Bring On the Taties, Bring on the Bread: Feeding, Eye Contact, and All That

“Bring on the taties, bring on the bread-- Won’t somebody get this baby fed!” Feeding hungry babies is a universal task of childrearing. Before they reach the toddler period, babies get frantically hungry and seem to think that only desperate crying will bring them anything to eat. Parents and other caregivers sometimes feel that they spend most of their time in feeding, and sympathize with mother and father birds confronted with wide-open beaks every time they return to the nest.

Obviously, feeding enough of the right things, in the right amounts and at the right times, is essentially to babies’ very survival, as well as to normal physical growth and development. The physical effects of feeding are so important and so obvious that it’s easy to forget that much happens during feeding other than transferring food from the outside of the baby to the inside. Studies of preterm infants have shown a number of factors that affect feeding and digestion even in very tiny babies who cannot suck and must be tube-fed-- these include the experience of smelling the mother’s milk, the experience of sucking a pacifier while being tube-fed, and the experience of being fed during a period of activity rather than when deeply asleep (all of these increase growth rate).

Even the youngest babies are actively engaged in the experience of feeding and are paying attention to events that they connect with being fed. This is a simple but powerful type of learning-- the kind Pavlov called classical conditioning-- in which the babies learn to expect one event to follow another one. More and more complicated learning builds on these early feeding experiences, until the hungry one-month-old who quieted when Mother began to undo her blouse becomes the one-year-old who tries to unbutton those buttons herself.

All those moments of learning are closely connected with social and emotional development. Except for the unlucky baby who has to make do with a propped bottle or pureed food in a bottle with a big hole in the nipple, infants almost always experience feeding as an interaction with another person. It’s an interactive experience of communication with a caregiver who does a lot of the physical work of providing food-- but who ideally does this in response to the baby’s communications of wanting to eat or wanting to stop. Both parent and baby use their best communicative skills to do this job. They both use their eyes to gaze at or look away from the other person or the food being offered, as well as putting out their hands to control a spoon or a bottle and their voices to show approval or protest. The baby wants food but may like some foods better than others, and prefers certain feeding rhythms; as he or she experiences a more satisfied appetite, there may be changes toward slower consumption or stronger preferences or avoidances.

These facts mean that ideally babies and caregivers have many sessions of practicing communicating with each other about a topic that is of great interest to both of them. It’s fun to eat when you’re hungry, and it’s fun to see your healthy baby consuming the food you’ve offered, so both of them are likely to find feeding time pleasurable and to associate that pleasure with their communication and social interaction. However, if a baby is sick or developmentally delayed, and if the caregiver is worried, depressed, afraid of wasting food, frightened, or exhausted, neither of them will have much fun in the feeding situation, and they will miss a major chance to learn to enjoy their interactions. They may not advance well in their abilities to communicate with each other, either about feeding or about other important things.

When parents and babies are not doing well together, they need support that pays attention to both adult and child needs and abilities, but they do not always get this even when intentions are good. A few years ago, I observed a program for adolescent mothers and their babies. There had been some concerns about neglect in the case of each participant, and the babies were receiving intervention in the form of supportive day care, while the mothers attended classes and discussion groups. The highlight of the day was supposed to be lunch, with each mother feeding her baby. The babies had high chairs and plenty of food provided. BUT--- nobody had remembered that it was important for the mothers and babies to be able to look at each other’s faces in order to communicate. There were no chairs for the mothers! Each young woman stood in front of her baby and bent over awkwardly to spoon the food into the baby’s mouth. The babies had to look up and away from the spoon to see their mothers’ faces, and even then saw only a tense-looking expression on a face held at an odd angle. What appeared to be a tiny detail actually caused a major impediment to the social and emotional interaction that’s a critical part of feeding.

It’s popular nowadays to emphasize early interactions, “skin-to-skin” experience, and so on, and I don’t dismiss those. But if we want to see how relationships, communication, and understanding of other people develop, I suggest we look at the thousands of feeding experiences that occur in the first year or so of a baby’s life. If someone invented feeding as a brand-new intervention, parents would rush to take workshops and learn how to do it. It doesn’t need to be invented, but parents need to understand its importance, and so do those who “coach” or support parents in other ways.

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

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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 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649838/ (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.****


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Eye Contact and Sign Language: A Comment from "Messy Mommy"

Blogger seems to be having difficulty in permitting me to respond to comments, so I'm going to use this method to call people's attention to a fascinating response I received to a recent post, http://childmyths.blogspot.com/2011/05/more-about-infants-and-eye-contact-gaze.html. "Messy Mommy" has written to describe issues that arose when her toddler was paying attention to gestures and not to faces.

Do read what she had to say if you're interested in this eye contact business.

If anyone has had other relevant experiences with their children, I would be very interested in hearing your stories.

More About Infants and Eye Contact: Gaze, Words, Gestures

How and why people make “eye contact” is a source of never-ending interest, especially to parents and caregivers of infants and toddlers. Experiencing a mutual gaze (which is probably a better term for eye contact) can be very gratifying to adults; it seems to tell us that some other person thinks we are really worth paying attention to. We don’t care for a stare-- when another person keeps his or her gaze ready to “catch” ours even though we pointedly look away-- but when we gaze at another, we are happy to find that that person gazes back at us. Because we find mutual gaze pleasing, parents are delighted when their infants return their gaze and carry on a prolonged shared look. When infants don’t do this after a few months of development after birth, their parents may also worry that there is something wrong. Perhaps the child’s vision is not normal, or perhaps there’s some burgeoning problem of early mental health. Autism is commonly feared by modern parents who have heard that lack of eye contact is characteristic of children with serious developmental problems of this type.

