Concerned About Unconventional Mental Health Interventions?

Concerned About Unconventional Mental Health Interventions?
Alternative Psychotherapies: Evaluating Unconventional Mental Health Treatments

Sunday, May 10, 2009

Eye contact with babies-- how important is it?

People have believed for centuries that the human gaze had remarkable powers. In the distant past, most people thought that rays came out of the eyes and explored the world, carrying information about objects back to the brain. (Some still believe this-- even college freshmen.)

One of the important abilities attributed to gazing involved the mutual gaze, or "eye contact", where two people look into each other's eyes and feel as if they are communicating powerful emotions. "Eye contact" is often said to play a critical role in interactions between adults and babies, and even to help create emotional attachment in early life. A related idea is that breastfeeding mothers and babies gaze intently into each other's eyes and thus establish an emotional connection.

Let's examine some of these ideas. Do babies see well when very young, and do they spend time in mutual gaze with their caregivers?

Newborn babies have vision, but it still has to develop for quite a while before it's as good as an older child's. Newborns (infants in the first month of life) can only see clearly at certain limited distances. They are well adapted to looking at a face from about 10-18 inches from their eyes, which would be a typical distance if an adult held the baby in his or her arms. Babies are more interested in some things they can look at than in others. They like things that are shiny, that move around, and that have patterns rather than just a blank surface. Of course, this set of characteristics describes human eyes-- they are moist and reflect light, they move as we examine something we're looking at, and they have white, colored, and dark parts, as well as eyelashes and lids that move. So, babies with normal vision do look at eyes when they get a chance. What this means to the baby, we can't tell, but it is very exciting and gratifying for the adult when "eye contact" is made.

A curious thing about young babies' eye contact is that blind babies do it too. How? They listen to the adult voice, then move their gaze so they are "looking" in the right direction. It appears to the adult that the baby is looking at him or her, and the adult may not even realize that the baby can't see.

What about the breastfeeding baby? Does he or she gaze into the mother's eyes while nursing? Actually, no; young babies, especially, usually squeeze their eyes tight shut while they nurse. In any case, because the baby has to turn its face toward the breast to take the nipple, it would have to work hard to be able to look up at the face at the same time. Older babies (8 months or so) may have figured out how to hold the nipple in their mouths while turning to look up at the mother or at someone else in the room, and they may let go the nipple and play or babble to the mother for a little while before nursing again. But an intense mutual gaze during breastfeeding is pretty infrequent. (And remember, breastfeeding mothers are not necessarily gazing at the infant. They may be eating, drinking, talking on the phone, or reading to an older child.)

As babies get a few months older, they can see better, and they also begin to use their eyes in a way that gives signals to an adult. For example, suppose you are playing with a baby and the baby gets tired, or maybe you have just come on a little too strong and been too stimulating. The baby turns the gaze away from your face, gets quiet for a moment, and just withdraws to have a little rest. The averted gaze works to tell a sensitive adult that the baby needs to back off for a bit. Then, rested up, the baby looks back at your eyes, smiles, and shows readiness to play some more. This slightly older baby gazes at the adult sometimes, but has the mature capacity to be able to stop looking. A baby who gazed at its caregiver's eyes a great deal of the time would not be showing the level of development we would expect by 3-6 months of age.

In the second half of the first year, babies begin to show a new use of the gaze for communication. They develop the ability for an important skill called "joint attention." The baby sees something interesting like puppies playing-- watches intently-- then turns to "catch the eye" of an adult, and looks back at the puppies again. Babies will do this several times until they get the adult to look at the puppies. Just like an adult, the older baby can use the gaze to point, as a pointing finger would be used. Also like an adult, the older baby wants to share the fun with a loved person, and wants to look at the puppies together with someone else. At the end of the sequence, the two look at each other and smile. (Notice that the baby does not do this in order to get the adult to do anything other than share the interesting sight. This is not a way to get fed, or picked up, or even carried over to see the puppies.) Again, mutual gaze or "eye contact" is only a part of the communication the adult and baby carry out with their eyes.

*** Readers, if you have found this post in your search for current material about eye contact and autism, please look at my post for Nov. 7, 2013,which discusses the Nature article by Warren Jones and Ami Klin.


  1. I have breastfed 4 babies, and they absolutely make eye contact while nursing, of course it depends on their age, and mood. A newborn like my 2 week old is not able to yet. As they get older they are very interested in mommy, even while nursing!

  2. Thanks for your comments. Of course an older baby will sometimes pause in nursing, sometimes still holding the nipple in her mouth, and make eye contact-- or even turn to see someone who has just come into the room. What I'm trying to do here is to reassure mothers who have been led to expect that very young babies will gaze into their eyes for extended periods, while nursing, and that failure to do this means that the child is autistic. So much that's written about this fails to point out that as you say, it's "as they get older" that they get interested and use the gaze in communication.

    1. Thank you for this article! my son (first baby) is now 5 weekes and never looks into my eyes during breastfeeding. Either looking at my shoulder or falling asleep and eyes closed. I have also been worried that he might be autistic, happy to hear it's not a clear sign of autism!

  3. What about the oxytocin that is released when eye contact is achieved, say nursing a 4 month old?

  4. Can you tell me what evidence you have that eye contact causes oxytocin to be released? And is it the mother's or the baby's oxytocin you mean?

    Certainly the mother experiences oxytocin release from nipple stimulation, otherwise her milk wouldn't let down. But a blind woman can breastfeed, so she's not dependent on eye contact to release oxytocin. Blind mothers with sighted babies have normal relationships, as do sighted mothers with blind babies, so I don't think we can attribute anything in particular to eye contact.

  5. Thank you for this article. I am a first time mother, my daughter is 6 weeks. Breast feeding has been going well but she does not look at me at all. Her eyes remain shut or sometimes she is focused beyond my arm. I have been extremely worried after reading endless web info and chat rooms. I will continue to look for any development cues/ mention to health visitor. But thanks for adding some balance.

  6. It takes longer than most people think for babies to "hatch". And actually breastfeeding time is not the most likely time for a baby that young to pay attention to faces-- when she's eating, that's the whole universe for her. When she's awake but calm, try holding her with one hand behind her head so she's supported, facing you, and not more that a couple of feet from your face. Be sure the light is on your face, and talk to her in "motherese" while you're looking at her-- also, some babies are interested if you open your mouth wide as you move your head toward them, then close it as you move back. You may get more of a reaction that way.

    But keep in mind that all this is to reassure you, not because she particularly needs it! I don't want to make light of your concerns, and I don't know whether you're more worried about autism or about visual impairment. However, this all sounds perfectly normal so far, and I wish people wouldn't scare new mothers the way they do.

  7. Thanks so much for this. I am also super paranoid about autism & my 2 week old isn't making much eye contact yet. Your article made me feel a lot better.

  8. Thanks so much for this article, made me feel a lot better. I'm a first time mom, very paranoid about autism & wasn't sure what to expect with my 2 week old & eye contact. When nursing he either has his eyes closed or stares straight ahead.

  9. Thanks for your comment. I do feel bad that so many new mothers are concerned about this issue when they need not be.

    Somewhere around 9-10 months, your baby will probably use his/her eyes to communicate with you by looking at something interesting, then catching your eye, then looking back until you too look at the interesting thing. When that happens, you can be pretty much assured that he or she is not autistic. But that's the kind of eye contact that's really important-- it's not a romantic mutual gaze.

  10. Hello, thank you for this blog post. I am looking for a little reassurance but please be honest with me.

    I have a 2.5-month-old girl who makes very little eye contact. Her older brother has autism. When he was a baby he had GREAT eye contact, smiled at 4 weeks, was laughing by 11 weeks. His eye contact is still really good with family and very farmiliar people. Yet he has autism.

    Now, my 2.5-month-old daughter makes very little eye contact. She does smile but not as much as her brother did, and has almost laughed, but again, her brother was fully laughing by now. Given the family history, I am really worried about autism. At what age should eye contact be regular? Thank you.

  11. Since I've never seen your kids, I can just try to answer generally. The social smile (in response to someone's face) usually gets reliable between 2 and 3 months, and some consistency of eye contact goes along with it.

