Concerned About Unconventional Mental Health Interventions?

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

Thursday, February 18, 2016

Eye Contact with Babies Part 2: What , When, Why, and How




Hello readers-- I am starting a new post for responses to http://childmyths.blogspot.com/2011/07/eye-contact-with-babies-what-when-why.html.

There is a long list of queries and responses on that post, and I cannot seem either to publish or to answer any more. I hope people will see my notice and come over to this one instead.

I am going to start with a query I received but could not publish on the old post.

AND--  I'm so sorry but I cannot make this query and response line up properly with the margins! It looks okay to me, but when I publish it's out of line. I hope people can figure out what this reader and I were talking about. When I have time I will retype the whole thing, which may be the only solution...  no, wait! Problem solved-- I managed to post this as a comment.





72 comments:

  1. Hi Dr. Mercer,

    First off, I find it so kind the amount of time you've taken to answer so many questions
    from concerned parents.
    I'm hoping you have time for one more as I've been worried sick about my son.

    I'm a FTM of a 12 week old boy (born 3 weeks early). Since birth,
    he has never made eye contact with anyone. He looks all around but never
    at faces. I've tried endlessly to get him to track toys and he won't do that either.
    I think I've been able to get him to track a page out of a book but I say think b/c
    I'm not sure he actually tracked it or I just happened to be holding it where his
    eyes landed. He's also fussy and doesn't like to be cuddled. Only will let you
    carry him over the shoulder. He does cooh but not often.

    As mentioned, I am absolutely terrified that he has autism. The lack of eye
    contact is so disheartening. Any advice would be appreciate.


    Dear Anon-- I am not sure whether you mean that he is now 12 weeks
    corrected age, or whether his age dating from when he should have been
    born is only 9 weeks. If it's the latter, I'm not at all surprised that he has not
    been making eye contact as you want,and I would be quite surprised if he had
    done so at birth! He will probably startvocalizing more, soon.

    A lot of babies like to be carried on the shoulder. Some even much prefer
    to be held facing outward, with the back toward the caregiver. These are just
    individual differences and not associated with any developmental problems.
    It sounds as ifyou've been willing to let him "teach" you how he likes to be held,
    and that's great.

    As for tracking things visually,you may notice that when your pediatrician
    does this kind of testing, he or she uses a small pencil flashlight which is easy
    to see against any background and in any light. You could try that if you want to,
    but please understand that if you can't get him to do it, you should mention it to
    the pediatrician, but it has nothing to do with autism.

    Like all mothers nowadays, you are frightened of autism, but let me tell you
    a few things. First, babies have a normal period of "autism" (focus internally
    rather than externally) in the first few months. It can typically be quite hard to
    get their attention during this time, or even to comfort them when they're upset.
    Second, babies cannot be diagnosed as autistic at this age, and even when they
    are diagnosed after the first birthday, many of them show typical development
    after that. All those "red flags" you've been reading about have to be considered
    in the context of developmental age.Third, even when toddlers or preschoolers are
    diagnosed as autistic, this is not the end of their development, and many have only
    mild cases.

    I hope you will try to get all these things into perspective. If you cannot
    manage this,it may be that you are feeling unusually anxious or depressed
    at this point in your life and need some help with those feelings. Your OB/GYN
    may be able to help decidewhat you need and refer you for treatment if
    appropriate. Post-partum emotionalconcerns happen to a whole lot of people
    and are nothing to be embarrassed about.There's help out there if you need it!

    Good luck!
    Jean

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  2. Dear Jean,
    Could you please give me your thoughts on my just 10 month old son. I have been worried sick (literally) about him since he was about 5/6 months old with regards to his development and engagement to others. He has always been a fussy baby since birth and suffered with reflux and found to have a cows milk allergy at 6 months. However this is now managed well and under control. My concerns are he has poor eye contact a lot of the time. Much better when he is at a distance. If he is in his jumper or high chair and I'm walking around the room he will not take his eyes of me but if I stop and try to engage/talk to him he will avert his gaze after a second and I struggle to get it again unless I make a funny noise, sing or pull a funny face. Which always makes him giggle. He responds to his name half of the time. His motor skills are way behind. Doesn't roll and dislikes intensely on being on his tummy, no crawling or attempts at pulling himself up. He has sat upright since 7 months. He seems to be very fidgety with his feet and hands. Has a habit of rubbing his feet together and opening and closing his hands. He eats and sleeps well. He is quiet a quite boy (apart from whinging - which he does a lot.) babbles a little but no words. He claps his hands most of the time when asked and copies someone else if they clap, he waves bye-bye most of the time, he has a fake cough sound which he does after he hears someone else cough, he can do a red indian type noise with his hands and mouth when requested and has just started to give kisses. He loves being sung too, tickled and peek a boo. Toys don't overly impress him. He will shake them, pass them from hand to another, bang them together or on a surface and mouth them. But don't seem to hold his attention for more than a couple of minutes. He cry's when I leave the room and has stranger anxiety too. I use to think he was hypersensitive to noises but I don't think so anymore. If there is a sound he doesn't like I can make him feel comfortable around it by having a happy face and saying "it's okay" then he's fine. He doesnt do joint attention. But if I say certain things like "do you want a snacker?" He will look at the cupboard they are in and then look back at me. If I say "where's grandad?" He will look at his photo on the fire place. So showing some understanding.
    Look forward to your response

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    1. Thanks for finding this page to put your comment on.

      Try to keep in mind that eye contact is about communication. That's what human beings use it for--we can figure out some things about other people from looking at their gaze, and we can communicate things about ourselves in the same way. Your little guy is clearly both sending and receiving communications at an excellent level. To look at the cupboard and then back at you is a form of joint attention,and he's using his gaze direction to show you that you are sharing an idea. As for looking away when you are nearby, I'm wondering whether you are staring at him with a serious face because you think he should be gazing at you and there's something wrong if he is not. They don't like to be stared at, any more than adults do. It sounds as if he does look at you when you do something interesting, cheerful, and entertaining, which is exactly what I would expect.

      As for the toys, what he does with them is age-appropriate. People are their favorite toys at this age. You may want to model toy play for him and make it interactive-- not essential, but can't hurt and would be fun for both of you.

      I'm slightly more concerned about the motor development, although it's great that he sits well.My guess is that he didn't care for tummy time, so you didn't do it much, if at all. He will eventually roll and so on, but like many back-sleeping babies he has not developed the muscle strength and skills that "the book" tells you he should have. Are you using a walker? There are safe ones on the market, and their use can encourage leg extension and reaching. Opening and closing the hands and rubbing the feet are common at this age, and they indicate that he is trying to get some motor skills going as well as he can. That he can hand off and mouth toys shows normal development of hand and hand-to-mouth skills.

      I can see that his early troubles made you ready to worry about him, but it sounds to me as if he's doing quite well and just has a bit of motor catch-up to do.(And that will happen eventually no matter what you do, unless there is some medical problem, which I assume you've investigated.)

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    2. Thank you so much for taking the time to reply to my concerns. I really appreciate it.
      Your right In the fact he has never really tolerated being on his tummy well so didn't have much tummy time although now he will tolerate it for longer and has between 20-25 mins aday. But is unable/refuses to push up on his arms in any situation. He presents as if his arms are weak yet he can lift heavy toys over his head and pull heavy things. Also he can weight bear but never has his feet flat on the floor. He rolls them onto their sides making him unsteady. It is very strange! I take him swimming and soft play weekly but doesn't seem to be improving his motor skills. I have made his HV and paediatrician aware of my concerns and he has now been refereed to a developmental specialist for further assessment. He had an audiology test today and passed. No hearing impairment. He just seems so uninterested and frustrated 50% of the time. It's like he can switch on and off like a radio. My gut feeling tells something is a miss with him. But everyone who should know about knows about him and it's just a case of waiting and see and how he goes. He's still very young. I'm also getting help with anxiety related problems to this and am focusing more on what he can do than not do and enjoying him as much as I can.

