. This is also a span of time where the highest rates of non-accidental infant injury occur.

Regional Health Command-Pacific sponsored a training March 31, 2017, with support from the Military Family Advocacy Coordinating Council, to improve Period of PURPLE crying training and roll-out efforts among social work professionals from the military and civilian community. The half-day session was designed to identify gaps in program deliveries and to come up with ways to streamline efforts.

"My role with the Regional Health Command-Pacific is to make sure that all of the Army medical treatment facilities in the region are leading the way in terms of coordinating this education in their programs," said Aoki, RHC-P social work consultant lead.

Medical and social work professionals from the Army, Marine, Navy and Air Force community attended along with representatives from local civilian medical facilities and child protection agencies.

The Department of Defense policy requires training specifically on the Period of PURPLE crying in every military treatment facility. While the same, or similar programs, may be delivered within the civilian medial community, the exact program requirement isn't specified.

"We have almost 900 military family babies born per year in civilian facilities. It's quite a number," said Aoki. "Hosting this training will help to ensure military families giving birth on or off base get the same training and in the same way as those delivering within the military health system."

Involving civilian social work partners on the training also allows for positive impacts within the local community. "The Period of PURPLE crying training can be equally helpful to civilian parents trying to understand why their baby might be crying so much. In the moment, it can be hard to remember that crying is normal and that feeling frustrated as a parent over it is also normal. Improving knowledge on this critical phase can help to prevent child abuse, shaken baby syndrome and abusive head trauma. This is an outcome we want to see happen for all families," said Aoki.

Kaylea Erickson, National Center on Shaken Baby Syndrome, Period of Purple Crying coordinator, says the shaken baby syndrome prevention program takes a positive approach to parent education, focusing on child development. "Crying is the leading trigger to the shaken event, with parents sometimes feeling frustration with crying. So we teach about what parents should expect," Erickson explains.

PURPLE is an acronym.

The first P stands for peak of crying, which speaks to the increased crying rate from two weeks to two months of age.

U stands for unexpected, meaning that crying may come and go unrelated to dirty diapers or feeding.

R stands for resistant to soothing. A parent can try everything to sooth their baby but the child may continue to cry.

The second P stands for pain like face, where a baby may look like they are in pain, even when they are not.

L stands for long lasting, indicating the length of time, usually 35 minutes to five hours, in which the baby cries per episode.

E stands for evening, which specifies the time of day where crying tends to cluster. The late evening is also typically when parents come home from work and may already be frustrated, with their child's crying, sometimes exacerbating the frustration.

Erickson says the PURPLE training program provides helpful tips for parents working through what is at times a challenging period. "Definitely increase the carry, comfort, talk and walk motions to try to sooth your infant. These soothing actions can decrease the crying by half."

Some infants may be resistant to soothing. In this case, Erickson recommends placing the baby in a safe place, such as in a crib, and letting them cry it out. "Take ten minutes to yourself and try to calm yourself. A frustrated parent is less able to calm their baby. Infants can sense this emotion. It's best to collect yourself and then come back and check on the baby and try again."

Erickson says the last tip, which is the most important, is to never shake or harm your baby, no matter how frustrated.

With the training underway, Aoki says the next step will be determining the number of shaken baby syndrome incidents in order to track the impact of the Period of PURPLE crying educational program within RHC-P.

Aoki says RHC-P is also continuing active involvement in child abuse prevention in the state of Hawaii.

On behalf of RHC-P, Aoki participates in the Keiki Injury Prevention Coalition, which coordinates child abuse prevention efforts in Hawaii as part of its mission.