New Parent Guide – Infancy Stage 1 (0-4 months)
Written By Guest Blogger: Jessica Zwilling COVT
“To understand vision we must know the child; to understand the child we must know the nature of his vision.” ~ Arnold Gesell, MD.
Everyone says at some point in their career that it seems that their patient’s keep getting younger. In reality, we are just getting older. In my case, however, my patients really are getting younger. I am still getting older, unfortunately, but lately I have been working with a lot less grade schoolers and a lot more babies and toddlers. My last blog installment was a call for awareness – for better education of parents and other professionals in the realm of vision development. I have started to compile information from highly regarded sources for my own benefit and that of my patients.
The following information is not new. It is old wisdom from a time when psychologists and optometrists worked together; a time when some professionals took the time to really study the whole child, to discover the sources of a problem, and to design preventive care plans. It is my hope that this installment will impart new knowledge to those outside of optometry, and also serve as a refresher to those within our optometric community who don’t work with babies and toddlers on a regular basis.
When a newborn opens his eyes for the first time, they function at more of a reflex level along with touch, sound, and mouthing. The immature nervous system is trying to organize itself, and self-directed eye movements are rare until about 4 weeks. From birth through the first month, baby can see clearly only to 8-15 inches away. His peripheral vision is intact at birth, but central vision takes time to develop. The eyes will wander and occasionally cross and will be sensitive to bright light. Newborns have no color vision and no depth perception as they can only fixate with one eye at a time. You will notice that baby can sustain looking at an object for only brief periods of time. He can track a close, moving object (slowly at first) from his periphery to his midline, although not smoothly. It is normal to observe that the eyes and head move together.
By the end of the second month, baby will begin to fixate with both eyes some of the time, but still lack depth perception as well as color vision. He is able to track a moving object slightly past his midline horizontally and gains the ability to track an object vertically.
At 3 months, baby has better binocular (two eyes) fixation and color vision begins to emerge. He can track an object for a full 180 degrees, although it is normal to see the eyes and head still move together. He starts to watch his own hands as well as a parent’s whole face instead of just one part.
By the time baby is 4 months old, his visual world starts to become quite exciting. He can hold his gaze on an object for longer amounts of time, and depth perception finally emerges. Baby is now able to scan between three or more objects, and the eyes begin to move independently from the head. Baby becomes proud of his ability to look, reach, and grasp although his aim and accuracy won’t be great yet. By the end of the fourth month, the appearance of wandering or crossed eyes should be gone.
When should a program of developmental visual care begin? Certainly, if a visual problem is suspected (baby not reaching visual milestones, poor eye contact, eyes not aligned), or if there are developmental delays (physical or neurological), a trip to a behavioral optometrist should take place without delay. However, if there are no signs of a problem, parent’s can foster proper vision development at home within this first stage of infancy.
“Activities and play, even during infancy, are the means for helping all children to more fully develop their own visual space world. The child with a good solid foundation in space has a better chance for success in school and is less likely to develop a visual problem as a reaction to classroom demands.” (Apell & Lowry, Preschool Vision, 1959)
Parents, during this first stage of infancy, are rarely thinking about school, as sleep deprivation and dirty diapers take over their lives. However, in this fast paced, competitive world in which we live, it is never too early to consider how to help ensure baby’s future academic success. I am not promoting Baby Einstein videos or some “teach your baby to read” nonsense. The following is a general home guide loaded with ways you can play with your baby while at the same time foster good vision development.
As mentioned in my last installment, Dr. Martin Birnbaum wrote “Home Guide To Child Development For The First Year Of Life” as an educational handout for his patients. His guide was compiled and adapted from Mommy and Daddy – You Can Help Me Learn to See by G.N. Getman, OD and J.W. Streff, OD, 1959. Here are some of the key points from this guide with additional input from yours truly in an attempt to make sure everything is up to current safety standards.
- From birth, the infant is attracted to areas of light. Keep a night-light on in the baby’s room so he will have something to look at whenever he awakens at night.
- Move his crib to various positions at regular intervals to allow him to respond to light from varying directions. This may not always be possible in a room with limited space. Instead, you can change the baby’s position in his crib at regular intervals so that light will stimulate each eye and each side.
- Use clear bumper guards so that the baby’s vision is not obstructed. Interestingly, the American Academy of Pediatrics has recently changed their viewpoint regarding bumpers. They used to be ok until 4-6 months when baby becomes mobile, thus, posing a threat for strangulation, suffocation, or entrapment. However, the new guideline from AAP states that crib bumpers should never be used, even the breathable mesh kind. This new safety recommendation works in favor of better vision development as well, so it is a double win.
- When the baby is awake, talk to him from different places in the room. This gives him a familiar moving target to watch and follow, thereby teaching him to associate distances and directions both in sight and in hearing.
- Approach and play with the baby from alternate sides and from different positions. This gives the baby basic and important seeing experiences from different positions.
- Hang a mobile about six to eight feet from the crib, at the level of the crib rails, so that it will be in line with the child’s gaze as he looks through them. If this kind of set-up is not possible, hanging a mobile directly above the crib is also beneficial. Choose a mobile with high contrast primary colors or black and white patterns like the one pictured here by Lamaze. The slow movements of these brightly colored objects assist him to learn what movements are and how to keep his eyes directed toward these objects.
- During the day, place the child in different rooms so that he may observe new sights and be stimulated by different objects, patterns and placement of light.