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    3. Pushing up with the arms usually begins with using the whole lower arm, not just the hands, to push. The shoulders and chest do the work, but just as would be the case for an adult, if the baby doesn't spend time using the shoulders, those muscles are not very strong. If you think about how this works at the gym, the shoulder press machine uses different muscles than the chest press. He may have arm strength to do other things, but it doesn't help him push up.

      Also, their ankles take a while to get strong enough to take the weight on the flat foot, and babies tend to use the toes or the side of the foot when they can, e.g. a walker or jumper.

      As for rolling over, this requires head control that is more easily developed on the tummy. The baby twists the head around and eventually the body follows, rather than pushing with the arms or legs as an adult might when rolling.

      Once again, babies who have not done much tummy time tend to be temporarily delayed in large-muscle motor development, but they do catch up.

      I don't want to ignore your sense that there is some problem, but a lot of what you've said can be accounted for by tummy time issues. I am glad you are getting help with the anxiety, so if there does turn out to be some problem you can deal with it effectively.

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  3. Sergiev Posad (Moscow region), there is an orphanage for deaf-blind children. These children have only a tactile contact with other people. This orphanage is working on при специальном обучении по методу И. А. Соколянского А. И. Мещеряков
    Источник: http://meduniver.com/Medical/Psixology/826.html MedUniver
    Even blind and deaf from birth, children begin to develop and sincerely attached to their caregivers and teachers. Is this not proof that the conclusions Attachments therapists are wrong? The child has only 2 связи with the outside world - the tactile sense and of smell. This is enough to intellect and affection evolved ... if properly use these senses.
    https://www.youtube.com/watch?v=oUWaZDr6dCI

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  4. orphanage for deaf-blind children in Sergiev Posad
    https://www.youtube.com/watch?v=mj3VrlAqcMU

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  5. What a difference a child looks into the eyes of the other party, or is not looking? Why it is important for therapists Attachments ?. Order "Look me in the eye" in the Russian nashkodil used if the child does not want to admit. To find out the baby was lying or telling the truth. If the child is lying ... he could barely stand up and look tutor his ears and cheeks begin to blush with shame and stress. I find it hard to understand how you can use compulsory looking eye to eye for occurrence of love and affection.

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  6. Hi Dr. Mercer, I am really glad I discovered your blog. it is really difficult to figure out how all the different things we read related to child development apply to our baby. Your posts and answers are so thoughtful and informative they feel like a breath of fresh air in the dreary situation we are facing.

    Our baby is 7 months old, his motor skill is quite delayed (can't sit up straight yet). While we are working on that, we also have been told by a pediatrician we saw that he doesn't seem to engage with people, such that he does not look at you if you call his name, and he rarely looks at the people around him. He also doesn't reach out to grab stuff. Combined that with a small head CF (3 %tile ), we have been told by the pediatrician (in Taiwan) that he may never be fully 'normal' and face a tough road ahead. (his weight / height are in normal range, he eats / sleeps well).

    While we are looking into early childhood intervention programs, I was wondering if you have any suggestion on how we best approach the situation and anything else we should be aware of.

    Thank you,

    Albert

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  7. I am so sorry to hear about the challenges you and your baby are facing. I do want to point out that normal weight and height are a good sign for later development, and that some babies with small heads do experience some improvement in head size as time goes on.

    You mention seeing a pediatrician, so I assume that his hearing and vision have been tested. If not, you should have this done, as poor vision and hearing can be the causes of the social and cognitive delays you describe. Because the retinas of the eyes are really outgrowths of the brain, anything that affects brain growth can also affect them. Babies with these problems can often be helped with corrective lenses or with hearing help.

    I am not sure what you mean by sitting up straight. If you mean actually sitting firmly without any support, 7 months is not really late for that. If you mean sitting on someone's lap where there is support, yes, that would be a delay. Was he ever described as a "floppy" baby, or with low muscle tone?

    If your baby has been sleeping on his back and not getting much "tummy time", that would be a partial explanation for any motor delay. The norms for motor milestones have usually been drawn from babies decades ago who spent a lot of time on their tummies, and they reached certain milestones earlier than babies who spend more time on their backs. Working on some "tummy time" may help with motor development, if you have not already been doing this.

    Early intervention programs focus on finding objects or activities that get a baby's interest and motivate him to look or even reach. But of course if there is any visual problem this would be more difficult. I would just suggest that in addition to getting early intervention you can explore things you can do that seem to get him to orient toward you or to get quiet as if paying attention. These could be things like singing or reciting nursery rhymes with a lot of intonation, or flashing a light on and off, or all of those together. The idea is to create an interesting spectacle. Please understand that I am not saying these activities will work a miracle, but they are things you can do that may help and certainly can't hurt.

    Again, do follow up on the vision and hearing if you haven't done this. As for being "fully normal"-- whether he is or isn't, he will still be a person and he will continue to develop with whatever help can be given to him.

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    1. Thank you so much for your answer. Yes, our baby has been described as floppy. When I mentioned that he is not sitting up straight, I should have clarify that when he is in a sitting position (in our laps for example), he has trouble holding his head up and mostly look down. He also prefers to turn to his left. We have been working on the tummy time (yes, he does sleeps on his back) and stretches that would help with his neck muscle (instructed by a physiotherapist we saw), I think he is showing some slight improvements in the past month or so.

      Thank you also for pointing out the vision and hearing tests, I don't think those have been done so far. We will definitely follow up on that.

      Best wishes,

      Albert

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    2. Good luck, and do keep up with the physiotherapy even if at times he does not seem to appreciate it! It can really make a difference, and if he can support and control his head better it will help him look around and pay attention to people.

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  8. Hi Dr.Jean,
    I am mother of a 8 week old baby boy(born 2 weeks early by c-section) He looks at light and windows mostly and doesn't make eye contact and smile. When we try to talk holding him close he stares at us but can't follow us when we move. Also doesn't respond on calling etc. Is it normal. Ear test is normal. I am very much concerned as my elder daughter has low vision.

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  9. Hi Prathe-- I am not surprised that you are somewhat anxious, because of your daughter's vision problems. However, you need to remember to think about the baby in terms of his corrected age-- the age he would be if you counted from when he should have been born rather than when he was actually born. That means he is really only 6 weeks old, counting from the later date, and he can only be expected to act like a 6-week-old. I would be very surprised if he looked at you when you call him, as that is not likely to occur for at least another 3 or 4 months. If he gazes at you when you talk to him, that is a good sign. He will probably begin to smile in the next few weeks, but even then you will probably have to work to get a smile from him! When he begins to make eye contact it will be very brief, also.

    Because your daughter has the problem with vision, I am sure you will be watching him carefully in the future, but I would say that at this point he is not doing anything to cause concern. Good luck with your family!

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  10. Thank you Dr.Jean for the quick response which definitely boosts my confidence. Will update his progress.

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  11. PAVI PAVITHRA-- I hope you will see that I am answering your query here. There is no more room on the page you addressed it too.

