We examined 242 healthy neonates. Five developed transient tonic downward deviation of the eyes and eight showed any resultant visual, systemic, or neurologic abnormality. However, five of the 22 children with neonatal skew deviation developed a subsequent comitant horizontal stabismus. Although transient supranuclear disturbances of gaze are common in healthy neonates, skew deviation is a risk factor for development of horizontal stabismus.