    But keep in mind that there are real individual differences in these things. Babies whose temperament (basic personality) involves a slightly negative mood and lack of enthusiasm for new things are likely to smile less often-- just like adults with those characteristics. Also, babies are less likely to smile and more likely to avert their eyes if they see a face that has a blank or worried expression-- could it be that your concerns show on your face and affect your little girl's response to you?

    Keep in mind that boys are quite a bit more likely than girls to be diagnosed with autism.

    You've answered part of your own question by describing your son's early and current social responsiveness and showing that autism is not necessarily related to lack of eye contact. But you also made me wonder at what age he was diagnosed. There are lots of false positives in autism diagnoses before age 3, and he may be among the children whose later development proceeds in a more typical fashion. Being treated for autism by conventional methods can't do any harm, whether it's an accurate diagnosis or not.

    It's not surprising that you're worried about the possibility of another autism diagnosis, but at this point the best thing to do would be to socialize with your daughter as normally as you can, try not to look worried, and don't press her to interact if she averts her eyes to tell you she needs a rest... wait until she looks back at you,and then respond to her signal.

    When she gets to be 9 or 10 months old, see if she does "joint attention" as I described it in the last paragraph of the post above. If she does not, that might be time to have her evaluated. But I'll bet she'll be doing fine!

  12. Hello! I googled "12 month old little eye contact during nursing" and found this article. It made me feel better too. My son has never really just gazed at me for long periods of time during nursing. Sometimes he will for a little bit and play "peek-a-boo" or gives me a high-five (while nursing--ha!). But then he just goes back to just gazing off. Sometimes he lays his arm over his eyes. He is a little bit behind developmentally (gross motor skills), and of course everywhere you look on the internet about this, autism shows up. And then you really go overboard to make sure they are making eye contact and pointing (which he really isn't pointing). I feel like I am going paranoid because I find myself saying his name so many times a day to reassure myself that he responds to his name. Of course he ALWAYS responded to it before, but now I've noticed in the last few days (when I say it 100 times a day) he doesn't respond every that leads to worrying more. He smiles often and laughs, especially when his 6 year old sister chases him saying "I'm gonna get you!" But he doesn't point. He waves when he says bye-bye. I have noticed him playing with a toy, and he looks at me and smiles when it makes a noise. Is that the "joint attention" you are talking about? The other day I was researching how to get a 12 month old from walking on their tippy toes (he only cruises holding on to furniture), and again I see AUTISM show up in reference to that topic. He says about 3 words (uh-oh, bye-bye, and Ella (his sister)), but because of his lack of pointing and walking tippy toes we are going to get an evaluation. Just this week he has started to gently tap his head once or twice on the floor...and there's another thing to worry about. My husband and parents think I am overreacting and look too much into it. But how can I not? Symptoms of autism are everywhere you look online. I know that early detection is vital and that it is so important for everyone to know the early symptoms. However, I also feel like I can't even enjoy my son's baby years because every little thing seems to be a warning sign of autism in some way or another.

    1. Dear Anonymous-- you do have my sympathy for your worries. And nobody seems to know the difference between "reacting" and "over-reacting"!

      It can't hurt to get an evaluation and I hope that will set your mind at rest.

      But, you are seeing many signs of normal development. Peek-a-boo is a great indication that all is well. Looking at you when the toy makes a noise is a kind of joint attention, especially if he looks back at the toy when he sees you're paying attention. Playing social games is also a good sign. Looking into space while nursing is perfectly normal, and I don't suppose even adults look into each other's eyes much while eating hungrily.

      As for the tippy-toes, you wouldn't expect anything else if he is still cruising and holding on. Toe-walking as a symptom of autism occurs when the child is walking independently. If he's still holding on, a typically-developing child points his toes to stiffen and strengthen his ankles, which are still not under his complete control. (But even perfectly normal toddlers who walk independently will still toe-walk sometimes for fun,just as they walk backward or "jump".)If he still hasn't developed ankle control, which might take another couple of months, there's nothing you can do to make him able to straighten the ankle--- best not to have him wear shoes, though.

      If he has always responded to his name,I'd guess that he just gets tired of having it said 100 times a day, and sees that it doesn't mean much for you to say it-- so why respond? I bet he responds when Ella says it,right?

      I know it's impossible not to worry, but don't torment yourself by comparing this baby's development with Ella's. They are different people, and the sex differences can be surprisingly big.

      Good luck-- I'm sure your evaluation will say that this is typical development.

  13. Dr. Mercer, Thank you so much for your quick reply. We are feeling very encouraged by your response and by behaviors we've seen in the last few days. You are right, our son does respond to Ella every single time. They crawl around on the ground together and laugh and chase each other so is hard to think something might be wrong. We are hoping nothing is. Also, he does point, but he actually touches what he points at. So we figured that didn't really count. I will point at something, and then he will point but get so close his finger touches it. He makes the sign for "milk" with his hand, but we think he does it for everything he wants...not just milk. I am rambling now. I just wanted to say "Thank You." My husband and I both read through your response and feel so much better.

  14. That's great to hear-- hope all continues to go well!

    I think touching counts as pointing. After all,it shows that he understood your communication.

  15. Dr. Mercer,
    My daughter is 2.5 months old and has a chromosome abnormality that has been linked to Autism. Her Drs have told us to just "wait and see" but of course, that is hard for any parent to do. I am a new mom so I have nothing to compare her development to. She smiles at my husband and me, but she doesn't smile every time we talk to her. She tracks toys with her eyes when we play with her but she does not turn her head in response to our voices. She makes eye contact but I wouldn't describe it as frequent....what is normal at this stage? Thank you for this article!

    1. I'm sorry to hear about your worries. Babies are so different from each other that even mothers with a lot of experience are not always sure what's going on.

      It would be surprising if your daughter did smile every time you talked to her-- you probably don't smile every time you hear someone speak,either! Does she smile when she sees you smile? That's more important, although she's not likely to do that every single time, either. But somewhere around 2 or 3 months most babies begin to have a social smile in response to other people's smiles.

      Whether she makes frequent eye contact will be more important when another few weeks have passed, and by "frequent" I just mean more times when she's face to face with you than not. You might want to try getting her attention by leaning toward her while you open your eyes and mouth wide, and then closing them as you move away again-- repeat a few times. This isn't something she has to have to stimulate her, but you might feel better if you see that you can get her to respond.

      As for turning her head when you speak, if she's lying on her back, like most U.S. babies nowadays, she may not yet be very good at turning her head back and forth. However, you make me wonder whether she was screened for hearing impairment soon after she was born. If she wasn't, you might want to have that done, just so you know what's going on.

      People used to describe all babies of this age as "autistic",in the sense that they didn't yet pay much attention to things around them. That developmental characteristic may be all that you're seeing here-- I certainly hope so.

      Best of luck to your family. By next Christmas, all these concerns may be forgotten!

  16. What do you think of this letter in today's NY Times?

    To the Editor:

    As a breast-feeding mother, I found one part of Barbara L. Fredrickson’s article to be off the mark. She says texting while breast-feeding may leave “life-limiting fingerprints” on the gene expression of new parents and their children, implying that a mother should instead gaze lovingly into her infant’s eyes during the entire feeding.

    But breast-feeding mothers are taught not to maintain eye contact because it is distracting and the child will not stay latched and eat as much as he or she needs to thrive.

    Breast-feeding is time-consuming, exhausting and unselfish. While I am thrilled that I have been able to breast-feed my son successfully, I become frustrated when his future ability to connect with others is called into question because I text someone during a feeding session instead of staring at a wall in a dark room for 30 minutes straight.

    I simply wish that Ms. Fredrickson had used a different example of technology obstructing the human connection in her otherwise compelling article.

    La Grange, Ill., March 25, 2013

    1. Good question! I was astonished by this letter and took it straight to a discussion group sponsored by "Zero to Three", where we had been discussing the original article.No one had heard of the advice Ms. Philips received, but one member, a pediatrician, said she would try to track down whether lactation consultants are saying this, and will let the rest of us know. I'll pass it on if she finds out.