It’s true that in typical development, there is a growing use of the gaze in communication. It’s not just relevant to love and attachment, but to thinking about and understanding what other people want and do. Watching another person’s gaze gives more than emotional gratification—in combination with facial expression, it can tell you what he knows about, what he’s afraid of, what he wants you to do, and so on. All these are important things for a baby to figure out. Let’s not forget, though, that visually-impaired babies, children, and adults usually manage to learn these things about other people even though they do not have the capacity for mutual gaze or for monitoring the direction of another person’s gaze. The typical pattern of development for the normally-sighted baby is probably the easiest to manage, but it is not the only way human beings can learn to communicate with others and we should not give it so much importance that we think of it as a magical factor.

A recent study by Eugenio Parise et al. (“Influence of eye gaze on spoken word processing: An ERP study with infants”, Child Development , 2011,Vol. 82, pp. 842-853) examined whether a person’s gaze, seen before speaking began, made a difference to the way 5-month-old babies’ brains processed the speech they heard. The babies sometimes saw a face gazing directly at them and sometimes saw one with averted eyes; they sometimes hear a voice speaking normally (“forward”) and sometimes heard a voice speaking backward. They seemed to be especially interested in the direct gaze-- perhaps signaling “Hey, I’m talking to you, kiddo”-- combined with the unfamiliar backward-spoken words. The point about their responding differently is that the babies did not act as if what they saw and what they heard were unrelated. Instead, their listening was partly guided by what they saw, and especially by whether there was mutual gaze or not. What they saw seemed to have a role to play in their attention to and learning of the spoken language-- an exceedingly important step in child development.

One thing this tells us is that caregivers who look at infants infrequently are not giving them as many opportunities to learn as they may need. Caregivers who use their gaze, either in direct looking at the baby’s face, to “point” to an interesting object, or to avert when occasionally avoiding social contact, are providing much more information about language than dozens of flashcards pinned around the room. Caregivers who rarely use the gaze in ways babies can learn from may be depressed, sick, tired, or overwhelmed with work --- an example might be day care providers who have too many babies to care for.

Now, here’s what I want to know, and to the best of my knowledge no one has asked or answered this question: what about gesture language? It’s presently quite fashionable to use gesture language with infants and toddlers, to teach it and to encourage the children to use it, either at home or in group child care settings. Where does the adult’s gaze come into this? Can a direct gaze guide the child to be especially attentive to a gesture? If the child has to look at the hands to see the gesture, rather than listening while following the adult’s gaze to see an object referred to, how is language learning influenced? The great advantage of spoken language is that we can look at the thing talked about while listening to speech at one moment, and look at the speaker’s gaze while still listening to speech at the next moment. This seems to be a pattern that comes easily to sighted babies by about 5 months of age, but what if they don’t often get to do it, or do it only while simultaneously trying to look at a gesture?

I don’t want to suggest that gesture language in some way interferes with the typical process of learning. Babies with both visual and hearing impairments learn to communicate, but they follow their own patterns of growth and development. Is the same true for babies who are taught to use and understand gestures? It might be. There’s much still to learn, but it’s clear that eye contact can play a complicated role in both social and cognitive development.

Eye contact? Part 2

"Eye contact", or prolonged mutual gaze, is something adults do when they want to communicate some emotional information. They may stare in order to try to intimidate another person, who looks back in resistance or drops her eyes in submissive response. They may gaze in order to flirt with an attractive companion, who may avoid the gaze, make repeated brief eye contact in a coy way, and perhaps finally permit a long mutual gaze as he or she acknowledges interest. Strangers who want to play with a baby they meet in public may keep on trying to catch the baby's gaze-- but for babies of 8-10 months old or older, this action is alarming, and the more the stranger tries, the more the baby avoids the look or even begins to cry. Lovers walking toward each other in public maintain their mutual gaze, and so do parents and toddlers as they approach each other, but acquaintances only glance at each other periodically, and even when standing together and talking will make and break eye contact frequently.

So, eye contact indicates the nature of a relationship or of the attitude of one person toward another. But, does eye contact actually cause the relationship, as would be suggested by popular beliefs about parents gazing into babies' eyes? Is the attachment of a toddler to a parent based on past experience of eye contact?

When several factors seem to work together, or have mutual effects on each other, it's quite hard to tell which cause determines which outcome. This is especially true when we can only look at natural events rather than doing experimentation. Sometimes, fortunately, natural events provide us with some information that can rule out an explanation.

Considering the connection between eye contact and attachment, it turns out that we do have some natural events that tell us that eye contact is at most one of several causes of attachment. There are some babies for whom a typical experience of eye contact is not possible. There are babies who are born blind or who lose their vision very early in life, and there are sighted babies who have blind parents. In either case, the baby and its parents did not spend time making "eye contact", although up to a few months of age a blind baby may appear to be doing so. Nevertheless, blind babies do develop attachment to their parents, provided they have opportunities for consistent caregiving experiences and social interactions like vocalization or mutual touch.

The fact of attachment without the opportunity for eye contact suggests that the cause and effect connection may be the other way around: that is, toddlers make eye contact with their parents because they are attached to them, not vice-versa.

What about autism? One of the most common ideas about autistic children is that they avoid eye contact and therefore fail to learn the ways of emotional communication which typical humans use with each other. It does seem to be the case that autistic toddlers don't show the "joint attention" behavior of shifting the gaze from someone's eyes to an interesting object and back again, nor do they use eye contact to try to get an adult to do something for them. A typically-developing toddler who wants help to open a container will make eye contact with an adult and hold the container out to the person; an autistic toddler does not gaze at the adult's eyes, but reaches for the person's hand and tries to put it on the container. However, recent research suggests that autistic children can actually pay attention to things they are not apparently "looking at", so questions about their gaze may need a lot more work.

Eye contact with babies-- how important is it?

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

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

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

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

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

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

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

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

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