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Updated: Aug 2, 2025
Gaze in Action: Head-mounted Eye Tracking of Children's Dynamic Visual Attention During Naturalistic Behavior
Published on: November 14, 2018
Atypical gaze-following behaviour in infants with congenital heart disease
Maria Feldmann1, Jessica Borer2, Walter Knirsch3
1Child Development Center, University Children's Hospital Zurich, Zurich, Switzerland; Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
Insights
Infants with congenital heart disease (CHD) show delayed gaze-following skills by 12 months of age compared to healthy peers. This early social-cognitive development difference highlights potential long-term impacts for children with CHD.
Area of Science:
- Pediatric cardiology
- Neurodevelopmental research
- Social cognition studies
Background:
- Complex congenital heart disease (CHD) is linked to neurodevelopmental impairments, particularly in social-emotional and social-cognitive domains.
- Early indicators of social-cognitive development in infants with CHD are not well understood.
- Gaze-following behavior serves as a key measure for assessing early social-cognitive abilities.
Purpose of the Study:
- To evaluate and compare gaze-following development in infants with CHD against healthy controls during their first year of life.
Main Methods:
- A prospective cohort study involving 23 infants with CHD and 84 healthy controls.
- Eye-tracking technology was used to assess gaze-following behavior at 6 and 12 months of age.
- Statistical analyses, including linear mixed models, were employed to compare groups and track developmental trajectories, adjusting for confounders.
Main Results:
- No significant differences in gaze-following were observed between infants with CHD and controls at 6 months.
- By 12 months, infants with CHD exhibited significantly lower fixation frequency and shorter looking duration towards gaze-cued objects.
- The increase in fixation frequency towards congruent objects with age was less pronounced in infants with CHD compared to controls.
Conclusions:
- Gaze-following development diverges between infants with CHD and healthy controls within the first year of life.
- These findings suggest potential early social-cognitive differences in infants with CHD.
- Further research is warranted to explore the clinical significance and long-term associations with social-cognitive development.
Background:
Neurodevelopmental impairments are the most prevalent non-cardiac long-term sequelae in children with complex congenital heart disease (CHD). Deficits include the social-emotional and social-cognitive domains. Little is known about the predecessors of social-cognitive development in infants with CHD during the first year of life. Gaze-following behaviour can be used to measure early social-cognitive abilities.
Aims:
To assess gaze-following development in infants with CHD compared to healthy controls.
Study Design:
Prospective cohort study.
Participants:
Twenty-three infants who underwent neonatal correction for CHD and 84 healthy controls.
Outcome Measures:
Gaze-following behaviour was assessed by eye tracking at 6 and 12 months. Difference scores for first fixation, fixation frequency and fixation duration towards the gaze-cued object were calculated across 6 trials and compared between groups at both testing time points while adjusting for known confounders. Linear mixed models were calculated to assess the longitudinal trajectory of gaze-following development while accounting for the nested and dependent data structure.
Results:
At 6 months, no difference in gaze-following behaviour between CHD and healthy controls was found. At 12 months, fixation frequency towards the gaze-cued was lower and looking duration was shorter in CHD compared to controls (p = 0.0077; p = 0.0068). Infants with CHD showed less increase with age in the fixation frequency towards the congruent object (p = 0.041) compared to controls.
Conclusion:
During the first year of life, gaze-following development diverges in infants with CHD compared to healthy controls. Further research is needed to investigate the clinical relevance of these findings and the association with later social-cognitive development.
