A Children's Eye Health Primer

Featured Article, Growth and Development, Health and Safety


August is Children’s Eye Health and Safety Month, so there’s no time like the present—especially during back-to-school season—to get an eye check-up for your children. In fact, it’s critical to find and treat vision problems early because the longer they go undiagnosed, the more they can affect your child’s future health and development.


The American Academy of Ophthalmology (AAO) suggests that newborns have their eyes examined as well as undergo a red reflex test, which is used to test for multiple eye problems, soon after birth. “If the red reflex—what some people call the ‘devil eye appearance’—is not symmetric when a picture is taken of the child with a camera, then the child needs to be evaluated,” says Dr. Barry Wasserman, a pediatric opthamologist at Wills Eye Hospital in Philadelphia. “Parents can also simply cover one eye on their child at a time and watch the behavior.  If a small child reacts very differently to covering one eye or the other, then medical evaluation is warranted. Finally, if the parents feel the eyes are not aligned, then that child needs to be evaluated.”

Over the next few months, a baby’s eyesight will go through many developmental milestones. When they are first born, babies have peripheral vision so they can see to the sides, but it takes them about a month to develop the ability to briefly focus on objects close in front of them (up to 3 feet away). Newborns are also extremely sensitive to light, and it takes their pupils approximately two weeks to open up so that they can begin to see a range of light and dark. At about the one month mark they become sensitive to the intensity of color, which is why bright, high-contrast images and patterns tend to attract their attention so much in the first few weeks. As their range of vision and light tolerance increases during the first month, babies will also become more responsive to faces and facial expressions.

As development continues, “Babies begin to follow targets and watch faces, usually by 2 months of age. If a baby is not tracking or following faces or does not respond to a parents’ smiles by 2 months, an eye exam should be considered,” Dr. Benegas explains. “It is common for newborn baby’s eyes to wander out or in.  By 4 months of age, the eyes should be straight all of time. Any eye wandering present after 4 months of age should be evaluated by an ophthalmologist.”

With all of these developments, it’s good to have a second screening between 6 months and 1 year of age. “Most serious vision problems are more able to be treated successfully at a younger age,” says Dr. Nancy Benegas, a pediatric opthamologist at the Tennessee Lions Eye Center at Vanderbilt Children’s Hospital. “And some conditions, such as amblyopia, cannot be treated when kids are older yet can cause permanent vision loss.”

If your baby’s eyes are not working together to focus and track objects, the American Academy of Pediatrics (AAP) recommends consulting a pediatrician. Dr. Orgë also names multiple alarming signs that indicate parents should immediately seek medical signs for their baby’s eyes: red eyes, excessive tearing, discharge, light sensitivity, misalignment of the eyes, abnormal structures of any portion of the eyes and surrounding structures, nystagmus (involuntary fast eye movements of the eyes), persistent consistent head positioning (tilt, turn, chinup and chin down positions), abnormal red reflex of the pupil, signs of lack of vision, lack of depth perception, severe and/or persistent headache and eye pain, and droopy lids.


The American Optometric Association (AOA) estimates that only one-third of children have an eye examination before they enter school. While we often don’t think about vision until a problem arises, “if there is a significant eye problem history in the family, [kids] should be seen by a pediatric ophthalmologist without waiting for vision screening or for problems to arise in the child,” says Dr. Faruk Orgë, Director of the Center for Pediatric Ophthalmology and Adult Strabismus at Rainbow Babies and Children’s Hospital.

Kids should also have their vision and eye alignment examined as preschoolers (between the ages of 3 and 4) and again when they enter school at around age 5. “Children who are non-verbal either because of young age or developmental disability can still have their eyes checked, and this should not deter a parent from getting an exam for concern or failed vision screens,” Dr. Benegas advises. Convergence, or the ability for both eyes to focus on one object at the same time, more fully develops at about age 7, so the AAO recommends that children with focus or alignment problems be treated before then.

Late-Elementary and Older

As children age and progress academically, parents should have them examined yearly. And since about 25 percent of school-age children experience vision problems, it’s a good idea to check in regularly to see if a child is experiencing any vision-related problems at school. “Children’s vision develops over the first 10 years or so of life. Myopia, or nearsightedness, often develops at the end of elementary school so a child who had normal vision in kindergarten may have blurry distance vision by fifth grade,” Dr. Benegas explains. “Eyes can look totally normal and not see well, so repeat vision screening at multiple visits is necessary to screen for vision problems.”

Eyesight problems, particularly undiagnosed ones, can significantly affect your child’s classroom experience, since “among the five senses, vision is the sense that we all rely on the most, particularly when we are learning,” explains Dr. Orgë. According to the AOA, up to 80 percent of learning children do occurs through their eyes. Critical vision skills for learning include visual acuity, focusing, tracking, eye teaming and visual perception. “Blurred vision can interfere with the ability to see what the teacher is working on at the front of the classroom and can make reading small print difficult,” says Dr. Benegas. The AOA lists multiple symptoms of a possible vision problem in your child, such as a short attention span, frequent rubbing or blinking, avoiding reading or other close visual activities, and tilting the head or closing one eye in an attempt to see better.

Dr. Orgë explains that refractive issues tend to be the most common cause of such symptoms, and can usually be corrected with a pair of glasses for younger children or contact lenses for teens. Dr. Wasserman says that parents who were teased for wearing glasses when they were kids shouldn’t be worried today. “The styles and choices for glasses are vast today, so there are rarely the psychosocial issues about kids in glasses. In fact, glasses have become so ‘cool’ that kids sometimes come in faking eye/vision problems so they can get glasses!” Contacts are also an option, but only older children who will be responsible about handling them carefully should wear them. When not worn or cared for correctly, “contact lenses are dangerous and can lead to serious eye infections and damage,” Dr. Wasserman elaborates. “Parents must make sure the child is taking proper care of the lenses and using good basic hygiene, just like washing hands.”

If your kids haven’t had their vision screened recently or they have recently experienced eye trauma, be sure to contact your pediatrician’s office for a referral, and set up an appointment.

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