The Five Senses in the Newborn

Seeing

Sight
One of the first questions a new mother asks is "Can my baby see?" When parents first lift the baby to face them, the eyes of an unmedicated baby will open and search the parent's face. Few responses on a baby's part have a more powerful impact on parents.

Picking up or rocking a baby will both soothe and alert a newborn (Korner & Thoman, 1972)¹ and set off a reflex response of eye opening and attention to a visual stimulus. A semi-upright (30° angle) position appears to produce the most prolonged alertness in newborns (Madansky, 1983).² Parents can see that when they rock or bring a baby up to their shoulders, the baby quiets and becomes more alert. When held out in front of them and rocked gently in a semi-upright position, the baby's eyes will come open, "ready" for interaction. Both the newborn and the new parent seem to become intensely involved, as if saying, "Finally, there you are!"

A newborn's ability to see and hear in the delivery room may be as important to the "bonding" process as the act of putting the baby to breast to suckle. The silver nitrate treatment, once routine, causes immediate swelling of the eyelids and is now postponed in many hospitals. Some hospitals use a less irritating antibiotic ointment. In a controlled experiment, postponing this treatment for thirty minutes after delivery allowed new parents to interact visually with their babies in the delivery room (Butterfield et al., 1982).³ Thirty days later, parents were significantly more sensitive to their babies' visual and auditory cues than were a matched group of parents who had not had opportunity for visual interaction right after delivery. All new parents have a hunger for visual interaction with their newborn after delivery.

Face-to-face interaction in the newborn period may be as critical as any other kind, such as breast-feeding, holding, or cuddling. Right in the delivery room, mothers want to hold their babies in an en face (face-to-face) position (Klaus & Kennell, 1982).⁴ Mothers attempt to elicit eye-to-eye contact with premature infants even while they are in their isolettes, in order to reassure themselves that the baby is all there, and in order to feel that he or she belongs to them despite the separation and the baby's difficulties. Visual ability in the newborn has powerful adaptive significance, attaching the mother to her baby.

A baby seems to be programmed for learning about human faces from birth. The visual stimuli that appeal to newborns the most seem to be the shiny eyes or the mouth, as well as the edges of the face (Salapatek & Kessen, 1966).⁵ This allows for very early learning about his or her caretakers and the human world surrounding the baby. Robert Fantz (1961)⁶ first pointed out the newborn's preference for certain kinds of complex visual stimuli. By pairing two pictures, he judged preference by how often the baby looked at one versus the other. This way he found many preferences in the newborn. For instance, he found that sharply contrasting colors, larger squares, and medium brightly lit objects were more appealing. These brought the newborn to a prolonged alert state of fixation. He and others found that the neonate preferred an ovoid object the size of a human face and one in which there were eyes and a mouth. The baby fixed on the picture's shiny eyes, the red mouth, and the edges of the face. A three-dimensional face was even more preferred.

Immediately after birth in the delivery room, babies will not only fix on a drawing that resembles a human face but will follow it for 180° arcs, with eyes and head turning to keep it in view (Goren et al., 1975)⁷. A scrambled face does not get the same kind of attention, nor do infants follow the distorted face with their eyes or head.

Preference for a responsive adult's face is shown by the newborn's increasing excitement as he or she follows it back and forth and even up and down in the delivery room. In fact, if one gets serious and presents a flat face after this, a brand-new baby will look worried and turn away. The responsiveness of an adult's face may be a critical factor in keeping the newborn's attention. Learning about important visual cues proceeds rapidly. A mother can tell that her baby has begun to recognize her face by the age of three weeks, and is responding differently to his or her father or another familiar adult by four to five weeks. Visual recognition quickly becomes a rewarding signal for both parents. The fact that a newborn learns about each of them so rapidly tells them that all the baby's faculties are intact and that they are important to the baby already.

For professional caregivers as well as parents, visual behavior in the newborn is one of the most reliable signs of an intact central nervous system (Sigman et al., 1973).⁸ The ability to become alert, to maintain an alert state, to fix on and attend to a visual display appears to be correlated with the infant's stage of maturity. It also signifies an optimal condition of the baby's central nervous system (Brazelton et al., 1966)⁹. Absence of visual responses, however, need not be thought of right away as necessarily signifying brain damage, since these are so dependent on whether the infant is in an appropriate state for visual interaction. Ordinary conditions can interfere with the newborn's capacity to come to an alert state-such as the usual exhaustion of the nervous system that follows delivery. Low oxygen or the usual stresses that occur in normal deliveries, such as premedication given the mother, can delay the baby's responsiveness. Other common conditions, such as hunger, fatigue, or being in an overlit delivery room or newborn nursery, can make a baby unresponsive. Mothers and fathers need to know this, so that they don't feel that the baby is damaged or impaired. Those who care for new parents can help them avoid disappointment by showing them how to rock their baby up and down and to each side in order to set off the reflexes that will alert the baby so that he or she can interact visually. This can be exciting for the doctor or nurse as well as the parents.

How far can a newborn baby see? This is difficult to determine. An early experiment measured infants' responses to a moving drum which circled over their heads as they lay in bed (German et al., 1957)¹⁰. Ninety-three of 100 infants responded preferentially to stripes at certain visual angles. The newborns were relatively nearsighted, and they preferred objects at 10-12 inches in front of them. By three months, a baby can see farther than 8 feet and an adult ability appears to be reached by six months of age (Dayton et al., 1964)¹¹. The newborn infant's inability to register a good image beyond y/z feet is due to smaller eye size and a greater relative depth of the eyeball. As the baby grows, the eyeball becomes rounder and more flexible. We have found that prematures see, too. Their sight is less reliable, and they are even more nearsighted, but they can also fix on and follow the lines on a moving drum.

