8.1 Child Abuse Prevention and Treatment Act

The Child Abuse Prevention and Treatment Act (CAPTA) was originally enacted by Congress in 1974 and reauthorized in 2010. CAPTA provides minimum standards for defining physical child abuse, child neglect, and sexual abuse that states must incorporate into their statutory definitions to receive federal funds. Under CAPTA, child abuse and neglect is defined as:

• any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation
• an act or failure to act that presents an imminent risk of serious harm

State, Territorial, and Tribal civil laws define the conduct, acts, and omissions that constitute child abuse or neglect that must be reported to child protective agencies. Physical abuse is generally defined as “any nonaccidental physical injury to the child” and can include striking, kicking, burning, or biting the child, or any action that results in a physical injury or impairment of the child.

Jurisdictions may expand on this definition, and many choose to include specific additional harms. In 21 states, Puerto Rico, and the Eastern Band of the Cherokee, human trafficking, including involuntary servitude, is included in the definition of child abuse. Ten states include female genital mutilation in their definitions of physical abuse. The Navajo Nation and Pala Band of Mission Indians include exploiting or overworking a child with physical labor in their definitions of maltreatment.

CAPTA defines the term near fatality as an act that, as certified by a physician, places the child in serious or critical condition. The act defines the term serious bodily injury as bodily injury that involves substantial risk of death, extreme physical pain, protracted and obvious disfigurement, or protracted loss or impairment of the function of a bodily member, organ, or mental faculty.

Neglect is frequently defined as the failure of a parent or other person with responsibility for the child to provide needed food, clothing, shelter, or medical care to the degree that the child's health, safety, and well-being are threatened with harm. Many states and tribes include failure to educate the child as required by law in their definition of neglect, while others include medical neglect in their definitions. Abandonment is often included in the definition of abuse or neglect, though some tribes make an exception if the child is in the custody of a relative.

Strategies to prevent SBS/AHT lean heavily on educating parents and caregivers about how to deal with the stress of crying babies. The Childcare Technical Assistance Network has provided a set of best practices for childcare providers:

Childcare providers have an important role that they can play in adopting prevention strategies to support themselves, other caregivers, parents, and families. These strategies include:

• learning about abusive head trauma
• sharing information on typical child development and self-care
• helping infants and caregivers build relationships
• connecting with community resources (such as home visiting and family support groups)
• identifying sources of household family stress and connecting families to resources in partnership with health and other systems

Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, outlines best practices regarding abusive head trauma. According to Caring for Our Children Standard 3.4.4.3, Preventing and Identifying Shaken Baby Syndrome/Abusive Head Trauma, the goal of this standard is that:

1. All childcare facilities should have a policy and procedure to identify and prevent shaken baby syndrome/abusive head trauma.
2. All caregivers/teachers who are in direct contact with children, including substitute caregivers/teachers and volunteers, should receive training on preventing shaken baby syndrome/abusive head trauma; recognizing potential signs and symptoms of shaken baby syndrome/abusive head trauma; creating strategies for coping with a crying, fussing, or distraught child; and understanding the development and vulnerabilities of the brain in infancy and early childhood.

Children with special needs or health problems are often at increased risk for abusive head trauma. One reason that a child with a disability may be at increased risk is that they are not meeting the developmental milestones that their caregiver is expecting. Children experiencing colic cry for longer periods of time which increases caregiver frustration and the risk of being shaken. Programs that are exempt from licensing need to meet health and safety requirements for abusive head trauma, as outlined by their state, if they care for a child for whom they receive federal childcare financial assistance (CCTAN, 2022).

Giving parents and caregivers tools that help them cope with frustration while caring for a baby are important components of any SBS prevention program. Health professionals play a key role in reinforcing prevention by helping parents and caregivers understand the dangers of violently shaking a baby, the risk factors and the triggers for it, and ways to lessen the load on stressed-out parents and caregivers, all of which may help to reduce the number of cases of SBS (CCTAN, 2022).

Prevention strategies are still being researched and developed. Some studies indicate that paid family leave and California’s earned income tax may have resulted in a reduction in AHT. The Period of PURPLE Crying contributed to reduced AHT in British Columbia, but not North Carolina. Another hospital-based program had some success in two New York regions, but not in Pennsylvania (Narang, et al., 2020a).

8.2 Shaken Baby Syndrome Prevention Programs

Many prevention and education programs strive to raise awareness about SBS, educate parents and other caregivers about the serious effects of SBS-related injuries, and inform them about infant crying behavior and safe ways to reduce and prevent SBS injuries.

Examples of common prevention strategies include (CDC, 2024):

• coordinated hospital-based primary prevention programs targeting parents of newborns
• home visits for new parents
• anticipatory guidance at well-baby visits in pediatric practice or health clinics
• school prevention programs for junior high and high school students providing them with an understanding of child maltreatment issues, anger management techniques, and childcare skills

The CDC urges parents and caregivers to focus on calming themselves down if they notice that they are getting frustrated with a crying baby. It is perfectly all right to put the baby down and walk away for five or ten minutes at a time. There is also a hotline for mothers who need some mental health support.

8.3 Not feeling like yourself? Let's talk about it.

The National Maternal Mental Health Hotline provides free, confidential, 24/7 emotional support, resources, and referrals to pregnant and postpartum women and their loved ones. Call or text 1-833-852-6262 (CDC, 2024).

According to the Office on Women’s Health, 1 in 8 women report symptoms of postpartum depression in the first year after giving birth. New mothers may feel sad, anxious, or overwhelmed. They may not feel love and care for the baby, and they may have no energy to do anything at all (OWH, 2025).

Labor and delivery nurses, discharge nurses, and health educators can distribute the Period of PURPLE Crying program materials to new parents prior to the baby’s discharge from the hospital or birthing center. Program materials include an educational video and booklet for new parents and other caregivers to help them understand and cope with infant crying.

The National Center on Shaken Baby Syndrome offers a school-based programs for junior and senior high school students, which teaches students about the medical aspects of shaking injuries, combined with basic anger management and childcare skills. Teaching students how frustration can lead to shaking emphasizes the importance of appropriate coping skills. There are also programs targeting new parents, with information and resources for providing safe and nurturing care for their new infants and safe strategies for coping with frustration caused by crying babies. Other programs emphasize professional education and trainings for doctors, nurses, therapists, social workers, and others providing family services (National Center, 2026).

8.4 Reinforcement by Other Organizations

During their regular interactions with new parents, pediatricians, public health workers, and representatives of foster care agencies, home visitation programs, and adoption agencies are encouraged to ask parents and caregivers if they have received the Period of PURPLE Crying materials (National Center, 2026). If so, they reinforce the key educational messages. If not, they give the materials to the parents and provide an overview of them.

Key points for medical providers include:

• Remind parents and caregivers that crying is normal for babies.
• Infant crying normally increases at 2 to 3 weeks of age, peaks around 6 to 8 weeks of age, and tapers off when the baby is 3 to 4 months old.
• During medical visits, ask parents how they are coping with parenthood and their feelings of stress.
• Remind parents that they may experience a sudden decrease in sleep, but that things will get better.
• Encourage parents to check for signs of illness, fever, unusual behavior, or discomfort.