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Special Problems
of Blind Infants
Blind Baby Profile
DOROTHY BURLINGHAM

IN OUR ATTEMPTS TO APPLY THE DEVELOPMENTAL PROFILE (ANNA

Freud, 1965) to blind children, we found that special provisions
must be made for the fact of blindness. While many of the
developmental factors that the Baby Profile (W. E. Freud, 1967,
1971) assesses are the same, others are unique to the blind. In this
paper I shall concentrate on the latter. In singling out specific areas
for observation and evaluation, I have a double purpose in mind.
On the one hand, careful attention to these areas will help in the
completion of a Baby Profile for the Blind, which in turn might aid
us in deciding some of the unanswered questions concerning the
development of the blind. On the other hand, the detailed
understanding of the blind baby's specific needs can serve as a
practical guide to help mothers of such infants.
All mothers of blind and physically handicapped children need
guidance with the tremendous problems they face, but we can help

The material used in this paper stems from the author's work with the Study
Group for the Blind at the Hampstead Child-Therapy Course and Clinic, London:
Annemarie Curson, Alice Goldberger, Anne Hayman, Hansi Kennedy, Elizabeth
E. Model, and Doris Wills. The Hampstead Clinic is at present supported by the
Field Foundation, Inc., New York; the Foundation for Research in Psychoanalysis,
Beverly Hills, Calif.; the Freud Centenary Fund, London; the Anna Freud
Foundation, New York; the National Institute for Mental Health, Maryland; the
Grant Foundation, New York; the New-Land Foundation, Inc., New York; and a
number of private supporters.

3
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4 Dorothy Burlingham

them only if we ourselves understand the special requirements of

blind babies.

FAMILY BACKGROUND

In all our contacts with infants we attempt to learn a great deal

about the background of the parents, their personal characteristics,
their relationship to each other, and their past experiences. With
parents of a blind infant it is especially important to determine
whether similar abnormalities have occurred on either side of the
family. If they have, we should attempt to find out whether the
parents have been warned beforehand by either pediatrician or
obstetrician that blindness may be transmitted to their child. We
have two significant examples where mothers blind from an early
age and married to blind husbands ignored all warnings and did
not see why they should not claim the right to produce children.
This contrasts very sharply with the almost ubiquitous tendency of
mothers to blame themselves unreasonably for the child's handicap.
For this reason, when we examine the personal history of a
sighted mother, we must pay special attention to the period of her
pregnancy because it is of the utmost importance to find out
whether she undertook any action which might have played a part
in her producing a blind child, whether this was at the time of
conception or in the intervening period before she gave birth.
Regardless of whether rational or irrational, her belief that some
action or behavior on her part is responsible for her baby's blindness
will have a profound effect on the mother's sense of guilt and
attitude to the infant.
In looking at the period after birth, we need to focus on six
aspects that are especially significant for a mother's relationship to
a blind infant:
1. The length of time during which the mother regards the baby
as normal
2. The actual moment at which either mother or pediatrician
recognizes the visual defect
3. The actual manner in which mother, or father, or both are
informed of the finding
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Special Problems ofBlind Infants 5

4. The mother's or parents' (as well as grandparents') manifest

and latent reactions to the information and subsequent changes in
their attitudes to the baby
5. The length of time during which the mother was estranged
from the baby (if she so was) and the duration of her concentration
on the handicap
6. The extent of the parents' eventual return to the baby as a
person and the manner of recognizing his specific needs.

BODY NEEDS AND FUNCTIONS

SLEEP

It is obvious that blind babies will take longer than normal ones to
establish a sleeping pattern with distinction between day and night.
Such a delay in the sleeping pattern might even prove significant
for the early diagnosis of defective vision.
It is well known that even sighted children may develop the habit
of waking in the night, wishing to play, much to the distress of their
parents. It is only logical that this happens much more frequently
with the blind for whom there is no alternation between light and
darkness.
It is worth investigating whether, in contrast to this, it is easier for
blind children to fall asleep when they are put to bed because one of
the distractions, namely, visual stimulation, is absent from the
situation.
On the other hand, the baby's favorite sleeping positions, the
specific sleeping arrangements (location, clothes), and the parental
attitudes to sleep, though they should be noted, may be expected to
be similar to those found in sighted children. Parents of blind
infants also want them to sleep at specific times.