- Change and feed the baby from alternate sides. If you are nursing your baby, this feature will be built in. If you are bottle feeding, you will have to make an effort to switch sides, so as not to develop a dominance in one eye.
- Massage time after a bath stimulates the new nerve buds of touch and awakens baby’s first senses.
- Allow for plenty of unconfined diaper-only time so baby may have the freedom to squirm, rock, and wiggle. While swaddling is comforting to some infants, it is not healthy for visual and motor development to have their limbs constantly bound. (I’ll save my opinions on that for a separate blog.)
- Incorporate lots of tummy time, especially if your infant sleeps on his back. Tummy time allows baby to develop the crawling patterns which are so important to the development of good eye teaming (binocular vision) skills.
The earliest form of eye-hand coordination starts when baby begins to be aware of the movement of her own hands. This sets the stage for the exploring of objects within her reach.
- Help the baby move her hands before her face so she can see these movements.
- Play “peek” by holding the baby’s hands before her eyes so she can start to learn the difference between having her eyes closed and having her view blocked.
- Place a lightweight rattle first in one hand, then the other, and help her shake it. She will not hold it very long, but it will give her a chance to feel, see, and hear it.
- Rattle socks and bracelets are a great way to stimulate baby’s eye-hand coordination.
Often, new parents wonder what kinds of toys they should get for their baby. Babies R Us is a very scary place to enter for soon-to-be and newbie parents. It’s downright overwhelming, and in my honest opinion, most of the baby gear in there is not necessary! Here are some ideas for age appropriate games and toys for baby.
During this stage, because of baby’s reduced sight, high contrast black and white patterns are the most interesting for a baby to look at. Checks, stripes, polka dots, and bulls eye targets provide high visual interest and can be used to stimulate baby’s vision. There are many toys and books available with these visually stimulating patterns. Lamaze and Sassy, to name a few, are baby toy companies which carry books, rattles, mobiles, etc. with high contrast detailing. There are even iPad apps available that play high contrast picture slide shows set to music, and some that are interactive to touch or shaking. I cannot, with a good conscience, promote sitting an infant in front of an iPad (or the TV, for that matter). Again, I’ll save my opinions on that for a separate blog. However, many parents will use an iPad or similar electronic device to entertain baby, so it may as well be something age appropriate and visually stimulating. There are many, but here are a few good apps to consider:
- Infant Zoo – Visual Stimulation for Babies
- Smart Tot Apps – Rattle
- Tap N See Zoo
- Fisher-Price Baby – B&W High Contrast
If you do choose to introduce your infant to screen time, please, make the duration short and the screen time interactive. Move the iPad into different points of baby’s gaze (up, down, left, right, and all diagonals), and talk to your baby about what she is seeing.
Faces are also particularly interesting during this stage, so be sure to put in a lot of face time with your baby. Don’t be afraid to ham it up with exaggerated expressions and tones of voice. Not only do babies love a good live show, but it also helps develop their visual-auditory connection. A good way to stimulate baby’s visual and vestibular systems while incorporating quality face time starts with laying baby in your lap, face up with her head at your knees. Place one hand under baby’s head and neck and the other hand under her bottom. Lock in eye contact with baby and slowly tilt her to the left up to about 45 degrees, all the while maintaining eye contact (using sound effects if necessary) and keeping baby’s head, neck, and body lined up. Slowly tilt baby back to center and then to the right. This will teach baby how to organize her visual and vestibular systems together, and how to maintain visual fixation without motor support from her head or body.
Placing a large, unbreakable mirror that fastens safely to the crib slats is another fantastic way to boost baby’s vision development. Baby won’t be too interested in it the first few weeks, but certainly by 8+ weeks, she will find a mirror quite entertaining. Mirrors provide babies with the opportunity to practice eye focusing and tracking and to observe and learn from her own movements. In addition, it promotes social and emotional development as she studies her own facial features.
In 2006, Dr. Claude Valenti wrote a wonderful article, Infant Vision Guidance: Fundamental Vision Development in Infancy, which can be found here: http://c.ymcdn.com/sites/www.covd.org/resource/resmgr/ovd37-3/147-155valentiessay.pdf
This essay is full of important information that new parents need to know. He also includes vision activities that parents can do with their baby along with detailed instructions and photos.
Caring for a newborn is exhausting work. Some days will be a blur of feedings and dirty diapers and playing vision games with your baby will be the last thing on your to-do list. Persevere! and try to incorporate some these games and tips into your daily routine and your baby’s vision development will be off to a great start.
Apell, R.J. and Lowry Jr., R.W., Preschool Vision. St. Louis: AOA, 1959.
Birnbaum, M., A Home Guide To Child Development For The First Year Of Life.
Gesell, A., The First Five Years of Life. New York: Harper, 1940.
Gesell, A., How a Baby Grows: A Story in Pictures. New York: Harper, 1945.
Gesell, A., Infant Development: The Embryology of Early Human Behavior. New York: Harper, 1952.
Gesell, Ilg, and Bullis, Vision: Its Development in Infant and Child. New York: Hoeber, 1949.
Getman, G.N. and Streff, J.W., Mommy and Daddy,You Can Help Me Learn to See. St. Louis: AOA, 1959.
Shelov, Steven P., Your Baby’s First Year. New York: Bantam Books, 2010.
Posted on August 14, 2014, in From My Perspective... and tagged Articles by Gesell, Babies, Claude Valenti, New Parent Guide, Vision Development, Written by Jessica Zwilling. Bookmark the permalink. 9 Comments.