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| Dr. L and her newborn daughter. photo credit to Melissa DeLorme Photography |
Try to picture what the world is like for a newborn entering the world. Suddenly they go from the warm, cozy, darkness of mother's womb to a loud, cold world of bright lights and blurry shapes. And yet, research suggests that newborns are not paralyzed by sensory overload, but their visual skills that have been developing throughout their time in the womb immediately are ready to kick into gear! Full term and even some premature infants can fixate their eyes on a near object immediately in the delivery room. This early visual alertness is used by doctors and nurses in the delivery room to assess the robustness and function of the central nervous system.
We can separate visual development in infancy into 5 main stages:
1. Awakening to the World
Visual alertness occurs in the first hours/days/weeks of your newborn's life. What your baby can see, and what you as parents can do to support visual development in this stage is the subject of this article!
2. Learning to Look
In the first 1-2 months the eyes are learning to move and work together by following and tracking objects.
3. Eyes/Brain/Hands
Around 4 months old, your baby is integrating vision into motor control. Hand-eye coordination and balance are all being developed at this stage.
4. Adjusting Focus
At 6 months old it's time for the baby's first trip to the optometrist! At this visit, the doctor will use retinoscopy to assess how your child is focusing on objects near and far, check for any differences between the two eyes, and determine if a prescription is needed to prevent against lazy eye (amblyopia) or strabismus (eye turn).
5. See to Move
At ages 8 months to 1 year old, babies are actively moving and navigating their world using visual cues like depth perception.
How can doctors tell what babies truly see?
Since you can't ask an infant what they can see, and you can't get them reading letters off a chart, the way doctors assess vision in infants is a bit more complicated. There are several different methods that scientists and doctors use to determine what a baby is capable of seeing:
1. Fix and Follow: Does a baby make eye contact with an object or light, and will they follow that object with their eyes? Studies show infants even a few minutes old can fixate and follow a stimulus with their eyes.
2. Resistance to Occlusion: If a doctor tries to obstruct vision by blocking the eyes, will the baby move or bat the blocking object away to try to be able to see again? Studies have shown that more interesting visual stimuli will elicit a stronger resistance to occlusion.
The above methods are very basic and only establish the the infant has vision. Neither can determine the degree of vision or how clearly the baby can see. To assess the brain's visual perception in greater detail, researchers use:
3. Forced Preferential Looking Technique. This technique was established by psychologist Robert Fantz in the 1960s. In this method, an infant is given two visual choices, one with a pattern or interesting stimulus like a face, and the other with a blank field. If the infant spends a longer time looking at the patterned stimulus, it is assumed that the infant is able to visually perceive the pattern versus the blank field.
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| Optometrists can use Lea Acuity Grating Paddles during infant eye exams to assess vision using Forced Preferential Looking techniques. via |
4. Visual Evoked Potential (VEP). This method actually measures how the brain reacts to visual input using a series of electrodes placed on the baby's head. If the infant has an intact visual pathway (eye to brain), when they are shown a patterned stimulus that is large enough to be seen a VEP response will be generated.
Stage 1: Awakening to the World
What Newborns Can See
What Newborns Can See
A newborn's visual system is wired to process and recognize human faces right from birth. In fact, research suggests that the brain's visual system is attuned to recognizing the T-shaped pattern of faces (2 eyes on top, and a mouth underneath) while the baby is still in the womb! Infant vision is clearest at a range of 8-12 inches from their face, the perfect distance to look at their parent's faces and to memorize what mom and dad look like. Long distance vision is much blurrier than in adults at this age, somewhere in the range of 20/200-20/400.
Recognizing mother's face is actually one of the first things that infant vision excels at. Multiple studies have shown that newborns will spend a longer time looking and "studying" their mother's face than that of a stranger. In addition to the T-shaped facial pattern that is specific to mom (distance between mom's eyes and from her eyes to her mouth), the high contrast outline of her face and hair also plays into recognition. If mom is wearing a shower cap for example, the newborn's preference for mother's face versus a stranger's face goes away.
Earlier research had indicated that newborns may be able to mimic their parents making facial gestures like sticking out their tongue, but those studies have been called into question. Newer science suggests that babies won't truly be able to mimic facial gestures until they are a few months in age. Why the confusion? Parents will actually mimic their baby's facial expressions once every two minutes on average, so who was copying who in those early studies?
In addition to facial recognition, infants as young as 2 days old are already understanding and processing the natural world around them. Multiple studies have shown that newborns prefer "biological motion" over random motion patterns. When a point motion light display of a walking hen (biological motion) is shown versus a random light motion patterns, newborns preferentially looked at the moving hen. If the motion of the moving hen was turned upside down (which would be unnatural movement in the order of the world), the preference disappeared. Interestingly, this phenomenon of preferring to view and track movements that would occur in the natural world is seen in more than just humans; baby chicks, cats, dolphins, and monkeys have all shown this preference in other studies.
In addition to facial recognition, infants as young as 2 days old are already understanding and processing the natural world around them. Multiple studies have shown that newborns prefer "biological motion" over random motion patterns. When a point motion light display of a walking hen (biological motion) is shown versus a random light motion patterns, newborns preferentially looked at the moving hen. If the motion of the moving hen was turned upside down (which would be unnatural movement in the order of the world), the preference disappeared. Interestingly, this phenomenon of preferring to view and track movements that would occur in the natural world is seen in more than just humans; baby chicks, cats, dolphins, and monkeys have all shown this preference in other studies.
