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Sunday, July 17, 2011

Eye Contact With Babies: What, When, Why, and How





When I look at the statistics Blogspot gives me, I see that day after day, large numbers of people end up at this blog when they Google questions about babies and eye contact. Parents are obviously worried about this issue, and that fact is confirmed by the existence of quite a few websites that give instructions about how to get your child to make eye contact more often. But what are the facts about all this? Can you get your child to increase eye contact? Do you need to? Why are we concerned about this matter at all?

What is eye contact? The term “eye contact” might be better replaced by “mutual gaze”, because of course there is no real “contact” about this common human action. In mutual gaze, two people’s faces and eyes are aligned so that each set of eyes is gazing at the other set. This is often very brief, although it can also be maintained for seconds at a time. Mutual gaze may also be performed in a sequence of episodes, for example as two friends approach each other, joining and breaking gaze along the way, stop and briefly engage in mutual gaze, and finally avert their gazes slightly while talking. Prolonged mutual gaze may indicate deep emotional involvement-- but it can be either a loving look or a hostile or frightened stare, depending on the context and the rest of the facial expression. Mutual gaze has a terrific communicative power for human beings, but it can have more than one meaning.

When does eye contact happen? From birth, babies are interested in looking at faces and especially eyes, and do this so carefully that they can and do accurately imitate facial expressions in the early days of life. Nevertheless, most new parents find that it is quite difficult to get a sense of mutual gaze until some weeks have passed. At about 4 to 6 weeks, as babies begin to do what used to be called “taking notice”, they start to look more responsively at people who are looking at them-- especially if the adult does something attention-getting like opening eyes and mouth wide and “looming” closer to the baby’s face. Soon, the baby smiles in response to a smile, and maintains a mutual gaze with a friendly adult (familiar or unfamiliar). If the adult looks blank or “stares through” the baby, though, the latter will avert the gaze, appear uncomfortable, and begin to cry. The baby expects the adult to “manage” his or her gaze in a way that coordinates with the baby’s gaze.

By about 6 months, babies begin to look toward an adult’s face and eyes for “social referencing” purposes, not for eye contact in and of itself, but to get information from the facial expression and the direction of the adult’s gaze. This information guides the baby in understanding the environment and knowing whether unfamiliar things are worrisome, neutral, or pleasant. The baby continues to pay attention to the direction of people’s gazes and between 9 and 12 months begins to show “joint attention”-- using the gaze as a “pointer” to show someone else where to look, and following another person’s gaze to see an interesting sight. These are not examples of mutual gaze, but they are other forms of communication that may emerge from mutual gaze.

It can be hard for an inexperienced parent to know whether a baby makes eye contact soon enough, long enough, or often enough. Anyone who expects prolonged mutual gaze many times a day from the time of birth is bound to be disappointed and frightened. The earliest eye contact events are fleeting, and even at 2 months the baby may not pay much attention without a good deal of adult effort. Mutual gaze during breastfeeding is not likely until the child is old enough to pause in sucking and look around, or let go the nipple temporarily and move the head-- perhaps 5 or 6 months of age.

Why is eye contact important? Mutual gaze is an important form of communication that conveys information both to the baby (“hey, people are quite interesting and pleasing”) and to the adult caregiver (“oh, my baby’s looking at me-- this feels so good-- he thinks I’m important and interesting”). It may be the foundation of other uses of gaze and other gestures for communication.

Looking at whether young children engage in mutual gaze can be a helpful way of understanding whether their development is typical or whether they have certain special needs. One of the best-known aspects of autism is the infrequency of eye contact. Individuals with Asperger’s syndrome, a disorder related to autism, may say that they dislike being looked at and find mutual gaze very uncomfortable. Persons with Fragile X syndrome are also known for their poor use of the gaze in social communication.

When people avoid looking at other’s eyes, or when they are simply inattentive to gaze information, they can miss much other information too. If an adult uses a word a child does not know, for instance, the child can often make a good guess by watching the adult’s gaze, to see what he or she is looking at. When a child also has poor language development, as is common in autism, the combination of underdeveloped language and of lack of gaze communication can make for serious difficulties, the appearance of deliberate noncompliance, and frustration for both child and adult. These facts all suggest that if a child is really not using mutual gaze or other gaze information, helping him or her gain those skills would be a valuable achievement.

However, it’s important to realize that increasing mutual gaze is not a way of increasing the child’s emotional attachment. Toddlers are more likely to engage in mutual gaze with people they are attached to, but increasing gaze episodes does not make them attached. Blind children become strongly attached to their familiar caregivers just as sighted children do; attachment is a very robust developmental phenomenon that involves hearing and touch as much as, or instead of, sight. Mutual gaze may have its strongest effect on adults, who are much influenced by the child’s gaze and feel a sense of emotional contact when exchanging gazes, so it’s possible that increasing mutual gaze can have an indirect effect on children through its influence on their caregivers. However, of course, blind parents also have strong emotional involvements with their children; they too can use other sources of communication to develop these intense relationships.

How to increase mutual gaze? I notice on several websites a variety of instructions for improving eye contact with children. These include wearing funny glasses (something like this was suggested by Nikolaas Tinbergen 40 years ago), playing games based on prolonging eye contact, and giving the child sweets while maintaining mutual gaze.

Whether these methods are a good idea depends in part on whether the child really does show too little eye contact for his age and situation. This is a point on which most parents need professional guidance. If the parent’s motivation comes from the belief that more eye contact would cause better attachment, and especially if the parent believes the child is poorly attached because he or she is disobedient, there is certainly little point in doing any of these things.

However, if the child is being treated for a developmental problem that is characterized by poor mutual gaze, the parent may already have received some training in rewarding eye contact or may at least be aware of how the behavior therapist works with this. An article that describes one method is to be found at (Hall, S.S., Maynes, N.P., & Reiss, A.L. [2009]. Using percentile schedules to increase eye contact in children with Fragile X syndrome. Journal of Applied Behavior Analysis, 42, 171-176). Similar work can be done at home, but it needs to be carefully thought out beforehand.

**** Readers, if you accessed this post in a search for current work on 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. Dear Dr. Thank you very much for these interesting articles. I'm an Italian mum of a toddler and a six month old baby girl. I'm really concerned about my second one who's very different from the first. I don't know whether it's a matter of temperament or a serious issue. My concerns are: 1. she gives me little eye contact when I'm close or I'm holding her (if I sit her on my lap in front of me she just looks in every direction but my face) 2. she used to smile a lot to faces until the fourth month, now it's more difficult to get her to smile 3. she does not respond her name most of the times and when she does she just gives me a glimpse and then goes back on what she's doing. 4.she does not always seem interested in people 5. she tends to look downwards. 6. she screams, goes "aaahh" and sometimes she cooes, I can hear some consonants but no babbling yet. There are some things that make me hope: 1. when I enter the room she smiles 2. she looks at my face for a longer time when I'm not too close 3. most of the times she enjoys "pick-a-boo" 4. she doesn't point to objects yet, but when I hold her, she reaches her arm out in the direction of the object she's interested in. 5. if her sister is around she is constantly looking at her moving. I mentioned my concerns to my ped but she said it's early to get worried. (according to what I have read, here in Italy we are far behind as far as intervention on children that show "red flags". Sorry for the long post, my questions are: Is there something I can do to work on her eye contact issue? Are there any signs i should notice in the next few months? should I take her to a specialist instead? thank you in advance. Hope you'll have time to answer my questions.

    1. Dear Laura-- when a second baby seems a lot different from the first one, it's very hard not to think that the first was "right" and the second "wrong". But they may just be different. After all, the second child is really born into a different family than the first, because the second gets experienced parents and a lively and interesting sibling.

      About your concerns: although by 6 months she can see clearly at a much greater distance than she could at birth, it may still be much harder for her to look at a face that's near-- also,the face may be in shadow, or (because you're getting concerned) it may have a serious expression that is not attractive to a baby.

      Up until the fourth month, she was just smiling at a pattern. Now her smile is much more social and has to do with the whole interaction, not just a facial expression by itself.

      Six months is about the earliest you'd expect her to respond to her name, and if she's busy and interested in something she may not be easy to distract unless she's learned that someone calling her name is followed by fun. I wonder if she's non-distractible in general, speaking of temperament? This can be a great characteristic in older children and adults, but can be more problematic in infants and toddlers, who want what they want and are hard to distract from it when they can't have it.

      You say she doesn't seem interested in people, but she's watching her sister all the time? I'm not sure what you mean here.

      Tending to look downwards-- is she sitting alone, or propped up? Looking down can be part of balancing as a baby develops sitting skills. What is she looking at? Is it her hands or her body?

      No babbling: this is a tricky one. It's been demonstrated clearly that first-born and later-born children tend to have different characteristic patterns of early speech, but I've never come across anything about pre-speech development. Not long ago, I was concerned about a baby in my own family who did not babble, even when alone in his crib. He really produced very few sounds but seemed to hear, and at 16 months began to produce words. I don't know what the story is here, but all you can do is to be sure that her hearing is intact and that she hears speech directed toward her.

      Don't expect here to gaze for a long time at your face. The important issue is that she communicates with other people-- which she does by smiling when she sees you and by playing peek-a-boo (and I want to tell you that she is quite young to be able to do this!). She also reaches in the direction of something that interests her, which you probably respond to. I would not expect her to be able to point yet or to be able to move her index finger independently of the others at will.

      In the next few months (but not weeks!), I think you will see "joint attention" develop. In this, she will look at something interesting, then look back at another person, then back at the interesting object, until she gets her partner to look too and share the interesting sight. To do this, she will use her gaze to "point" just as adults do. You will also see her begin to look at your face for information when she encounters something strange and possibly scary.

      I know there's no point in telling you not to worry (but keep in mind that she won't much like to look at a worried face!). I agree that it's too early for even the most specialized specialist to detect problems.

      Keep on playing peek-a-boo, that's one of the best things you can do!

    2. Do you have any update from Laura? My baby does the same so would be interested to know how she is getting on. Thanks

    3. No, I'm sorry-- I'll post as soon as she comments--

  2. thank you very much for your reply! (maybe my translation of peek-a-boo is wrong... I hide my face behind my hands or an object and then I show it and say "cip!" and smile.... Rebecca usually smiles back..) I'll keep you updated.... thank you!!!!

    1. Yes, that's peek-a-boo, and she's doing well if she does that at 6 months!

  3. Your article really gave me hope..i am a mother of a toddler and a seven months baby and my baby is similar to Laura's baby and I was worrying like hell because each time I Google I end up with autism :(
    We are Egyptians and we don't have early intervention program for autism here. I was alot worried until I found this article and your reply to Laura :)

    1. Dear Anon-- I wonder whether you got worried because the first and second babies are so different? Any two babies are very different, but somehow we're surprised when our own are different from each other!

      Best of luck, and remember that the best thing you can do for any baby's development is to be responsive and playful. That's really all that any early behavioral intervention does, anyway--:)

  4. Jean, your article also giving me a lot of hopes! My situation is exactly like Laura. My little one is 6 months now. He keeps looking at other things (especially my clothes with cartoons) when I held her close to my lap. He doesn't really smile to strangers but he laugh out loud playing with his brother and sister. He hasn't been babbling yet but will have conversation with us using aahhh. He screams when excited too. And hr lives blowing rasberries. He loves peek a boo too since young. What worries me also is he likes to stick out his tougue, rolling it or sometimes going back and forth. I hope he's teething else it's really scary as it shouldn't be for a 6th month baby. He response to name sometimes but not all the time. Sometimes even totally ignore me which really scary. Yes, and my first one is a super quick learner and active!

    1. If he likes blowing raspberries, he probably likes tongue play too. Totally ignoring you sometimes may just mean that he's not easily distracted from what he's paying attention to-- which would be good-- but of course this is just a guess on my part.

    2. Yes, he likes to play with his tongue! He started of blowing bubbles then move to blowing rasberries and that's where the tongue thingy is getting worst. Luckily he does make eye contact, smiles and 'talk' to me when im breastfeeding. And you are right, he won't be happy seeing my worried face and I should play more with him for more stimulation. Thanks for your comment. Really appreciate it

  5. Hi there, Jean - excellent information, thanks.
    Quick question. We have 7-month-old twins. They're both very friendly, sociable girls but avoid eye contact while being held. They'll look and smile at you if you someone else is holding them but very rarely when you're holding them yourself. I'm pretty sure it's not a problem but wouldn't mind a little reassurance...

    1. They sound like they're doing fine!

      When you say they avoid eye contact, do you mean they look at something else? Anything in particular? Or is it that when things are too close or not well illuminated, it's not so easy for them to see? It does take a while for babies to be able to see clearly when things are near them, although I would think your girls were past that point, unless there's some vision problem that's not obvious yet-- beyond just the fact that children usually stay a bit far-sighted until closer to school age. Of course, I'm not really sure what position and distance you have in mind when you say you're holding them.

      I'm assuming that as twins they were born a bit pre-term. Don't forget that when you think about what they "should" be doing, you need to use their corrected age, counting from 40 weeks gestational age, not from their actual birthdate.

  6. I guess they're usually around 8-12 inches away from our faces. One of them has just started (yesterday) to look at me a little when I hold her. But not the other one so far. They just look around at whatever takes their fancy. They were 7 weeks prem but, according to our ped, they have caught up now.

    1. It's hard to tell how the vision develops without special techniques, though, so that may not be as "caught up" as the rest. But really, I don't think you need to be worried about autism, if that's what's concerning you.

    2. I am also a father and my baby looks at me so much to the extend that I begin to think why..because too much of everything is bad .I begin to think may be she think I am a stranger or I am not the father etc...most interesting i am black and my wife is white and the result is Afro -white.I sometime say it is because I am black. Please I understand from here that it is good if the child look at his daddy most at time. Even when her mum is playing or feeding her. She just see t look at me and smile on and on so lovely and amazing. Please your advice.. what is not right

    3. I think this sounds as if everything is fine in your family! You don't say how old your daughter is, but if she is still only a few months old she may find the contrast between your dark skin and your eyes easier to see than the lesser contrast between pale European skin and eyes. Also, I think you look at her affectionately and smile, so no wonder she likes to look at you!

      Please don't worry, this is not too much of anything. Just enjoy your lovely family!

  7. Hi,
    My son is 9 monts,born 3 weeks before term. When he was 3 monts we tought he could not hear,but at the hospital they took som tests an said everything is normal. I doesent sit on his own,does not turn his head when there are sounds behind him,and there is no babbeling only aaaah oooh. When ond back he males some eye contact, but not when we hold him up. When i search the internet only thing that comes up is autism. What do think about that?

    1. I think you're right to be concerned about these problems. Autism would not explain why he doesn't sit up. What does your pediatrician say? Can you have the baby examined by a pediatric neurologist?

      I'm very sorry you are seeing these difficulties, and I hope you will be able to get a clear diagnosis soon.

  8. Hi. Thank you for responding. When he was 6 months he started fysiotherapy beacuse he could not lift his head when on back. Now he is in a crawling position but dont crawl. The childcare center i see has never mentiond enything wrong with him;only thing is they feel he is a bit weak. When others hold him,he will look into my eyes. And when playing with him, he will smile when we make funny noises.he also can look at the tv for houres and nit get disturb or look up when i go behind or in front off him.I just feel somthing is wrong,but everyone in my family think he just normal.ill call my doctor on monday and get an appointment. Im so scared that somthings wrong with him. What are your first thougts about him?

    1. I'm sorry, I can't really speculate since I have never seen him. I'm glad you are following up with your doctor. It's true that some babies are slower to develop than others and then catch up, but if he will need any kind of early intervention, now would be a good time to find out. He may be hypotonic (have muscles that are too weak or relaxed) and he can be helped with that.

      I would not have him looking at the TV for hours-- in fact, not at all would be better at his age.

      Please do let me know what happens.

  9. Dear Dr,
    Thank you very much for your article. I'm Vietnamese. My little baby is now 5 month old and is exactly the same as Laura's baby. I am so much worried about her. Have you got any update info about Laura's baby? I try to contact Laura but impossible. Do you have any contact point to her. If yes, can you share with me. I'm so worried now. Thank you so much.

    1. Dear Pucca-- I'm so sorry, I have no way to contact Laura. If she reads this,she can send me her contact information to give to you-- I can do that backchannel, without publishing it here, if you do the same.( I mean, if you write a comment here, it does not get posted unless I make that decision, but I will receive it on my e-mail.) Please read carefully what I wrote to Laura. You may not need to worry so much!

  10. Dear Dr,
    I`m mother of a toddler and 10 weeks baby girl.
    I`m concerned about my little baby. When she is lying on her back she is making eye contact for few seconds and staring in my face, returns to my smile and makes sounds goo, ahh..she is tracking toys, but when i hold her up she is not responding to her name, she is looking anything but faces.. nobody can gets her attention. Is it too early or we should make some tests?
    thank you

  11. My guess is that when you hold her upright she sees a lot of interesting things to look at-- things that are hard to see when she is on her back. Are you being sure to give her a lot of tummy time, so she can look around by herself a bit?

    I do think it's much too early to test for autism. Here is an article that might be helpful to you if you can get it:

    Sheinkopf, S.J. (2014). Autism in infancy: Advances and implications for clinical practice. Brown University Child and Adolescent Behavior Letter, Vol. 30 (3), pp. 1, 4-5.

    This author points out that early signs of autism are subtle, and even after 12 months there should be caution about the diagnosis.

    Your baby is still very young and I would bet that she will become much more responsive in the next month or so.

  12. Dear Jean,
    your advice about tummy time was so helpful. She hated to be on tummy, but every day it's getting better.

    Now she is 3 months 10 days and yes, she is much more responsive-looking at me as long as I want, smiles back to me, cooing a lot. Sometimes when I put toy in front of her she is reaching her arm and touching the toy.
    But still when I hold her up in my arms in upright position, rarely she will respond if somebody is standing just in front of her talking and smiling,hardly trying to be seen.
    hearing test is normal.
    thank you a lot

    1. She sounds as if she's doing very well. Could it be that when she's upright she just wants a chance to look around? The person in front of her may not seem very interesting if the light is behind them, anyway.

