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Concerned About Unconventional Mental Health Interventions?

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

Sunday, September 4, 2016

Worried About Whether Your Baby Looks at You? Take a Developmental Perspective

Dr. Seuss was so right when he said “a person’s a person, no matter how small.” But he forgot to say that a person who is small is not exactly the same person he will be when he gets bigger. Remembering that fact can help parents of young babies who get worried sick when their babies don’t behave in ways that are much more characteristic of older people. To know what’s going on with any big or small person, we need to know where that person is developmentally.

Every week or two, I get a query from a frantic young parent who is terribly concerned that her baby, somewhere in age between birth and three months, does not make enough eye contact or even seem to be interested in looking at the parent. Mothers particularly seem inclined to jump to a conclusion that a young baby will not look at the mother because he does not like her face.

The anthropologist Ashley Montague recognized that babies in the first few months do not pay a lot of attention to what is going on around them. He referred to the first months after birth as a period of “exterogestation”--  when babies continue to develop along the lines they followed in the uterus, but now do their developing outside the mother’s body. Montague pointed out that in fact humans, with our large and complex brains, need a year to develop after conception, but have to be born too early because our big heads could not otherwise fit through the mother’s pelvic bones, thickened as those bones are by our walking upright. Other authors, like Margaret Mahler, have referred to this period as one of “normal autism” because young infants seem to be so self-focused and inattentive while they continue through their first months of development.

During this early period, infants’ behavior is very much affected by what is called their state. This term refers to the effects of a group of variables in the nervous system that determine what behavior a baby is likely to carry out. We adults have “states”, too, but we usually think of them just as being asleep or being awake—though we may also understand differences between REM (rapid eye movement) and non-REM sleep. For babies, there are six states that make a difference to behavior. These are 1. active or REM sleep, 2. quiet or non-REM sleep,3.  drowsy awakeness, 4. quiet but alert awakeness,5.  fussing and high activity, and 6. crying. Of these six states the fourth, quiet alert awakeness, is the one in which attentiveness and learning are most likely to occur.

 For very young babies, states shift rapidly and are poorly organized. There is a lot of sleep, and periods of quiet alertness, when looking at faces and interacting with people might occur, are brief. It can be hard to get a baby’s attention even during one of these brief quiet alert periods, even if some parenting “tricks” like opening eyes and mouth wide while moving toward the baby’s face are deployed. After about three or four months, babies spend more time in the quiet alert state and are more attentive to adults. Their vision also improves over this period of time and they are more able to see in low-contrast situations like dim light or light coming from behind a person’s face.

State issues mean that young babies do not spend much time looking around them, at people or -in looking at other things, but this fact needs to be interpreted in light of the reality that they do not spend much time looking at anything. This changes with further development--  they look more, and it’s more evident that they like faces, as time goes on.

Most of us feel that we’re aware of a special experience when someone makes eye contact with us—a sort of “zap” that’s different from how it feels when they just look in our general direction. But that “zap” is not necessarily a good way to measure whether a young baby has actually looked at somebody. It used to be difficult to measure and record whether a baby did look at a face, so for a long time we did not have really good information about the developmental progress of this behavior. Nowadays, though, there are much better baby-friendly devices that can measure where a baby is looking.

Writing in the publication Child Development Perspectives, the Finnish psychologist Jukka Leppanen  recently reviewed what is known about developmental changes in babies’ looking at faces(“Using eye tracking to understand infants’ attentional bias for faces”, Child Development Perspectives, 2016, Vol. 10 (3), pp. 161-165). The review reported that when babies were given several things to look at, 4-month-olds looked at a face only on 15% of the exposures, but by six months the proportion was 50%. (Adults looked at the face preferentially 90% of the time, not 100%.) Three-to-six-month-olds did not look particularly at faces when face pictures were given in shades of grey. At 6 months, when looking at faces rather than other things 50%, babies did not act as if everything besides faces was the same--  they also showed a lesser preference for looking at upside-down faces, at pictures of body parts, and at animals.

Leppanen also reviewed information about how long babies looked at faces once they had noticed them. Before five months, babies easily move from looking at a face to some other interesting and distracting object. For 5-month-olds, continuing to look at a face when something distracting comes into the picture is done, and happens in the same way whether the face has a neutral or an emotional expression. By 7 months, babies look longer at a fearful face even though some other interesting distracting sight is available. Compared to what a newborn can do, these older babies show great progress in finding faces visually and continuing to look at them without getting distracted.

Parents who are worried about what they think is a delay in looking at faces have often been influenced by Internet material warning them of signs of autism. As we have seen here, it is quite typical for young babies not to look much at faces or “make eye contact”. It’s not until six months or more that this kind of looking becomes more like what adults do and expect, so it’s best not to be too concerned about whether young babies seem to look at faces or eyes.

As for detecting autism in those early months--  well, there is work being done to try to measure whether there are characteristics of very early looking that can tell us whether a baby is likely to be diagnosed as autistic a couple of years in the future, but the work is not finished yet, and this may not prove to be possible.  While we wait, let’s just remind ourselves that babies of all kinds benefit from having cheerful, affectionate caregivers who understand that a small person is not exactly the same as a bigger one.


  1. Hello! I have a query which is most likely my anxiety more than anything. My baby is now 3 months corrected age, was born weeks early. He is doing fairly well milestone wise. He had severe our and was born at 790 gm and we got him home by term at 1.5 kg. I got an experienced nanny soon after for the day because i was atm and a fairly anxious and confused one. the help is excellent very experienced.
    He us 3.7 kg now and is a happy child. he had been formula once he got home so I am not nursing him.
    He is a social child and we with my in laws and everyone takes turns having him around. He coos and smiles at nearly everyone, his face lights up when he sees his father and the nanny. Since last week he has been looking at me intently but diya not smile. He will make complaining sounds and will maintain eye contact but will simply not smile - for everyone else the smile comes fairly easily. Is it a phase when they ignore mom? I can believe he likes his nanny better because she is really good with him but even strangers get more smiles than I do. I am worried he doesn't know who his mom is or doesn't enjoy or need me.

    1. Yes, I think it probably is your anxiety more than anything-- but that does not mean that it is not worth thinking about!

      There is no phase where babies ignore their mothers. (Also, keep in mind that although he knows you he does not share your concept of what a mother is and how mothers are different from other people-- he just responds to how each person acts toward him). I am guessing (!) that he is reacting to something in your expression, which he is now old enough to recognize as sometimes different from other people's expressions. If you are anxious or distressed, he can see that in your face and be puzzled by it.

      You have been through a lot with this child's early history and it is no wonder that you are still anxious. In addition, it's possible that you had some perinatal mood disorder that no one noticed as it blended into the "natural" anxiety of dealing with a small and early baby. Now that he is "out of the woods", your anxious mood may be more noticeable to you and everyone else, including the baby.

      Perinatal mood disorders are not always matters of obvious depression, and anxiety can be a very important aspect.I would suggest that you talk to your obstetrician/gynecologist about this and get evaluated for a mood disorder. These things can be treated effectively and treatment can help you present to your baby a face that is more cheerful and affectionate.

      You understand of course that I am speculating here about what the problem is, but I think that what I've suggested is worth a try. Good luck!

  2. Thank you for the reply. I realise that I am almost a year later in replying to you. Of course all this has changed now. And yes I was definitely going through a lot and possibly ignoring it. A long visit to my mother's place helped. And now, nearly a year later he and I do have a bond. Thank you for replying.