    You asked about a baby boy, corrected age 5 months, who has recently begun "avoiding eye contact" after a period of frequent eye contact. You said that he smiles and plays peek-a-boo.

    I am not sure what you mean by avoiding eye contact. Is he looking more at other things than faces, or do you feel that he makes eye contact and then averts his gaze?

    If he is still smiling and playing socially, I would not worry about this at all. He may simply be realizing that there are other interesting things to look at, besides faces. There is nothing magic about eye contact-- it is just one of our human ways of communicating, and if he continues to communicate in other ways, that is good enough.

    Can you be more specific about what you mean by avoiding eye contact?

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  12. Dear Dr.Jean am here again with some doubts. Sometimes I hav observed unusual eye movements(moving eyeballs up and down continuously, looking inwards etc.) in my baby's eyes when he looks at some places. The other times he looks straight.My daughter has Nystagmus and does my son has the chance of having it. But his eye movements look diff than hers. Am very upset and really worried. Please guide me.

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    1. Dear Prathe-- I see that you also made a comment about the baby not having smiled at you-- that comment did not appear here, but I was able to read it when it was sent to my e-mail.

      Nystagmus can take several different forms, so it may not look the same in two children. It can have a hereditary component, so it is quite possible that both the children have it. Do you have access to a good ophthalmologist? There are some treatments that can help with nystagmus and help to preserve vision, which is important even if it is at a low level.

      I don't want to alarm you further, but it would be a good idea to start treatment as soon as possible. Your children are at a period in development when the brain is "learning" to work with the eyes and respond to vision, and this will be more effective if the images sent from the eyes are clearer.

      I am sorry that you are having this worrisome set of problems. Please seek medical help for both children as soon as you can.Children with nystagmus do not necessarily lose their vision, but they need as much help as they can get in early life.

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  13. Yes Dr Jean, I mentioned that he didn't smile and smiles looking at tubelights. So is his vision problem that restricts him from smiling looking at faces.. Can u suggest me some good hospitals where treatment for Nystagmus is done as I'm not finding any here. My daughter's eyeballs shows jerky movements but sons is different. So should I conclude my younger one is also having problems with vision.

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    1. It's possible that he does not see the faces very well.

      Could you tell me where you are so I can try to find out what hospitals are near you?

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  14. ANONYMOUS with the very anxious 18-month-old:

    I hope you will see this. The page you commented on cannot hold any more comments, so I am trying to get people to come to this page instead.

    The situation sounds very difficult for you, and it is no picnic for the little guy to be so fearful and to have trouble regulating his feelings. Do you have an early intervention service where you live? Do you have a regular pediatrician you can ask about this? It does not matter so much whether you want to call the problem SPD or something else-- the real issue is for you to become able to help him take a calmer approach to life.

    You didn't mention whether he talks at all or whether he is able to tell you what he finds so disturbing.

    Generally speaking, some fear of strangers is a good sign developmentally, but his reaction seems unusually strong. Also, he cannot be getting enough sleep, and you can't either. You need some support on this and I hope you will be able to find it.

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  15. FOR IATHA PRIYA DARSHINI--

    Again, I have to answer your query here because the original page cannot hold any more comments. I hope you will see this.

    I am not at all surprised that your 3-month-old does not respond to his name. I'm sure he will do so in another few months. You also said that he smiles and looks at you when he is in his crib but not when you hold him. This may simply be that when you are holding him your face is too close for him to see it clearly, and when you are a little farther away he gets a clearer image. It's a very good sign of his development that he socializes with you like this.

    Unless there is some other problem that you did not mention, the only thing I can tell you to do is to keep on with what you have been doing! He sounds fine to me!

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  16. Dear Dr. Mercer, I used to consult this page when, some weeks ago, I was very worried about my then 3-month-old son. He did not make ete contact nor did he smile. your posts helped me to keep relatively calm and not to automatically jump to to conclusions. We went to a pediatrician and also to an ophtalmologist where my son got

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  17. fitted with glasses. About two weeks later, his behavipur started to change dramatically. He now practically stares at us all the time and smiles at us from time to time. I am not sure whether the glasses caused the change or whether he just needed some more time to develop his capacities for interaction. Anyhow, I am incredibly happy about this development (today, the pediatrician confirmed the baby now seemed totally "normal" to him now and had made an incredible leap in his development). I just wanted to say thank you for your blog and share this experience - perhaps it can give some hope to other worried parents.

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    1. Thanks so much for this comment. I do hope other people will read it and realize that there may be lots of different reasons for "problem" behaviors in the early months, and lots of ways in which they get cleared up or clear up by themselves.

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  18. Hello,
    I have really enjoyed reading your blogs. I am a teacher and since the day I found out I was pregnant I have been worried about my child having Autism, as I want the best for my child. He has always been a fairly happy and easy baby. I thought this was amazing, however, after reading articles, I see that this could be an indicator of an autistic child because they don't know to communicate or get upset. These are things I see my baby doing, (he just turned 6 months)
    - He will smile and laugh at us. Some days it takes more work than others. He does belly laugh and smile when smiled at, just not all the time.
    -He can roll from his back to his stomach, but can't roll from his stomach to his back, is this normal?
    -He makes eye contact, but doesn't hold it for periods of times.
    -when I leave the room he will follow my movements, when my husband walks by he will follow his movements
    -he loves to play with toys and uses both hands, he follows toys and can grab them when they are far away.
    -he is sitting independently, but isn't showing signs to start crawling yet.
    -he babbles, somedays more than others, squeals when happy and grunts when he isn't happy
    -he is making a lot of scream and sounds, but doesn't make a lot of double sounds like mama dada
    -he smiles when playing peek a boo, but I don't think he gets the game yet.

    These are things I am worried about;
    -he isn't making long periods of eye contact with me or strangers like other babies we play with. Some of my friends babies stare at their parents and strangers.
    -he will smile at strangers but then quickly look away
    -he doesn't look at me when he feeds, he will come off and look at me and smile, but will not make eye contact during his feeds
    -when he is doing tummy time he moves his arms like he is swimming he hasn't learned to put his hands down and push up... only does this when he is following a toy I move from side to side
    -sometimes he will wake up and coo and cry for me but most times he will play with his stuffed animal for a 10 minutes before calling out
    - he doesn't always look when his name is being called.
    -He makes a lot of eye contact when he is on his back and playing with toys, but doesn't when he is on his belly or sitting (he just learned how to do this)
    -He doesn't like making eye contact when his face is right infront of mine.
    -He likes to look around the room consistantly

    I am mainly worried about his eye contact. All the babies in our groups seem to have more eye contact than him. Some tend to babble more than him as well. Could that be personality or red flag to autism?

    Thank you for your input, I have tried to talked to my doctor but he doesn't seemed concerned, however, I can't stop worrying.

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    1. I'm going to answer this on the other page where you posted it--

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    2. This sounds 110% percent to a T exactly like my son who will be 6 months old in two weeks, my son was born with a cataract and is currently using a contact lens to try and get vision in that eye but he is still currently blind. I was wondering if that had something to do with it or was it early signs of autism. Id love some feedback. Thanks.

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    3. Wow, it sounds as if your family has had some real challenges to deal with! Let me just point out to you that before 4-6 months babies do not have binocular vision-- they don't look at things with both eyes at once as older people do, but instead switch their attention back and forth from the left eye to the right eye and reverse. For typical babies, that means that the two eyes see pretty much the same scene but alternate looking at it. For your son, he would have had to look with only one eye, and if he switched it would be from seeing something to seeing nothing. I would think this would interfere temporarily with the way he responded to people and objects. But as Anon pointed out, the shift from being unresponsive to being responsive does not take place on a given day after birth and can involve different patterns for different individuals.

