Caring for Your Eyes

Infants and Young Children - Newborn to Age 6

Eye exams are vital to children's wellbeing.

Although physicians examine babies at birth, it's a good idea for an eye doctor to observe how the baby, at 6 months, uses his or her eyes, focuses, and whether both eyes are used together as a team. The specialist will also check to make sure there are no diseases such as congenital cataracts or other eye problems, and will determine whether nearsightedness, farsightedness, or astigmatism is present.

Although a baby can't give verbal feedback, the doctor has equipment that provides an "objective" evaluation of the eye. One instrument, for instance, shines a light into the eye, which reflects back to determine the eye's refractive power. Because the eye's automatic focus response will disrupt measurement, eye drops are used to dilate the pupil and temporarily stop the focusing. The drops take effect after 30 minutes or more, and the infant exam itself takes about 15 minutes.

At about age 3, children should have their second eye exam. Their eyes will be tested using eye charts that contain pictures, numbers, or letters. At this stage, the specialist measures a child's visual clarity at all distances, checks depth perception and color vision, examines the health of the eyes, and looks for nearsightedness, farsightedness, and astigmatism.

Another eye abnormality that eye specialist can detect is amblyopia, or "lazy eye," a condition in which sight does not develop normally in one eye. But unless the eye is misaligned, it is possible that neither the child nor the parents may be aware of the condition. If left untreated during early childhood, amblyopia may not be treatable in later years. The amblyopic eye may develop a permanent visual defect and/or depth perception may be lost.

It is important for children to have an eye exam before starting school. Vision screenings conducted through schools are not complete eye examinations. A comprehensive children's eye exam should check health of the eyes, visual acuity, and proper eye alignment and muscle function, and it should include a refractive test to determine whether a child's vision needs correction. A recent study showed that only 14 percent of children entering school in the United States had ever had an eye exam. Early detection and treatment of vision problems or eye disease is very important to the health of a child, so it's best to schedule that appointment before the school bus comes!

Vision trouble signs to look for

Symptoms that require immediate attention from a physician include:

• A white pupil
• Sudden swelling or drooping of a lid, accompanied by a red eye
• Enlarged pupil in one or both eyes.

Other conditions, which are not as urgent but still require attention by a specialist, include:

• One or both eyes turning in or out
• Tearing, redness, or discharge that lasts for a number of days
• A baby's eyes that seem to move continuously or do not appear to look directly someone
• One pupil that appears larger than the other.

Parents should be attuned to signs of potential visual problems in children aged 2 to 6:

• Covering one eye when looking at a book or object
• Complaining of headaches
• Asking to sit closer to the blackboard at school
• Sitting too close to the television
• Squinting or rubbing eyes excessively
• Difficulty catching a ball
• Not wanting to look at books

Should you notice any of these symptoms, make an appointment with the eye doctor.

Preparing for a visit to the eye doctor

Make an eye appointment for young children or babies when they are well rested, usually in the morning. Tell young children where you're going and what to expect. Let them know that they'll be looking at pictures and talking to the doctor. Bring a favorite toy or juice in case there is waiting time or the child needs some familiar comfort.

For an infant exam, schedule the appointment for the baby's least fussy time - after he or she has napped and been feed. And, because those quiet times between naps and feedings often don't last very long, it's best to not spend time completing required paperwork at the doctor's office. Instead, have the paperwork sent to you ahead of time and either mail the completed paperwork back prior to your visit or bring it with you at the time of your appointment.

In summary, the vision system in a young child is immature and requires equal stimulation for both eyes to develop normally. Very early detection of treatable eye conditions in childhood can have far-reaching implications for vision.