Newborns are relatively myopic with only 20/150 vision, as determined by this same technique (Dayton et al., 1964)¹¹. It does not seem that newborns are able to accommodate well to a moving object. They have a fixed focal length of about 19 cm (10-12 inches) and cannot follow unless the object is moved very slowly. In order to capture a newborn's interest with an object, an examiner must present the object at 10-12 inches, move it up and down slowly until the baby alerts. Then the examiner can move it slowly to each side, waiting for the newborn to follow it.

Sight in a newborn is more than a passive ability. From the research just described, it is clear that newborns will actively try to prolong their attention to an attractive object. As a bright object is brought into a newborn's line of vision and is moved slowly up and down to attract his or her attention, the baby's pupils contract slightly. As the object is moved slowly from side to side, the baby's face begins to brighten, eyes widen, limbs become still, and the baby stares fixedly at the object, beginning slowly to track the ball from side to side. A newborn will actively maintain this stilled posture in order to attend to the ball. A newborn's eyes first track in small arcs, moving past the target, but as the baby becomes more invested, the eye movements become smoother and more efficient. The baby's eyes move, tracking the object. The baby's head begins to turn from one side to the other. A newborn is able to follow an object for as much as 12° to right and left and will even make eye and head movements to follow it 30° up or down. Meanwhile, interfering body movements and startles are actively suppressed. The baby can often maintain this intense visual involvement for several minutes before startling, becoming upset or dull, losing the alert state that is necessary to this kind of visual behavior. When watching a human face, the newborn's involvement is more prolonged. Normal newborns in the proper alert state can fix on and follow a face, moving their eyes and head in long, slow arcs and brightening as they do so.

The seemingly simple act of watching a face or a ball is not possible without coordination between an alert state, the motor capacity to turn the head, suppression of distracting motor reflexes, and the visual behavior itself. This coordination implies a complex and highly developed nervous system. It is difficult to believe that the cortex is not involved in maintaining the alert state and controlling the motor behavior. Newborns without this capacity to maintain alertness have less opportunity to learn about their environment.

The ability to watch and follow an object should be distinguished from a fixed stare that does not change and which does not change over time. This is not a good sign. It may mean that the baby cannot cut down on visual input. After several minutes of stimulation, a normal baby will begin to shut down and turn away. The baby who cannot do this is at the mercy of such stimulation. A healthy response to visual stimuli in a newborn is thus more than alert attention and might be described in four stages: (i) an initial alerting, (2) an increasing attention, (3) a gradually decreasing interest, and (4) a final turning away from a monotonous presentation.

An interesting experiment by Lauren Adamson (1977)¹² revealed how important sight is to the newborn baby. She covered an alert baby's eyes with first an opaque and then a clear plastic shield. He swiped frantically at the opaque shield and attempted vigorously to remove it. When it was removed, he instantly quieted. When a clear shield was substituted, he calmed down to look through it. Being able to see seemed to outweigh the disturbing aspects of something covering his face, thus implying a real investment in vision, even at birth. This dovetails nicely with the parents' eagerness for visual response from their babies, as described earlier.

¹Korner, A., and E. B. Thoman. "Relative efficacy of contact and vestibular-proprio-ceptive stimulation in soothing neonates." Child Development 43(i972):443.

²Madansky, D. Personal communication, 1983.

³Butterfield, P., R. Emde, M. Svejda, and M. Neiman. "Silver nitrate and the eyes of the newborn." In R. Emde and R. S. Harmon (eds.). The Development of Attachment and the Filiative Systems. New York: Plenum Publishing, 1982.

⁴Klaus, M., and J. Kennell. Maternal Infant Bonding. St. Louis: C. V. Mosby, 1982.

⁵Salapatek, P. H., and W. Kessen. "Visual scanning of triangles by the human newborn." J. of Experimental Child Psychology 3(1966):155.

⁶Fantz, R. "The origins of perception." Scientific American 204(1961):66-72.

⁷Goren, C., M. Sarty, and P. Wu. "Visual following and pattern discrimination of face-like stimuli by newborn infants." Pediatrics 56(1975):544-549.

⁸Sigman, M., C. B. Kopp, A. H. Parmelee, and W. Jeffrey. "Visual attention and neurological organization in neonates." Child Development 44(1973): 461.

⁹Brazelton, T. B., M. L. Scholl, and J. S. Robey. "Visual responses in the newborn." Pediatrics 37(1966): 284.

¹⁰German, J., D. Cogan, and S. Gellis. "An apparatus for grading the visual acuity of infants on the basis of opticokinehe nystagmus." Pediatrics 19(1957): 1088-1092.

¹¹Dayton, G. 0., M. H. Jones, P. Ain, R. A. Rawson, B. Steele, and M. Rose. "Developmental study of coordinated movements in the human infant." Archives of Ophthalmology 71(1964): 865.

¹²Adamson, L. "Defensive reactions to visual and tactile barriers during early infancy." Unpublished doctoral dissertation. University of California, Berkeley, 1977.

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