      Are you saying that your son also showed the pattern that Anon described? Did you feel that you also had a mood problem-- which might well have been connected with the natural emotion created by your son's condition? Just wondering-- you don;t need to tell all, but it might help other people if you tell your story--

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    4. We have been through a very emotional and physical challenge with our son. He is our first and we found out at 4 days old that he has the cataract, since then we have been through two surgeries, many many many eye appointments with dilation and not so fun pressure checks. Now we are battling the contact lens and a eye patch over his good eye.

      Like the anonymous above my son sounds just like her child, last night he engaged in a game of peek a boo and had the sweetest belly laugh.
      He makes great eye contact when laying down but when he is standing in our laps he seems to struggle. He also doesn't respond to his name and sometimes doesn't turn to the sound of a new voice in the room. He is a very very laid back baby. He will play for long periods of time alone which seemed to be concerning to me. Maybe im just blessed with a happy content son.

      I do think I have struggled with postpartum anxiety and I wasn't evens sure that was a real thing but now having addressed it I am much better. I still have days where I struggle, wondering if my son could be autistic but I am now just enjoying him and his quirks.

      Thanks!

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    5. Aren't those belly laughs the greatest! I swear, if we could genetically modify humans so they laughed much earlier, we would probably cut down the child abuse rate a good deal.

      I am not sure what to say about the other things you mention. It's early for him to do peek-a-boo, but maybe his experience with seeing/not seeing things has speeded this up. I would expect him to respond to the sound of his name sometime soon-- but like an adult, he will not do it every single time.

      I would just suggest that you not always leave him to play quietly for long periods (I'm not sure how long you mean, but perhaps not more than 20 minutes) without checking to see whether you can get him to play with you. If you can't get him to, you can't-- but just keep in mind that after all he's been through, he may be choosing peace and quiet when a bit more activity and stimulation would actually be helpful for him.

      However-- you know your baby, I don't, so please take what I've just said as speculation, not evidence-based advice!

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    6. His laugh is contagious and I live for it!

      The peek-a-boo, Im not sure if its the surprise of it all or what but he laughs when I pop around the corner and say boo.

      My family has given him a lot of nick names and I wonder if the lack of hearing his name has caused him to not associate the name with himself. Ive been working on using it more and saying things like Cash would you like to take a bath. Cash are you hungry Etc...

      Its hard to say for how long, usually after 10 mins or so I will get down on the floor and engage with him but he really doesn't pay me a whole lot of mind. He will smile at me when I get on his level and say hello then its back to the toys. He "talks" when hes down on the floor playing, and changes toys from hand to hand,he also does this swinging arm thing like hes banging his hand on the toys. Sometimes he does it when there isn't a toy at all he will do it on the floor. He rolls over from back to belly but not the other way around and he cant sit up yet. he would much rather walk around in his walker than play on the floor. I have really been trying to get him to have more tummy time to help the process of crawling. ( Not showing any interest yet) When he wakes up from naps and sleep he almost never cries out to be gotten up. I check on him every 5-10 mins since he sleeps on his tummy so I find him awake and maybe that's why? Maybe he never has the opportunity to cry out for me.

      I really appreciate your feedback :)

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    7. If he doesn't always hear the same name for himself, there is really no way for him to know "which is him"!

      He sounds to me as if he's doing very well. One thing you need to keep in mind is that they don;t progress at exactly the same rate of speed on every aspect of development, but instead often have a long plateau without change in one area while they work on a different one, then suddenly show dramatic progress. That's one reason all those average milestones are not always a lot of help.

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  19. Dear Jean,

    I have a one year old son who is an absolute delight. He smiles and laughs, and uses eye contact effectively to communicate and interact. I wanted to post because I visited read your page numerous times when I was feeling anxious and found your rational and informative responses reassuring. Up until about 9- 10 months I was incredibly anxious that my son wasn't interacting much or communicating well- particularly in terms of eye contact. I identified with so many of the concerns that people have posted, including fears about Autism even though I knew that such early diagnosis is not possible. I took him to the Dr a few times and despite their reassurance, my gut feeling was that something was wrong. I think parents with young children are faced with a lot of information and we also spend time around other babies who are developing different skills at different paces. Whilst this can sometimes be reassuring it can also be unnerving, depending on perspective at the time. On reflection I think I had some unhealthy postpartum levels of anxiety and seeking treatment for this helped me to shift my focus and start to enjoy my son again while his social skills continued to develop.
    Thanks for all the work you do and the time you take to write replies. It’s a minefield out there and a lot of the other information I came across on the internet served to heighten, not allay my fears.

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    1. Dear Anon-- thank you so much for this letter. I would like everyone to read it, so I am going to post it as a separate blog post (if I can figure out how to do this!). Your point about making comparisons with other babies is so important.

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  20. You're welcome and I enjoyed reading the commentary with your blog entry. Post natal depression is widely spoken about but I don’t remember hearing as much about anxiety. It just blindsided me really, with a rational worry (vision being a little delayed to develop) spiraling out of control into major worries about all aspects of his social communication development. Reflecting on how I would have read my letter above, if in the midst of anxiety, I would have thought ‘lucky her, but I’m so worried that I’ll never feel that sense of relief that my baby is okay’. Trust me, my fear was deep seated and felt real. I had a long list of ‘evidence’ and I thought it was only a matter of time before other people around me started to worry about him too. Some people will have concerns that do need to be followed up, and that is why it is so difficult –I thought that if I didn’t stop worrying I would not be ready to intervene when I needed to. Like you said in the blog- no amount of reassurance made a difference. I think there needs to be more of a public discussion around post natal anxiety, as well as depression. While they are often interlinked I think they can manifest a little differently and for me I wish I had detected it and sought treatment at least 5 months earlier.

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    1. Thanks again for your comments. You have reminded me to emphasize anxiety in a piece about perinatal mood disorders that I'm writing for a child development encyclopedia.

      I know that your fear not only "felt real", but it was real. It takes a lot of strength to try to look at the situation objectively when your emotions are screaming that they are telling the truth. Congratulations on having managed to get some perspective and find some help, and thanks again for telling this story.

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  21. Dear Dr
    My name is monowar.My twin girls are 11 months old. One of them is very active and she always smiles back.But there are some facts that really makes us concerned.
    She use to flap her hands.Rarely responses to her name.Hits her own head somtimes. Utters repeted sounds like Ba BA ga ga da da. But she can clap whenever we tell to do so. She can stand on her own. Can not walk. Now some of the symptoms are making us concerned please help.

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  22. Dear Monowar-- I hope you will see this answer. I had to move your comment over here because there was no more room on the original page.

    I am guessing that your twins were born a little prematurely, so that the corrected age is possibly 10 months. It sounds as if this twin's development is in many ways typical for her age, including the babbling and the hand-flapping. I would be more worried about her failing to respond to her name. Have you had her hearing tested? Has she had many ear infections? Ear infections can leave a baby with temporary hearing problems even after quite a few weeks.

    I am also wondering about her hitting her head. What are the circumstances when she does this? It can be hard to give each twin enough attention, and I am wondering whether she is alone or unoccupied when she hits her head.