FEEDING

In the interaction between mother and blind child during feeding

the absence of visual contact is of overriding significance. The
observer should note how far the mother replaces this with skin
contact or vocal contact, the extent to which the baby listens to the
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6 Dorothy Burlingham

mother's ministrations and seeks communication with her, and the

degree to which the mother is able to recognize and respond to
these approaches.
Rooting or pleasurable sounds, signs of hunger or thirst-any
mother would be pleased to answer to such signs: these areas have
nothing to do with vision and a mother concerned about her baby,
sighted or blind, would be relieved by such signs. The indications of
hunger and thirst, the patterns of food intake, passive or active
feeding would be similar for blind and sighted, but other factors are
not.
Since the blind baby cannot watch the approach of food to his
mouth, it should be noted especially in what manner the mother
inserts the nipple, bottle, or spoon into the baby's mouth and
whether there is a moment of hesitation on the mother's part in the
expectation that the infant will react to the approach of breast or
bottle. We should also note any changes in the mother's handling
before she is aware of her baby's blindness and after she has this
knowledge.
Instead of noting the infant's watching of the feeding operations,
the observer must give the same attention to the infant's listening to
them.
Special note should be made of mouth movements toward food
and body postures since we do not know how far these are
occasioned only by the sight of food and how far other sensory
avenues, for example, smell, play a part here. Such clues to
self-feeding as hand-reaching movements toward the mother and
toward food, grasping, will have to be expected to occur later than
in the sighted.
We can assume that interruptions of the feeding process are even
more unpleasurable to the blind since nipple, bottle, or spoon, when
removed from physical contact with the blind infant, disappear
completely from his awareness.

OTHER NEEDS

PROTECTION AGAINST INAPPROPRIATE STIMULI

AND PROVISION OF APPROPRIATE STIMULATION

Although most of the needs listed for sighted children apply equally
for the blind, there are some quantitative and qualitative differ-
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Special Problems of Blind Infants 7

ences for which the Profile will have to make provision. One is that
the role of auxiliary ego which every mother has to play is an
extended one; the blind child is altogether more vulnerable and
needs more protection and assistance. The other concerns the blind
infant's extreme need for response and stimulation. This is not easy
for the mothers since as sighted individuals they are more alerted to
a visual interchange and get discouraged if they receive no response
to their efforts of attracting the baby visually. The observer should
note here whether this causes the mother to withdraw or whether
she is inventive in finding other modes of interaction and stimula-
tion.

STABILITY AND FLEXIBILITY OF ROUTINE ARRANGEMENTS

It may be important to keep in mind here that blind infants profit

more than the sighted from the stability of routine arrangements
and less from their flexibility. Since they are prone to be frightened
of anything new and lack reassurance by the mother's glance,
routine as the recurrence of expected events is helpful and gives the
infant a feeling of security.

PRESTAGES OF OBJECT RELATIONSHIPS

It is obvious that with the blind the anaclitic relationship lasts

longer than with sighted children. Security is found in the mother's
closeness and in her ministrations. Interruptions of the anaclitic
relationship are therefore all the more disastrous for the blind.
The means by which the blind baby recognizes his mother, on
the other hand, are far from obvious. It would be very important to
know which perceptual modalities the infant uses, whether it takes
a longer time for him to know that a different person is feeding him,
and whether, on the contrary, he is more sensitive to such changes
than sighted children.

INDICATIONS OF PLEASURE AND AFFECTS

PLEASURE-UNPLEASURE SIGNS

While the reaction to unpleasure would be the usual ones, such as

withdrawal and crying, we cannot expect the blind infant to show
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8 Dorothy Burlingham

the normal manifestations of pleasure since his concentration on

listening, even if pleasurable, and the immobility required for
listening prevent the visible manifestations of pleasure from ap-
pearing. It may well be that observers are misled into thinking that
the blind infant is indifferent when in reality he is engaged with
pleasurable acoustic impressions (Burlingham, 1972).
All infants derive much pleasure from sucking their fingers.
However, in the blind infant, the last phase in finding the
hands-looking at them before bringing them to the mouth-is
missing. This may make a difference in the important develop-
mental step of hand-mouth coordination and has to be taken into
account.
We should also observe carefully whether the blind infant
develops other means of gratification.