  13. Hello Dr, Thanks for helping people. I sincerely thank you to help out people in this great manner.
    I also have twins ( 1B + 1G). My Girl is doing very fine by all God's grace but My son ( both 4 months as per birth but 4-5 weeks pre term) is not making good eye contact for long time. He looks upwards most of the time. Though he recognize and moves his hands, legs like her twin sister but make very little eye contact. When I show him mobile in active mode , he tracks that . My doctor ( Pedi) ask me to get the vision test done which we are doing tomorrow. He says ooh oha etc also when he is in need of milk. He was admitted at NICU for 7 days for pneumonia. We are very worried if this is normal or we should do something about it. Pleaseee help it here. I will keep you updated.

    1. Dear Shyam, I think the vision test will have told you some important things, for example whether there is a problem related to gazing upward so much. At his age (effectively, 3 months), that is more important than the eye contact itself. Other than the possible vision or eye muscle problem, he sounds as if he is doing well. Don't forget that you need to think about him as younger than his chronological age. Let me know how the vision test went.

  14. Hello Dr, Thanks for the reply. We got the vision test done and dr also did Retinopathy test due to preterm delivery. By all God's grace, there is no retina damage and everything seems fine. But Dr think that he has some number due to oval shape of eye lenses instead of circular. Though Doctor did not suggest anything right now but told us to get the eye tested after 3-6 months once again. What do you conclude from this sir?
    Also , I would like to mention one thing here that my boy has flat head shape from one side which is from birth. I have read that this will come in shape automatically with time. But do you think this could also be the reason that he doesn't make good eye contact as he may not feel comfortable due to its head shape.
    I again thank you from bottom of my heart for all your help.

    1. That's good, that there is no retina damage. Are you sure the shape the doctor mentioned was the lens alone and not the eyeball? But in either case his vision may be blurry because of it. It may improve, or he may need to wear eyeglasses later to make the image clear.

      As for the head shape, I don't think he is uncomfortable because of it, but you may want to try to make sure that he does not always lie with his head turned toward the flat side. If he sleeps or lies with his head in different positions it will help the head shape become rounder. Also, if he sleeps on his back, be sure you do a lot of "tummy time" with him lying on his tummy. This will also help him develop his chest and neck muscles and encourage him to lift his head and look around.

  15. Hello Dr , Thanks for the reply once again. I am not very sure but Dr said its Lens shape.
    Thanks Dr for giving us tips on head shape and Tummy Time. We will definitely get him practice for this.
    At last , We need your blessing for my child and for us.

    1. You certainly have all the blessings and good wishes I can give, for your dear babies and yourselves!

  16. Hello Doctor , This is Shyam again. Now We can see that our son have improved in making eye contact. He started tracking objects ( say Mobile) perfectly. He makes good eye contact when he is filled with mile and quite comfortable. He tracks the light , colorful toys etc very well. Only thing is that he is not so good in smiling as her twin sister is. though he smiles but we need to put an effort to get him smiled.
    What do you conclude Dr now ?
    Keep giving your good wishes also to my children.
    Thanking You & Regards

    1. I think the two babies simply have different personalities and temperaments. If you didn't have the little girl who smiles easily, you probably would never have worried about why the boy is less enthusiastic! It's hard not to compare babies to each other, but actually they each need to be understood in terms of their own patterns and developmental pathways.

  17. Thank you for your reply!
    I think that when she is upright she is a little confused and doesn't show affections. maybe is overstimulated??
    But few days ago I noticed that when someone else is holding her up and I call her name she is trying to find me moving her head in my direction but can't see me. That makes me think about blurred vision???
    And again when she is lying on her back it's easier for her to find me. she is already blowing raspberries. smiles almost every time i smile and talk to her. gives me big smiles when i'm kissing her legs and tummy.

    1. She may be a bit overwhelmed if people are coming on too strongly. Does she avert her eyes, or look at her hands, or begin to drool or hiccup? If she does, she might need the interaction to be a little less intense.

      It may be that you are a little too far away for her to see, or the light may not be good enough, or it may be that her vision was also slightly affected by prematurity. Have you had her vision tested too?

  18. Hello Jean Sir, I can see improvement in my child ( Twin son) now. His tracking ability is quite good especially mobile or Toy etc. Eye Contact is being improved but I guess due to minor vision issue it is not going so perfect. Due to which smile is not coming on his face all the time. Though he sense everything, babble etc. His shape of the head is also going good. His mother is giving him all lots of loves.

  19. This all sounds very good! Congratulations,parents of twins!

  20. Hi Dr. Mercer,

    Two or three weeks ago, my 6 month old was making "ahh-goo" sounds and raspberries; however, he is now only making "mmmm" sounds - mostly when he is frustrated or tired. He has always been a smiley baby and has laughed with us quite a bit, but I've also noticed lately that it has become MUCH harder to get his attention, get him to make eye contact, and get him to smile. Our pedi says not to be concerned, especially because our son noticed her and made eye contact when she entered the room. She also says that his verbal skills have likely taken a backseat to his motor skills right now. He just cut his first two teeth and started sitting by himself yesterday, but he is still not himself. My main concern is with the drop off in eye contact, noises, and smiling. Can these things be caused by teething or hyper focus on learning a new skill, like sitting? He also seems to have a strong interest in feeling textures (with both his feet and hands) - is this normal? Do you think we should get a second opinion? Thanks in advance!

    1. This is a tricky question, and I can try to answer in terms of what I think is probably true, but honestly I don't know that anyone has looked into this systematically. The question is: do babies "work" on one thing at a time, so they reach a developmental plateau in one area (like communication) and then put their energies for a while into another one (like motor control)? It's my impression that they do, and especially that new skills are so fascinating to them that it's almost as if the skill is "doing the baby" rather than the other way around. I remember when one of my sons first sat by himself, I put him in his crib at night and he just bounced back up into a sitting position even though he was almost asleep -- finally I just stood back and watched, and he keeled over asleep, but with his legs still "sitting"! I do have the impression that they work on one thing for a while, then go back and pick up another skill where they temporarily left it, but I cannot give you chapter and verse on this and I doubt that your pediatrician can, either.

      Keep in mind that sitting opens up a whole new set of experiences, as he can look around without using his arms to keep his head up, can reach for and examine objects and bring them to his mouth. This is in many ways even more of a breakthrough than walking will be, so it's not surprising that he's focused on it.

      As for the feeling of textures, this is not only normal, but some people worry a lot about babies of this age who avoid such sensations.

      One other thing about the reduction in smiling etc.: a 6-month-old is approaching the point in development where he will begin to be fearful as he never was before. He may presently be at the "wary" stage, where he is not afraid of things (like loud noises or new sights) but he is "wary" and checks things out seriously before he warms up to them. This stage comes before showing anxiety about separation from you, so don't be surprised if your cheerful, sociable baby gets more "difficult" in the near future.

      I don't think you need to worry about a second opinion right now, if ever. Just keep trying to follow his lead and encourage him in what he wants to do. That will be the best way of keeping communication going.

    2. Thank you so much for your quick and reassuring response! I often feel overwhelmed with the abundance of opinions and information out there -- I just want to make sure I'm doing the best I can for my son. It really helped to have your advice!

  21. Hi Doctor,
    Just like some of the others shared... I have been very concerned about my 6.5 month old daughter, who seems to be like Laura's baby. I have a set of boy/girl twins... My son is extremely intense and focused, ALWAYS smiling when he sees me and the second I smile, he does the same. He makes eye contact and holds the gaze and is just very aware and interactive, in general.
    However, my daughter at times will be smiley and laugh when I do raspberries or peek-a-boo. But sometimes when I hold her up on my lap, she will look everywhere else but in my eyes or in my direction. My son will be focused and she'll just be kind of "blah," staring off into space. She has a fixation on Mickey Mouse so will smile at other things or people (even SOME strangers), or songs. But the intermittent lack of eye contact and blah-ness that happens frequently just worry me. She's just in such contrast from her twin. Sometimes, I fear autism, like the other folks have shared... or some other mental/developmental issue. I'm hoping she's just more mellow - she smiles less, but also fusses less than her brother. Thanks for any additional input. All the best to you.

    1. Hi Juliette-- let me say once again that I never see any of these babies, so I can certainly not provide any kind of diagnosis! But my guess is that there is simply a temperamental difference between your twins, and if you didn't have the one lively twin you might well not notice that the other one is less lively. I would just suggest that you make sure that you give her as much attention as her twin, even though she doesn't seem to ask for it. Also, you may want to make sure that when you hold her up on your lap, your face is in the light, rather than having her see a shadowy head against a light background.

      Nobody can actually diagnose autism at this early age. I know it's useless to say not to worry, but keep in mind that girls are less likely to be autistic and that there are levels of autism that allow for good functioning. Also, if you have to have something else to do right now,you could have her vision and hearing checked, if that hasn't already been done. Best wishes!

  22. Hello Doctor,
    I keep coming back to your blog post week after week. My son is 9 weeks old and was born two weeks premature. He rarely has a mutual gaze and when he does it's only for a few seconds usually. He especially does not like to look at me or his Dad when we are close up, which is weird because I thought they can see 8-12 inches away first before they can see farther away. This doesn't seem to be the case with him. He smiles sometimes but only at the wall...When the room is dark he stares off as if he can't see at all. I know it's early but I'm really worried. Any advice?

  23. And also thank you for this blog post and for all the suggestions and advice you've given to parents on this post!

    1. Hi Candice-- so, your son is actually 7 weeks old, corrected age, and it's not surprising that he doesn't do much mutual gazing yet.

      If I were you, I'd be very careful about thinking that he "does not like to look at" you or his Dad.He doesn't do it, that's all! If he were an adult and didn't look at you, you might well conclude that he didn't like to look at you, but at this age all you know is that he does not, so please don't start telling yourself that he doesn't like to see you!

      It's true that infants can see 8-12 inches away before they can see at greater distances, but even then their vision is rather blurry compared to an adult's vision. He needs brighter light and higher contrast than you do, and he probably does not see much when the room is darkened.

      People used to call that smiling at the wall "smiling at the angels", which I think is charming-- all the same, what you want is a smile at you. I am thinking that you will probably see more of this in the next couple of weeks. You can try to get a bit more by "looming" at him-- move closer while opening your eyes and mouth wide, then back away while closing them, then repeat. At this age they often need a lot more of a social stimulus to get smiling than you would expect.

      If you are concerned that he actually does not see you, ask your pediatrician whether there was any problem associated with his preterm birth that might have caused some visual problems.

      So sorry I can't be more specific or reassuring, but remember that this first three months is what has been called 'exterogestation". The baby is still more like an unborn child than he is like an older one, and only further development can show you what his abilities really are.

    2. Thank you very much for reply! It does mean a lot! And you're right, I shouldn't jump to the conclusion that he doesn't "like" to look at me. I've spoken to my pediatrician about all this and she says that right now she sees no reason to worry...maybe I'm just hyper-aware because I'm alone with my baby all day? It's just that I keep reading he should be interested in my face more than anything else and to me it seems like the opposite. He also rarely tracks objects, which I've read he should be doing. I will try the "looming" as I have not heard of that technique before...I've been doing full broadway numbers trying to get him to smile and pay attention to me (which perhaps is only laughable to me ;)
      Thanks again for your response and for this blog :)

    3. Better stick to Little Theater at this point!

  24. Hi jean.....i have a toddler of 18 months....she is very active and sociable she is always called by all a happy baby smiling laughing giggling around.. but when i hold her she hardly do any eye contact. but when she is far she does. she is still blabbering and trying to talk. But when i ask her to do something she gives no interest at times, sometime she does. she hardly say 2-3 words. her doctor said hold her close and try to talk her as much as you can. but she hardly stays at one place. is it something to worry about.

    1. Dear Varsha-- I don't want to say you "should worry" about this, but it's true that your little girl is a bit below average in her present language development. This may mean nothing, as many children develop in jumps and plateaus rather than just gradually day-by-day. She may show much more interest in speech soon.

      But at the same time, you don't want to be doing things that fail to support her language development. I would cut out all screen time of any kind. Reading and singing to her are good approaches. When she does use words, reply in a way that expands on them. (For example, she says "car", and you answer "yes, it's a big red car".) Don't use your cellphone around her unless you have to,because she needs to see that saying words is something people do together.

      I agree that talking a lot is important, but I would be afraid that holding this active child close would simply frustrate both of you. She may not seem to be paying attention while she is running around, but she probably is. Try to take advantage of whatever interests her-- for example, you could say that she's running, now she's stopping, etc.

      What are the kinds of things you ask her to do? Do you think she doesn't hear you, doesn't understand the words, or gets distracted?

    2. Yes she understands the words and also does when i ask her to do something (For example, throw it in the trash or get me the spoon) but not always :) . And one more thing i forgot mention is she is always hooked to iPad. She love listening to rhymes...and now we literally have to hide it from her. And i am trying to talk to her more. Kindly help me know how do i interact with her so that her language development increase

    3. If she does what you ask sometimes, then she must understand you at least sometimes, which is an excellent sign. there might be many reasons why she sometimes does not do things-- for example, something else might distract her.

      Do keep that iPad hidden. If she likes the nursery rhymes, you can say or sing them to her. Remember that understanding speech is not all about hearing, and it helps her to see your mouth and the way it moves to produce a sound.

      When you see that she's interested in something, try to build on that attention by talking to her about it. If she uses a word, reply to her and use the same word in your reply. If she babbles excitedly about something, talk to her about whatever is going on. Also, read aloud every day, for half an hour if you can manage it-- this is a good bedtime routine.

      I would bet that you are going to see some language advances quite soon!

  25. Thank you so much for the advice.....i will definitely do what ever you have mentioned and let you know
    thanks again

  26. Hi dr. I contacted you about 4 months ago concerning my son, then 9 months. He was born 3 weeks before term. I was really worried about his eye contact and how he did not respond to sounds. Now we finally found out he has a hearing loss of 60 db on left ear and 90 db on right ear. He is diagnosed with bor syndrome. The eye contact is much better, but still we have to work on that. Even now that we know he has a hearing loss, i still have the feeling that there is somthing more, still somthing wrong. He is really friendly with everyone, smiles to every human beeing he Sees, and also want to go to them. And i cant make him play with me, i can only hold hus focus for 1-5 minutts before he crawls off to somthing els. And we have a really hrad time feeding him, he only eats mashed food. He will close his mouth and turn his head if given enything not mashed. He has hearing aid now, and has had them for 2 months.
    Im so desperat now, are children with hearing loss somhow semilar to those with autism in symptoms?

  27. Dear ramz-- this sounds as if there are many challenges for your little boy and for yourself. To answer your last question first, yes, there are resemblances between hearing-impaired and autistic children at this early age. Without the hearing test that your son had, it can be hard to tell them apart.

    The hearing loss you mention is a pretty severe one. I am wondering whether you have learned sign language and are using it with him. If you haven't started this, it would be a good idea. Is there a school for the deaf near you? If so,they may be able to help you plan for how you are going to support his good development.

    You may need some help to follow his lead and use his interests to expand on your play together. On youtube, there are some excellent videos on "Floor time" that may give you some ideas about how to do this. However, he may not be mature enough to play for more than 5 minutes at a time, and if you can't use speech with him it's difficult for you to help him organize his play. Using sign could be very helpful here.

    As for eating, it would be good if he could start on some lumpy or chewy food. Can you offer him something liked cooked carrots or peas to finger-feed to himself? He should be able to do this by now, and if he can't, you may need to work with a physical therapist to help him develop skills in using his hands.

    Because he has the BOR diagnosis, I am thinking that you will have a lot of medical help, and the doctors should be able to suggest other services for you.

    Finally, I wonder whether you are getting the kind of support you need yourself. I'm sure you're uncertain about what the future holds and feel a lot of anxiety about your child. Has anyone suggested counseling from a specialist who understands these genetic or similar problems? I understand that you are very worried, but when you say you are desperate, I think you may need more help than you are getting.

  28. Thank you so much.
    We have started on the sign language now, it 's hard to learn, but we have a great plan for that i norway. We have a total of 35 weeks at sign language school.
    I will try the food you suggested, and contact his physical therapist about work ing on his hands. He does put food in his mouth , but he gags and spit out.
    There are no specialist on BOR in Norway, there are specialist on each symptome.
    I will also try the floor time with him.
    Thank u again for talking time to answear me.

  29. I just want to say that is amazing and rare in this day and age to get such wonderful and personal responses from a professional. Reading the above has been very helpful to me.

    I would like to add my own experience and if you have anything to add it would be so very much appreciated!
    My little guy is 7 months and is similar in many ways to the above children. All his developmental milestones are great in many ways - his gross motor is ahead, he is already army crawling and pulls up to stand. He smiles and babbles and loves everyone. He is super affectionate, and he laughs at silly things his brothers do. But he really struggles to maintain eye contact with me. He wants to look at everything else around him! He will smile at me across the room and gets really excited when I come into the room when he is awake in his crib after a nap. He is my 6th child (yes 6th!) and I understand all babies are different even within a family. My worry is that I know how important that "shared attention" milestone is as we have two children with very high functioning autism (they are my baby's half siblings) and I keep watching and waiting for it and its not there. He stares at unusual things but doesn't check my face for my reaction. Should I be expecting that at 7 months? The only time I have seen it so far is once at the doctor's office, he looked up at me then back at her during his exam. I honestly didn't know to even look for this with his older sibs so I may just be hyper aware and overthinking it, but it is causing some anxiety for me so I would love to get more information. Thank you!

  30. one more thing...he does not yet respond to his name. He will look at us if we make funny sounds to get his attention, but simply calling his name gets no response if he is busy playing with something. Reason for concern?