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    1. Hello Dr, First off, thank you for all your sound advice. I've been reading through the comments above and identify a lot with what some of the previous commenters are saying. I do however want to run my situation by you, since my anxiety levels are sky rocketing.
      My daughter will be 8 months old in 3 days. She’s always lagged behind on the percentile charts, however her pediatrician said he wasn’t worried about her. He also looked at her muscle tone and said she was fine. However, I have noticed a few things that have me worried.
      • She’s flexible to the extent that she can reach her toes and nibble on them.
      • Literally, almost from birth, she’s been craning her neck and trying to raise her head to get a good view on what’s going on.

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  23. While she’s been doing crunches, she started to roll over from back to tummy at around 4.5 months. She then forgot about it in a week, and didn’t do anything till the 6 month mark, when she did a short start and stop of rolling again. Now, at 7 months, she’s been rolling from back to tummy to the extent that she gets on her tummy and can’t get back. I know she knows how to because she used to be able to do it. But now. It seems like she’s just forgotten how to. She at least lies on her tummy for 30 mins or so at a stretch, which she just wasn’t doing till some time back.
    • When she gets on her tummy, she is able to change directions and move 360 degree. I can see her trying to move forward, but when she can’t, she sort of gives up and just lies down with her head on the ground.
    • We lay her down to sleep on her back, and these days. She’s started to show a preference for sleeping on her side. If she gets on her tummy while asleep, she gets hysterical.
    • Till a few days or maybe a month back, she was ready with smiles. She’s never been a terribly smiley baby, but she would smile when she’d see us. Now she sort of just looks at us and looks away. When we come home and see her, she doesn’t seem excited to see us. Even after we call her name and make funny faces, we might get a glimmer of a smile. She will laugh and squeal only when being lifted up to the ceiling, or being tickled near her chin. It just sort of seems to me that she’s regressed when it comes to social skills and laughing and smiling. We are in a nanny share with a baby a month younger and the other kid is constantly smiling. It’s hard not to compare.
    • She cannot pull herself to a sitting position, but sits without support by herself for several minutes now. She grasps a toy with one hand while balancing on the other, and then slowly moved the other hand to hold the toy with both hands. After maybe 10 mins in a sitting position, she leans forward and cannot balance.
    I know they say not to compare, but when I see other babies born at the same time as her, and they’re mobile or getting close to pulling themselves up, I can’t help but get worried. Do I have a late bloomer on my hands? What can I do to encourage physical skills? Are there any social skills or cues that I should be watching out for and am missing?

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    Moderate comments for this blog.

    Posted by Anonymous to CHILDMYTHS at June 15, 2016 at 2:51 PM



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    1. Dear Anonymous-- I hope you find this response to your message. I find that most people do not notice what I said on the original page-- that there is no more room to publish there! I ended up bringing your message over here in two parts, which is why it looks a bit odd.

      Yes, they do say not to compare, and they are perfectly right. There is no way that any parent can see enough other babies to be able to make a sensible comparison of their own child's development, or to understand the enormous individual differences in the timing and pattern of developmental change. For example: the normal range for walking independently is from 6 (!) to 18 (also !) months. The mean (all the ages added up and divided by the number of kids) is about 12 months, but that average really tells you nothing about how any individual, perfectly normal,child will progress.

      Now, let me address some of your specific statements. I am assuming that when you say she's behind on the percentiles, you mean she's small for her age. Not to invoke Garrison Keillor, but you know, everybody can't be above average!
      Good muscle tone is an important indicator of development, and looking around from birth is certainly an excellent sign (but if people are reading this whose babies did not do that,don't fret, they are not all very vision-oriented).

      High flexibility: yes, she is at the right age for that (which she could not do earlier). Not a problem-- on the contrary.

      Rolling over and sitting: let me mention a couple of things. You've had her sleeping supine, like lots of people nowadays, and that means that her motor development will be delayed RELATIVE TO what you see in "the book". The old norms were based on prone-sleeping babies, whose motor development followed a different pattern. She gets tired in sitting because she still does not have good hip strength, but she'll get there. She's obviously motivated to use this position because she can play with objects as she cannot in other positions, so that's great. BTW, it's great that you've got so much tummy time going on.

      About rolling over: if you could measure what she is doing with her muscles, you would see that the way she rolls now is different from the way she rolled before. She is bigger now and her weight and length require different movements to turn her. In addition, every baby develops motor control from the top down, so her physical abilities are different than they were earlier and she has to develop new ways to roll. She can't "know how to do it" because like all babies she has developed so quickly that the way she knew to turn before no longer works for her.

      Now let's get to the smiling. She used to smile more, and the younger baby smiles more than she does. Doesn't this suggest than smiling less may be a function of development? She is just at the age where most babies begin to be concerned about differences between people and about separations and reunions. Not to say that you shouldn't leave her-- but she is likely to respond to the fact that you have gone and come back. Also, things must work differently for her when she's with a nanny and another baby so close in age than when she's with you, and she may need to "shift gears" as she goes from one situation to another.

      I am not sure what has you so worried, although I wonder whether you yourself are responding to your separations from her and anxious about that. I would not see this child (as you have described her) as a late bloomer at all, but instead just as someone who is "blooming" according to her own pattern. My advice is just to play with her as much as you can and to follow her cues that tell you what she's interested in. Being sensitive to her communications and responsive to them (hide the phone when your with her) is the best thing you can do.

      I hope you will think about your own anxiety and whether you might need some help with that-- in case it's not really all about your separation from your baby.

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    2. Dr, Thank you so much for this. A couple things to note -
      1. You are right about my own anxiety. She fell from the bed (during the week she was rolling over very well) and the guilt from that has just been unsurmountable. I have been thinking a lot about this and am trying my hardest to not worry and be calm and be the relaxed happy parent she needs
      2. She was born with a spot of hip dysplasia. We had her in a pavelik harness for the first 4 weeks of her life. Ultrasounds revealed that her hip is ok. So, I know that her hip is fine. I cannot help but wonder if her delay in rolling over etc is a factor of her hip issues
      3. There was mild trauma when she was born, when she had to be "yanked" out of me, and her left shoulder experienced some bruising. Clavicle wasn't fractured, but there was some strain for sure.
      4. You're right about the nanny and the other baby. My daughter probably needs time switching gears like you said. However, the one thing that does make me wonder - our nanny is huge on sleep training. I am not. I have always comforted her when she's crying before sleep or wakes up crying. I am ok letting her cry for a few minutes, but anything beyond 5-7 mins doesn't work for me. I know our nanny lets her cry a lot longer. Is it really true what they say about sleep training, can it "alter" a baby's disposition?

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    3. Hi-- well, you've added a lot of interesting information! It's certainly possible that the hip dysplasia and harness experience could affect her use of those muscles, not in the long run, but with respect to the orderly progression of motor control in the first year or so. Hip dysplasia can be affected by supine sleeping, as the pull of gravity moves the thighs and legs in the "wrong" direction-- I am not suggesting that anything terrible has happened here, just that her motor development is a complex matter that may have been affected by a lot of things you would not necessarily think relevant. It will all work out after a while, but you can see that there may have been reasons for the "late blooming".

      As for the fall off the bed, I wonder a)whether that sensitized your anxiety about rolling, and b) whether she has picked up on that anxiety herself. Again, very little chance of long-term effects, but possibly one more factor in the mix. (You see, even if they weren't born individuals, babies would quickly become individuals because of their varied experiences.)