PLEASURABLE USE OF THE MOUTH FOR APPROACH,

GRASPING, PERCEIVING, AND EXPLORING

The use of the mouth should be especially noted and described in

even greater detail than normally. For exploration and differentia-
tion, its use can be quite extraordinary. Blind children find the
mouth the finest tool for differentiating and for acquiring knowl-
edge of objects (spatial relations, surfaces, texture, shape); therefore
it is of importance to know when and how this ability and
preference develops, whether the blind's use of the mouth as a tool
persists into later stages because it is rewarding, while the sighted
give it up at an early age when other methods take its place. In any
event, the persistent use of the mouth in the blind, despite its
pleasurable elements, should not be interpreted solely as a manifes-
tation of oral gratification, because it substitutes for and serves the
purposes of important ego functions.
At a later age, I observed a little girl who in examining a room
went along the wall, stopping to feel everything she met and could
reach; she felt the floor with her feet and hands and finally with her
tongue. Similarly, I know of a blind woman who, when she wanted
to examine a fine detail of an object, secretly felt it with her tongue.
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Special Problems ofBlind Infants 9

AVAILABILITY OR ACCESSIBILITY OF AFFECTS

Just as the pleasure manifestations of the blind infant differ from

those of the sighted, his affective responses require special attention.
It is my impression that the blind's affective responses are less
strong or wide in range than those of the sighted. This is probably
due to lack of response or withdrawal on the part of the mother, as
a result of which there may be reduced input of stimulation. But
even if the mother is highly inventive in stimulating the infant, the
absence of vision greatly reduces the input of the many diverse
signs, gestures, and facial expressions by which the sighted recog-
nize and respond to affective expressions.
In contrast, the blind infant's limited understanding of what is
going on around him gives rise to specific affects expressing this.
Thus we should be alert to look for signs of bewilderment, fear, and
confusion, which in the blind occur frequently.
For these reasons, it is especially important not to make hasty
judgments concerning the inappropriateness of affects in the blind.
So often the observer is unaware of what the infant is reacting to, or
why he shows the opposite reaction from the expected one. Very
careful study is therefore required to determine not only the nature
of the affective response but also its probable source-whether
pleasure or distress or lack of affective manifestations occur in
response to external or internal stimulations.

MOTILITY AND AGGRESSION

AGGRESSION

When we look for signs of aggression in blind infants we should note

in particular its lack where aggression would be expected; for
instance, distress rather than aggression as a response to frustration.
There is great fear of showing aggression when the dependence on
the caretaking person is all-important. Only subtle ways of showing
aggression are then permissible and tolerable.

MOTILITY

Like the sighted, the blind infant becomes more active and more
mobile in relation to the opportunities for pleasurable discharge,
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10 Dorothy Burlingham

which are stimulated by the caretaking person. While the avenues

of discharge available to the blind do not differ from those of the
sighted, it is very interesting that for the blind the feet seem to play
a far more important role than the hands. The blind baby's use of
the legs as a means of discharging libidinal and aggressive drives
should therefore be explored. Moreover, a possible delay in the use
of the hands in general (Fraiberg, 1968; Wills, 1968) should be
noted.
The early preponderant use of the legs contrasts with the marked
delay in motility, which becomes apparent at a later stage when the
child has some awareness of the dangerous consequences of moving
into the unknown. When the blind toddler has learned to walk, he
will do so, but he will stay in the same place.
Despite the normal maturation of the motor apparatus a certain
retardation of motility in the blind is expectable for several reasons.
There is for the blind infant no known environment-s-such as walls,
furniture, windows-which on the one hand gives stability and on
the other tempts the growing toddler to move toward things or
around them. Movement for the blind occurs in a vacuum.
Although sound provides a certain amount of orientation, this is not
sufficient.
This lack of environmental stimulation is further reinforced by
the mother's protective attitude which is designed to guard the
child's endangering himself as soon as independent movement is
possible. These two influences act together as a delaying force.