    1. I'm so glad to hear that this is helpful to someone.It's certainly very interesting to me to read what people share!

      I think that what you're looking for is not joint attention, but social referencing. In joint attention, the child tries to get you to look at something interesting that he sees, and I wouldn't expect that to happen until 10-12 months.

      Social referencing means noticing that something unusual is happening and looking at the adult's face to see whether he or she looks scared or happy. If the adult looks scared, the child looks serious and wary and backs off-- if the adult looks happy, the child goes ahead and approaches the strange person or thing. Social referencing comes earlier than joint attention, but I wouldn't expect it to happen until the child has begun to be scared of strange people or things. At 7 months he might begin to be wary and give strangers or unusual things a serious look (maybe this is what you called staring at things), but then to warm up to them. At 8-10 months you typically get fear of strange people, sudden moves, or loud noises beginning. But until that happens,he won't check out your face to see if you're scared, because he isn't.

      I think that what you saw him do at the pediatrician's office was neither one of these, but just looking at the differences between your faces as she handled him in ways that you usually do.

      I'm not sure whether you mean he doesn't respond to his name at all, or just doesn't notice it when he's paying attention to something else. If it's the latter, that isn't very surprising or different from what all of us do from infancy on up. If he really doesn't respond to his name ever, even when there's very little background noise, you might want to have his hearing tested.

      As for the eye contact, I wonder whether you're expecting him to do this more than they really do (even though with 5 others I guess you'd know!). You make it sound as if he sees your face better at a distance. It could be that when you're close your face is in shadow. Also, it sounds like there are plenty of other interesting things for him to be looking at.

      He sounds terrific to me. Just as a footnote, I wonder whether with lots of other kids in the house he doesn't depend on you to socialize the way a single baby would, so he doesn't look at you as much as you might expect. Not only are all the children in a family different,as you say, but in fact if you think about it you'll realize that except for twins no two children are born into "the same family", because the family changes with each child as well as with other events.

    2. Thank you so much for your response. Yes, I guess I am looking for social referencing. And it makes sense that would not appear until he starts needing that reassurance as a result of his own fears of strangers, etc. I know when to expect that milestone (usually not before 8 months). I have a background in early childhood ed in addition to all my mothering experience so I have a good handle on a lot of the developmental milestones, but the joint attention and social referencing, mutual gaze, etc are "newer" ones to look for that I just don't quite understand yet! Thank you for clarifying which is which.

      I think he hears perfectly fine. I can get his attention with my voice, but if he is playing with something and I simply say his name, he doesn't look at me yet. I think he just doesn't respond to his name being spoken when he has other more interesting things that are holding his attention. I guess with all I have read about kids on the spectrum that if he doesn't immediately look at me when I call his name that is supposedly a red flag...but I don't know that any kids immediately respond to their parents when they are interested in something! I think it is confusing to separate normal development and potential concerning early "red flags" for autism.

      He seems very interested in people in general and when someone else is holding him, he is more likely to interact with me using eye contact. He will make it when I change his diaper and sing songs to him. But if I try to hold him in my lap and play with him, he tends to look everywhere other than my face. There IS a lot to look at around here and I think you are right, he has multiple care givers and helping hands so he doesn't need my attention as much as another baby would. I notice when I am holding him and someone is interacting with him he makes appropriate eye contact. I will have to see how this is affected by light in the room. I do a lot of his feedings in a chair with its back to the window meaning my face would be in shadow, whereas I change his diaper in an area where the light is on the side and so he can more clearly see my face and he does make more eye contact there.

    3. I think this "red flag" stuff is very scary to people because nobody mentions the range of ages within which it's typical to see various behaviors begin. Behaviors that are seen in older autistic kids, like saying "you" for "me", flapping hands when excited, and toe-walking, are all characteristic of typically-developing younger children. Autism involves developmental delays as well as other things, so "autistic" behavior is seen in non-delayed younger children who will stop doing it after a while. (Actually,people used to talk about the first three months as a period of "normal autism", but we seem to have lost the idea that being unresponsive can be perfectly normal for some ages and situations.)

  31. Hello Dr. Mercer,
    I am a first time mother of an almost 5 month old (4 months, 3 weeks). I have some concerns and would appreciate your advice!
    My son seems to go through a personality change when he is lying down and when he is sitting up. Lying down, he laughs at songs, squeels with delight at peekaboo and can stare at me for minutes at a time - even likes to reach out and touch my face (same goes for when he is resting on my knees). When we hold him, there is no way of getting him to look at the person holding him. He will look and smile at other people around the room, but not intently (like babies "should"?), just fleetingly and never the one holding him. And I mean never - I have even used a toy that he can track in front of us and his eyes will drop as soon as it nears my head. At a distance, he's also fine (smiles at both of our reflexions in the mirror and at other people), although I have only heard him laugh three times when he wasn't on his back. People have commented on the fact that he is a "serious" baby and doesnt make eye contact- which stresses me out!
    Also, my baby rarely cries. He can be left alone in a room up to 10-15 minutes before he starts fussing and even then it's fussing, not really crying - sometimes he does an upset squeel (which I also don't like). Of course, he does cry SOMETIMES, but I think only when he is in pain or wakes up in a place that is not our home.
    We checked his eyes and they are fine (although dr said he could tell already that he would need glasses when he is in elementary school).
    What are your thoughts, please? Yes I am worried about early signs of autism, but the "red flags" seem situational. I understand he is too young for a diagnosis and that you can't say anything specific without seeing him but I would appreciate your thoughts based on your experience, and advice or a reference on how to improve his eye contact in different positions (I don't think I can do anything else about the other things I am concerned about).
    Thank you in advance!

  32. Dear Unknown-- so many people have asked similar questions about distant and near faces that I've just done a whole post about it:

    I am assuming that your baby is sleeping supine, as most do nowadays. There is reason to think that this sleeping position slows down aspects of motor control that are encouraged by prone sleeping or lots of "tummy time". This could mean that the effort of staying upright is taking a lot of his energy when he is not lying down. Be sure you do plenty of tummy time, even though he might seem not to like it at first. This will not make any difference developmentally in the long run, but it might make him more able to respond now and thus make you feel better.

    As for being left alone for a bit without crying, my guess would be that he has a mild temperament with a positive mood. In addition, he is not old enough to feel afraid when left alone. The squeal may just be practicing making different sounds, which he's getting old enough to do.

    People should SHUT UP and not comment on whether a baby makes eye contact with them! Tell them he's busy thinking about his investments and planning his college applications. Or if you dare, say "I guess he doesn't like you!"

    1. Your response just made my day! Thank you, so much Dr. Mercer. I have just read your other blog and it was enlightening to me. Having zero medical background or child rearing education, I was even wondering if some neurological wiring was getting disconnected in my baby's brain when he was held up. Your explanation makes much more sense and puts me at ease. My baby is still shakey when he is being held up, so now I see he really needs his concentration for that and I notice him turn towards who is holding him as soon as he get's a little bit of distance (held at full arm's length, for example) which can explain it is more comfortable for his current vision.
      This new mom business can be scary and your blog is a wonderful source for us. Much better than a bunch of moms trying to figure things out on our own or using another mom's individual experiences to "assess" our own babies. Thank you for giving us access to your expertise! Jessica

  33. Hello dr.

    My son is seven weeks old ( eight weeks on the 7th two months on the 12th) and the last two days he seems to have lost his interest in any eye contact or face gazing which last week he was doing all the time. His smiles have been less frequent as well these last two days and I am beginning to worry because these are things he had been doing and suddenly stopped. His temperment is normal though he has been sleeping a bit more often. If it continues I plan to mention it at his two month physical but do you have any thoughts in the mean time? Is it normal for a baby to seem to temporarily loose a skill they seemed to have mastered or should I worry at this sudden change?

    1. Infants and children can lose interest in doing things they've mastered-- they don't lose the skill, but just stop doing things when there are more interesting and challenging options. I don't know whether that's what's happening in your case, but with the extra sleeping it sounds as if he is going through some kind of organizational change. This kind of change is one of the many reasons for the variability and unpredictability of infant behavior. We can't expect infants to act the same all the time, but I know it's worrying to see the apparent loss of something we thought was important and valuable. He is at a transitional time in terms of being able to use his eyes together, so that may be what he's dealing with right now. (I did a post on this kind of change a couple of days ago.)

      Do you mean that his temperature is normal, rather than his temperament?

      My guess is that there's nothing to worry about, but I know that won't stop you! I hope your doctor can reassure you.

  34. Hi Dr my name is Martha, i have a 6 and half months daughter, she had her 6 month apppitment yesterday and her pediatrician is concern her head is not growing, she is bellow the average on the chart so they going to run some tests. As everybody else im concern that she is a little behind, she is a happy baby always smiling when i make sounds or call het name but she doesnt make eye contact for a long time, she looks at me smile and turn her head. She doesnt reach for toys or passes them like she should. She always sucking her fingers and grabbing her hands, she also pulls my hair and necklace or earrings ( not sure if that count as reaching) she also makes a lot of sounds and imitates when i make a sound. Any advice will be appreciated, thanks

    1. Dear Anonymous-- I am sorry to hear to hear that your daughter is not doing as well as she might, but she sounds like a lively and happy little person. The most important thing for you to do is to follow up on what your pediatrician
      wants you to do. It's possible that the head growth will catch up, because growth is not exactly the same as the average every month. However, if her head growth is delayed, it's essential to find out why this is and to see if treatment is possible. She might "outgrow" the problem, but you can't count on that, so please do everything the pediatrician suggests, and if he or she does not seem to be actively working on this, find a medical specialist to help you. That's all the advice I can give, I'm afraid. I hope this all goes well in the near future.

  35. Hello Dr,

    As mentioned in last post , what if Child ( 7 month Old) is not started up sitting. though he is very lovely child and smiles ( laugh) a lot , response good when called by names or sound. He makes good eye contact when lying on the bed but not much when in the sitting position. He cries only when he needs milk , rest of the time he is very good boy and doesn't trouble for any thing. Is everything normal in this case and it is just delay in Normal growth. We are very positive about him and loves to play him a lot but still feel sometimes little concern. what do you say doctor?

  36. Can he sit with support, for example on your knee with your hands on his hips? If he can do that, it would suggest that he is just a little behind in motor development. If he cannot sit in that way either, you should have a specialist check him.

    What happens when you try to put him in the sitting position? Does he lean forward for a few seconds as if he is trying to balance? That would be the beginning of sitting.

    Has he been sleeping on his back or on his tummy? Babies who sleep on their backs are often somewhat delayed in motor development in comparison to the norms you will find published.

    Are you seeing other developments like reaching for objects? Is he beginning to hold a bottle to feed himself or to pick things up by scooping with the side of his hand? Those would be achievements that would tell you that most of his development is normal.

    Do you have a pediatrician you can discuss this with? I would like to see you have some peace of mind if he is really doing well, or if ,there is a problem, to know that you are finding help.

  37. Hi Doctor, Yes he can sit very much with his support from hand for 50-60 second before he lean forward. Also to my surprise, he sleeps on his tummy on his own and prefers to that way but we do change his position time to time. He reaches objects also like toy, mobile, watch etc. he doesn't hold for the bottle right now but he is cares for the other objects.
    We thank you for help and need your blessing for my child too.

    1. My guess is that this is only a slight delay, but please ask your pediatrician! Also, be sure that you talk to the baby a lot, even though he is quiet and "good". He still needs it even if he isn't asking for it in an obvious way.

      You have my very best wishes for good development and a happy family!

  38. Hi Dr, I just stumbled on this article. I have been very concerned about my 9 month old daughter. I work with babies and so I am unfortunately always comparing my daughter to them. My daughter has never been good with eye contact. She looks at me occasionally but it's not often. When I sit her in my lap she will turn her head just to avoid looking at me. Some of the children I work with will stare at me and explore my face, my daughter has never done that. My other concern is her response to us calling her name. There are times when I can call her name 20 times and she won't look in my direction or show any sort of response. She has turned to her name a few times but I can't tell if it's her reacting to a sound or actually responding to her name. I also feel that she doesn't follow with her gaze if I point to something or look to something. On a positive note, she has always been smiley and laughs when we tickle her or play peek-a-boo. She has babbled for quite a while and says ba ba ba, da da da, and recently ma ma ma. She rolled very late but once that happened she picked up crawling and pulling to stand soon after (started crawling the day after she turned 8 months). She has also recently been following me if I leave the room and will try to climb into my lap when I'm on the floor with her. She has always been a snuggler and loves to be held and cuddle when she's sleepy. Do you think I should be concerned about the eye contact and response to her name?

    1. Although she seems to be right on the right page in a lot of ways, I can see why you feel concerned. Have her hearing and vision been checked? I think that should be the first step in trying to understand what's going on.

      I'm sure that like everyone else you are worried about autism, but it really cannot be diagnosed this early, and many young children who seem to have autistic-like behaviors lose them later on anyway. However, you can get information about vision and hearing now, and when you have that you may have a better idea about how to proceed-- or, it's possible that you may not, but it's worth trying to find out how she is seeing and hearing the world, which could explain what seems to be her unresponsiveness.

  39. Dear Dr Mercer,
    Thank you for this article and all the further advice you have given in the comments. I was wondering if you could shed some light on what I am experiencing with my daughter. She is 14 weeks, but was born 4 weeks early, so is closer to 10/11 weeks developmentally.
    I have two children and my eldest, a boy of 2.5, is undergoing a diagnosis for an ASD. I always knew there was something different about him from practically the beginning of his life. He made extremely little eye contact, didn't have cooing conversations with you, was limited in his babbling, didn't do joint attention as he grew, never pointed, never called us mama or dada and then regressed and became mute at 12 months. There were loads of other factors all pointing at autism and it turns out I was right (I wish I hadn't been). I now worry for my daughter. I should preface this and say that at the moment, when I am being rational and pragmatic, I don't think she is autistic, but there are two things she does that I can’t help but worry about in light of everything that we have been through with our son.
    The first is to do with her eye-contact (it’s what led me to your article). She makes the most amazing eye-contact and smiles socially all the time except when you’re very close to her, like when you hold her, sit her in your lap or lie face-to-face with her in bed. All other times she is amazing. She’ll stare you down and try to get your attention by smiling at you, kicking her legs and doing a lovely little half laugh half yell. She seems so sociable and loves gazing into your eyes. She does this when she’s in her pram, swing, on her play mat, in someone else’s arms when I am looking at her, when she’s lying in my lap and even when she’s breastfeeding. She stares at me when she’s nursing a lot and breaks off to smile at me. The problem comes when I hold her or she’s sitting in my lap, or when I’m lying in bed with her. She just won’t look at me, as if I’m too close. It’s really worrying me! And when I see other people holding her and she’s just seemingly ignoring them I get such a panic, as it reminds me of my son’s babyhood when it was as if we weren’t there to him. Is this normal?
    The second worry is to with her cooing, she doesn’t do it very often and very very rarely does a back-and-forth cooing conversation with me (she’s probably done it twice in her life). She’s pretty quiet most of the time, except the little half-laugh she gives when we’re exchanging smiles or she’s trying to get my attention. Is this also normal, or something to worry about? My son never cooed really, so it’s always on my mind. Just to add her hearing appears normal as she responds to loud noises (by being shocked and surprised) and she turns her head towards my voice.
    Thank you

    1. Dear Charlotte-- I'm so sorry I couldn't answer this earlier. I was travelling and for some reason was not able to sign in to the blog from where I was.

      I think you need to consider your daughter's corrected age and the developmental changes that go with it. Many babies of 10/11 weeks do not have "cooing conversations". More vocalization will come later-- in fact, it may already be apparent after this last week has passed, but it's still very early for a lot to occur.

      As for how she looks at you, she sounds as if she is doing very well. It seems strange to adults, but young babies have a lot of trouble seeing things that are too near. They also have trouble seeing things that are in shadow, as faces may be in many positions where the adult face is close to the baby's face.

      I think you are understandably anxious because of your son's atypical development, but your daughter sounds to me as if she's doing very well, and I think that in a few months or maybe weeks she is going to set your mind at rest (as much as mothers' minds are ever at rest!).

  40. Hello doctor....I have been following your blog and must say that it is the very informative. I have a 7.5 month boy. He is below the chart for head size but that was the case when he was born. The curve is moving upward only but below the chart. He is a asymmetrical iugr baby. My concern is he rarely reaches for objects and that too big objects. He mostly never reaches for small objects. He will stare at it and move his hand but I feel he is not able to touch it. Should I be concerned.

  41. Dear Anon-- I am sorry to say that there are always concerns about babies whose heads are small. Please be sure to follow up on all medical issues. In addition, do you live in a place where early intervention help is available? Ask your pediatrician about this. Your baby may need professional help to encourage movement skills and it's also possible that he has some problems with vision.

  42. Hi Dr. Mercer,
    I have a 7 mo old daughter who overall is such a good baby! She really only cries when she needs something or something really bothers her - she's very content and can entertain and play with herself very well. My concerns are that she doesn't seem like socially she is connecting well. People keep telling me she seems just more of a serious personality type or more independent and not to worry but it's hard not to as a FTM. She has never had good eye contact. She never looks up at me when nursing (unless I work hard at engaging her), when she does give eye contact it's not for long and mostly it seems like she watches me mouth more than my eyes. Other people will talk to her and sometimes she doesn't look at them at all except for a quick glance. She's also very hard to make laugh. She will smile most of the time at peek-a-boo and if I give her raspberries or tickle her but rarely can we get a laugh. I've told her peds about it and they didn't seem too concerned. She also won't always smile back at me. It's very hard to get her to smile for a picture - most of the time she'll look up quick and then look away or go back to what she was doing. She also won't always respond to her name. Sometimes it seems I have to say it 20x before she will look at me but other times she will right away. Could she just be a more serious baby? I'm so worried about autism...I just feel like she has so many 'red flags'. Any words of advice would be so greatly appreciated!

    1. Dear Lauren-- I can certainly see why you are concerned, because what you describe is unusual for a baby this age, Unfortunately for your anxiety levels, there is no way to diagnose autism in a baby this young. However, you could have her vision and hearing assessed, and a problem with one or both could produce less social behavior than we usually see.