      Babies who get non-parental care always have different experiences around daily care routines and sleep when with parents and other caregivers. I can understand why the nanny is into sleep training, as the care of two babies of these ages is extremely demanding. I don't think it's sleep training that alters dispositions in your case, but simply the fact that she is at an age where there are abrupt reorganizations in emotional responses and especially an increase in wariness and fearfulness. Maybe it would help if you think of this sort of thing as being maturation-- as one who notices differences between people and situations, she is now more like an adult than she used to be.

      I understand your ongoing sense of guilt perfectly-- I still occasionally have a flashback to an event decades ago when one of my children almost choked on a piece of food I had hurriedly not cut up small enough-- but you're right, if you can find a better equilibrium that will be good for your whole family.

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    4. Dear Dr, Thank you so much for your thoughtful and detailed response. This has helped me immensely. This, and the other comments from parents and your counsel to them. I was able to really face my anxiety and address it for what it was. From the time I emailed you to now, maybe a week or so, I can already see changes in my child. Just goes to show that children are constantly changing and growing, and everything balances out in the end. Thank you again.

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  24. My daughter turned 1 on 7th June and generally is a truly delightful baby. However, there are things about her behaviour that have really started to worry me over the last couple of months and like so many parents who have posted here, Google keeps pointing to autism. I am at the point now where the anxiety around her being autistic consumes my days and I don't enjoy my time with her anymore because I am constantly looking for behaviours to reassure me. My husband is convinced she is absolutely fine, but I don't know whether I should be pushing for her to be seen by early intervention.

    The aspects of her behaviour that concern me:
    - She very rarely responds to her name when we call;
    - She doesn't reach out to be picked up;
    - She's very happy playing on her own and rarely engages us in her play. If we're on the floor with her, she will sometimes pass us things she's holding (but won't always let go of them!)
    - She frowns a lot - but if you frown back at her she will smile back;
    - She flaps her hands (but can be distracted from it);
    - She plays with unusual things - there is a screw in her cot that she presses like a button constantly;
    - She has slept through the night (12 hours straight) from 13 weeks - in the mornings when she wakes up, she'll play with the screw in her cot and babble until we go in (doesn't cry for us);
    - She babbles but doesn't say any meaningful words yet;
    - She can commando crawl, but not crawl on all fours, and she can't really bear weight on her legs yet;
    - We've never had a problem with stranger anxiety;
    - The good things are - she waves and claps and will do so (mostly) if we ask her to. She points all the time - at things she wants, like her water cup, but also at say a dog if we're out for a walk. However, she just points at the dog and doesn't look at us while she's doing it. If we point and look at things she will mostly follow our gaze to look at them too. She likes peek a boo and will squeal with delight when we chase her. She's generally smiley and happy but I worry she's not affectionate. If I ask her for a kiss, she will (sometimes) lean into me, but she never initiates affection herself.

    I know she's still young, but I'm worrying myself crazy and I don't know if I should be more forceful and seek further help.

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  25. Dear Anon-- these are subtle differences that you point out, but I see why you feel her behavior is not completely typical. Do you have access to early intervention services? You might want to ask your pediatrician to refer you just on the basis of the crawling delay. Whether autism is an issue or not, there may be something she needs help with in her development of movement.

    She sounds as if she is quite social and can communicate well by pointing and having chase games. That would be an argument against autism. The presence or absence of stranger anxiety doesn't really speak to autism, but it is unusual that she has never displayed any by this age.

    I am not surprised that she does not offer you a kiss, because babies generally don't do this unless they have been taught to.

    If I were you, yes, I would ask about early intervention, if only to stop your worry and feeling of helplessness. But at the same time let me point out that toddlers who are diagnosed with autism often turn out to be developing quite typically a few years later.

    Best of luck with this, and I hope to hear from you in the future that all is going well!

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  26. Dear Doctor. My son is 5 months old. And he is a really curious boy who want to stare every single details around him. And it is too difficult to take his attention. I try everything such as speaking in loud voice or slow singing while he is on lap or lying on his back etc. But generally i got only a glance about 3 sec. Max. İf i sing to him he holds his eyes a little bit more on my eyes with a serious face. İf I talk to him he is sometimes looks smiles and turns his head to look other things around him. Generally he doesnt hold for long periods. And these things generally happens when he is lying. Novadays he looks to his grandmom while he is on my lap. When he was 3 months old it was impossible to make him look at while he is being hold. On the contrary he contacts and tracks toys very well even if it is close or far.And sometimes i feel that he stares me while i am not looking at him. When i look him again he avoids his eyes.
    He constantly wants to be on my or anyones lap. he coos angryly and looks me in the eyes to take my attention. When i hold him everything looks ok. When i play peek a boo hi is smiling but i thing while we playing he is looking at my hands intead of my face. Sometimes i try to speak to him while my hands around my face than he looks a little bit longer. I dont understand The reason.
    Besides His motor skills look good so far. Novadays he really consantrate on turning. He tries over and over... almost there...
    I am afraid a lot about autism. I hope my son get over all these situations. Thanks for reply...

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    1. Dear Duygu-- I had to move your query to this page because there is no more room on the one you sent it to. I hope you will find this.

      Babies do not gaze into people's eyes for no particular reason any more than adults do. Three seconds is a reasonable time. As for turning his head away, I wonder whether you are looking at him with a very serious, worried face or even a frown, which babies don;t like to look at. I expect he looks more at your face with your hands around it because it's unusual.

      You've mentioned several points that are certainly NOT indications of autism. He tries to get your attention. He looks to his grandmother. He wants to be in someone's lap. These are not things autistic children do very much.

      He is rather young to be playing peek-a-boo and I think he just finds it interesting that your hands are where your face usually is.

      Don't be so impatient-- he is still a very young baby and he just is not ready to do a lot of things! In another month or two I think you will see a lot of changes.

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  27. Dear dr,

    I have a query about my 4 month old daughter which would be helpful to get your insight on.

    As it's my first child I just don't know how much eye contact she is expected to have with me. Whenever I pick her up she's always more interested in looking everywhere- she literally scans everything (my partner calls her cctv!) she's very curious about the world around her and wants to always be facing outwards looking around. I can however get her to look at me and give eye contact- I sing songs which is responds to and laughs. But not sure if this is enough- as its like I have to always try and get her attention as she would rather look around her. She also hates being restricted- e.g. In the car seat or even cuddles- she just wants to be able to see what's around her. I'm not sure if this is 'normal' behaviour or something to worry about. She coos and ahhs and you can have 'conversation' with her. Physically she is doing great. She can roll, hold her head up, reach and grasp objects and put them in her mouth. She's a very strong girl and even can sit up for a couple of seconds on her own. I guess I'm even more worried about things as her half brother is severely autistic and I'm not sure if there are the early subtle signs or just normal.

    Would really appreciate your input. Thanks

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    1. Dear Anon-- I'm trying to answer this with intermittent Internet--I'll just say,sounds good tome!

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    2. Let me try again and maybe the Internet connection will last long enough to publish this. Some babies do like to look a lot and prefer to face outward for that. I know of no problems associated with that. Your baby is social and communicative, and her motor development is good-- these both suggest typical development at this point. I understand your concern because of the half-brother, but I'd say all is well.

      Many babies hate to be restrained, and in the old days of people like John B. Watson doing baby experiments, they used restraining the arms as a way to make the babies angry-- it worked, too.

