Visual stimulation to improve visual fixation and tracking in a late preterm infant: A case report

A 4-month-old late preterm child was brought in with the parent, complaining of reduced visual tracking and visual fixation. The study was conducted with the approval of Clinical Trial Right of India from 9 December 2025 to 12 January 2026. Written informed consent was obtained from the parent for participating in the study and publication of data. Intervention and assessment were conducted at a multispecialty hospital in Chennai, India. Clinical findings met ICD-10 criteria for a late preterm born, a disorder associated with the neurological and sensory systems' relative immaturity. The baby had difficulty following moving visual stimuli and demonstrated a limited capacity to focus on faces and other objects. There was no history of genetic problems, seizures, congenital abnormalities, or serious neonatal difficulties. The infant was deemed clinically stable after a routine pediatric and neurological assessment revealed no red flags. Caregiving was acceptable and consistent, and the psychosocial history was unremarkable.

Four weekly sessions, each lasting 5–10 minutes, were held. The baby's mother was trained on how to carry out the activities consistently and properly. The mother was advised to wear black lipstick, a large dark bindi, and dramatic eyeliner before each session to increase facial contrast and take advantage of the newborn's natural preference for high-contrast visual cues. This enhanced the baby's ability to focus on and respond to facial signals.

Week 1 focused on exposing the baby to simple visual stimuli and promoting visual fixation. Black-and-white cards, toy or rattle tracking, dim flashlight tracking, and exposure to high-contrast geometric patterns were among the activities. To encourage persistent concentration, the geometric patterns and cards were displayed at eye level from 10 to 16 inches. To start visual tracking, the toy and the dim flashlight were moved slowly in both horizontal and vertical directions. The objectives of this stage were to increase the infant's capacity for fixation, promote early visual attention, and familiarise them with controlled visual stimuli.

Week 2 concentrated on improving visual tracking and boosting attention span. To encourage coordinated eye movements, the same exercises were repeated with slightly longer and more effective tracking motions. Contrast sensitivity was enhanced using high-contrast patterns and black-and-white cards, while smooth pursuit was developed through flashlight and toy tracking activities.

Week 3 concentrated on improving tracking over more complex visual surfaces and maintaining visual engagement. While dim flashlight and toy tracking involved both horizontal and vertical movements with slow shifts across the midline, high-contrast geometric patterns were displayed with brief pauses to encourage sustained focus. To enhance visual discrimination and attention, black-and-white cards were used. This stage aimed to improve visual responses, midline crossing, and more fluid visual pursuit.

Week 4 focused on consolidating and integrating the visual skills learned in prior weeks. To promote sustained attention, improved fixation, and coordinated tracking, all visual stimulation exercises were carried out in a structured sequence. During face-to-face interactions with the mother, the newborn demonstrated increased visual engagement and attention. The aims of this final stage were to optimise visual responses, enhance visual-social interaction, and support early visuomotor development [7, 8].

Throughout the four-week programme, the infant was attentively observed for signs of stress, including yawning, finger splaying, gaze aversion, or colour changes. The intervention was well tolerated, with no adverse reactions observed. At the end of the four-week intervention, reassessment demonstrated improvement in both neurobehavioral organisation and visual function. The HINE score improved from 23/78 at baseline to 51/78, while the Visual Tracking Assessment score increased from 6 to 14, indicating enhanced visual fixation, improved attention to visual stimuli, and smoother horizontal and vertical tracking.

The mother expressed satisfaction with the visual stimulation programme, noting enhanced awareness, improved object tracking, and improved visual fixation. The activities improved the mother-infant relationship, were simple to carry out, and the baby tolerated them well.