      I am wondering whether she passed a neonatal hearing screen, and whether she has had ear infections, which can cause intermittent hearing loss and sometimes make.children pay less attention to sounds even when they can hear.

      I don't tend to think of "serious" babies. There are certainly babies who tend to a negative mood, but she doesn't sound like that-- and there are babies who react very mildly to both positive and negative things, which she might be. As for being "independent", that's not a concept that really can be applied to a baby this young.

      When she glances at other people and looks away, does she appear serious or wary? She is about at the age where babies who were previously friendly begin to take time to warm up to strangers. You would expect that in the next couple of months she will show much more intense fear of strangers and concern if she thinks you are leaving.

      What does she do when she plays by herself?

      If it makes you feel any better-- autism is a good deal less common in girls than in boys. Also, many children who are diagnosed with autism at early ages develop along more normal lines and by 3 or 4 are doing very well. Her behavior may all be a matter of temperament or individual differences.

      I wish I could tell you something more concrete, but really the assessment of vision and hearing is all that can be done at this point.

      best wishes,

  43. Dear Doctor,

    I am a mother of 2 sons. Elder one is 3.5 years and the younger is close to 7 months now. The younger one was premature, born at 34 weeks but did not have any complications then. We are concerned as our younger son is not establishing eye contact. He responds to sounds. He reacts when I enter the room or when I leave away from him. He babbles. When we show him an object, he is able to reach for it and grab it. He has not turned on his tummy yet which the doctor said might be because of his body weight. He enjoys when his elder brother is around. He is able to match sounds and their faces. He is able to follow a pencil or a toy when shown. Still, he does not establish eye contact with humans. He either see the head or sees us for a fraction of second and immediately turns away. Doctor said eye contact is very important milestone for learning and might be the kid is a little slow. We are concerned about him not establishing eye contact and what could we do for his improvement. Are these really worrysome?

  44. Dear Anon--

    I am not sure whether you mean your son is almost 7 months by corrected age, or was born 7 months ago at 34 weeks. In either case I would expect eye contact by now, But he sounds very sociable and communicative, so autism would not be the first thing I would think of.

    I am wondering whether even though there were no apparent complications at birth, he has some visual impairment.That is not uncommon for premature babies. Visual impairment might not be obvious when he grabs at an object, but it could be that it is harder for him to see the details of the eye that normally interest babies a great deal. Would it be possible for you to have his vision tested? If vision is the problem, it could make a lot of difference to his development if he had corrective lenses.

    When you try to make eye contact with him, try to smile and look cheerful. I know this can be difficult when you are worried, but even at this age babies are distressed by sad or expressionless faces. If his vision is good enough to see the details of your face, he might give up looking quickly if the face he sees looks unhappy.

    I don't know that I would say that eye contact is important for learning, but it is certainly unusual for a baby this age not to look at eyes, so I think you are right in trying to understand what is going on here.

    Good luck with this investigation-- your baby sounds very sweet and lively!

  45. Dear Dr,
    I have a 17 month old son. He is my first child so my experience with toddlers is limited. I am hoping I am just being a worrier or perhaps not doing something correctly. I will preface all of this with a couple things I find important. My wife had a long labor because my boy’s umbilical cord wrapped around his neck. My wife developed a fever and so did my son. Although, neither had a long fever. Also, my mother watches him when I am at work so I don’t have to pay for daycare. So, he is not around other children often. We are changing this soon.
    He is not yet speaking any words. He appears to understand many commands and even tones. If we raise our voice when he is misbehaving then he understands – usually. But, he is not speaking any words yet.
    He does an odd laugh –sometimes. The best way I can describe it is – it’s as if he is taking in deep breathes of air. He might go a day or two without doing it and then he will start back up. With that said, he also has a normal laugh that he has done since he started laughing. I am hoping he is just experimenting with different noises.
    He was weird obsessions. For instance, if he sees a shoe on the ground, he picks it up and will walk around with it. He won’t put it down. He loves shoes. It’s his favorite toy. He will ignore all other toys if he can get to a shoe. He also does the same with remote controls, phones, etc. But, the shoes are his absolute favorite. If we go to visit my mom, he will walk in the door and completely pass her by for the shoe or the remote control. This happens at most other houses we visit too. Is that strange???
    His gaze is not the best sometimes. He will have large chunks of the day where he will meet with us eye to eye. Then, other parts of the day, he won’t establish it at all. He is very good at ignoring us. I will call him by name over and over and over and he will completely ignore me. He can completely tune us out if he wants to and he does so often. And then sometimes, he will listen to us. I can’t put my finger on it.
    He has trouble eating. I can get him to eat baby food (with him fussing) but he will not touch 99% of foods out there (of course, he will eat french fries and things I don’t want him eating). But most “adult” foods he will avoid like the plague.
    Lastly, he is not big on taking naps during the day. He does sleep well at night though. However, he will scratch and pinch himself (not hard and not enough to make marks) when he is tired at night when we are putting him down for bed. He has done this his whole life.
    Anyway, thanks for your time and please tell me if I am being the nut. Perhaps, I should lay off the message boards. Thanks again.

    1. Dear Dylan-- I wish I could say that I thought you were being the nut, but there are a number of things you say that do seem to be cause for concern. Have you discussed any of these issues with your pediatrician? If not, I think it's time to do so. If there are early intervention services in your area, you should find out about using them.

      I'm sure you know that some of the problems you mention can be aspects of autism. However, I think there are some other problems that should be ruled out, so please don't jump to the conclusion that I'm saying he is autistic.

      I'm wondering whether his hearing is normal and whether he has had many ear infections. Ear infections cause a temporary loss of hearing that may not improve for several months. When a child has had many such experiences, he or she sometimes begins to ignore sounds because they are so "unreliable"-- seeming quiet sometimes and loud other times. A hearing assessment to rule out hearing impairment would be an excellent step, and if there is hearing impairment, speech and hearing therapy can be extremely valuable.

      I am also wondering about the eating problems. Given his early history, could he have a mild form of cerebral palsy that would interfere with chewing, swallowing, and speech as well? Again,you need an expert assessment, and if this is a problem he will need treatment to help him master these skills.

      I have no idea what the shoe thing means! It is certainly unusual, and I'd rather see him be interested in people, but toddlers do have their little individual ways and they often like to carry things around with them. I think that if he had no other problems you would simply laugh at this behavior, but there are other problems as well.

      Please do consult with your pediatrician and insist (if you need to) on specialist opinions. But also keep in mind that many toddlers who show worrisome behaviors do turn out to develop typically by school age, and I hope that will be the case for your boy.

  46. Hello Jean. My baby Boy is similar to Lauras baby. He will be 7 moths on Monday. I have one question for you. Is it possible that baby who has eye muscles problems gives less eye contact? Because my baby has it. (Convergent strabismus).


    1. Interesting question-- it could certainly make it more difficult for you to tell which eye is "looking" at you, and could give the impression that the gaze was elsewhere. It does seem to be the case with adults with "wandering" eye that we pay more attention to the eye that's moving and feel as if they aren't looking at us. Are you planning to have the strabismus surgically corrected, or what's happening?

  47. We have to exercise whit both eyes for now, to see what happens. . Can it be surgically corrected in this age?

    1. I suppose it could be done, but the problem is that if the external eye muscles then change in length, the outcome may not be what's wanted. That's why people wait to see whether maturation and exercise will help. I just wondered about future plans-- didn't mean to suggest it should be done right now.

  48. Is it normal, that he wants to play alone on his rug at 7 months? He does not cry for me. When I lie next to him he looks me for one second and play whit his toys.

  49. I can't really say "normal" or "not normal", but I think it's not very typical. When you see that he's interested in a toy, can you get him to interact with you over that toy? You might put your hand over it and take it away again while you smile at him, or hold it near your face. Are there any things you do with him that engage his attention-- singing,or tickling, or swinging him up in the air ? If there are, you might try combining those things with the toys he's interested in, in some way. I hope you'll let me know whether any of these things work to get more interactions going... When you say he doesn't cry for you, do you mean he never cries when you walk away? He may be a little bit too young to do that yet, or to seem frightened of strangers.

    1. When I take away the toy he interacts. When I sign to him or, tickling him or swingin or play pika boo with him he interacts. And he does understand when I say No to him, he makes than a sad face and looks at me and trys to do it agai...yes this I mean that he does not cry for me. Should I be worried?

    2. Sounds to me as if he's doing very well! He will probably start to cry when you go away in the next few months. As I said before, he's still young for that.

    3. But sometimes I can not get his attention, specially when he is tired or hungry. Is this typical? I mean when he is lying on his tummy and plays. When somebody else is holding him or when I put him on table front of me he looks at me at 90 % and smiles. is this enough? He also watches when we eating and want then eat that to. He is more interacting with my daughter (8 y) and other as whit me, could it be that he is not interested in my worried face and eyes? I am crying allot lately. Any updates how Lauras Baby is doing?

    4. It is certainly typical of all human beings that it's hard to get our attention when we are tired or hungry. I would say that 90% of the time is a really good indication that he is doing well. Do you think you are anxious about him because of whatever else it is that's worrying you? Can you get some help that will make you feel better?

      I don;t think he would be "not interested" in your worried face, but he may want to actively avoid looking at a face that appears blank or frightened.

      I'm sorry, I did not hear anything else from Laura. If I do, I'll post it here with these other comments.

      I hope life will improve for you, Anon!

    5. I am just anxious about autism. He is hitting all the others Milestones.
      Yesterday we had a visit from my husbands aunt and he gazed very often in her Eyes and was playing with her and done funny faces and then waited for her replay. I talked about this whit her and she said that her son was similar and sometimes did not want to look her in her eyes at that age and he is now 10 years and is normal. Said his word at 9 monts. And she said that the eye contact would be better in few months. My husband was also the same. Could that be just genes? Or his character? He reacts on diffident noises al the time. And responses when we calling him and I have a feeling that he can not look every time in the eyes because he has problems with eye muscles.

    6. Dear Anon--- as you know, I haven't seen your baby or met you, so I can't say anything definitely, but honestly this child sounds as if he is doing very well in every way except the strabismus. Everyone, at every age, has times when they do not look another person in the eyes. I would not think of autism at all in your son's case, but I do feel concerned about your state of mind and why this has become so frightening for you. Do you have anyone you can talk to about how you are feeling?

    7. I am concerned beacause I know how hard you have to work with this kids with autism because I am a teacher and see this every day. I do not understand why is it so hard to get his attention sometimes and why he is beter with eye contact when lying down or whit strangers. I get the filing he does notneed me becase he never crys when strangers hold him. Is it true that some babys first develope motor skils and then social?

    8. Your baby does need you! He may not be telling you in ways that are easy to understand, but he does. He may just need to develop a little more before he is really concerned about strangers and how they are different from familiar people.

      It's true that different babies can develop abilities in somewhat different orders, and they do not all move along "step by step" in the same way. But I am not so much concerned with how your baby is developing as with how you are feeling. You seem to be quite anxious and depressed, and you focus those feelings on your baby. Is there anyone you can talk to about how you are feeling? I would like to think that someone near you could help you feel more comfortable about this child, so you can really do your best for him.

  50. Doctor,

    First off, thank you for being open and continuing to reply to a lot of worried parents here. You being active in replies means so much to those that choose to ask a question and to those that are just here to read. Please continue to do what you are doing, you are helping.

    We have twins (1B and 1G) that will be 12 months old next week that were born on time an of normal weight for twins. Having two makes it easy to compare milestones, something we know we shouldn't do as all kids are different, but it's challenging at times. Our son is my main concern at this point.

    He does not respond to his name no matter how many times we call for him, he had his hearing checked at birth, fine. He doesn't make eye contact with us even if we are a foot in front of him, he'll look over our shoulders or perhaps give us a quick look then we lose it. He can focus on the TV while we are feeding him, but we struggle to have him focus (eye contact) on us. He's walking on his toes at times, but he's just now starting to take a few steps on his own, I never knew that was a possible red flag, I've always dismissed it as him learning to walk (which may be the case). No words yet, just dada. Sometimes he'll close his eyes while he's crawling around, or make a squinty face as he's moving. He likes to bury his face in the soft play area we have set up and do pelvic thrusts over and over (this happens frequently). Doesn't really understand basic words such as "bye bye" or "no no", does not wave goodbye, though he does do a "high five" (low five actually) when he's up for it. Over all, a happy baby with a healthily appetite (86 percentile in weight at his 9 month check up). He loves the ceiling fan, but doesn't stare at it, and has no probs playing with his toys.

    My main concern is the lack of eye contact and him not responding to his name, among the other things listed above. Our daughter is pretty much doing all the things except for speaking words.

    We do plan on bringing this up with our peti next week on his 1 yr check up. Should I be concerned and insist on a specialist? Do you see any red flags, or am I being a worry-wort?

    1. Dear Anon-- thanks so much, I hope I am being helpful to somebody!

      I understand your concerns about your son. Let me say first,though, that it is PROLONGED toe-walking that is a symptom of autism. Many babies toe-walk when they are just starting to walk, and even do it later for fun, just as they walk backward and look pleased with themselves. Because autism involves many apparent developmental delays, it's easy to mistake typical "baby" behavior for autism when it first begins. Toe-walking, not just for fun, at age 2 years is more likely to be a symptom of autism.

      Even though he passed a hearing screen at birth, I'd like to know how his present hearing is. Ear infections can cause intermittent hearing loss for months at a time, and can even result in children paying no attention to sounds when they can hear them. That he closes his eyes when crawling also makes me wonder whether there is some visual impairment. Those are the points I would say to bring up with your pediatrician, and they could be tested now. Even a specialist would not be able to diagnose autism at this age.

      I do have a suggestion to make about handling him and encouraging better communication. I would not have the TV on around this child at all, but especially not when feeding him. One-on-one interactions while feeding are the best way to help any baby take an interest in other people and begin to notice what gaze tells them, as well as facial expressions and speech sounds.

      I want to ask-- when you spoon-feed him, does he open his mouth in anticipation of the spoon?
      That might tell something about his vision and his responsiveness to other people.

    2. Thank you for the response!

      We will try turning the TV off, the issue is our little girl won't eat unless the TV is on :). We've had a rough year with her feedings (she was 6th percentile when she was 6 months). We discovered that she has no problems eating when we play some cartoon songs/music on the TV while she eats, she needs the distraction for some reason. It's proven extremely successful as she is now up to the upper 20 percentile, I just hope we aren't doing anything wrong to my son's attention span as he in the chair next to her watching the same TV songs during feedings. Putting them is separate rooms so each "has their way" is rough since I'm at work 8 hrs a day and my wife is at home. We'll work on that and report back.

      Yes he opens his mouth in anticipation of the spoon. Feeding him has never been an issue. We can place the spoon in front of him and he'll know to open it when he's finished what's in his mouth and will open for more. When he's playing, he has no issue with turning his head when he hears his "favorite" sound (he loves the noise the door stop springs on the baseboards). He's even known to cross an entire room when he hears it so he can play with it. I just wish he would do the same when he hears us call his name.

      It's hard to help him with words or gestures since he doesn't make direct eye contact with us, if he doesn't it's extremely brief. Saying and showing him how to say and waive "bye bye" is difficult when he won't look at you to learn it. I've read that some babies take on tasks one at a time. Such as: he's learning to walk now so all other things are put off. Once he has walking down, he'll move on to the next milestone. Any truth to this? Or are these normally done at the same time in tandem?

      Thank you again.

    3. Well, it does seem like I'm asking a lot, to suggest that you feed them separately, but it would be better if at least some of the time you could do it one-on-one with him and leave the TV off. If you want him to focus on you, things will go better without any distracting sister or TV.

      I asked about the spoon because there's been a report that babies who were later diagnosed as autistic did not seem to anticipate a spoon and open their mouths.

      It's true that a lot of babies do seem to work on one achievement at a time. However, responding to a spoken name usually occurs at 6 or 7 months, so that seems pretty far out of synch. Were these twins born much premature? Are you using corrected ages (measured from when they "should" have been born)?

      As I'm sure you know, I can't really tell you whether everything's okay or not. However, I can't help feeling that he would benefit from more, and more intense, one-to-one engagement, without any distractions. You don't have to do it when feeding, it's just that that's sort of an ideal time when you are already communicating over the feeding. It can't hurt to work on this, anyway. And I would definitely mention what you notice to the pediatrician, who doesn't see babies in their normal comfortable habitat and depends on parents to report some things.

    4. The twins were born at 38 weeks (normal is 40 right?). My wife did a great job of keeping them in there until we were told they needed to come out due to the space in the womb.

      I'll report back after our pedi on 1/17/15 and share our findings. Thanks again for your help Doctor.

  51. Wow, that was great work-- I was assuming 35 or 36 weeks!

  52. hello dr..
    i have 3 months old baby..she is delivered 3 weeks before her due date..she is not making an eye contact with any one..but she good on noises she also response on light keep looking on it..she start to lift her head for few seconds and also move it side by side..she dnt like her tummy time and also not want to sit..she wants to lye down and stare at wall.. i dnt know she is actually playing with her toys but when we make a sound from them she response it too.. she plays with her hands and take them in the mouth..and try to grab things like her cloths my finger etc..she also produce a giggling sound like ggooo huh hann.. my main concern is about her eyes..why she is not making an eye contact..please advise me what to do

    1. Dear Maddy-- I think the most likely reason that your baby is not making eye contact is that she is still very young. She is 3 months old counting from when she was born, but only 2 months and 1 week counting from when she should have been born. This does not seem like much of a difference to adults, but it is 25% of her life. In another few weeks, you will probably find that she is beginning to make eye contact quite a bit.

      I would be very surprised if a baby this young were actually playing with toys, or if she was comfortable in a sitting position. The things she is doing with her hands and her cooing sounds are really just right for her age.