      First of all, I think Ms. Philips is quite right that the original statement was an exaggeration. Nursing mothers through the ages have done other things while breast-feeding-- eaten, drunk, cooked, read to other children, gossiped, cleaned the baby's ears and cut the nails. In our modern lives, young mothers are often very isolated and lonely, and they seek with their phones the companionship that used to come automatically when living was more communal. Human babies only need the proverbial "good enough mother", not the perfect mother (whatever she would be), and good enough mothers have many tasks and interests other than their babies.

      As for what Ms. Philips says she was told, I have certainly never heard of any such instruction being given as a general rule. I can imagine, though, that if a baby kept stopping nursing to look at interesting things and people, and the mother was considering weaning because it was all taking so much time, it might be suggested that she try a more boring environment to see if the baby would concentrate better. Also, if an older baby who still likes to get up and nurse in the night seems to think it's a good time to party, a darkened room might be helpful.

      Incidentally, some research done with indigenous peoples of Guatemala a couple of decades ago looked at their practice of keeping babies in a darkened hut for the first year. When they emerged, those babies seemed a bit delayed, but quickly caught up to where we would expect them to be. Is having mothers texting sometimes any more of a problem than that? I doubt it, although I have to say I can't imagine what people find to text about all the time!

  17. Thank you! That's more or less what I thought, so I was really surprised by that letter.

    (Also, just to say, I teach at Brandeis! Did you overlap with Sophie Freud?)

  18. Hi William-- I've just been up in your part of the world for the first birthday of my grandbaby, whose father is a Brandeis alum.

    No, I didn't overlap with Sophie Freud-- as far as I know, and surely I would have known! But in those days Psychology and the Heller School were not really on speaking terms, so I suppose it's conceivable that we could have walked past each other every day--- nah, that doesn't seem likely, but then I don't know exactly when she was there.

    As to the letter, we had a lot more discussion of it on the 0-3 group. Someone mentioned that sort of advice being given to anxious mothers with very young, easily disorganized babies, which makes perfect sense. Whether the letter-writer overgeneralized advice she got, or whether someone else did the overgeneralizing and passed it along, I have no idea. But I hope we haven't been in at the birth of yet another popular misunderstanding-- the opposite of the one about constant mutual gaze.

    I was trying to figure out who you are by looking at Brandeis psych and social work faculty-- no Williams as either first or last names--but maybe not your real name? Just curious about what you do.


  19. Hi Jean --

    I am a prof in the English Dept!

    Who is your grandchild's father? I've been at Brandeis since 1985.


  20. Ha-- no wonder I couldn't find you.

    It's Peter Dempsey, 2003, computer science-- so you probably never encountered him, but maybe-- Brandeis certainly gave him a marvelous broad liberal arts education as well as his major.

  21. Ah - I don't think I know him, but I'm sure he knows my friend Harry Mairson.


  22. My dd is 10 weeks old and makes minimal eye contact and hasn't given a real smile yet. She has smiled at our sofa and our bookshelf, and she loves staring at things. It seems sometimes as if she tries to avoid looking at us - parents and siblings.
    I would say I have the best chance of having her look at me in the mornings, when everyone, including her older siblings are out of the house.
    None of my other kids took this long to smile, nor do I remember being so concerned about lack of eye contact before, either.
    What is an acceptable amount of eye contact?
    I would say we can probably get at most, once a day, a few minutes at a time, sometimes with her cooing at us as we talk to her.
    Is there anything I can do to encourage more eye contact and to get her to smile?

    1. I'm sure you'll understand that since I haven't met you or your baby, I can't say anything specific, but I'll try to provide some ideas that might be useful.

      1. Babies who are blind from birth often appear to "look" at the eyes of adults who talk to them, right up until perhaps 4 months of age. I don't mean to suggest that your daughter is blind-- just to say that a certain amount of what seems to be eye contact actually is not real eye contact in either blind or sighted babies, so we shouldn't be too concerned about what is and isn't acceptable.

      2. It takes a certain amount of organized functioning to look at faces and smile at them.Since you say she does best when everyone else is out of the house, I wonder whether she's just a bit overwhelmed by too many people and too much activity, and disengages because she finds things a bit over the top. Would you say that on the whole she's sensitive to small differences, like whether a bottle is warmer or cooler if she's bottle-fed, or whether you've had a recent breast infection if breast-fed? If so, she may just find life in a lively household more than she can easily cope with. Then she might "avoid" looking at people when a lot is going on.

      3. Some babies have a rather negative mood quality even when nothing much is wrong, and don't smile so easily. Would you say she's generally a little more negative and a little less positive in mood than most?

      4. If she does look at you sometimes, and acts sociable by cooing when you talk, that's probably enough for showing normal development, although I know you'd be more comfortable with more.

      5. I wonder whether you are getting very worried and show her by your face and voice that you're anxious? Or do you look at her "blankly" as you hope for a response? Those are facial expressions that she might find disturbing or just uninteresting.

      6. Have you tried "looming"? By this, I mean positioning yourself above where she's lying, with enough light so she can see your face. Then move your face down toward her, simultaneously opening your mouth as wide as you can-- then move back up, simultaneously closing your mouth. Repeat several times. She might not actually smile, but if she looks interested then you know there's a social connection,which is what it's really all about.

      7. I don't want to make a big thing of this, but if you do want the eye contact, try wearing lots of eye make-up. It could help.

      As I said,these are just some ideas-- I hope they help-- but don't forget that she may suddenly re-organize developmentally and get very sociable, just on her own.

      Best of luck to your family!

    2. A point I forgot to mention: even at this age, many babies are more visually alert when propped up than when lying flat. It may help to get her more upright.

  23. Hi Dr! I have always worried about my child making eye contact while feeding. My daughter is going to turn 4 months old in about a week and I have been concerned about her since the very start. I have considered getting her evaluated but my husband has convinced me to wait till 6 months. anyway - firstly, until 2 months old she used to gaze upwards a lot. Her eyes are in good sync but she used to look up at the ceiling a lot. We got her eyes and hearing tested which came out okay. Within next few weeks, she stopped looking upwards. Our next concern came with smiling as she used to rarely smile back to us at 2.5 months. Over the course to next month, she started smiling more than before but it was still less. May be like 5 -6 smiles a day? This month, I have realised that she doesn't smile/laugh until we are playing with her. With a lot of wide mouth movement and noises we get her to smile. She seems to be very moody though and won't smile readily. She makes eye contact while feeding now and sometimes tries to initiate a talk while feeding, but she never seems to be intently looking or staring at my face otherwise. She coos since she was 1.5 months old and still does but not often. She coos sometimes when we coo and sometimes at the ceiling fan. But my biggest concern is she makes extended and good eye contact while laying down, but she needs to be entertained, played or sung too for getting that attention. she doesn't intentionally look at faces otherwise. She does not make eye contact when she is sitting up or standing. She looks left and right but will avoid direct eye contact with person holding her. Rarely, she look you straight in the eye and smiles back in those positions. She has not started rolling over yet either. She is very active visually and loves tracking everything. She knows watches people coming and going out of the room, tracks toys, grasps, holds them. I have been worried though. And my husband does make sense that no one is going to evaluate her so soon and waiting is our option. What do you recommend? This is my first time baby and I'm very anxious. Thank you

    1. How is your baby doing? I ask, because my baby girl has a similar behavior and i 'm a bit concerned.

  24. Just to add - she doesn't always look at people but she likes to have them around because she does cry when she is alone for more than few minutes. She has been mixed bag with strangers. Sometimes she has cooed and smiled at them, and other times she glazes at them one time and start avoiding them.

    1. I know how hard it is to wait when you're worried, but I think your husband is right that 6 months is a better age than 4 months for an accurate evaluation, if one is needed at all.

      Unfortunately for parents' peace of mind, all babies really are different, and they haven't read the books that say what the average baby does! It sounds to me, just on the basis of the information you've given, that your baby is within the normal range of development.

      I am wondering about two things. One is whether you are so worried that it shows in your face, and you can't help staring at her with an anxious look. You might try averting your eyes and then quickly glancing back at her with a smile and away again, as if you were flirting with her. Stanley Greenspan (whose work you might like to read) talked about this age as a time when parents "woo" their babies into a relationship. Of course, how to "woo" depends on what a given baby likes.

