Dr. McGurk,

I recently saw a 2 month-old baby girl in my clinic. Although she would occassionally engage in her mother's face and smile, she had a tendency to look out into "space" more often than at faces. Would you expect a 2 month-old to be more engaging? Is this abnormal?

You are right to notice that this behavior is not the maximum engagement you would hope for at two months. By 8 weeks you really want to see a social smile that the baby is using to engage others as well as a specific response to a socially turned-on face you present to him.

In this case, you have to consider at least 3 possibilities. First, all infant behavior is "state" related, and this baby may be half asleep or post-prandial or for some unknown cause, busy internally. You could ask the mom, try to observe the shots, or check him in a little while. Second, the great fear would be that she does not see, and the occasional regard and smile are coincidental. Being sure you see a red reflex and trying to actually focus on the retina to see some normal tissue is a good idea. You can sometimes see the retina of a sleeping infant by holding open his lids while he continues to sleep. Of course a dilated exam by ophthalmologist would be next. Third, major CNS abnormality could be associated with this behavior, and it can be surprisingly hard to tell without social responsiveness.

The old literature, reflecting the bad old days of institutionalization of infants, refers to the "apathetic infant" (H. Stack Sullivan, etc.) who is severely neglected and understimulated, and very subdued, but you're not likely to see that now.

I have often been spurned by a baby who liked the overhead lights better than my face, and have often wondered if they're really looking at the lights or just turning their eyes up, but I really don't know why some are like that sometimes. Mostly they seem to be okay. Looking into space seems a little more ominous.

It's been so long since you submitted this question (sorry) that I'm wondering if you have an answer by now about the vision. If so, would you let me know?

Yours, Harriet McGurk