      Babies of this age who sleep on their backs often do not care for tummy time. You need to make it more interesting and fun for her. You might try putting her face-down across your knees, and then pat her back, sing, and jiggle your legs rhythmically for a few minutes. Don't try to go on for a long time until she gets used to that position. Later, when she lifts her head a bit,you could put her on a bed or padded table where you can put your face down so she can see you.

      Young babies are usually most interested in things that combine several kinds of stimulation-- seeing a face, being moved rhythmically or patted, and hearing a voice singing or talking in a high-pitched way. They do not like to look at blank or very serious faces, so be sure to smile at her.

      She sounds like a sweetheart, and I think you will probably find that she is much more social soon. But if by four months she still does not seem to make eye contact, you may want to ask your pediatrician whether her vision can be checked.

    2. Hi Dr Mercer ! And thank you for giving good advises and responses to worried parents like me! I have a son who is 5 months old. And i am worried about his eye contact. When i have him on my lap or on my arm he wont give any eye contact. And not when i an brestfeeding him, he has only looked up at me a few times. It is easier to get eye contact with him when he is laying om the floor or on the bed, but its not fore a very long time. He is otherwise hitting his milestones, and smiles alot. He often smiles and laughs when his brother and sister is playing with him. But i am so worried about autism and it keeps me from enjoying my time at home with him. So i guess my question is, should i be worried at this point, or could this just be the way hi is without it beeing something wronge with him? Cathrine from Norway

  53. Hi Dr Mercer ! And thank you for giving good responses and advises to worried parents like me! I have a son who is 5 months old and i am worried about his eye contact. He will not look at me while he is on my lap or if i hold him on my arm, and i dont have eye contact with him while i brestfeed him, he has only looked up at me a few times while brestfeeding. It is easier to get eye contact with him if he is laying on the floor or on the bed, but it is not for a long time, only a few seconds. He is otherwise hitting his milestones and smiles alot . He also often smile and laughs if his brother and sister play with him. But i am so worried about autism, and it keeps me from enjoying my time at home with him. So i guess my question is, should i be worried, or could this just be the way he is without it beeing something wrong with him? Cathrine from Norway

    1. Hi Cathrine-- it's really too early to tell about autism, but I would say that if he smiles and laughs when playing with his brother and sister, that seems to indicate very normal social development.

      Young babies are usually so hungry that they do not gaze at their mothers while breastfeeding, but just close their eyes and go to it. If he has the nipple in his mouth, he probably has to turn his eyes to look up at you, and that's not easy at this age. In any case, you will probably get only a few seconds of gaze at this age, whatever position he is in. I think you will see him using his eyes for communication much more a few months from now.

      I know there is no point in telling you not to worry-- but I don't think you need to! Just remember that communication with other people is the goal, and eye contact is only one part of that.

      But you should try not to stare or look very serious when you look at him, even though you are worried. If you do, he's even more likely to look away,and then you will be even more worried--

  54. Hi Dr. Mercer-- I don't have a question, but just wanted to say that I think you're wonderful to take so much time to address each situation here in such comprehensive and compassionate ways. I know there are probably a lot of other parents who would agree with me! Best, Kelly

    1. That's so nice of you to say! I really enjoy hearing these stories and trying to figure out what's going on-- so I should thank readers, too.

  55. Shoot.. I just wrote out a big comment and it doesn't seem to have posted. If this ends up being a duplicate I am sorry.

    I want to start by saying that it is so great that you take the time to respond to all of us "worried" parents. Thank you!

    My son is 9 months 2 wks and born at 37 weeks. He seems to be on par with his physical developement. He is crawling all over (since 8 months), pulling up on everything (since 8.5 months), and feeds himself finger foods. I am concerned about his babbling, his eye contact and him responding to his name.

    He started to say mamamama for a few days at about 6.5 months then he sort of backed off and only says it now and again. Then he started saying dadadadad and then backed off of that too. He mostly babbles with aaaaa haaaaa waaaaa yaaaaa mmmmm... not so much with ddaa baaa maaa. Is it odd that he started then kind of stopped?

    With responding to his name.. I have to be honest that we only recently started looking for him to respond to his name every time. He will sometimes but if he is focused on playing with a toy he will not respond.... It seems like he is more likely to respond to his name when you first enter the room. He is unlikely to respond and look up at you if you have been sitting with him for a while and he is focused on a toy or watching our dogs (his favorite). When you enter a room he sees you he will let out a huuuge smile of excitement to see you. Its almost like if you've been there for a while hes bored of you, but if he hasn't seen you in a little while you are new and fresh and exciting. He will play with a toy and if you can get his attention he will focus on you for a second then go back to playing with his toy. I feel like he is very selective with when he wants to make eye contact.. like it is on his terms and if he doesnt feel like responding to his name or making eye contact he wont and if he feels like it (and isnt focused on another task) then he will. He just seems so independant for a 9 month old.

    I am concerned that he is pretty fearless at home. He doesn't look for approval when he is crawling towards a new exciting object or our dogs (which we dont want him getting too because he just tries to squeeze them and crawl all over them). Should he be more warry at this age?

    He loves when we do patty cake, always smiles but he does not try to imitate the motions. He also does not clap yet or do "so big". He will always imitate raspberries when you start doing them and he reaches out to try to grab your mouth. He will reach out for you when he wants to be picked up. He will reach out and try to eat your arm if you are sitting with him and he want out of his high chair.

    He also used to love looking at new people but yesterday we were at a gathering and everyone who came up to him he tried to avoid looking them in the eye and he wouldn't look at me in the eyes either.. is it normal to be really overwhelmed at this age in large groups? He also was approached by his uncle who made a really intense happy noisey approach and he started to cry. It seems like lately if he is a new setting with people he doesnt know or hasnt seen in a while and they come on very strong he will start to get upset if they get in his face.. is that normal??

    I guess Im just wanting to see more babbling and better eye contact and wondering if what he is doing is normal or cause for concern. Thank you so much for your time!

  56. ps... when I said patty cake I meant peek a boo!!! : )

    1. Sounds to me as if he's moving right along!

      To answer the last part first, yes, it is perfectly normal for him to be overwhelmed by large groups. I'd feel more worried if he wasn't overwhelmed. This is the age when the capacity for fear comes "on line" for the first time-- not just fear of something painful like a shot, but social fear, fear of strangers,of separation, and even of people who just come on too strong. Babies avert their eyes when something is just too much for them, just as adults might decide to go to the bathroom for a little break when the party is too much-- all the baby can do is not look, he doesn't have the option of excusing himself.

      Wariness is a term usually applied to mild social fears. He's not afraid of the dogs because they don't give him the social cues that make him anxious, and I assume he's never been bitten or even growled at, so he isn't wary. If he hasn't already done so, he may soon start to look at your face when he sees something strange, to see if you look scared. If you do, he will not approach the thing.

      Your son sounds very communicative and sociable when he's comfortable. I don't think you should expect him to "answer"to his name when he's preoccupied-- after all, if you were reading, or watching TV, might you not need to say to someone "Oh,sorry, were you speaking to me?"

      I see what you mean about the vocalization, and it is a bit unusual IF he was saying ma and da as words (with reference to you), but I don't think he was using ma and da as words when he said them. They were just babbles without specific meaning. He may now just be practicing new and different sound combinations that are harder to make than ma and da and has not yet gotten to using sounds as words-- which would not be surprising at his age.

      It sounds to me as if he has "read the books" and is doing what he ought to do!

  57. That’s really amazing and extraordinary blogs & can help those who get issues in searching this type of information. visit

    1. I only published this one so interested readers can see a great big chunk of pseudoscience in its natural habitat. Quantum physics, indeed! That's the most recent ploy of charlatans.

  58. hi dr i have a 4 month year old and she's coos and she smiles and laughs she also makes eye contact i wanted to know when they start babbling dada mama and stuff like that.. what should she be doing at this age

  59. Btw she will be 5 months in a week

    1. Cooing is the beginning of language development,so she's right on target for her age. In the next month or two I would expect her to start what's called syllabic babbling like ma-ma, da-da, la-la. These aren't really words because the baby doesn't use them to refer to anything particular, or understand them if someone else says them. Then in a few more months (the baby doesn't go by a book of instructions!) she will begin to put different syllables together: ma-ba-ba, boo-boo-moo-moo. Then , she may show she understands some words by looking in the right direction when you say someone's name, By about a year she will probably begin to make some sounds that you can recognize as having meaning: ma-ma, kee-ka (for kitty-cat), bah (for bottle), etc. but she will still say a lot of syllables that don't seem to have meaning. Some time around 18 months, many babies seem to start to learn dozens of new words every day.

      Be sure you talk to her a lot, and don't use TV or other screen devices around her very often. That will help her learn about language. Singing and saying rhymes is also fun for both of you and helps language development.

      She sounds like a fun baby, so have a good time!

  60. Dear Laura,

    My daughter will turn 1 in 2wks and I'm so worried about her development.

    Lets start with what she can do:
    1. she babbles alot but no words yet
    2. she can clap and wave but she doesnt do it when we ask her to. She will do it when she feels like it but it's also seldom she'll do them.
    3. she can point but she wont look at me after she points (no joint attention)
    4. she can initiate peekaboo
    5. she will offer her food to me when she is eating and i will pretend to eat it
    6. she started giving me her toys like she will pick up something raise and her arms and look at me like she is giving it to me
    7. she is generally a happy smiley baby
    8. she can follow if i say where is the ball or balloon and she will get it but not bring it to me

    Now these are my concerns-
    1. she has poor eye contact and lack of respond to name. she wont look at me when she is playing or when i call her if im beside her. and when i leave she wont even look to see where im going then when i call her name frm a distance she will then look at me. but i feel like she has good eye contact with her brother, dad and strangers except to me! when strangers are talking to her she will look them straight in the eye with the look of trying to understand what they are saying.
    2. she doesnt repeat our sounds/gestures
    3. she doesnt know how to play with toys. i try to teach her to shoot the ball in the hole but she will look at me do it and when i try to say your turn and give her the ball she wont even take the ball! she only knows how to bang things together, empty things out of a box, flip books.
    4. she doesnt ask for help or i feel like she doesnt care. like when i take a toy away she wont protest or if she wants to open smthg she will try and whine if she cant open expecting her to look at me to ask for help but she doesnt make that eye contact.
    5. no joint attention

    I've read that these are red flags for autism and i cant eat or sleep worrying about her. :( Im looking back at old videos and she used to sit in her swing and she will look at me and babble back to me while i talk to her. but since she started learning to pull herself up she wont sit still for anything!
    Im a FTM and I feel like I dont know how to play with her its so frustrating if she's not looking at me then how do i teach her things? So my question is, how do I get her attention so she will engage with me?

    1. I'm not "Laura", but that's okay!

      I would like to smack these "red flag" people who have succeeded in scaring so many young mothers. Please keep in mind that the symptoms of autism are also the "symptoms" of quite young children. If your daughter still did these things a year from now, you would have reason to worry. Right now,you don't.

      I think you are confused about joint attention. This is not the same thing as pointing. Joint attention involves the baby seeing something interesting, then looking at an adult, then back at the object, a few times until the adult looks there too. It's like using the eyes to point. But this won't happen unless a) there's something interesting to look at b) the adult is paying attention and participates.

      I think that at her age she quickly forgets about the object you took away. This is the handy thing about this age! In a few months she will protest loudly.

      If she does not signal you that she wants help to open something, it may be that it is simply not very interesting to her. Can she see what's inside the container? When people use this test for autism, they have a transparent container, and inside it the child can see something that's bright colored and moves. You have to catch their attention first.

      About responding to her name: nobody responds to their name every time, if their attention is already elsewhere. How many times have you had to repeat an adult's name before they heard you?

      I think you are expecting her to play in a way that's beyond her present developmental age. I would not expect her to do much with toys except bang them together or throw them. The organized play and pretend play you're looking for will probably come over the next 6 months or so. The same is true for taking turns doing something, which is really a hard task for a little person-- she has to wait and still pay attention, then at "the right time" she does something, then she waits, and so on. She's very likely to have her attention distracted very soon after you begin this.

      Saying two words at one year is just an average. Some babies say more, lots say a lot less. The important thing is that she understands some words, and she communicates with you by things like offering you food.

      Babies tend to concentrate on one developmental thing at a time, and that's why she doesn't babble to you when she's busy pulling herself up. When she gets good at that, she may suddenly come back to vocalizing.

      At her age, you can't "teach her things". What you need to do is to see what interests her and follow her lead. Provide things she might like to explore and play with-- they don't have to be expensive toys,just old pots and pans are fine. Baby-proof your house and put everything dangerous or breakable up where she can't reach it, so you don't have to constantly interrupt her exploration. Watch her or follow her and show your pleasure in the interesting things she finds to do.

      When you talk to her, be as cheerful and enthusiastic as you can. She's much more likely to listen if you talk "motherese" (you can Google this if you don't know what it is ). You get her attention by doing that and by engaging with whatever else interests her.

      You seem to feel that she's more attentive to other people than to you. I am wondering whether you are somewhat depressed, and that makes you worry a lot and also look serious when you look at her-- babies don't like to see faces that are frightened or worried. If you think this might be true, can you seek some help? It could be important for you and helpful for your daughter's development.

      In any case, she sounds to me like a child who is developing very typically for her age. My best wishes to both of you!

  61. Hi Dr. Mercer

    I am a FTM of a 14 month old boy and I am starting to have some serious concerns about his development. I tried to publish this once and I am not sure it went through so if you receive this twice, sorry. I think it might be easier to just list things my son is and is not doing.
    - he is not walking. He is will walking along the couch, with his walker or holding my hands. He crawled at 8 months and pulled himself up too
    - he won't stand on his own, maybe for a few seconds and when he realizes he is not hanging on to something or someone is hanging on to him he immediately goes down to his knees
    -he says a few words for sure, dada, baba (bottle), dog - my sitter says he can say blanket, cold, crackers
    - he eats and sleep pretty well - he prefers real food and likes to feed himself
    - he points at objects he wants like his pacifier, but not at things to show me. I am not sure if he is really engaging in joint attention.
    - he loves playing games like when I chase him or make funny faces
    - he looks at me probably 80% of the time when I call his name either on the 1st or 2nd time. I can't tell if he is looking at my eyes or mouth
    - I have a very difficult time getting him to look at me when I am holding him, he seems to avoid looking at me or looks at my mouth and puts his finger in my mouth or on my noise
    - with strangers he looks at them briefly then turns away, but will look back at them and watch them, eventually after awhile of talking to them he will interact with them and give them a high five or blow a kiss
    - when he is playing he will put a block into his train and then look back at me and smile, I can't tell if he is looking at my eyes or mouth
    - when I read to him, he will bring me a book and I will read it, occasionally he will look at me as I am reading but I can't tell if it is at my mouth or eyes
    - he seems to watch kids, in the grocery store, he is constantly turning his head when kids pass by
    - he waves bye bye, signs more and is working on please
    - he will also shake his head yes and no, not always responding 100 accurately

    I guess I am mostly concerned about his eyes contact, joint attention and not walking. Any help or insight would be wonderful. Thank you!!

    1. Dear Natalie-- your little boy sounds like a perfectly normal and well-developing kid! And I am very annoyed with these "red flag" people who are doing nothing but scaring young mothers.

      First of all, making eye contact is not gazing soulfully into one another's eyes. It is using information from the eyes to communicate. It's good for a baby to look at your eyes in order to see what you're looking at. This helps them understand what things are important, and also lets them use your facial expression as a way of finding out what you think (is the thing scary, or nice?). They also learn that by moving their gaze, they can communicate to you-- that they want you to look at something, or that they've had too much of some activity, for example. Using information from eye movements is a major way to understand other people's feelings and thoughts, and to understand that they are people with feelings inside, like you, not just big fleshy machines.

      Joint attention is not pointing with the finger. It's looking at something together with another person, and checking their eye position to see whether they are looking the same place. It often culminates with looking and smiling at each other, as you described in talking about putting the block in the train. It's not about getting something they want, it's about the pleasure shared with another person when you do or look at something together. So, he does show joint attention, from what you say.

      If he looks at your face, it doesn't really matter whether you can tell if it's at your mouth or your eyes. He's interested in you, sees that you're a person, and enjoys your interaction, which is the whole point. Exploring your mouth and nose is just part of that. He would probably explore your eyes, too, but I'm sure you pull away if he tries to poke them!

      14 months is not unusually late to walk. I know you've read that the average is 11 months 14 days or whatever it is, but the normal range is something like 7 months to 18 months. Keep in mind that if he slept in the supine position, as parents are told to do nowadays, he will hit motor milestones later than the "book" says, because the "book" figures are based on babies who slept prone. Supine-sleeping babies do catch up-- I'm just saying that at this point he may seem slightly delayed, but he is still very much in the normal range, and what's more you might expect him to be a little later.

      He sounds terrific-- and if it's autism you have on your mind, I would say you can stop worrying about that. Good luck with all this! By the time you have your second, you won't have time to worry so much, so that's something to look forward to!

  62. Thank you for the insightful article. I think you’ve answered my questions about eye contact. I have a 7 ½ month old daughter and she was born 9 days early via c-section. After reading your article, I believe she makes an appropriate amount of eye contact. She smiles and laughs when doing such things as peek-a-boo or when we act silly around her. She’s very good at grabbing objects and transferring them between her hands. She sits up well and reaches for objects.

    My question involves her twirling her hands and moving her fingers with her arms out to her side, almost like she’s conducting an orchestra. She used to shake her head back and forth as if saying “No” when she was falling asleep. She doesn’t do this as often any more. She doesn’t really roll over that much. I think she rolled over from her tummy to her back 4 or 5 consecutive times when she was 5 months old and hasn’t done it since. Although, I don’t think we do was much tummy time as we should. She also puts her arms out to her side with her hands down towards her hips like she’s skydiving, which also makes it difficult for her to roll over from this position. I’m concerned because of the autism “red flags” that you read on the internet and I have an autistic niece, so I’m hypersensitive to her movements. Do you think there is any cause for concern for autism?