STATE AND FUNCTION OF THE MENTAL ApPARATUS

It is evident that when vision is absent, one or more of the other

senses will be called on to take over some of its functions. In many
respects, however, the development of the other senses has to be
stimulated and taught. The substitution of sensory modalities brings
disorder into the usual sequence of the development of the sensory
apparatus as well as the ego functions dependent on them. We must
therefore take into account that-
1. Perception and attention are dependent on the use of listening
2. Exploration and recognition rely on touch
3. Reality orientation takes place via sensations called forth by
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Special Problems of Blind Infants II

sound, touch, vibrations, and probably also odor. These need to be

integrated with each other before one can expect the blind child to
have some awareness, for instance, of space
4. Memory traces are laid down by means of acoustic and other
sensory modalities and will therefore differ greatly from visual
memory traces.
The diminished sensory input requires a far greater intellectual
effort on the part of the blind to arrive at the same degree of
understanding that the sighted have of the environment. Special
attention needs to be given to whether the infant is helped or
hindered in this respect by the parents' efforts.
In this context, I also want to reemphasize that a blind child's
apparent withdrawal from the external world need not be a
reaction to unpleasure or a sign of lacking interest. Quite the
contrary, it is a prerequisite for intensive listening and therefore a
normal manifestation.

FORERUNNERS OF FIXATION POINTS

There is no doubt that blind children more than others have a

notable fixation in the stage of autoerotism. Again, this is partly
attributable to the fact that they, much more than others, are "left
to their own devices." Lacking perceptual stimulation and fre-
quently also stimulation from the mother (who tends to pay less
attention to a quiet baby), the blind infant spends much time in
such autoerotic activities as rocking and swaying.
In the blind, the eyes often become a libidinized area, and their
investment is significantly increased by examinations of and
surgical interventions to the eye, restriction of touch after opera-
tions, which are so frequently necessary. Such experiences should be
carefully noted.
Altogether blind infants have greater difficulty in progressing
from the familiar and known to the unfamiliar and unknown. This
in itself may create the semblance of fixation on a particular stage
of development.
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12 Dorothy Burlingham

GENERAL CHARACTERISTICS

In the Profile for sighted children we list general characteristics that

have special prognostic relevance for the assessment of their
development. These are not applicable to the blind and have to be
replaced by others. Frustration tolerance can serve as an example.
As with all handicapped children, frustration in the blind is the
order of the day and a basic fact of their lives to which the children
adapt in some way or other.
Instead I suggest a number of characteristics that might have
special prognostic relevance for the blind's normal or abnormal
development-
1. The infant's ability to make use of his remaining senses
2. The infant's ability to respond to appropriate stimulation
3. The infant's ability to express needs and wishes
4. With advancing ego development his intellectual ability to use
the meager sensory data at his disposal for adequate orientation.

SUMMARY

In selecting certain sections of the Profile for comment, I have tried

to underscore two basic considerations in assessing the blind. On the
one hand, we need to give special attention to those areas which are
most affected by the impact of blindness; on the other, the usual
. behavioral manifestations we observe may have a different meaning
in the blind.
The amendments I propose are a first step toward constructing
the Baby Profile for the Blind. As our knowledge of blind babies
increases, others will be added.
An early application of the Blind Baby Profile would be very
helpful in assessing the normal or abnormal development of the
blind, in sorting out the factors that are due to blindness, or to
additional brain damage, and those that derive primarily from
external sources and therefore can be influenced by appropriate
guidance.
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Special Problems ofBlind Infants 13

BIBLIOGRAPHY

BURLINGHAM, D. (1972), Psychoanalytic Studies ofthe Sighted and the Blind. New York:
Int. Univ. Press.
FRAIBERG, S. (1968), Parallel and Divergent Patterns in Blind and Sighted Infants.
This Annual, 23:264--300.
FREUD, A. (1965), NorTTI(J/ity and Patlwlogy in Childhood. New York: Int. Univ, Press.
FREUD, W. E. (1967), Assessment of Early Infancy. This Annual, 22:216-238.
- - (1971), The Baby Profile. This Annual, 26:172-194.
NAGERA, H. & CoLONNA, A. B. (1965), Aspects of the Contribution of Sight to Ego
and Drive Development. This Annual, 20:267-287.
WILLS, D. (1968), Problems of Play and Mastery in the Blind Child. Brit. J. Med.
Psychol., 41:213-222.
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