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  28. Dr. Mercer,
    Over and over I see concerned parents. I know how they feel, because I was there. One thing I would say to all of them; if your child does end up being on the spectrum, it is not the end of the world. As you pointed out, Dr. Mercer, many are on the mild end. And while it may be a long time before you really know how autism may affect your child's functioning, and so you may worry sometimes, you really need to focus on your child as a child, and not so much as an autistic child. I know that's hard. But it's necessary for both you and your child. My daughter, who will be 3 next month, is likely mildly autistic, she has some sensory issues, Apraxia of Speech, but she's is an absolute delight to be around. She is so sweet, and kind, and can make eye contact, and tries to socialize. Does she have her "quirks?" Yes she does. Does she get frustrated with her difficulties communicating her wants/needs? Yes she does. Does her constant movement wear me out? Yep. But I wouldn't change her for the world. She's made my world a more beautiful place and while I may teach her lots of things, she's also taught me so much. So to all you parents out there, take a deep breath. Pay attention to your concerns, ask your kids' doctors, check with early intervention, but don't let your worries consume you. This period in their lives goes by way too fast to not take the time to enjoy it.

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    1. All very good points! An autistic person is... a person!

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  29. RITESH BHATIA has left a new comment on your post "Eye Contact With Babies: What, When, Why, and How":

    Hi Doc... My son is now 18 month. Below are the some points which I would like to share. Need your views and suggestion.
    1) he don't see in our eyes.
    2) always remain in within self...
    3) says papa.. Baba... But not recognize. Mother and father.
    4) never see us when we call him.
    (see us only when we loud our voice).
    5) cry when ever hear sudden loud voice.

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    1. Ritesh, I hope you find this answer. There is no more room on the page you sent your comment to.

      Do you have a regular pediatrician or access to early intervention services? I think it is time for your son to be examined carefully for any physical or mental problems, including hearing and vision problems. Please do this if you possibly can.

      Meanwhile, you need to talk and play with him as much as you can manage, using whatever kind of play seems to interest him most.

      Good luck to your family!

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    2. Hi Ritesh, Hi Dr Mercer, I am no expert at all. But when the same thing happened to my now 20 year old cousin, they got her eyes checked and turns out the poor child was near blindness. Her eyesight was terrible and that was causing some of her issues. Once she got glasses, things got so much better. Knowing NOTHING about your case, Ritesh, I cannot say my counsel is good counsel by any means. But maybe worth asking your paediatrician if you haven't already?

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    3. Absolutely worth it, and thanks so much for giving this good example!

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  30. Hi Dr,
    I came across your blog while searching online to get some reassurance about my daughters seeming lack of eye contact but all I have managed to do so far is get myself even more worried and worked up! I am a first time mother and I suffer with anxiety so I know I am more prone to obsessing over these things so I shouldn't "Google" symptoms but I have! Any help/advice you are able to give me would be very much appreciated.
    My daughter is 11 weeks old and there are a few things I am worried about:
    1) she doesn't look at me while breastfeeding. Sometimes she will close her eyes or her eyelids will flutter, other times she just stares at my arm or off at something else behind me. I have tried making sounds to get her attention, calling her name and physically turning her head towards me but her eyes will remain firmly anywhere else but looking at me. When my husband gives her a bottle of milk he says she does the same although will sometimes look at him. When I am breastfeeding however, if my husband comes over, she will sometimes make eye contact with him.
    2) she won't look at me when I hold her on my knee facing me. If I try and move my face into her line of sight to "force" her to look at me she will turn her head in the opposite direction and will keep doing this each time I move my face to get her to look at me. Sometimes she will start crying.
    3) sometimes I will catch her staring at a blank wall and smiling
    4) she does smile but we seem to have to work quite hard to get her to do it and when she does smile at someone she often looks away just before she actually smiles
    5) she has started cooing but does not do it often (couple of times each day perhaps).
    6) she prefers to be held either over my shoulder or in front of me facing away from me.
    7) she seems to spend a lot of time staring off into space.

    A few things that she does do however... She plays really well on her playmat and bats at the toys and will happily stare at herself in the mirror that is attached to it. She will sometimes look at me when she is laying down for a nappy change (today I actually managed to keep her gaze for a good 30 secs to 1 minute while making funny faces and I got a few smiles). She does seem to take notice of new faces (but difficult to see if she is making much eye contact). The back of my phone has patterns on it so when I take a picture she stares at it and will follow the phone if I move it. She responds to sounds and will usually turn her head if you shake something next to her. She will look for me across the room and will follow me as I walk around. She likes tummy time and can roll over from front to back.

    I did also see today that when her daddy was holding her she was staring up at his face for a good couple of minutes but when he handed her to me she avoided my face again. Could it just be my face that she doesn't like?!

    Not sure if this is relevant but she has prolonged jaundice and has had several blood tests to ensure the bilirubin levels are decreasing (which they are but are still raised).

    I appreciate that it may still be far too early for signs of autism but I just wanted to know if any of these behaviours would be considered "red flags" as I am making myself sick with worry reading articles which list out signs to watch out for that seem to contain these behaviours.

    Apologies for the length of my post and thank you so much for taking the time to read it.

    Thank you
    Jo

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    1. Hi Jo--

      It does sound to me as if you are making yourself sick with worry! If you have had problems with depression or anxiety in the past, or if you continue to suffer from this much anxiety, do please see whether your doctor can recommend someone for you to talk to, just to get you through this difficult period of time. I know this is confusing, because young mothers do normally worry quite a lot, but it sounds to me as if you are putting much too much energy into this.

      Let me just start with the idea that your baby does not like your face. Babies don't care what people look like, thank goodness! They like friendly-looking people, and as time goes on they like familiar people. I am not sure what is happening with your situation, but I would guess that either 1. you are so worried that you think she doesn't look at you, or 2. you look serious and worried when you look at her, and she does not like to look at that, or 3. it was just chance that she looked at your husband a lot on that occasion.

      If you try to make her look at you (or anything else) she is bound not to like that, as she is not yet very good at just ignoring things she's not interested in at the moment. If you look stressed and serious, especially, she may not want to see that expression (and it's a sign of good development if that's the case).

      As for a baby this age looking at someone who is feeding her, well-- on the whole, they don't. If you are expecting her to imitate those romanticized ads where the baby is gazing raptly at the nursing mother, just ask yourself how many shots the photographer had to take before getting that one. We adults convince ourselves that breastfeeding is a great flow of soul between mother and baby and the way attachment occurs, etc., etc., but in fact for the 11-week-old baby it's just how you get food.

      I do understand that the jaundice got things off to a bad start for you and continues to frighten you, but everything you say sounds to me as if she's doing very well. I feel like telling you to relax but I know quite well no one can do this on command! However, I hope you will think over what I said about excessive anxiety and decide whether you need a bit of extra help to deal with your feelings right now.

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  31. Here is a question from Anonymous which I moved over from the crowded page where she left it. I hope she will find this.

    Hello dr,
    My baby boy was born SGA.born at 36 weeks while his gestational age was 37and 5 days.
    He looks at me (sometyms)when i m standing but hardly looks into my eyes while being held or on my lap.
    His cousin is autistic
    My question is does sga has to do something with his poor eye contact?he is now 3 months old

    Dear Anonymous-- I am a little confused about what you've said about his gestational age, but I gather that he was preterm as well as small for gestational age. It's not surprising that you are concerned about these various risk factors.

    The issue about his SGA status is really about why he was not well-grown. Has he been tested for prenatal infections like toxoplasmosis and cytomegalovirus? Infections like those can cause visual problems that could possibly be the source of what you are observing.

    From what you said, I think you are most concerned about autism, and it's true that having the autistic cousin does raise the chances of this a little. However, your baby is much, much too young for autism to be apparent or diagnosed, and the behavior you describe is within the normal range for a baby this young.