    1. If she is sociable and plays peek-a-boo, I would say that she is not acting like an autistic child. I don't have a crystal ball, of course, but although it's true that odd movements can be precursors of autism, my bet is that her little ways have to do with the supine position. I wrote about this a while ago at That post describes a program for working with supine-sleeping children to help improve their motor development.

      But I'm not sure what position she's in when she's doing this sky-diving and conducting. Is she lying down?

  63. Thank you Dr. Mercer. She usually does the conducting while sitting, i.e, in her high chair or when being carried. She'll do it sometimes when lying down being changed and she likes to scratch the wall with her nails or on other surfaces. I guess she'll do it from any positions. She does the sky diving technique when on her belly, she kind of teeters on her belly with her arms along kind of looking like a little duck.

    She does only sleep in the supine position.

    1. I wish I could be of more help on this. I've been searching research on movement issues in autism. Unfortunately, not only do most of the studies focus on eye movement, few of them look at children under 12 months of age. You're right in thinking that repetitive stereotyped movements can be precursors of autism, but infants and toddlers who are developing normally also do these things-- like hand flapping-- sometimes. Babies do also play with their fingers and hands as they begin to get control over using the fingers individually.

      She's still sleeping in supine and doesn't move from the position you put her down in? If so, she may really need a lot more tummy time. What if you pull one of her arms forward gently when she's doing this teetering, or put something she's interested in where she can see it and be tempted to reach? She needs to get her arms and shoulders forward in order to push up.

      It's really a good sign that she sits well and can transfer objects. To me, that suggests that her real motor development is well along, whatever the rolling and prone inactivity would say. And her social development seems fine, which would argue against autism.

      Do you have an early intervention program in your area that your pediatrician could refer to? I would love to know what a physical therapist would make of this-- but I really see it as a puzzle of physical development, not anything that would suggest autism at this point.

  64. Hi Jean! Not sure why my first post was not published. Anyways, thanks a lot for helping all concerned parents. I'm also concerned about autism in my 14 week old son, born in 38th week. I was worried he was blind as he wasn't tracking any moving object until his 10th week. His eyes were checked and all is fine. He also had brain sonography and this was also ok. Physiotherapist noticed he is a bit hypotonic on his upper body so i have started giving him lot of tummy time which i was not doing before. He can hold his head and look around and smiles sometimes now in this position but does not fixate his look onto anything. When lying on his back he smiles into air and on his favourite super colourful toy but does not look at us in the eyes when we play with him. We believe he was looking us in the eyes and smiling in his 12week only and I expected him to continue and smile even more but it is as if he doesnt see our faces. He does coo and loves to be carried. I'm not sure if all this is normal and if you have any tips on getting his attention - i put his favourite toy next to my face or in front and he keeps looking at the toy. However, i drew a basic human face in black on white paper and he did smile on it and was looking at it without problems. Also, sometimes when I pley with him he smiles, maybe more reacting to my voice? Many thanks!

    1. Hi Am-- I don't know why your first post was not published either. I never saw it-- just some electronic gremlins at work, I guess.

      I'm sure you know that nobody can diagnose autism in a baby this young. I am wondering whether he just has some slight developmental delays (like being slow to track moving things) related to being slightly preterm-- delays that will be made up before long.

      I certainly agree that plenty of tummy time is important. That little bit of hypotonia can interfere not just with control of eye movements, but with the strong head control that's needed for skill at looking around. In order to locate things in space, we need not just to know where our eyes are "pointing", but where the head is "pointing" too. The head and eye systems need to be coordinated for efficient looking, and poor muscle tone in the upper body will delay that coordination.

      Also, babies of this age are usually better at looking at things when they are upright. Carrying him may give him more opportunities for using his eyes.

      There are things you can do to help him along, in addition to the tummy time. I wrote about one useful program at

      I would suggest that you talk to him a lot and avoid screen use around him as much as you can.

      Now, I'm going to make one other suggestion, for whatever it's worth. Some babies do not give their parents very good communication cues to show that they're interested in something. When you're playing with him face to face, you might set up a phone to do a video of his face and one to do yours. Later, look at the two side by side, and see if you see that he is giving you responses that you don't notice at the time. If you see anything like that (where you didn't respond to what he did), try to keep it in mind and use the information next time you are playing. This is a technique that is helpful when parents have trouble communicating with older babies, but it might be fun and interesting for you to try.

      By the way, when you are trying to get him to look and smile at you, make sure that there is plenty of light on your face rather than behind you. The vision of babies of this age is still not as well developed as you would think, and it may be that he just doesn't get a clear enough picture of you. (Try some bright red lipstick, too.)

      Good luck-- and keep in mind that some temporary developmental glitches can come from prematurity!

  65. Hello! My 11.5 month old is concerning me. Physically he seems to be developing normally. Crawls, climbs, pulls up, trying to start walking. But his social skills are making me nervous. He says dada and dog but nothing else. No babbling of any other sounds but those (been the same since 7 months). He won't look at you when you hold him. Ever really. But he will look at other people while being held. He loves to play alone. He doesn't look up at us during play. He doesn't involve us or "show us" anything. He doesn't point. I can't really tell if he is looking at things I point to or not. He does not acknowledge his name being called. He doesn't wave. He does clap. He has had multiple ear infections. His hearing was okay at birth and we have scheduled another hearing test next month. I watched a video on the differences of Autistic and normal 14 months old playing. He definitely seemed to play more like the Autostic baby, but is it that or the age? He's 11 months and those babies were 14 months. Any advice would be greatly appreciated.

    1. Dear StephG-- I certainly understand your concerns about this little guy. I think you are taking the appropriate step by re-assessing his hearing. Babies who have intermittent hearing loss because of ear infections may simply stop paying attention to sounds because they are so unpredictable to listen to-- and of course, if there is long-term hearing impairment the effects would be similar.

      You are right to think that a video of 14-month-olds is not a big help for assessing 12-month-olds. Autistic children behave in many ways as if they are younger than they are, so an autistic 14-month-old and a typically-developing 11- or 12-month-old might do some similar things (like hand flapping).

      You mention two words he says, but you don't say whether he says them meaningfully, with reference to dogs or daddy. It's more important that he understands words than that he says them. You mention that he does not respond to his name, but I am wondering whether he responds to other words, like food words.

      Does your area have early intervention services? Your pediatrician or child study team may be able to tell you how to get in touch with such services, and although he is too young for a diagnosis (except for a hearing problem) you might be able to get some help from them.

      Meanwhile, I would suggest that you might look at youtube videos on Floortime. This is a method that parents can use to increase communication with young children. Although it is not well-supported by research evidence, many parents and children enjoy doing it and I can pretty much guarantee that it won't do any harm. An example of Floortime methods is that when your child is playing alone, you offer a "playful obstruction" by holding on briefly to something he's trying to pick up, or when he puts something down you move it a tiny bit. This can help attract his attention to you as a part of his play.

      Keep in mind that there are other explanations than autism for his delays, and also that many children who seem to show early signs of autism are developing typically several years later.

      Best wishes for a good outcome!

    2. StephG-- I also wanted to ask, have you been doing sign with him at all? If the problem is about hearing, that could be a real communication breakthrough for him.

  66. Dear Mrs Mercer,
    this is Laura, the Italian mum from the first comment in this page. When I wrote my comment, on October 2013, I was concerned with my daughter Rebecca, as for lack of eye contact and response to name. I just want to update you about her, hoping this will be useful to other concerned parents. She's now 2 years old and perfectly healthy! As you told me, few months after writing to you, I started noticing signs of "joint attention". I will never forget that time she managed to turn a musical toy on and she looked up at me smiling! She still isn't fond of prolonged eye contact, cause she is shy and a bit introverted, but it's simply part of her character. When she was about 18 months I was much less concerned about her but brought her to a neuropsychiatrist for an evaluation anyway. The observation took place over a certain period of time and in the end they told me she was meeting her milestones and there weren't any signs of autism. As I look backwards I realize how I was giving too much importance to eye contact in such an early time... she was too young! Another mistake I was making is to compare Rebecca to her older sister, all children develop at their own pace! In closing I'd like to thank you doctor, for your kindness and helpfulness, it's amazing how you find the time to answer to all of these parents!!! Thank you very much for reassuring me when I was stressed out and worried!

    1. Laura, thank you so much for telling me this and letting other parents read your reassuring story!
      Your message that children are different is really an important one that I hope everyone will take to heart.

      You know, if you wanted to write a "guest post" about your experiences, I'd be honored to publish it. I usually write between 500 and 1000 words, but you can do whatever length you like.

  67. Dear Dr Mercer,

    First off I want to say that it is amazing that you are personally replying to my each post. It is helpful to read other people's experiences and understand how they are dealing with it.

    I have 3.5 month old twins, a boy and a girl. They were born at 36 weeks so their adjusted age should be 2.5 months, I would think.

    My son makes great eye contact, coos, has good weight etc. my daughter however seems to me to be much slower. She wasn't making eye contact till 3 weeks ago. Her eye contact currently is intermittent. Her caretaker or me sometimes get eye contact for a minute or so. Every Other time she will just look at me once and look away. She has reflux and is mostly propped up on a pillow. She tends to look down then. She tracks objects very well and if she sees people come in out and of the room she will track them as well. She smiles when she sees a face the first time (for eg when she wakes up she smiles at us), but that's about it. She squeals and smiles when I blow raspberries. She always seems to be looking around rather make eye contact. If she was an adult, I would call her moody and distracted.

    She is a little low on weight but not too bad. About 5.9 kegs. She is a bit of a bobble head but manages to hold her head up during Tummy time decently well. She also can flip on her stomach when she is propped up on her back on a pillow.

    Most times, It takes a lot of effort for me to get her to look at me. However if we put a musical toy in front of her she focuses immediately. As you can imagine, I am concerned about her lack of social responsiveness, especially considering her brother is very responsive. My paediatrician has told me she seems to be a little slow and we need to keep an eye on it. I try to engage her a lot. She gets annoyed with too much stimulation.

    I am not sure what I should be feeling about this. I try and not think of autism as I know it's early but i can't help but worry. Could you tell me if she is doing ok and will improve (based on cases you have seen. I understand there can be no definitive answers yet)? Should i be worried? Will more stimulation and engagement help ?

    Thank you so much

    1. Dear Monami-- I'm glad it's helpful to read what other people have written. Most people these days have too few children to really understand the variations in babies-- and those who have more are too busy to think about it!

      I think you are seeing two different personality patterns in these two babies. The little girl may be a bit uncomfortable because of the reflux, also. But I think it's wonderful that you are sensitive to her annoyance with over-stimulation. If she averts her eyes as you describe, she is telling you that whatever is happening is just a bit too much. It's good to try to engage her, but also good to follow her lead when she averts her eyes and just wait until she looks back at you.

      I am wondering whether you look serious and worried when you look at her, and that this expression is sort of "the last straw" as far as she is concerned-- she's easily over-stimulated anyway, so when she sees a serious face staring at her she averts her eyes.

      By the way, most babies this age do not make eye contact for any longer than what you mention. The real point here is that they need to learn, as they get older, that if you look at someone's eyes, what they do with their eyes will tell you other things, like what they are about to do. Just gazing into eyes is not the important thing.

      So, my guess is that in her behavior you're seeing a personality characteristic, combined with the effects of the reflux and the prematurity. But at this point I can only suggest that you avoid screen exposure as much as you can-- certainly, you should not be talking on your phone much when you are around her. She needs to understand that voices and facial expressions are predictable and interesting, not something to be ignored. Keep on responding to the message her averted eyes give you-- that's the best way to show her that social interaction is fun and not too overwhelming.

  68. Thank you for your prompt response, Dr Mercer. I often feel she's overstimulated/distracted because I have an older son as well; him along with the younger twin and the help are often making noise. It's never a quiet place. The noise doesn't distract my boy twin because he carries on conversation in spades.

    I try to be as smiley as possible but yes I may unconsciously be projecting a worried face once in a while too.

    I will continue to engage her and avoid talking over her head as it may be. Will also keep you updated on her progress if that is ok with you.


    1. Yes, do let me know-- I hope to hear that you are less worried soon--

  69. Sorry I forgot to add; she does not coo much. She certainly squeals if she is annoyed and cries loudly to express her displeasure. But herb cooing is extremely limited. Her hearing test was done at birth and was normal. Thank you.

    1. I think this situation may be confusing just because her brother seems to have "read the book" about how to develop. This may be only another individual difference. It's really more important that she become able to understand words-- but not yet!

  70. Hi, I am a grandparent of an 8-week old baby. He is a very fussy/gassy baby. He is not smiling or making any eye contact yet. He seems to always be looking at light. He was born 2 weeks early and we are wondering if this might have any bearing on his being behind on these 2 milestones. His parents and I are worried about him.

    1. Dear anonymous grandparent-- I know nobody can tell you not to worry, but in fact there doesn't seem to me to be any discernible problem yet.

      1. There is no day on which milestones must be reached. There is a range of ages within which the great majority of babies do things, and this baby is certainly not outside that range, nor will he be for a month or more.

      2. If he was 2 weeks early, his corrected age is only 6 weeks, so it will only make you worry more if you think of him as if he is developmentally 8 weeks. That 2 weeks seems like nothing to adults, but it's a quarter of his post-birth life.

      3. Behaviors like smiling and mutual gaze are very much influenced by whatever else is going on. If he's unhappy and crying a lot, he will for the time being be a lot less likely to be smiling and looking at people. If you are upset and crying, do you also smile? I certainly don't, and I don't expect a baby to!

      Worry is part of parenthood and of grandparenthood too, but honestly I don't think anything so far indicates that you "should" worry.

      Best wishes for a calmer baby soon!

  71. Dear Dr Mercer,

    We have 12 month old boy. He has poor eye contact to. But he points, claps, waves by by, understands a lot of words, gives joint attention, follows simple instructions such as " give me the ball", bring me the toy" or give the ball to daddy, "dance",....He has no odder "red flags". But he sometimes does not respond to his name. He walks on his own and has no problems with fine motor skills. He says mama, dada, daddy and when he point sometimes he say see and babels al the time. He knows where the nose is and where the ears are. He shows it on my face.
    I do not understand why he has such a bad eye contact if he is understanding so much. I am worried all the time...What to you thing Dr Mercer what the problem is?

    1. It sounds as if he's doing very well and communicates with you in a lot of ways, so I don't see any "red flags" for autism here. I wonder whether you are expecting a longer gaze at someone than young children usually give? If he really does joint attention, which means that he looks to see where you are looking, he must be looking at your eyes. Eye contact can be just a glance at someone's eyes-- it does not have to be a prolonged mutual gaze.

      As for not responding to his name sometimes, I would guess that he is preoccupied with something that interests him and does not notice that you are speaking to him. I don't always respond right away when someone speaks to me, and I will bet that you don't either!

      Your son sounds to me as if he is doing very well developmentally and is even ahead of where you would expect him to be at this age. I know it's useless to tell you not to worry, but I don't think there is a problem here.

    2. Yes he really does join attetion and looks in to my eyes but only for one second. Never longer. And always when he looks at me when I talk to him it is always for a second to. Is this long enough? I have a feeling that other babys in his age have longer mutal gaze. I noticed that his eye contact was a litle bether before he started to walk on his own. Is this posible that he works on walking now and that is why his eye contact is poorer now? At wich month the eye contact gets longer?

    3. It's possible that he is too busy with walking to look at people so much. but from what you say, he communicates very well. Eye contact is just another form of communication. There is no great advantage to a prolonged mutual gaze, although adults enjoy this.

      Just think about how you do things when you are talking to an adult friend. I doubt that you hold the gaze for long. People usually make eye contact, then break it, look away, and look back again many times during a conversation.

      The reason people are concerned about eye contact as an aspect of autism is because autistic individuals communicate poorly in general, and as eye contact is one of the early methods of communication, its absence may indicate that other communication problems may follow.

    4. And I should add that blind children learn to communicate very well without being able to make eye contact.

    5. This morning he looked perhaps 10 times in to my eyes in half of hour. But just for second. And he always when I ask him for example "where is the clock" or “where are fishes" he always answers with pointing but not always looks at me. He imitates also what we are doing for example yesterday he imitated grandmother when she was plucking vegetable from garden, then he took some to and gave it in a bag. He interacts also more when we play pika boo. And sometime he hides behind the curtains and plays with me and smiles.
      Could be this also a part of his character that is making less eye contact? Perhaps he is more shy?

    6. The evidence is that both boys and girls at this age do take quick looks at people's eyes and do not do lengthy gazes. By the way,pointing and joint attention are different-- in joint attention, the child uses his gaze to get someone else to look at an interesting thing, shifting the gaze back and forth from the other person's eyes (to see where they are looking) and the object the child wants to have the person look at. It's like using the gaze to point, just as adults sometimes do.

      I can't tell whether this little boy is actually doing mutual gaze less than other children do, but if he is, yes, personality and temperament may be part of the explanation-- although I doubt that he would be shy with you if he knows you well.

      Peek-a-boo, pointing, imitating-- these are all excellent signs of normal, even advanced, development.

  72. Dear Dr. Mercer,
    I am Mum of three children, one of them is autistic (the second one, daughter). Now I have a baby, son, he will be 5 month old for a week.
    I am not worried but I am not convinced that he is not autistic.
    Some facts which I found very important:
    - he react to my voice with smile and look, he react the same with his father and sisters, even the autistic one (he react with smile when he see her);
    - he follow me across the room
    - he follow toys, he play with them with both hands
    - he tries to turn to his belly
    - he was cooing very well (from second month), now he produce some sounds, (I do not hear any more aguu), especially in the morning
    - first he look at my (curly) hair then he look in my eyes, sometimes is just a glance
    - he likes to look shadows, threes etc
    - he have problem with looking at me when I am close to him, but I found method to improve that, I slowly progress to his face, and then he look at me, not always at the eyes but most of the time
    - he do not imitate my sounds
    - he likes when I hide and surprise him (peak a boo?)
    - he sleeps and eats well
    - generally he is responsive, happy baby

    I know so much about autism but yet I can not convince myself that everything will be (or not be) fine.