      I also wonder whether what you are seeing is a matter of temperament. Some babies have a slightly negative mood quality and seem to be on the sad or unresponsive side when there's nothing wrong. They would also be expected to smile a little less, and to cry a little more easily. (There is nothing wrong with this, it's just a matter of individual differences.) I know you are probably not familiar with a lot of babies, but do you have any sense of this in your daughter?

      You probably know that young babies don't see well when an object is too close to them, but even though she's getting past that stage, you might want to be sure you're not nose-to-nose when you try to interact with her.

      Also, you might keep in mind that babies who sleep on their backs are slower to develop good head control than "the book" says. What's in "the book" is based on information collected from babies who slept on their tummies. That might explain why she seems to respond better when she's lying down and doesn't have to work to hold up her head.

      Is autism what you're worried about? I would say that if she sometimes smiles back, watches people walk around, and cries when left alone, that's not very likely.

      Good luck,and remember, you're not really a mother if you're not worried about something!

  25. Hello. I have a 2 month old daughter who does eye contact occasionally but not always. At times she looks over the shoulder, at the mouth,beside us or through us when we talk to her. Is this normal for a 8 week old baby? When should she be giving frequent eye contact?

    1. Babies don't make eye contact all the time, any more than adults do. If you watch two adults talking to each other,you can see that even though they're very much engaged, they make eye contact sometimes, avert their eyes other times, look at each others' mouths and face and clothing, and so on. Babies and adults both make eye contact as part of their responses to the world, and whether they do can depend on their mood, the appearance and behavior of the other person, whether they're tired or interested, and so on.

      Eye contact is just one part of human communication using the eyes. The eyes are also used for signaling like "pointing" (when we look at something we want someone else to see) and for letting people know we need a little break from intense contact by averting the gaze.

      As your daughter matures and gets better at communication, she'll use her eyes for communication more often, exchanging glances, averting her eyes, or looking toward something interesting and then back at you. She'll also look at your face for information when she sees something new and possibly scary. But you probably won't see a lot of this until she's between 6 and 12 months old. Even then, you won't often see a prolonged gaze into another person's eyes, nor is there any particular need for that to occur.

      If you would enjoy more eye contact with your baby now, there are some things you can try. Be sure you don't stare at her with a blank or serious expression on your face. Try "flirting" with her by looking at her, away, and back again while smiling. She's too young for peek-a-boo, but she may find it interesting if your gaze "comes" and "goes".

      The anthropologist Ashley Montague talked about the first three months after birth as the "fourth trimester" of gestation. Some people have even talked about the first months as a time of "normal autism" when babies don't readily take an interest in things outside themselves. After those three months are over, you'll find that your daughter becomes steadily more sociable and communicative.

      If you're worried that infrequent eye contact in a 2-month-old suggests autism-- no, it does not. If you're worried that she won't be attached to you unless she makes a lot of eye contact, let me just point out that blind babies, and babies of blind parents, attach perfectly well.

  26. I have a 9-month old son and I am concerned about his development especially eye contact. Whenever I am holding him, he never looks at my face when I am speaking to him or in general. He does look at me from a distance but not for long periods of time. What is considered normal eye contact at this age? My main concern is autism but he has been seen by his pediatrician, a neurologist, and early intervention who say nothing is wrong. I still can not help worrying. I know it is not a vision problem because he picks up little lint pieces off the floor. Any suggestions or am I being paranoid?

    1. I haven't seen this baby, so of course I can't know for sure, but I'm thinking he may have trouble seeing things that are too close to him. This sounds silly, because we are used to the idea that near things are easier to see than distant ones, but those of us who are middle-aged or older know that it can be hard to hold the newspaper far enough away to read.

      Babies begin life with vision pretty much limited to things at a distance of 12 to 18 inches from the eyes. Either too far or too near objects are blurry. After a few months, they get clear vision for more distant things, but still have trouble with things that are too near. Like older people, babies can have individual differences in their vision, and it's quite possible that he could see bits of lint on the floor but not see something that's closer to his eyes.

      In addition, when people say that babies make eye contact, they don't mean that they gaze into someone's eyes like lovers in the movies. They use their eyes in much the same way that adults do, using the gaze like a pointer that gets another person's attention or "checks in" briefly. Toddlers may maintain eye contact while they approach a parent, but they break it when they get close, just as adult friends do.

      Does your baby react with fear to strange people or things yet? If he does,you will probably see that he looks toward you or checks your facial expression when something is strange. If he doesn't show fear yet, he probably won't be as interested in looking at your face.

      There are some things you can do in the near future (next few months) to reassure yourself that he is not autistic. For example, you can hand him a transparent plastic box with an interesting object in it and a lid that's hard to get off and see whether he indicates to you that he wants help-- not by grabbing your hand and putting it on the box, but by looking, holding out the box, vocalizing to you. He will also soon begin to use his gaze as a communication when he wants you to look at something-- he'll look at the object, then at you, then back and forth until he gets you to look where he's looking. This will be for communication and fun, not for getting food or anything else practical.

      You're anxious,like all mothers, but I wouldn't say paranoid! I hope the next couple of months will show developments that will make you feel more confident.

    2. Thank you for your response. When you say check-in how often should that occur? When he is playing with a toy it can be difficult to get his attention or when I hand him something he just looks at the object and not me. Usually when he does look at me he is often looking at my mouth while i am talking instead of my eyes. I tried the transparent box and he just poked at it without ever indicating a need for help. I assume that this is to show "joint attention". Does that usually develop around the 10th month (he will turn 10 months on Sunday)?

    3. It's hard to say how often, because you'd really only expect it when something strange or unfamiliar occurs, like being approached by a strange person when out shopping.

      Joint attention usually starts between the 9th and the 12th month. It involves looking back and forth from you to an interesting sight, until you also turn and look at it and indicate that you see it.

      Has he seen the transparent box opened? Does he like or want the object inside it? It can be hard to tell what the child's response is if he doesn't know you can open the box, or doesn't care about getting the contents. But the point is to see whether he will communicate with you when he can't manage by himself.

      Has he had his hearing checked? Do you think he hears well? I'm just wondering whether looking at your mouth is a way of clarifying what he hears. However, both babies and adults do sometimes look at the mouth of someone who's speaking, and don't necessarily look at eyes even when interacting socially with someone.

      If you hide something he likes under a cloth in front of him, will he pick up the cloth in order to get the object?

    4. He did not know that the box opened. I will re-try it later. His hearing was checked by Early Intervention and they said there was no issue. I did read about a study that showed infants between 6 to 12 months shift there gaze more to the mouth than the eyes and then around 12 months focus on the eyes again as a means of learning language. He does look for objects under blankets or for his ball when it rolls under the dresser. The last few days he has started pointing at the lights and the fans and getting excited. Of course, I am holding him so he does not make eye contact while pointing. He has also started clapping during which he will look you in the eye but when you try and sit him in your lap to sing or play patty-cake he will only look for a second and then wants down to go play.

    5. He sounds as if he's doing great! To do the box thing, he would have to know that it would open and that there was something he wanted in it, too. He does seem to be communicating with you. I think you've just been frightened by the idea that babies are supposed to gaze deep into their mother's eyes for minutes at a time. They don't really do that.

  27. Dr. Mercer, Many thanks for your article. My daughter will be 4 months in a week from today. She keeps looking away when we look at her, but she looks at the ceiling and constantly babbles; She doesn't do it with us. We thought she was a sound sleeper when she didn't wake up with all the noises we were making at home, but our doctor asked us to get a hearing screening test done, which came out negative. I have discussed her condition with many doctors, and I am quite convinced that she will be able hear one day with much therapy. But we are more concerned that she is not looking at us. Most of the articles on the internet are really very scary. I have read that 1/3rd of babies with hearing impairments have other developmental issues. Like you say it is too early ascertain if my daughter has other problems, but is there anything that we can do at this early age to prevent those? We are doubly concerned because we live in India, and here, we do not have many agencies that will help us like you do in the U.S.

    1. Dear Vijay--

      I am sorry that you have these worries about your daughter. As you know, because I haven't seen her I cannot say anything specific about her development, but I will try to make some comments that may help you figure out what is happening.

