DIAGNOSIS of mental retardation, which must precede counseling, is the responsibility of the pediatrician or family physician. In the absence of certain stigmata such as hydrocephalus, microcephaly or unmistakable signs of mongolism, the diagnosis can seldom be made in the neonatal period. The physician should have his suspicions aroused by failure of the newly born infant to suck, cry, exhibit Moro and tonic neck reflexes on proper stimulus. However, predictions based on behavior in the first days of postnatal existence are best kept in the physician's mind or, perhaps, carefully inscribed on the hospital chart. Cyanosis, twitchings on frank convulsions in the postnatal period are ominous, but not necessarily followed by permanent damage. The physician must be as certain as possible in medical prognostication before making parents aware of his fears for the future mental development of their child.
As the infant progresses through the first few months of life he will give clearly discernible signs of mental development if he is normal. By the second month he should be looking at objects, and soon thereafter be able to follow a moving object with his eyes. By the third month he should respond with some facial expressivity to words, to the usual "clucking" sounds or low whistles, commonly directed at small infants. Somewhere between the second and sixth months the physician should be able to detect retarded mental development, preferably before the mother suspects anything is wrong. Dr. Watson believes that the physician should confine his opinions to himself, or a few judicious words entered on the chart, until he is quite certain of the retardation or until the mother raises the question.