    Is it to early to tell? Does he shows some red flags? How to do early intervention? Is it playing and loving enough?

    Thank you dear doctor in advance.

    Pardon for my English.

    1. Please don't worry about your English-- I am sorry that I do not speak your language!

      From your description, it seems to me that your baby is developing very well and I do not see anything at all to be concerned about. I am sure you know that brothers and sisters of autistic children are slightly more likely to be autistic too, but the chances are very much greater that they will develop typically.

      It sounds as if you are doing excellent things with him, and I want to compliment you on your ability to find ways to interest and engage him. It sounds as if he is developing very well and showing you clearly what he likes or doesn't care about. And, you are following his lead, which is a very important way to support good development.

      I would be very surprised if at this age he already imitated your sounds! That comes months later.

      Congratulations on your healthy baby, and best of luck for the future!

  73. Dear Dr,
    thank you for your quick and valuable answer. I hope you are wright. If not, I"ll be back :).
    Little update, he turns today in his belly for the first time.

    Best wishes to you too,
    Regards from Croatia

  74. Hi There. I'm a concerned aunt and wanted to get your input. I have a niece who is almost 2 and she passed her milestones too quickly and she is too smart for a 2 year old. She has a younger sister who is 9 months old and I'm worried for her for so many reasons. When she was born, she had a bad reflux, throwing up every time she had milk (this is now no longer the case). She also had very bad/dry skin (this is also no longer the case). She was also told she had a heart murmur, but that it may be nothing. Somehow, she also had a very flat head and her parents took her to a specialist and she was put in a helmet for 6 weeks. Now her head looks much better. My main concern is that she doesn't react most of the time when you call her name. I feel the times she does react is because there is noise rather than the fact that someone is calling her name. She has some eye contact, but not really. It is for a very short period of time and she doesn't really look someone in the eyes. She will look at the nose or teeth. She doesn't point or wave. She doesn't mimic expressions or actions. She also doesn't babble. She'll make screaming sounds. We talk to her all the time and keep repeating mama and papa and it doesn't do anything. She doesn't cry and plays by herself with toys. She'll ONLY cry when she is hungry. She just started to sit and crawl (army crawl) and she can pick up toys. She would also pick up small finger foods, but never put this in her mouth and she finally started today. I love my niece and will always be here for her. However, if there is something wrong, I want her to get help as soon as possible rather than to wait and see. Also, what else can I and my family do to help her move along with development? Thanks in advance for your help.

    1. Dear Anon-- it's a lucky thing for children when they have an extended family to care about them, and I'm sure your concern will be helpful.

      Your description of the 9-month-old gives a mixed picture. She evidently had a bit of a rough start in life, so it's not surprising that you're concerned.

      She is still young to be pointing or waving without help. Many babies these days are put to sleep on their backs and as a result are relatively delayed in sitting and crawling, so this is not necessarily a problem. It can also be hard to decide whether a baby is making eye contact "enough".

      I'm more concerned by her playing alone as much as you suggest and not crying for attention or other social reasons. These are unusual behaviors at her age. Also, I would expect her to react to her name a lot of the time, if not always.

      Is her pediatrician concerned or able to refer the family to an early intervention resource? I would wonder whether her hearing is normal. Has this been tested?

      It is going to be hard for anyone to diagnose any problems at this age, except for hearing and vision, so you may have to wait for further information. Meanwhile, I would suggest that you play with her as much as you can, and keep talking to her. You might also want to go to youtube and look at demonstrations of "Floortime", a method for engaging in play with children who are not very responsive. I don;t want to claim that "Floortime" will "fix" any serious problems, but it does give good guidance for how families can work with young children.

      Good luck with this, and please keep me posted on her progress.

    2. Thank you so much for responding to my comment. I really appreciate it. My niece had a hearing test at the hospital when she was born and it was normal. She was told at a later check up that she has a lot of ear wax...but this seems to be ok now. She has also never had an ear infection or anything like that. She can definitely hear because when something falls on the floor, she turns her head. She just doesn't when we call her name. The other thing I forgot to mention is that she doesn't care to be picked up and doesn't reach with her arms for someone's attention. I've seen her literally one time crawl to her mom (and I think it was maybe because she was upset). I went to youtube to look up "floortime". However, most videos are for older children. I will keep looking and thanks for the suggestion. The pediatrician basically said that we have to watch out and keep an eye on it. Thanks again.

    3. I can see why you're concerned, with these additional things... I do think you can use some of the Floortime methods, like playful interference with something she's trying to do, even with a baby as young as this. Good luck with your efforts!

    4. Hi Dr. Mercer. I wanted to post a follow up to my comment and would really appreciate your thoughts. My niece is now 10 months old and some things are different. She now has stranger anxiety. When other people pick her up, she cries and is only ok when people pick her up that she knows. She also has separation anxiety when we leave the room, she cries. She also now lifts her arms (at times) to be picked up by us. One other great thing is that she will follow us in her little walker. So if we are in the kitchen and leave to go into the living room, she will follow us. And she has learned to clap (even though she claps at the most odd times).

      Unfortunately, she still does not babble and coos rarely. We talk to her all the time and she just doesn't make many sounds.

      Also, if we call her by name from far away, she'll turn 7 out of 10 times. However, if we are closer to her and call her name, she'll maybe turn two times out of 10.

      Also, her eye contact is not good at all. It's like she tries to avoid eyes at all cost and in every way possible.

      My sister called early intervention and over the phone was quickly brushed off and told that my niece would not qualify. I told her to keep trying to at least help with speech.

      What are your thoughts on these changes or updates?

      Thank you so much in advance for your help.

    5. You certainly have some very positive developments there. Signalling to be picked up and complaining about separation are very much age-appropriate behaviors that indicate good development. If you are worried about autism, you couldn't have much better evidence that she is interested in people.

      I would not expect her to coo at this age, but some babbling or speech-like sounds are usual-- but there are certainly children who do not do much of this but by age two have completely caught up.

      I really don't know what to say about the eye contact, but all the other social development seems very normal.

      It's too bad that early intervention is not available, but I think the reason for that is that many babies have "peculiar" development before 12 months and then straighten out, so it's difficult to know whether there's a problem until 12 months or so. Could you afford a private speech therapist or other intervention person? I don't know that this is essential but it might ease your mind.

      I'd like to suggest that in addition to speaking to her a lot, you might want to introduce some sign language (see ). Combining sign and speech gives an extra way to communicate, and if you see her imitate signs that will give you more confidence that she will develop language well.

      Once again I'd recommend Floortime. I think you'll find that it's easier for you to do at this age.

      Best wishes, and let me know what happens, please.

  75. Hi again ..

    My son just turned 10 weeks . His eye contact still sounds like poor but he is good in tracking objects and following the sounds . Also he sometimes follow me walking in the room .. I shared my concern with my hasband and he said that we will love ourson whatever if he has autism or not .. But i'm sure that we have to do something in this age ..! What are the benefits from those scary red flags websites while there is no real diagnose and therapy ?! why are they have been written ?! To inform us and keep us worried about little tiny things in our babies and stop enjoying them with a lot of thoughts that making us feeling so low and what to do with them while everyone say wait and see ! When will i stop waiting ?! Till getting a real diagnose in a late time that he might have better if he have got therapy earlier ? Can't stop worrying!
    What to do ?

    Sorry but i hope that you respect the way i feel stop enjoying my baby with a lot of stress feeling sorry about him and to be honest feel like it is my fault and that guilt with the people her believe in the refrigerator mother who caused her children to have autism !

    1. Dear Fatima-- I'm so glad that you spoke to your husband about this. I don't think your baby is autistic, but even if he were, this is not a death sentence and many autistic individuals develop quite well.

      I strongly agree that many of these "red flag" web sites seem to exist more to scare people than to provide real information.

      I am concerned about the stress and anxiety you seem to be feeling. It's so uncomfortable for you, and it does not help you give your baby or your husband what they need from you. Can you talk to your doctor or a religious leader about how you are feeling?

  76. Reading this whole thread I was somewhat appalled how worried many parents are about children that seem to be developing very well... but now, you have got me worried too!

    Our 7 1/2 month old seems to develop very well, he crawls since a month, pulls up to stand and starts cruising, claps hands, babbles, and self feeds 'adult food" with his fingers. He has also had very good eye contact since a very young age (a week or two old), and can hold a mutual gaze for quite long periods of time.

    However, on several instances you point out that enjoying to play alone for longer periods of time is a potential red flag. Our baby has always enjoyed playing alone in his room, since he was a month old or so he would play alone for two hours or so every morning on his playmat/babygym etc (of course we would occasionally check on him) and be very contented (he typically would be more clingy and needing our attention in the afternoons). We have always seen this as a very positive point, as it seemed to show a long attention span and "independance", which you say a baby that age cannot have. (now of course, we have to hover about him all the time since he's crawling and pulling up). Is this really a problem?

    He's also very sociable and engaging, with his parents and a host of strangers. Not a hint of stranger anxiety here, he loves people, and everybody simply adores him. Even at a young age, he never minded huge gatherings of people, no breakdowns or overstimulation even being handled for 3 hours by a dozen of different people. At 4 months, he sat through a 2 hour funeral ceremony without a wimper, instead very attentively listening to the musicians and speakers and had all our family in awe.

    He also completely refuses to be spoonfed, but self feeds a loaded spoon quite well and east finger foods even better and drinks from a small glass.

    Is the long, independent (and lonely) play really a red flag? As is the lack of stranger anxiety and the general scarcity of crying and fussing?

    1. Dear Belsha-- If you look back at the original post you'll see that I am not the one who made the point that playing alone is a "red flag". Being able to play alone for a while is an excellent skill, and back in the day of Dr. Spock, parents were encouraged to create a daily solitary play period for infants and young children. The issue is really whether the child prefers to play alone all the time, even when social play is available. Your baby's good social engagement suggests that he takes advantage of social play when he can get it.

      Your child sounds like a highly adaptable, low-intensity, "easy" baby, rather than like one who is socially disengaged.

      As for stranger anxiety-- two things: One is that he is still a bit young for it. These behaviors tend to emerge between 8 and 12 months. For the month before he begins to show stranger anxiety, you may see that he acts briefly suspicious of strangers and checks them out carefully, but quickly warms up. But also keep in mind that as a baby with an adaptable, mild sort of temperament, he may not make nearly as much of a fuss about strangers and separations as do babies with more "difficult" temperaments.

      Let me make a comment about the self-feeding. This is really a sign of good development, so please do NOT let yourself be influenced by the claims of some "attachment experts" that you must not let him feed himself because then he will not be attached to you. This is nonsense but is to be found on a number of web sites.

      Sounds like you have a very nice baby-- enjoy each other!

  77. Dear jean ,

    I can't talk to a doctor or a religious leader about my feelings . But can you help me enjoying my baby ? Or can you tell me how to improve his eye contact or to put my mind in rest because my mind is over reacting and feels like i'm wasting my baby time that he needs an early and quick help to not develop autism ..

    1. Dear Fatima-- you really need to talk to someone, and it does not really need to be a professional if you can't do this. Your husband, a sister, your mother-- if you explain to any of these people that you need to talk about your concerns, they will probably be able to help to some extent.

      If you can improve your mental state, that will help you interact with your baby in ways that will be pleasurable to both of you, and that's the best thing that can happen.

      But once again, if you could talk to your doctor, that could be very helpful. Some antidepressant medication might be the best thing for you right now (but please understand that I am not a medical doctor and am only bringing up one possibility). Please, also, if you ever feel that you might want to harm your baby or yourself, that should be a signal to you to seek medical help. I hope you will ask your husband to read my replies so he can be aware of the whole situation.

      Please think carefully over what I have said here. I am sending you my best wishes for a better mental state!

  78. Dear jean

    I've sean your replies to others and advices about avoiding screens as much as possible in front of their babies.. Actually i've used the cell phone around mine since birth taking pics and videos because my husband wasn't around and i was sending those to him .. Also i've used the front camera to video call and other videos and pics! another thing that he had to re do the tsh test because it was high during the after birth test . In the re do the test the result was normal .. It was 33 then 6 which is normal! Does it mean that i had the high tsh during pregnancy which lead to have this result in the after birth test ? They say that there is a link between the TsH and autism .. Also me used the screen a lot around him .. Does it affect a lot ?! Feeling guilty and i think it is not depression ..? Can i do any thing to correct my mistakes of using the phone around him ALOT ? And is there any real link that when he had this result of the TSH after birth test?

    I just want to not waste my baby time if he actually has it ..

    Should i try to use those ways of drawing faces on a paper or other things ..?

    1. Dear Fatima, once again I have to say that you need to discuss your concerns with your husband and your doctor or other professional helper. Feeling guilty when you have done nothing wrong is an aspect of depression. I feel very concerned about you and would like to feel that you are confiding in people who are near you and can support you.

      For you to tell people near you about your worries would be much more constructive than drawing faces for this very young child,who cannot even recognize a line drawing.

      As for the screen issue-- let me just point out that autism is not caused by things mothers do. I never meant to suggest that screen use caused autism! The point was that babies can have experiences with their mothers that help them develop communicative and language skills. Having the mother look at a screen and talk to an unseen person is not a good way to provide those experiences. It's not a matter of direct harm being done, but of preventing good experiences from occurring as much as they might.

      I really believe that the problem you perceive is based on your own feelings and not on the baby's characteristics. Please, please confide your fears to someone near you!

  79. Hi Dr. Mercer,
    I have an almost 9 week old baby boy who is making very little eye contact. He will avoid eye contact when up close by looking over my shoulder, turning his head, or looking at other objects such as a window, light, wall, etc. He will however stare at me when I am far away if walking by or sitting far away. He tracks moving objects far away, but exhibits difficulty with this up close. When calling his name, he very rarely turns his head to the stimuli, although he passed his hearing test in the hospital. I have tried decreasing the amount of background stimuli to hopefully increase his attention, however it doesn't seem to make a difference. I have been able to get his attention about 1-2 times this week and maintain good eye contact, however this is rare. I have a 3 year old who hit every milestone early and am trying very hard not to compare. He also will not make eye contact when nursing (looks at the wall, other objects, or my breast). He has started making sounds this week such as: goo/gah/sticking out his tongue/squeeling/ and occasionally smiling. He seems to be fussy and good deal and out of a 3-4 hour time frame he is awake 1-1.5 hours with about 30 minutes of play/interactive time of which I try to get eye contact. I am a speech therapist who has worked with developmentally delayed children in the past (during grad school) and worry because these could be "red flags"...??? Should I be worried?

    1. Hi Christen-- you say you are trying very hard not to compare, but I think comparing is exactly what you are doing! Your baby is still young enough that he may have trouble getting a clear, focused image of very near objects-- it may also be that near objects are less illuminated and in less contrast with their surroundings than more distant ones. Also, a fussy baby is likely to be harder to engage socially in the early months (just like a fussy adult).

      As for maintaining good eye contact, for 15-week-olds about 20 consecutive seconds of eye contact is about the max, so don't set the standard too high. And, despite all the romance about this, nursing babies of this age do not usually gaze at their mother's face.

      I would not expect a baby to respond to his name until six months or so. The way he's vocalizing suggests that he's right on track.

      In my opinion, without seeing this child of course, you are looking at individual differences, not red flags. Try not to stare and look worried when you gaze at him-- that is very likely to make him avert his eyes!

  80. Thank you for your response. It has eased my mind a little. I tend to worry easily... We have a check up tomorrow with our pediatrician and will run it by him too.

  81. Will just re write
    I have an 8 month old girl
    For the past few days she's been doing this waving gesture looks like opening and closing her hand she does it when we say hi but also when she's just playing of watching tahe sits alone she babbles like gaaaaa guaaaa faaaaa maaaaa daaaa but doesn't yet say mama or dada to us she says it but doesn't know what it means
    She plays with her toys and occasionally answers to her name she put her arms up when we go to pick her up and she also rotates like a clock when on her tummy
    I went to google the waving hand and it came up with autism and now this has really taken over my thoughts and it acres me
    Sometimes she doesn't answer when we call her lots of times she avoids my face when I try to meet her eyes but she stares at me when I play peekaboo
    Also she doesn't cruise or crawl or stand yet
    It's scaring me because it was a silky search can you help please

    1. Dear Sara-- calm down there! Let me tell you a few things that may help.

      I'm pretty sure I know the gesture you mean-- it's sort of like grab-grab-grab, right? First of all, that's not what those "red-flag" sites mean by hand-flapping. Hand-flapping is flapping the whole hand loosely at the wrist. Many babies do that grabby gesture, and it seems to mean that they are looking at something that interests them, sort of like pointing.

      But second, and IMPORTANT: the point is not that the baby flaps hands or toe-walks or doesn't always respond to the name or doesn't use words. Those are all things that typically-developing babies do. Those things become possible signs of autism when they are still being done well into the toddler or even preschool period. Remember, one way to look at autism is that it involves developmental DELAYS. Autistic children continue to behave in some ways just as younger children do. That doesn't mean that the younger children are autistic.

      Your daughter sounds perfectly normal for 8 months. She's doing the right kind of babbling, she sometimes recognizes her name, she plays with things and likes peek-a-boo, she signals to be picked up. If you are trying hard to make eye contact with her, you may be making her avoid that intrusion. As for the crawling etc., I expect you've had her sleeping on her back, yes? If so, her motor development will be delayed compared to what the old "books" will tell you, but that's okay, she'll catch up.

      I hope this information will help. Just keep following her lead, and if you want her to look at you, try "flirting"-- look at her and then drop your eyes, look back for a minute, drop your eyes, etc., and smile while you're doing it. That may work better than trying too hard to get a look.

      But I promise you, she sounds great so far!