      First, I need to say that I am confused about the hearing test.When you said it was negative, I assumed that meant that there was no problem, but then you mentioned hearing "with therapy", so there must be some hearing impairment.

      If she has an intermittent hearing loss resulting from ear infections, it may be possible to help her hearing by placing drainage tubes in her eardrums until she grows enough to allow her middle ears to drain properly. If there is some more serious problem, though, there may be no effective treatment other than cochlear implants, which can work very well.

      If she has some hearing, she will probably be showing you that in the next few months by increasing her babbling and beginning to babble in a new way with changing syllables ("la-ba-la-ga" instead of just "la-la-la"). If her hearing is seriously impaired, she will gradually babble less. Don't worry if she does not babble "at you". Babies usually babble more when alone or at least not looking at people.

      If you are feeling very concerned about hearing impairment and its effect on her development, you may want to begin learning sign language and using it with her. She won't understand at first and won't make signs for quite a few months, but it may help you feel you have an extra method of communication, and if she does have a profound hearing impairment it can start her early on a very effective type of communication. She can learn to speak as well, but sign can be used much earlier than speech.

      Are you concerned that her avoidance of looking at you indicates autism? I would not start thinking about this just yet. However, I do wonder about her vision. There are some things you can try that may help her look at you. When you want to get face-to-face with her, have one person hold her up,looking over the adult's shoulder, while the other person looks at her from the other side. Young babies are often more visually alert when they are upright and "zone out" a bit when lying down.

      Also, be sure that the light falls on your face so she does not see you as just a dark blob. Smile, look pleasant and animated so your face is interesting to her. If she responds by changing her expression, her movement,or even just her breathing rate, wait briefly and then change what you do a little bit too.

      If she looks away, wait until she turns back to you and then give her a big smile, but don't overwhelm her with excitement.

      When she turns away from you, does she look serious? Does she put her hands together? Does she drool or hiccup?

      You didn't mention whether she smiles at you or not.

      It must be very difficult to know that you do not have many sources of help. If you'll answer some of my questions,maybe I can give you a little bit of guidance.

      Jean Mercer

  28. Many Thanks for your advice Dr. Mercer.
    Maybe I should give you a brief history before I begin asking for advice. We preferred an election LSCS at 38 weeks. My daughter weighed 6.3 pounds at birth but lost about 2½ pounds by the time we came back from the hospital. She didn’t gain the weight for over 3 weeks, and we started her on formula and after about a month she weighed over 1 pound more than her birth weight.
    Since my last query to you, my daughter passed her ABR hearing test. She, however, still does not react even we speak loudly. If we sing to her she calms down when she is crying though.
    She smiles generally but does not smile at “us” per se. The doctor told us that she has a social smile but not smile of recognition. Since my daughter doesn’t have complete neck control, the the doctor wants to see her regularly for the next few months. One area of concern the doctor had was that my daughter has deep-set eyes. We tried to look for symptoms of 1p36 and Down at home from whatever we could information we could get from the internet, apart from the deep-set eyes we could not find much that matched with those symptoms listed on the internet. Now my daughter weighs 13 pounds, so it may be that her eyes look small because she is very chubby. Either way, we just have to wait to figure it out.
    We have been waving bright objects in front of her, she follows it for a couple minutes, she doesn’t make an attempt to grab them. She woke up once while she had just slept when the door banged. This apart, she has not met any of the other milestones that a baby her age would have touched. We are meeting the doctor this Friday. I cannot thank you enough for trying to help us out.

    1. Dear Vijay-- I can see why you are concerned, but keep in mind that you should be calculating her milestones from 40 weeks gestational age, not from her birthday at 38 weeks. If she is 4 months old, that two week period is one-eighth of her lifetime, as one year would be for an 8-year-old.

      She certainly had a rocky beginning. I am wondering whether the weight loss and slow but complete recovery were due to poor sucking, or the breastfeeding difficulties of an inexperienced mother,or both. But she is apparently sucking well now-- is this with a regular nipple, or do you have to use a special one?

      I am not surprised that she does not reach effectively yet, but I would expect her to flap her hand or move the hand toward an object that interests her. Keep in mind that even if she reaches at this age, she will not yet be able to reach her right hand across to the left side of the body or left hand to the right.

      Is she sleeping in the prone or the supine position? Babies who sleep supine usually take longer to get good neck control than the norms indicate.

      Also, I am wondering whether she still shows the Moro reflex strongly. This means that when you hold her on her back with her head supported, then suddenly move her downward, she throws her arms out as if clutching for support. Looking at this is just a way of seeing whether her development is following the usual trajectory. Ordinarily the Moro reflex has weakened a good deal by 4 months.

  29. hi,

    i discovered my aunt's son, aged 16 months always looked up at the ceiling and sometimes he will bend his neck really backwards just for the sake of looking up. sometime in idle state, his eyeball will move up to the right corner of his eyes then follow by the entire head and this happened very frequently. is there anything wrong with the baby? my aunt insisted her baby is ok and its normal for baby to behave like that.

    1. Of course, I haven't seen this baby and know nothing else about him, so I can't really answer your question. However, I would suggest that if this happens frequently, I would begin to make notes of when it occurs, and to ask the pediatrician's opinion at the next well-baby visit. I'm not suggesting that this is an emergency, but it might be a good idea to rule out any possible problem, and because this behavior will probably not happen at a time when the doctor can see it, a record of observations would be helpful.

  30. Hi Jean.

    After reading your previous answers I feel more at ease. As a first time mum Autism seems to be something I constantly obsess about. My son is 9 months old and does make eye contact regularly but has never particularly enjoyed making eye contact with someone who is holding him. He is pretty social and babbles away... he loves to clap his hands so that ill sing a song for him and waves hello (we are still trying to teach him that a wave is for bye bye aswell haha). He is now also starting to offer kisses which makes me feel very loved.

    I am however ALWAYS worried about something with him. When he was younger he used to use a scrapping motion (open and closed hand and fingers) to feel things, this has faded away since he's learnt how to crawl tho but still happens sometimes. He also loves toys that he can flick (ie beads of an abacus) but i wouldn't say that he is obsessive about it as he will only do it for max one minute.

    Am I just trying to convince myself that he is fine?? Should i take him to be evaluated? I dont want to delay treatment if something is wrong :(

    1. Dear Sarahh-- the first thing to learn is, being a mother is all about being worried! When this particular concern is past, there will be plenty of others to keep you fretting. It's always a balancing act between ignoring or denying problems and obsessing about them.

      As you know, I've never seen your little guy, so I'm not in a position to say anything definite. However, I'd be astonished if anybody so sociable was autistic (but there is a tiny chance of later regression to an autistic condition for a few children who are evidently normal earlier).

      Don't forget that autism is a form of developmental delay. This means that autistic children continue to act in some ways that are normal in early life for typically-developing babies. Normal babies will flap their hands when excited or when they want something and will toe-walk when they first start to walk (the extended ankle helps stiffen and stabilize the foot). They also tend to be fascinated by flickering or moving things -- otherwise why do we give them crib mobiles when they're tiny? When they begin to master their hand control, they like to poke things with the index finger, but before that they pick up using a scooping motion that gets the object into the palm.

      Everything you describe is part of the behavior of a typically-developing child of his age. Only if these things persist for many more months, or if he goes beyond them and then starts them again, would anyone think there was any need for evaluation.

      I won't say not to worry, which would be silly advice to any young mother. But do just go on having fun with him, which is the best "treatment" you could possibly do.

  31. Hi Jean,
    I have a 8 week old baby that doesnt make eye contact and doent track objects often. He seems to look to nowhere and lights. He does coo and smiles when i talk to him but not at me, lokling aways.
    Im very concerned this could be early signs of autism. Could you let me know what else it could be for my baby to be so uninterested in this world?

    1. Yes, I do think there could be something else-- just being 8 weeks old!

      You speak of his being "uninterested in the world", and this is so typical of this age that in fact years ago some authors referred to this period as the "autistic stage", meaning that the child seemed to be interested primarily in what went on inside himself. Some people also referred to what happens after 10 or 12 weeks as "hatching", when the child begins to come out like a chick out of the egg. The anthropologist Ashley Montagu talked about the first three months as "exterogestation", a time when babies were still developing as if they were in the womb-- but because of our large human heads they had had to be born already.