    If you can have his vision tested, I think that would be a good idea. If there are visual problems it would help him to start using corrective lenses before he is many months older.

    Good luck to your family!

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  32. Hi Dr. Mercer,

    First, I am specifically writing to tell you thank you for your work to help parents feel less burdened by the weight of our own anxieties, often brought about by what we don't know, and what the internet tells us when we google our fears at 3am. I was just that new mama! My daughter who will be 20 weeks this Friday, and is the absolute joy of my life, has blossomed over the past month. Before this, I was sick with worry that she had autism or any other number of developmental delays as many parents in your comment sections also worry about. I was so busy comparing her to other babies her age. A friend of mine once told me, "Comparison is the thief of joy." This was profoundly true for me. I could not fully enjoy my daughter just the way she was. And what she was, and is, is a little girl who has developed and met milestones in her own time.

    She would give a passing glance around 11 weeks, but even then I had to really work for it and it was only if you were a certain distance from her face. She gave her first smile around this time as well, but again, I had to REALLY work for it. She seemed rather disengaged and not very interested in socializing. She also would not bat at or grasp at toys, she actually ignored them even when held right in her line of sight. She seemed to be at a standstill in making progress in this area until week 16 when she really blossomed. She began making eye contact very effectively, started smiling on her own without me making an effort to get her to do so. She found her first chuckle at 17 weeks and her first belly laugh at 18 weeks. She discovered her hands around week 17 as well and now grasps at and bats at her toys to her great amusement. I'm detailing this to show that it really can take our little ones time to learn how to socialize and learn. She, I believe, chose to observe and absorb her new world as long as she needed to (which was longer than every development milestone book/blog/website ect., listed it should take) before she was really to actively engage in it.

    Additionally, I, like some of your readers, struggled with post-partum anxiety. My daughter’s pediatrician referred me to get help, which I did. Incidentally, once I had begun taking anxiety medication and seeing a therapist and started feeling considerably better, my daughter also began to blossom. Whether my emotions had an effect on her or not, I'm not sure, but I think it's worth being aware of.

    Anyhow, thanks again for your blog! I actually found it while I was googling "8 week old not making eye contact" and came across several “red flags about autism” sites and forums full of anxious moms worrying about the same thing. One mom posted a link to your blog and how much it helped to relieve her excessive worry and I'm forever grateful to have found you through her!

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    1. Dear Nikki-- thank you so much, first for your kind words, second for your telling your story in a way that I am sure will be a great comfort to some anxious mothers.

      One of the problems with "the book" as a source of information for mothers is that these sources give averages but almost never refer to the earliest and the latest ages for a "milestone" that are in the normal range. They also fail to say that many babies do something once or twice, then don't do it again for months and months-- for some reason the conditions were right on the first occasions, even though the baby wasn't really ready to do the action in any but ideal circumstances. The fact is that the age ranges and patterns of development for actions have not been very well researched on the whole-- I wish we could put some Ph.D. students to work on filling in this gap in knowledge.

      I also want to say that I wish we didn't use the word "milestone". It is not really a very good metaphor for describing development, and it has such a final sound to it. We need something else to describe how babies progress from not being able to do something, to doing it sometimes and under ideal conditions, to finally completely mastering a skill.

      BTW, I think you are right that some babies watch and consider for a long time before they try something, while others don't mind trying unsuccessfully for quite a while. I can't back up this statement with research, but I do share your impression.

      I also think your point about how your treatment helped encourage your daughter's development is an excellent one. We think about treating depression and anxiety as something that's done for an individual, but it can help the whole family, babies and young children above all.

      Best regards, and best wishes for continuing happy life with your daughter!

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  33. That you so much for your response Dr. Mercer! I couldn't agree with you more regarding the use of the term "milestone." I do think that a change in the vernacular would have a positive effect on the way we view a babies development. My daughter, Naomi, seems to prefer doing something once or twice and then waiting a while (weeks even) before she'll try it again. I've learned that's just her way.

    I wish sources would do what you said and highlight the early and later times that you might see a new skill emerge. For instance, her latest skill is making the razzing sound, however, she first started that at week 16, she did it constantly for a week, and doesn't do it but once every several days now. Unlike before, I'm not longer concerned because I'll know she'll pick it back up when she wants to/is ready to. She seems to want to be successful at something before she either tries it or continues doing it. I really love her little inquisitive nature.

    On a personal note, I just recently finished my Masters in Counseling (so I really knew the value of getting help when I needed it), and I've really been enjoying reading your blog as a whole not just the posts about babies and their development. Continue the great work; you're a great resource!

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    1. Thanks again-- when I get a chance I would really like to post your comments on a new page so they're easily seen--I think what you have to say would be heartening for many new mothers.

      I don't really know whether people
      read these comments, that's the trouble.

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    1. I did, but what a struggle-- this blog thing does not like to deal with material that's not in its usual format! It just kept on cutting off half your words. Okay now, I think.

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  35. Hi Dr. Iv been following your blog for some time esp they eye contact bit and finally decided to post my query. My 1 yr old sometimes has very good eye contact and sometimes fleeting. Usually doesnt make good eye contact with the person holding him but looks at others well. From a distance eye contact seems good but not from close. He also looks elsewhere usually when being breastfed. Also he has a fair bit of separation and stranger anxiety. He takes time to warm up to strangers. He doesnt cry but just stays reserved.as a baby he was happy and smily now hes become reserved. Also he enjoys looking and even babbling with other kids but plays independently but i think thats normal in this age?
    He is quite independent and loves doing things himself. Otherwise hes ok. Points, babbles, says a few words. Im just worried about his eye contact and a bit about his independent behaviour. Googling only brings up autism. Waiting anxiously for your reply

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  36. Sorry i forgot to add that he loves opening and closing doors and turning lights on and off. Does that come under repititive behaviour? Also he ignores us when hes busy in mischief and doesnt respond to name. He understands no but doesnt obey. Is it normal for his age?

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    1. This all sounds okay to me, for his age.

      I expect that you also, like other normal adults, do not make intense eye contact at every opportunity! Most eye contact is pretty fleeting, and in any case it's not magic, but a way human beings have of "pointing" to things and understanding where someone else is looking, what they know, etc. think of the gaze as a tool for communication, not for "making soul contact", and I think you'll feel better.

      Separation and stranger anxiety are a good indication that you've enabled him to become emotionally attached to you. They are normal and actually desirable at this age. I have always joked that I would like to create a greeting card that says "Congratulations, your baby was afraid of a stranger today!" Pointing, babbling, and saying some words are all tight on the mark for his developmental age, too.

      As for repetitive behaviors, typically-developing babies do this a lot more than seems good to adults-- it's the way they learn at their age. ignoring you when "busy" and disobeying "no" are also par for the course, and it takes a while for parents to develop their skills at managing a newly independent child. But you will learn, and so will he.

      Playing near but not with other kids, parallel play, something you will be seeing for at least another year.

      So why do you see some of these things listed as signs of autism? Because they are signs-- IN OLDER CHILDREN. Autism manifests as a set of developmental delays in which children continue to show the behavior of earlier ages, or return to their earlier behavior. What is normal for the one-year-old is not normal for the two- or three-year-old, just as the milk-focused diet of a 6-month-old would not be normal or healthy for a two-year-old.

      Good luck with your very typical little boy! Unless you see him still doing the same things a year from now, you can relax a bit (oops, until he pulls the tablecloth off the table).

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  37. Thankyou soo much for your prompt reply. God bless you

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