  82. Thank you so much for the quick response
    Yes she sleeps in her back she has just started to roll to her tummy when she sleeps so I guess she's getting there she started rolling not long ago so I presume not long til she tried doing other things. I think using google wasn't a good idea and I need to try and focus on enjoying my baby on these precious moments. I may have been comparing too much with my friends babies which isn't s good ideal also
    This website is very handy
    Thanks for the reply

    1. Motherhood is all about anxiety,of course, but probably better not to increase it by comparing and searching. People used to talk about medical student's disease, which was thinking you had everything you read about-- I think there's also a "young mother's disease" which is thinking your baby has everything you read about!

  83. Hello Jean,

    I came cross this blog when searching for "early signs of autism" as I see many worrying parents did. I appreciate a lot you giving your perspective/advice to us. You are such a caring person with a heart of gold.

    My baby is 5 1/2 months old, she has been a very EASY baby since birth.
    She was 8lbs at birth, now weighs at 17lbs. She rarely cries, seems to only cry when she's really hungry. She started sleeping through the night since 3 months old (from 7pm-7am). She rolled at 3.5 months and is now tripod seating and practicing crawling. She can get to places using her arm and tummy (if you know what I mean) so I think her motor skills are on track.
    She smiles when smiled at. She has eye contact with us. She sometimes will ignore our face or us calling her name. Sometimes she turns her head to us when hearing her name, although I am not so sure if she's responding to her name, or just my voice.
    What we've always been feeling lucky about has recently become my biggest concern! She doesn't seem to "need" us at all. She is a very good self-soother and self-entertainer, she can play on her own for quite a while if I let her. I have seen her on the monitor waking up at 5 or 6am, but she would just lie there or suck on her fingers with her eyes wide open, but she wouldn't make a sound! If I go in she will smile when she sees me, if I don't go in she'll soothe herself back to sleep! I used to feel so lucky that she's so easy but now this got me very concerned because it seems that she doesn't care or need us.
    She started in full time daycare since 3.5 months old. I will have a talk with the teachers in the infant classroom to see how she is like while she is there, and if she shows any attachment to the teachers.
    I want to add that we started introducing purees at 5 months and so far she loves everything (cereal/fruit/veggie).
    Please let me know what you think. Do you think there's red flags or am I really just very lucky.. Thank you!!!

    1. Hello K-- my take on this: You are lucky! But also, she is still too young to be much concerned about whether you are there or not. I doubt that she shows attachment to the day care providers, either, because she is not developmentally ready to do that.

      As for only responding to her name some of the time...wouldn't that also describe you, if you're busy with something? It certainly describes me. Babies aren't machines that get the "name" button pushed and have to respond to it, any more than adults are.

      You need to just believe that she needs you, because she does, and she would not be doing so beautifully if you had not done a good job. (This is not a smack at those with more difficult babies!) She doesn't need to "care" in order to need you, and that's fortunate because she is too young to care in any way that you can easily detect.

      I wonder if you are really worrying that early group care is not a good thing for her, and looking for problems that might be related to it-- like not "caring" about you. I think it would be a good idea for you to talk to the child care staff about her and get some sense of what happens when you're not there. That might make you feel better about your relationship with her.

      If she is going to be in group care while an infant, I think it's a good thing that she has started now. That will save both of you a lot of grief when she does begin to show attachment and separation concerns-- some months from now.

      Stop with the Googling and just enjoy your luck. I bet your next baby won't be so easy!

    2. Hi Dr. Mercer, Thank you so much for your reply! It really means the world to me. I had a talk with one of my baby's teacher yesterday and she told me my baby doesn't seek adult attention unless she's hungry or she needs a diaper change. She said my baby watches other babies when she's there and is smiling etc. Her response didn't bring lots of comfort to me as I was mainly concerned about why she never cries for our attention, such as "I want to be held". I can tell she is happy when she's held, but she's also perfectly content playing on her playmat alone.
      Another thing is that she hasn't made any consonants. She mainly does "ah" "oh". When she was younger we used to have "conversations" back and forth, but now it's much less often. It seems the only thing she's interested in is practicing her crawling and sitting.
      She enjoys me playing games with her. She'll sit on her dad's lap and I will hide behind the door and say "baby where is mommy?" then suddenly appear. She giggles everytime. And my husband told me that even when I haven't made my appearance she's looking at the direction of the door and already started giggling, then of course when I pop up she'll laugh harder.
      I wonder when "social referencing" begins to develop. Some say 6 months some say 8 months. My baby doesn't do that yet. And she doesn't put her arm up to be picked up.
      This whole worry has taken over all my thoughts and I am "crazy" searching everything, I can't sleep or eat, which I know isn't healthy at all. You are right, I wonder if I made a right choice to go back to work and send her in daycare that early. She usually takes 2 naps while she's there (8:30-4), about 35-45min each. When I pick her up at 4 she's usually pretty tired and doesn't look very focused. I will have a talk with her primary teacher on Friday for her input and I will update then...Thank you again for your reply!

    3. You won't hear consonants or see social referencing for a few months yet. If she peek-a-boos you have a pretty good indication of excellent development.

      I think both you and the baby are tired -- it's unfortunate that we can't usually move gradually back into the work force.

      Let me know what happens--

  84. Dear Dr.,

    I’m a mom of baby girl, 5 and a half months old. I’m so much concerned about the autism.

    She smiles and laughs very little. She rarely makes eye contact when I’m close. But when I tried to make some movement, she will follow her eyes to my movement. Sometimes, I think she looks at my eyes, but when I move myself, she is still looking at something at the same position. She watches at the strangers for longer time than making eye contact with me. She smiles to me sometimes when entering the room or when she just wakes up. She turns her heads to the sounds, but rarely to the human voices. She can roll over to the prone position, but not yet for supine position. She likes playing with my fingers and bringing everything to mouth.

    I'm also concerned on her motor skills as she still cannot roll over to the supine position yet. And I'm much more concerned when I came across one article mentioning about the roll-over of autism baby. In the articles, it says autism baby will arches the head and pelvis sideways upward, moves the top legs forward, and topples over en bloc without the sequential segmental rotation like normal baby does.(

    Now, my daughter rolls over so fast, and I’m not sure if she has sequential segmental rotation or not. But she doesn’t arch her head up (I think).

    My question is does that pattern of movement (for autism baby) can be a signal for autism? Also, does she have any signs and should I be concerned, and what else I can do? What should I do for early intervention?

    Thank you for your time.

  85. I DO NOT think you should be concerned at this point! I think you are looking at behaviors that would be signs of autism in a toddler, and trying to apply them to a much younger baby. You are not the only one who does this, of course, and I am very annoyed with these 'red flag' websites that neglect to tell you that most of the things they describe are perfectly normal in young babies, but autistic children do not stop doing them on schedule.

    A couple of things about the rolling over: 1) she's early on rolling over, and autistic children are more likely to be late 2) if she rolls so fast you can't see it, she can't be doing this nonsegmental rotation, which takes longer (try to do it yourself and you'll see what I mean) 3) this article by Philip Teitelbaum, that is upsetting everyone recently , was published in the late 1990s, and it never led to any solid information about diagnosing autism.

    For "early intervention", just play and interact with her and don't expose her to lots of screen time-- just do normal stuff, and stop Googling autism! I know it doesn't make any sense to say "don't be anxious"-- but if you could concentrate on the fun things she does, you would probably both be happier.

    Good luck!

  86. Thank you very much Doctor, I really appreciate your advice.

  87. Dear Dr,
    here is Mum from Croatia (I wrote you a post 3 months ago, I have one autistic child).

    My baby son is now almost 8 months old.

    His motor skills are on track (we check it at specialist).

    He babbles a lot bababa, mamama etc. He started to babble at 6 and half months. He sometimes imitate our sounds but that just started.
    We can easily make him smile and laugh. He smiles when we speak to him.
    When I introduce to him new toy he is more interested in (silly) me then toy.
    He also likes to play with toys alone but he occasionally looks at us. I try to interrupt him (get and share his attention). I am successful in that.
    When I (or member of family) leave the room he mostly cries.
    When he met "unknown" people he cries (and looks at us). We are sure that he recognize us-caregivers from others.
    We think that he understand few words (like "eat")
    When he was crawling and bang himself he immediately rotate himself toward me and searches my support (he was crying).
    His eye contact is OK, he does not stare but he looks at us often.
    He eats and sleeps well

    He does not always response to his name when he is playing. Sometimes we need to call him for 4-5 times.
    He does not reaches his arms to be picked up (he does it when we reaches our arms toward him).
    He does not wave (we just started to teach him that).
    He does not look at pointed things (he looks at me or at my finger).

    I need your support and opinion are we on a good path of development. I do not have early intervention in my country.

    Thank you dear Dr! You are very special person and we are happy to have you.

    1. He sounds as if he is doing very very well-- I wish all babies would show such excellent development! Don't worry about his not responding to his name right away. If you will look at the post I put up yesterday, you will see that this is very common.

      You are right in thinking there may be a risk factor because of the autistic child, but I certainly don't see anything to worry about at this point . Keep up the good work!

  88. Dear Dr.,
    thank you a lot for your answer.
    One more question, please help me if you are familiar with that.
    My son (8 month) stopped to put things into his mouth (he has a problem with breathing throw his nose, he has a light cold, I do not know is that connected). I noticed it because he do not want to feed himself with finger food or spoon, he only put his hand into the plate and play with that no move to his mouth). I did not notice that he has problem with touching any material. It is early for eating by himself, I know that, but what about exploring toys? He reaches for toys, plays with them (bang), crawls to them. Why he stopped? :(. When I mentioned that to my family they were sure that he puts toys into his mouth because he was doing that a lot.
    Do you know anything about it?
    He eats mixed and various food, drinks milk, water and juice from bottle.
    I will go crazy so I will not google anymore anything I will just ask you for informations.
    I hope I am not boring you.
    mom from Croatia

    1. I would guess that your little boy does not want to put food into his mouth because his nose is stuffed and he can't breathe easily if his mouth is also full. He may also have less appetite than usual because he is not feeling as well as he might.

      I would guess that his cold explains everything, and that when he gets better he will be completely back to normal.

      Has his doctor or nurse shown you how to use a bulb syringe to clear his nose a bit? Or have you had him sit in a hot (not too hot) bath so the steam may relieve his nose?

      I think you will see improvement soon, but if he still shows this change in behavior after a few weeks, you should speak to a doctor. Good luck to your family!

  89. O dear Dr Mercer, you are really quick!!! Thank you.

    I want to correct my previous post and write:
    "... He reaches for toys, plays with them (bang), crawls to them. Why he stopped putting them into mouth?"

    I just want to be clear with your advice-if he does not put toys or food (does hands include?) into his mouth by few weeks (as he gets better) I have to speak to a doctor.

    Best wishes to you and yours dearest,
    mom form Croatia

    1. Yes, that is what I meant-- but I think everything will soon be normal again.

  90. And yes, he eats and drinks less.
    I use bulb syringe but because he is fussy I do not have some results.

  91. Dear Dr Mercer, I wrote you in May - my baby boy was slightly hypotonic and had poor eye contact. He is 9 months old in a week - has been crawling since 6.5 months, sitting soon after, now since three weeks he can lift himself up and hold with just one hand. When he is happy about his achievements (lifting himself up) he usually looks and smiles at us. He will never look at us for longer periods, but I understood that this is not necessary.
    He babbles baba papap also combinations such as babu and he enjoys looking at me when i hide behind furnitures he smiles and also when i cover and show my face. He laughs usually at games involving physical action - such as me surprising him from the back and touching him on a leg, back, etc or he laughs when we say words he finds funny such as whoops, puf, etc. We have a toy when you press its red nose it shine and makes sound, when it was new and i pressed the nose he looked at me smiling and then back at the toy and at me - is this joint attention? He hasn't done this for a few days now though.
    When i hold him in my arms (his favourite position to fall asleep) i sing to him and sopmetimes he looks at my mouth or touches my teeth but would not look into my eyes. I believe this is ok. He almost always responds to his name, more when i call him than my husband and when we are a bit further a way than right next to him. But responds even if i just whisper his name. When i call him and use a gesture for him to come to me, he used to crawl to me and he used to follow me literally everywhere in the house. However since a few days he got a bit more independent and it is a bit harder for me to make him come to me when i call him and sign and he is not following me anymore. He likes plugs and when I say NO he looks at me straight but sometimes touches them anyways.
    He Only lifts his arms to be picked up once I am already stretching my arms towards him - i assume this is enough? He would crawl towards us and pull on our trousers to get up as well.
    What concerns me is that he doesn't imitate me (eg tongue out, clap hands, etc) but likes it when we imitate him and generally it is hard for me to "teach" him sth - as if he didn't pay attention - no waving bye bye, no clapping hands, he won't hand me a toy and moves from one toy to another quickly. he mostly plays with toys just by putting them in his mouth, no banging together, however he did bang against the floor a bit today.. He also likes to spin the wheels on his car, but won't do this longer that a few seconds and loses interest so I think it is fine. I have a friend with a baby same age as mine and mine starts crying everytime her boy starts to cry or makes such a squealing sound or some very loud sounds. I am home alone with him, no TV, radio- maybe he is just not used to much noise? He was afraid of a blender and our vacuum cleaner, but now before using them i say attention! and point to my ears and he got used to that. Before he used to look at me and start crying and i noticed that if i smile while using eg the blender he would usually be fine. Could this be the social referencing? Also, he looks and smiles at people who come visit us at home but he is not very smiley or social when outside, eg on a street and sometimes won't look at people at all eg if we meet someone in the elevator or generally when we are in a new environment like at doctor he will browse with his look everywhere for a few seconds.
    I read all development milestones and read that some babies his age can wave, hide their face behind a spoon to make their parents laugh, etc etc and it makes me tripple think if we are on the track.
    Thanks so much.

    1. Dear AM-- every baby is different, and you will generally see that an individual baby is a bit ahead of the "milestones" in some ways and a bit behind on others. Two months later you may see that this has reversed! You are certainly seeing joint attention and social referencing, which is excellent. I think the imitation, waving,peek-a-boo and so on will be seen quite soon. It;s great that he is doing so well in motor development, especially because he was a bit hypotonic. It all seems to be on track-- congratulations on your good work!

  92. Hi Dr.,
    My twin girls are 9 weeks old. They were born at 36 weeks 5 days with a relatively normal pregnancy (Signs of preeclampsia only on the last day.) Twin A has been smiling with lots of eye contact for well over a week now. She seems very happy and knows who her parents are and smiles frequently. Twin B could not be more different. She NEVER has eye contact with me or my husband, whether she is laying down, sitting up, etc. She does seem to fixate on objects both near and far (her mobile or the ceiling fan), but never at my face or my husband's face. She also is fussier in general and is hard to get to bed each now. Both twins are on the same 3 hour feeding schedule and Twin A goes down at night immediately whereas Twin B will take 1.5 hrs+ to soothe and get to sleep, all while she wildly looks around in every direction but our face. Obviously I'm concerned and we have our 2 month check up tomorrow but wanted to also gain your thoughts.....thank you!

    1. Are they 9 weeks old corrected age-- counting from when they "should have" been born-- or actually 9 weeks after birth? In either case, they're still well within a range where many babies don't yet do much smiling or making eye contact. But they also sound as if they have very different temperaments, with B being much more irritable and responding more negatively to the world and therefore not having as much calm time to be interested in faces.

      Do you know whether they are one-egg or two-egg twins? If two eggs, it's not unusual that they are of quite different temperaments, just as non-twin sisters might be. If one-egg, the big difference in fussiness would be less expectable, and I suppose might have some source in their pre-birth and birth experiences-- were their birth weights similar? But your pediatrician can tell you about that much better than I can.

      To summarize, I would not be surprised if neither was making eye contact yet, at this age-- A seems to be ahead in development, but this may just be because of her temperament. My guess (and that's all it can be) is that A has more calm time to look around at people, and B has less, but otherwise their basic development is similar.

      I would be very interested to hear what your pediatrician says, if you have a chance to let me know.

    2. This comment has been removed by the author.

  93. Dear dr, i posted my comment 3 times but i don't know why i doesn't appear , i am a first time worried mum for a 71/2 month old baby boy he is not making eye contact when being held and when someone tried to kiss him on the cheecks he turns his head so quickly. He avoids close eye contact, he makes his feet when being excited or when listening to music or being excited or tired & doesn't smile to strangers or family members that he doesn't see that frequent.he responds to his name and smiles to me and to family members who they see frequently, he is very senstive to any sound turs his head when he hears the bell rings . When sitting on the floor playing he looks to me and smiles and then look back to what he was doing . If he looks at me when being held i guess he looks to my mouth and puts his hand into my mouth . While nursing he sometimes not always looks at me and i try to engage him too look at while nursing. He is very excited seeing the red light of the ac and the green light of the microwave. He puts all his toys into his mouth.. He plays peek a boo My concern is about not looking at me when being held and turning his face quickly, circling his feet . Taking into consideration that his dad is short sighted and has high asytgmatizm . Hope u could ease my worry

    1. I'm sorry for the delay in posting your comment! They are only posted when I tell the site to publish, and I have been traveling and did not have access to the Internet to do this.

      I think your little boy sounds as if he is doing very well. Babies do not gaze at their mothers all the time when they are nursing , and that is perfectly normal. It sounds as though he is developing well-- to respond differently to familiar and to unfamiliar people is a good indication of development. Looking at you and putting his hand in your mouth are also good signs.

      Babies tend to be far-sighted at this age, which means it is easier for him to see you clearly when you are a little farther away than when you are very near. I think that may be why he averts his face when a kiss approaches-- he can't see very well what is happening and it's as if something just "looms" over him. He doesn't know yet that a kiss is a sign of love, so he just responds to not being able to see very well.

      He sounds to me as if he's doing fine, so try not to worry so much!

    2. Thank you so much dr for your quick response . About circling his feet is ok ?! And he loves music and songs he always circle his feet when he listens to music and/or when angry . Thanks again really appreciate ur reply

    3. I think this is just general excitement and interest that he's showing.