      You could try to make sure that the light is on your face when you want to encourage him to look at you. Also, you can try "looming" by bending toward him while you open your eyes and mouth wide, then backing away while you close them. This sometimes gets a baby's attention. By the way,he doesn't need you to do anything like this, but you might like the response.

      I would say to give it several more months before you start being so concerned about possible autism. Remember that he's not going to gaze into your eyes in any case. Also, keep in mind that of babies who are diagnosed with autism early (12 months, say), many of them are developing in a more typical fashion a year later.


  32. Hi Jean,

    I have a nearly 7 month old ( 5 months corrected) that was born at 32 plus 4 weeks and also small for gestational age.

    I have been concerned for him since the get go ( of course being in the NICU didn't help) . He is doing well with his growth, though still on the 3rd percentile and our Drs all seem happy with him and his development. He is reaching for objects, hands in midline, can hold head steady, smiles,laughs, no head lag etc.

    The thing is he has had strange eye contact issues from birth ( there are some vision issues involved with ptosis of the left eye and possible nystagmus although this has not been confirmed yet, only questioned by the ophthalmologist ) . Anyway we can get eye contact out of him, but we have to really work for it and it seems to be better when he is laying down and is some distance away from us. The thing that really worries me is that he is constantly staring out of the corner of his eyes to both sides ( can be a sign of autism?) and the nystagmus also seems to be more pronounced when he is doing so. He rarely stares straight at you when being held facing you. I have asked a couple of paediatricians about this and none seem concerned since he is reaching most of his milestones ( except rolling- only starting rolling consistently last couple of weeks belly to back) but I have to say it is starting to really concern me. I don't think I would be concerned if he wasn't staring out the corner of his eyes so frequently. Any thoughts?

    1. Dear Anon-- I don't think it's silly for you to be fretting about the possibility of autism, because you do have some risk factors there. However, my bet is that the ophthalmologist is going to be the one to answer the question. I am thinking that the problems with control of eye muscles, as shown by the ptosis and possible nystagmus, may be a big part of what's going on. I also wonder whether his looking out of the corners of his eyes may be a sign of difficulty in seeing with the central area of the retina, and he may turn the eyes so the image falls on the periphery rather than the center-- this would give blurry vision, but might be a better choice than a central area that didn't function well (which could happen either because of direct damage, from oxygen for instance, or damage to the brain areas that receive messages from that part of the eye). I know what you mean about autists doing a sort of peripheral perception, but there can be other reasons for the way he uses the eyes.

      I also wonder whether he seems to do better when lying down because in that position he doesn't have to adjust head and eye movements to each other-- even though you say he has good head control, if his eye control is not as good, the combined task of head and eye control could be too difficult at this stage.

      Do you see more of the "looking out the corner" when he has to hold his head up too?

      Also, did he have any brain bleeds? And was there any explanation for the size for gestational age?

  33. Hi Jean, thanks for the speedy reply.Yes I do see more looking out of the corner of his eye when holding his head up. He has moments of good eye contact when I am feeding him his bottle. I was intending on asking the ophthalmologist when I see her next but unfortunately that is not till early next year so a long time to wait. You have raised some good questions though- I do believe that nystagmus is also associated with sideways looking but without a definitive diagnosis is hard to tell. No reason has been provided for the small for gestational age at the moment. We have been through all the genetic tests and they haven't found anything yet, my Obstetrician thinks it was placental insufficiency. He also had quite a few head ultrasounds and no brain damage seemed to have occurred, although without an MRI there could be some things missed. All up been a stressful experience, but I am so happy that he is alive and doing pretty well by all accounts. I know it could be much worse, the possibility of autism does very much concern me though perhaps more than other developmental issues we may face.

    1. You certainly deserve to feel stressed out and hypervigilant after going through all this. However, it really is too early to diagnose autism, and from what you say the "disconnection" is pretty situational. You mention using the eyes well when he's sucking-- that's really a good test, because sucking helps him organize behavior that may be a little more than he can easily handle at this point. Do keep in mind that an "autistic" or "inward-directed" phase is a normal part of early development, and the word "autistic" actually used to be applied to that period rather than to later developmental delays.

      Wish I had a crystal ball to tell you the future-- but it sounds as if you're doing the best things to ensure good development at this point.

  34. Hi Jean my son is a week shy of six months old, he was born 3 weeks early I went into labor due to excess fluid, but that wasnt known until they did the emergency c-section. He has head lag and can't sit up without support, meaning he would fall towards his legs without using his arms for support or will fall backwards and his arms open wide to his side if he feels himself falling backwards. During tummy time he can hold his head up for hours move his arms to grab for toys but he still doesn't push up with his arms, if he he does it's only with his forearms. I try to keep his attention when pulling him into a sitting position, what worries me is as soon as he feels me pull his arms even if it's not enough to get his head off the rug he pulls his head back with his chin to the ceiling and just stares off. If I can keep his attention long enough he will pull up somewhat but otherwise his head would just hang. My ped wants to see him back in a month. His head is above average for his age but so was my first sons. He is social, cooing, grabbing everything, puts toys in his mouth, but when it comes to sitting or trying to stand he is more like 3 month old. I didn't think anything was abnormal until the doctor brought it up at his appt. Unfortunately Google has put me in a panic and I feel overwhelmed and have no idea where to start. My ped seems to be all over the place with his concerns. I just don't know where to start and with this not being a concern until an appointment for a cold I feel like I should of noticed something before this. Any insight would be greatly appreciated, I know it's a small amount of information but with all the things it could be causing the head lag and other delays I'm not sure what's important to look for and what's normal. Thank you in advance for any insight- Kristine

    1. Dear Kristine-- not having seen the baby and not being a medical doctor, I can't really say exactly what's going on here. However, what you describe sounds as if some of his reflexes are still what you would expect in a much younger baby. When you try to pull him to sit, it seems that either his head lags or he actively holds it back. When he feels as if he's falling, he displays the Moro or startle reflex which is usually pretty much gone by his age, even if we use a corrected age of 5 months.

      The sociability and grabbing and mouthing are all excellent signs that a lot of really important things are going right, but the movement problems need to be investigated. I would suggest that you ask for a referral to a pediatric neurologist. It may be that there is some nervous system damage affecting his motor ability, and/or he may need to be treated by a physical therapist if it's a matter of muscle weakness in specific areas. You don't mention any sucking or feeding problems, and if there are none that's very good. But this is a good time to begin treatment if he eneeds it in other areas.

      Good luck, and I would be very interested to know what you find out. I hope you live somewhere where you have access to the specialists you need.

  35. dear..dr,,im first time son 7 week old..he's not eye contract while nurse. and he's not look at me when im talking.but hes smiling and talking babies calander.
    im so worry about this.plz help...

    1. Young babies usually don't make eye contact while they are nursing. I would expect another month or two to pass before he begins to respond in the way you would like. Meanwhile, just keep talking to him, and try not to worry!

  36. Hi, this was very informative. I have been googling about infant eye contact because although my three month old makes good eye contact with me and people he is familiar with he avoids it at all costs with other people while he is being held. For example I'll be holding him while we are out and about and someone will try to get his attention and he actively avoi

  37. Oops it might have entered too soon - so my question is, is it a red flag that my three month old avoids looking at strangers. Everything I read says infants are supposed to be interested in faces and although he's interested in mine, is this a red flag? I hope you answer, I've been quite neurotic about this. Thank you!

    1. Three months would be unusually early for the normal development of preferring familiar over unfamiliar people. Could he be avoiding because they stare at him or because their expressions are serious-- rather than because they are strangers? It's generally true that babies like to look at faces, but even at this age they will be disturbed by and look away from a staring "still face". In any case, I don't see this as a "red flag" at all-- I think you must be referring to autism here?

      Just wondering, how does he actively avoid? Just moving the gaze somewhere else,moving the head ? I'm only asking out of interest, not because these are symptoms of anything!