Promoting Visual Development in the Newborn
In the first few weeks of life, visual development is focused on the baby making connections with you as the parent and observing and processing the world around them from the security of their parent's love and protection. This is the groundwork for developing higher order skills like hand-eye coordination and depth perception which will start developing in the coming months. The best way to get vision off to the right start for your newborn is:
-Change sides when you nurse between each feeding so that both of baby's eyes are given a chance to develop equally. When a baby is nursing, one eye's vision is often obscured against your chest. If vision is routinely blocked in one eye versus another, it is possible that this eye could become amblyopic (or a lazy eye) with time.
-Make eye contact and interact with your baby. As a newborn, infants spend the overwhelming majority of their time in one of two states: sleeping or eating. It's essential during that eating and awake time that they are receiving visual stimulation from mom and dad. When nursing, put down the phone and make eye contact with your little one. Stimulate baby by making faces and talking to them, even if its just babbling noises. Watching your mouth movements and integrating vision with sound will start them on the path towards language skills down the road.
-Don't leave your baby "contained" in swings or cribs for extended periods while they are awake. Research shows that for vision to develop properly at this early stage, babies need a wide range of visual stimulation from different angles, views, and positions. Research with newborn kittens that were raised in a room with only vertical stripes for just 30 hours showed significant visual impairment and reduced motor skills.
-Wearing your baby is a great way to let their visual system experience different positions and movement, and reduces the amount of time that baby spends flat on their back, which can lead to positional plagiocephaly (flat head syndrome). When positioning your baby in a wrap, make sure they are sitting high enough that they can comfortably view your face with both eyes and that you can make great eye contact with baby by comfortably looking down. This video is a great tutorial that works for any brand of wrap!
-Don't leave your baby "contained" in swings or cribs for extended periods while they are awake. Research shows that for vision to develop properly at this early stage, babies need a wide range of visual stimulation from different angles, views, and positions. Research with newborn kittens that were raised in a room with only vertical stripes for just 30 hours showed significant visual impairment and reduced motor skills.
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| The American Medical Association recommends that babies sleep only on their backs to reduce the risk of SIDS, so when baby is awake it is very important that they spend time in different positions - side lying, tummy time, held, or worn. photo credit Melissa Delorme Photography |
-Wearing your baby is a great way to let their visual system experience different positions and movement, and reduces the amount of time that baby spends flat on their back, which can lead to positional plagiocephaly (flat head syndrome). When positioning your baby in a wrap, make sure they are sitting high enough that they can comfortably view your face with both eyes and that you can make great eye contact with baby by comfortably looking down. This video is a great tutorial that works for any brand of wrap!
-How do you play with a newborn? High contrast toys or books will be best to keep baby's attention at this stage! Look for black and white patterned toys or board books, but no toy will be more interesting than looking at mom and dad. Despite conflicting reports online, babies are not born colorblind but they do not have mature, adult color vision. In a 1987 preferential looking study, newborns were shown red, yellow, green, blue and gray squares. Newborn infants preferred looking at any of the color squares over the gray (achromatic) square, but had no preference between colors. By 3 months of age however, infants preferred red and yellow (long wavelength) colors over blue and green (short wavelength).
-Start tummy time activities right away, even if your baby can only tolerate it for a minute or two. A great way for newborns to do tummy time is to place baby on your chest and make eye contact and talk to baby from this position. Studies show that tummy time is a core fundamental to developing visual motor skills. Infants that don't spend as much time on their stomachs are more likely to skip crawling, and can even have trouble later in elementary school with handwriting and fine motor control. Creating a strong foundation for vision development from those very first days is essential to subsequent childhood developmental milestones.
For tummy time ideas and tips, check out occupational therapist Rachel Coley of Can Do Kiddo:
-Parents of newborns will be taking lots of pictures of their new little one, but did you know that you could use this photography to help your doctor find ocular health issues? Alert your doctor if you notice a white reflex from your child's pupil. Infant pupils are often large enough for a strong red reflex to occur with photography. Seeing that red reflex is great! What you shouldn't see is a white reflection coming from your inside your child's eye. A white reflex could indicate a serious visual issue that could result in blindness or even death, like congenital cataracts, a retinal tumor, or an optic nerve anomaly. Let your doctor know right away if you have any concerns about your child's appearance of behavior so they can investigate things further.
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| Usborne Baby's Very First Black and White Books are designed with high contrast images to draw baby's attention. via |
-Start tummy time activities right away, even if your baby can only tolerate it for a minute or two. A great way for newborns to do tummy time is to place baby on your chest and make eye contact and talk to baby from this position. Studies show that tummy time is a core fundamental to developing visual motor skills. Infants that don't spend as much time on their stomachs are more likely to skip crawling, and can even have trouble later in elementary school with handwriting and fine motor control. Creating a strong foundation for vision development from those very first days is essential to subsequent childhood developmental milestones.
For tummy time ideas and tips, check out occupational therapist Rachel Coley of Can Do Kiddo:
-Parents of newborns will be taking lots of pictures of their new little one, but did you know that you could use this photography to help your doctor find ocular health issues? Alert your doctor if you notice a white reflex from your child's pupil. Infant pupils are often large enough for a strong red reflex to occur with photography. Seeing that red reflex is great! What you shouldn't see is a white reflection coming from your inside your child's eye. A white reflex could indicate a serious visual issue that could result in blindness or even death, like congenital cataracts, a retinal tumor, or an optic nerve anomaly. Let your doctor know right away if you have any concerns about your child's appearance of behavior so they can investigate things further.
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