Hi Dr. Heather,
I came across your website when doing a search for signs of autism in infants. Our 3-month-old doesn't look at us very much, doesn't track objects across the midline well, and doesn't often respond to our voice. He stares at the wall or just beyond us pretty much anytime we hold him in our lap looking up at us. He is very calm and mellow, and only cries when he is tired or hungry. He would sit in his bouncer or swing all day if we let him. We also have a 3-year-old very active boy with sensory processing problems so I know our baby doesn't get as much attention as i would like to give him. We know he is way too young for any of these signs to be a definitive answer, but I am having a hard time finding information on what we can do preventatively as we observe him over time. There is a program in our city, but other than that, everything I find is geared towards 18 months to 2 years, since that is the time that it is easier to see more clear signs. Can you help?
I'm so glad you are aware of this crucial aspect of your baby's cognitive development. I think most parents would be happy to have a "mellow and easy" baby who would happily sit in his bouncer all day. But you recognize that he might not be reaching out to you for the important "give and take" and communication that he needs to trigger important aspects of his development. He needs to engage with you and play "Baby Games" in order to solidify his relationship with you, which forms the foundation of his cognitive growth. What to do?
I understand that you want to be as proactive as possible, given your experience with your older son. And while there is a possibility that your baby may suffer some similar developmental issues, it's also quite possible that everything you describe is well within the norm for typical development. First of all, try not to over-worry, but maintain the watchful engagement that led you to research your concerns. Your baby can pick up your fears and anxieties, and this can push him to be even more distant. There is some interesting psychological discussion and observation going on about this very basic "give and take" in the parent/infant interaction, and in the ability of a baby to pick up on his parents' feelings. When a very anxious parent reaches out to a baby in a way that seems desperate or demanding, the infant can sometimes seem to feel pressured, and retreat even more. So, as with many aspects of parenting, containing and managing your own feelings is Job One.
That said, there are many things that ALL parents can -- and should -- be doing to maximize this incredibly important time in a baby's development:
Carefully watch your baby's sleep/wake/activity schedule for clues as to when he is most likely to be responsive to parent interaction. Sometimes he'll be fussy, or seem overstimulated by your efforts. Other times he may be more receptive. Often, these receptive times are shortly after waking from a nap and having a feed. But you are your baby's best expert; try to figure out when he's most approachable.
Then, make a conscious effort to play "Baby Games" during these times of approachability. Try to match his energy level and catch his gaze. Follow his lead; if he coos and looks away, try to respond in kind. You want to reinforce any efforts on his part, even brief eye contact that might be just 1 or 2 seconds long. Each baby is different; perhaps your baby is more auditory and responds well to your cooing back, other babies might be better reinforced by a brief touch to the face or hand, or from a big returned smile. Experiment, and see which response generates another round of interaction from your baby.
Don't give up if your baby continues to avert his gaze. Take a deep breath if you start to worry, and try to be as available as you can for "Baby Games". Give him time and keep trying.
Jennifer, I have a 3-month old too. Although she does engage in periodic eye contact, coos and smiles, she is much more reserved than her siblings were at this stage. At first I also worried about her relative lack of eye contact and her willingness to hang out in her crib for long periods of time. I can't help but think that the noise and chaos of our busy household causes her to be a bit more protective in her interactions; there's a lot for a little baby to absorb in this household! But her Daddy and I have been engaged in the exactly these exercises with our little one, and I can see the difference in just a couple of weeks of consciously trying to engage with her.
Dr. T. Berry Brazelton has some excellent suggestions for engaging a baby who might have sensory issues or sensitivities. Use your parents' detective skills to determine WHICH senses your baby tolerates -- and DOESN'T tolerate -- very easily. Use this information to "fine tune" your interactions with him. For instance, our baby seems to respond longer to us, and with more smiles, when I'm quiet. Responding both with my facial expressions AND my voice seems to be too much for her, and she turns away. But if I keep focused on giving her a big returned smile, maintain eye contact, and maybe even stroke her hand or her cheek, she's much more likely to stay engaged in our "Baby Game" than if I coo or talk back to her. Eventually, she'll develop the ability to tolerate my voice as well. But until then, I'll hold back a bit. Experiment with using different modes of communication with your baby and maximize what works.
I also double-checked on the expected timeframe of infant response to parents' voices, and most authorities agree that this isn't regularly observed in most infants until 4 months. Our baby is 14 weeks, and only in the past few days has she started responding to our voices on a somewhat-regular basis.
Now, I'm not able to evaluate your little one, but there are many things you can do to maximize this important aspect to your son's development. Over time, you can judge his progress and if you're not satisfied, have him evaluated by the program you mentioned in your city. If they're not yet able to enroll him due to his young age, perhaps their specialists can take a quick look at your son and make some further suggestions to you. I'm a firm believer in erring on the side of having a child evaluated early, not only for reassurance of an expert opinion, but for the often very helpful recommendations that the specialists can give you, even if there's nothing really atypical with your child.
And I can't stress this enough: At 3 months of age, you should be aiming for interactions measured in SECONDS, not minutes. Feel good if you generate a few "rounds" of interaction between you and your baby at this age. Over time, you'll both want to stretch these interactions to last longer and become more complex. But at 3 months of age, your baby is still very young and new to the world of interaction. A 3-month-old is only recently "hatched" -- our psychological term for the opening of awareness that marks the end of the "squirrelly newborn" phase. So manage your expectations accordingly.
Jennifer, thanks for the opportunity to write about this extremely important topic. I hope you'll write back to update us on your progress!
Mom of Four, Parenting Expert