  38. Thank you so much for answering! I've just come back from lunch with our family and have been observing and am now really concerned. Basically anytime anyone tries to look at him he avoids by turning his head side to side or he will actively focus on something else, like their striped or colorful shirt. If the person holding him tries very hard to get him to look and gives it time he will but not for long. It's definitely worse when he is tired and worse when there are a lot of people around (like in a busy restaurant.) I first noticed this when people would come up to him and try to get his attention and he would avoid them. The other reason I'm worried is because everyone says what a good baby he is and that always comes up as potential cause for concern too (which makes me sound crazy when I worry that he's too good).

  39. Sorry - the comment box keeps stoping me from typing before I'm done. But yes, autism has been my concern ever since I found out he was going to be a boy thanks to all the rising scary statistics and I feel like I've been scrutinizing him since he was born. So the fact that he's "good" and doesn't interact with people accept under certain settings worries me. To add color, he's pretty smiley and has been laughing for a few weeks (although its a pretty weird pterodactyl type laugh). I would just love to stop analyzing and enjoy this time more so I really appreciate your input!

  40. This does not sound to me like any known sign of autism. My guess is that he just wants to be able to see what's going on when there's a lot happening. If you feel you must DO something, you could ask for his vision to be tested... it may be that he's not seeing close up as well as he might.

    As for being "good"-- do you mean he's not demanding, or that he doesn't cry much? I understand your concern, but there are a lot of individual differences that are perfectly normal.

    Actually I'm more worried about your level of anxiety. Do you have anyone to talk to about your concerns? I don't mean that I think you're doing a bad job, just that you might feel more comfortable if you had more back-up than you seem to have. However, I don't think most people really enjoy this stage of life, except that the baby is so adorable when asleep! In retrospect, they might think they enjoyed, it but they were probably quite tense and anxious at the time.

  41. It's funny that you mention my level of anxiety - I was just talking to my husband about this and its really a problem. I am going to look into getting support. As for my little guy, I'm actually starting to think it really is a coping mechanism for him when he's overstimulated. When we are out, usually in overwhelming settings is when people try to come up to him and engage and he looks at everything but them. When its calm and he's not tired or hungry is when he will engage with us. Anyway, what I mean by "good baby" is that he rarely cries and fusses. He sits in the bouncer during dinner and is fine, doesn't fuss when being passed around, and in general doesn't need a lot of soothing. He cries when he's hungry or a loud sound startles him but other than that, he's very peaceful. I just want to thank you again so much for responding. I love your blog!

  42. This sounds like a very sensible analysis and a sensible decision on your part. Thanks for writing, and good luck with the "good baby"!

  43. Hi Jean,
    I am first time mum and I am so much worried about my 9 week old son (he is full term baby).
    He never made an eye contact yet with anyone, not even during nursing. He does smile a lot and coo at photo frames and window shades but he never smile at people and he always like to look at light coming from window. When I try to bring my smiling face near him, he just turns away.
    I don’t see any hearing or vision problem with him as he is more alert towards even a small noise and he tracks people who move around.
    Is he showing signs of autism? I am so much worried.
    Awaiting your reply.

    1. Swathi, I think your baby is still too young to be making eye contact or smiling socially. Babies this young usually just close their eyes and suck furiously when they are nursing, then fall asleep when they are full.

      When you bring your face toward him, shadows on your face may make it too difficult for him to see that it is a face, so he looks for something brighter to look at. I know it seems strange to think that it is harder to see something close than something farther away, but that can be true for babies.

      I think you will probably notice him smiling socially in the next few weeks, but at the beginning he will not do it every time he sees a smiling face. If you want to try to make him smile at you, make sure there is bright light on your face. You can also try moving your face toward him while you open your mouth wide and then away while you close your mouth-- sometimes this gets their attention.

      It's not really important that he "gazes into your eyes", now or later. What will be important months from now will be that he looks at people's eyes in order to see what they are looking at or where they are about to go. Human beings use eye movements to signal our intentions, and that's what babies need to learn about-- but not as young as your baby is!

      Good luck, and I really don't think you need to worry at this point!

  44. Dear Dr.,

    Thank you very much for posting these articles about the eye contact. My daughter will be 8.5 months within a week and we also have some problems with her eye contact.

    She doesn't look at my eyes if I am holding her close, -face to face-, for example in my arms. Only of I sing a different song then she tries to look but it looks like she cannot hold the eye contact, she wants to look but she somehow cannot, something is stopping her. Because while she is in my arms, if I am talking to someone else, she is looking at my face for sometime. I turn back to her and look into her eyes and immediately she turns away.
    Her eye contact is better when she is lying on the floor, she can hold it for as long as 10 seconds. Also she is watching me when I walk in the room around.

    She also doesn't imitate anything we do, doesn't babble, she did it for sometime around 5-6 months then stopped, then started with bababa two weeks ago and stopped again. She only screams, blowing raspberries with a tongue sound or making gggggg sounds from the throat. No letter!

    She also doesn't look at where I look or where I point. She cant sit on her own still and our doctor tells us not to teach it until she can sit up by herself. She also cant put weight on her legs. No crawling. Just rolling.

    Still, our developmental pediatrician says it can still be fine because at this age they just check basic things like, if she is taking a toy in her mouth, responding sounds...For those things, she looks ok.

    I can imagine that it is hard to diagnose with anything but waiting is so painful for a first time mom.

    That is why after reading your article I am hoping that she will show some joint attention in a couple of months. She just looks at me when a stranger holds her for the first time, if I am smiling, she smiles back and then looks back to the stranger.

    As to the peek a boo, she smiles back mostly, sometimes laughs if she is in the mood. She doesn't laugh out too often, but the only game makes her laugh hysterically is when my husband hides behind the couch and pops up from different sides of it and their eyes meet.

    1. Dear Anon-- you shouldn't expect a prolonged mutual gaze-- she looks at your face to check whether you think that stranger is okay (this is called social referencing), and she plays peek-a boo-- these are social communication skills that are very important, and she has them right on schedule, or even a bit early. What she is doing at this point is certainly not autistic behavior.

      She sounds a little delayed in motor skills, but not much more than lots of babies who have slept on their backs. Have you been doing plenty of tummy time? I wrote about a program to help babies at You may want to try doing some of these things. She will most probably eventually catch up on the motor development anyway, but it's possible to work on it.

      It sounds as if she is experimenting with sounds she can make. There is a lot of variation in normal language development, so it's early to tell what's happening here (I know, I know, you're really tired of hearing that). I would be very careful that she has little or no screen time at this point and that she hears you speak most of the time against a quiet background-- also, that you talk a lot to her,just chattering about what's happening. I don't know if it really makes a difference, but I tend to think that young mothers shouldn't talk on cell phones a lot around their babies-- let it be obvious to her that making sounds with your mouth is something you do together with another person.

      She sounds like a fun baby, and it's my bet that the motor stuff is just because of positioning experiences. You wouldn't think off the top of your head that lying on the tummy is so important to development, but it is!

  45. Hi. My baby is 4 months old in a few days. He was born 10 days earlier. My concern is his eye contact. He only makes eye contact when laying o floor and this doesnt happen always. Even when i speak to him he doest look at me. He can hear because he passed his newborn hearing test and he can open his eyes wide because of loud noise.
    When i smile at him he can smile back but not always. He can talk back to me but not always. I am worried about autism. When i hold him hi avert his eyes all the time. Never make eye contact while i give him a bath. He can track objects quite well. When somebody is holding him over the shoulder he constantly looks down.
    He also have eye streptoccocal infection since birth. One eye is fine now.
    He doesnt grab for toys yet.
    Could this be something like a vision problem? Or
    last thing is that he has tummy problem since birth like bottom.has and he is crying a lot because of that.
    I am very worried.

    1. Dear Katarina-- I think your first concerns need to be with his medical problems. If one of his eyes and his tummy are quite uncomfortable and he is crying so much, he is not likely to be very interested in looking at people.

      But also, remember that when you hold him your face may be too close for him to look at easily. The facts that he sometimes smiles at you and sometimes talks back to you are very good signs. You can't expect him to do these things all the time, especially if he is not very comfortable.

      Passing the newborn hearing test means that he could hear at that time. It doesn't guarantee that his hearing will always remain good.

      Given that he is uncomfortable a lot of the time, it sounds to me as if he is doing well developmentally. If I were you, I would just try to get him more comfortable and smile and play with him when he seems calm and relaxed. It will be many months before the way he behaves could be seen as an indication of autism.

      I think things will probably look better to you in six months!

  46. Hi! I am very worried because my baby (3 months) doesn't look at me while eating; she doesn't want to be in my arms or anybody's arms; she sometimes avoids eye contact when I try to force her. When she is in her bed she makes eye contact and sometimes she smiles (sometimes it is easy, sometimes it is hard), but it seems that she doesn't want to maintain her space. Moreover she babbles a lot interacting but sometimes she babbles the same sound alone putting her hands in her mouth and licking them. Is she autistic?

  47. I forgot to tell you that the birth lasted 49 hours (25 with the oxytocin) and finally they used vacuum. Ah! She does not reject being carried in a vertical position. She hates the normal baby position. Thank you, I am so worried

    1. Dear Anonymous--

      You probably know that autism cannot really be diagnosed until a baby is a year old or more, but I'm sure that after your very uncomfortable labor and delivery you are worried about a lot of things.

      Your baby sounds to me to be perfectly normal for her age. Many babies do not like to be held in a horizontal position, and I think that's especially true for babies who sleep on their backs. Liking to be in the vertical position is very common, and you can see why they like it because it helps them look around better.

      No baby likes to have eye contact forced. If you stare at them, they will usually avert their eyes.

      Also, babies this young usually close their eyes tightly when nursing or bottle-feeding. It's not for many more months that they look much at their mother's face while feeding, and even then they are likely to put their fingers into her mouth or up her nose rather than pay so much attention to her eyes.

      Babies actually babble to themselves when alone more often than they babble to other people.

      Mouthing her hands is very normal and helps her develop the hand-mouth coordination that she will need to feed herself and that will develop into hand-eye coordination.

      Of course I can't promise that your baby will never have a developmental problem, but so far I think she sounds very healthy. Best wishes to your family!

  48. Thank you so much! I wanted to say that she wants to maintain distance (I wrote the contrary). you have made me understand a lot of things.
    Thank you so much!!

  49. Hi jean .as i'm reading a lot about child development and babies have to be interested in faces and specially eyes . my son turned 8 weeks yesterday. As everything in the internet looks like he had red flags or signs of autism . As he doesn't show much interest in faces . Actually he will look every where ruther than faces . It breaks my heart while his father trying his best to catch his gaze or even make him look at his face . He looks at my little brother sometimes and even smile but i'm not sure if he is really looking at him also my sister he give her big smiles when he put him on her knees . Actually he hates to sleep on his back on my knees and on my mom's too . Also he cryes when i put one hand under his head and look straight at his face . He seems like he is pushing me away from him also while breastfeeding sometimes he look like he is looking at something scary on the windaw with his eyebrows up and crying with getting far of me . Maybe i have to mention that he had bottle for three time cause it was hard to me to feed him that my nipples hadn't show up tell using the bump. He doesn't look at me and my hasband while we are talking to hin. He is cooing with full of joy and smiling moving his arms and legs looking at every thing else in the room but us . He can hold his head up and i feel like he try to get it away from my chest or shoulder . He likes to be held steady like when burping him rather than on knees . Also i want to mention that he doesn't seem like he is responding to noise while sleeping . I even tried to shout . I know that i'm looking so crazy concerned new mother . But honestly sometimes i feel like he is really autistic and i'm crying a lot feeling sad for him and his father who loves him so much and ask a lot about when will he be talkative and talk with me and play with me and i'm concern that he will not be able to. I think he is not having hearing problem because once when he was crying his father played drums and he just stopped with focusing and flinching eyes . He looked so cute and funny cause when his father stopped he started to cry and when he start again he did the same stopped crying and flinching his eyes. I catched some smile and he looking at me sometimes mostly in the car but also i'm not sure ! I moved my head in front of him and he doesn't seems like trucking not sure if my worries who make me see everything as a problem i just feel like he will be diagnosed with autism !! . His father family have few diagnosed with autism and the internet seems like hill to me with a lot of websites about red flags of autism. I know that there is nothing to do in his age even if he is really autistic ( hope not ) . Wait and see is also very hard . I tried to move things in front of him and he was trucking . But when i do it a lot he looks away to the closet or anything else in the room . I know that i've wrote a lot with no organized but am really worry waiting for your respond even if it will hurt or not. Sorry for bothering you ..

    1. Dear Fatima--

      Yes, it is very hard to wait and see, I know that. But you will not help yourself or your baby by spending so much time worrying about red flags that you read about on the Internet!

      His behavior is still very much in the normal range. Some babies look at faces and eyes a lot by this age, but many do not for several more weeks. Even when they begin to look more, they do not look for a long period of time the way adults do.

      I know it seems strange to you that he does not wake up when there are loud noises, but this is very common with young babies. I remember that one of my own children slept for hours while his father used an electric saw to cut some wood in the same room with him!

      When he seems to push away from you, I think this is probably a matter of trying to keep his head and upper body under control. It is not a sign that he does not like you.

      If a baby looks away from you when you are moving your head or other things in front of him,
      that is his way of showing that he has had enough of that for a while. Give him a little break and see if he looks back at you again. Some babies are easily over-stimulated and need to have a rest before looking at interesting things again.

      I think that in another month or two you and your husband will find your baby much more playful and responsive to you than he is now. You know, years ago people used to call this stage of a baby's life "autism" because the babies seemed so uninterested in anyone else. They thought of this as a normal stage of development, and it is normal, but we don't call it autism any more.

      I am sure it did not make the slightest difference to the baby that he was bottle-fed three times. Bottle-fed babies are not any more likely to be autistic than breast-fed babies.

      Really-- try to stay away from those scary red flag sites, and tell me in another month how the baby is doing! Best wishes!


    Unfortunately, i couldn't stop searching about how was the autistics while they were babies . As my cousin whose my hasband's brother is an autistic and his mother told me that he was called as ( the good quite baby) as my baby called who is rarely cry and sleeps a lot ! Other people said this about their autistic children while they were babies . Also many talked about staring at the light and no eye contact ! I'm feeling so low. Can't enjoy my time with my baby ! I don't know if i have to share my concern with husband or not otherwise he loves the baby to the fullest and there is no really anyone can make sure diagnosed and therapists to him now if he has it . I know that early catching make a big different but when they can actually give an actuall diagnose and therapies the earliest ?! And where? when and how to tell my hasband about my concern ? Will i live with this stress tell he become one year or above ? What to do? I try my hardest to enjoy my time with my baby singing and talking to him and as he shown that he is more interest in everything in the room and act like i'm not around is killing me .

    1. Dear Fatima-- if I were you, I would tell my husband about my concerns. He has met autistic people, and he may have exactly the same worries that you have and not be able to voice them. If the two of you can talk about this worry you may both feel much better. I don't think he will love the baby or you less because of knowing your concerns.

      I think the biggest problem here may be your own anxiety and depression, which prevent you from enjoying your baby. Is there a religious leader or other counselor you could talk to about this? Or can you go back to the doctor who delivered the baby and tell how you are feeling? Obstetricians are often trained to recognize young mothers' distressed moods and to find ways to help them.

      A baby of two months old is not really "interested" in his mother. He needs you, but he does not know that. In another month or two he will begin to find you interesting! Meanwhile you need to just go on acting as you are, singing and talking, so that when he is ready to take an interest you will give him something interesting to see.

      And let me just suggest once again: talk to your husband; talk to your religious leader; talk to your doctor. If your fears are justified (and I am not saying that they are!) it will be good to have all the information and help these people can give you. But if this is primarily a matter of your own emotional state, you need support right now.

  51. Hii sir my 9 month old son not propereally eye contact. When he born he is not cry after 6 day he started to cry. Every doctor say his brain damage so all activiti was late. My son is not eye contact, not sitting, not standing. So what happens in future sir please replay me

    1. Dear Goswami-- please ask your doctor if there are any early intervention services available where you live. Your baby needs a lot of extra help to try to overcome some of the damage that was done. Try to keep talking to him, touching and playing with him as much as you can, even though he does not seem to pay attention. But he does need professional help, and you will not be able to do everything he needs by yourself.

      My best wishes for his improved condition!