Kiddipedia
By : Marvin Janet (Dip Optom SA, FOA, MCOptom)
Young children often can’t tell you their vision isn’t right. A baby can’t explain blurry sight, and a toddler or preschooler usually assumes everyone sees the way they do. Children also adapt, so they rarely complain. It’s usually up to parents to spot the signs.
As I often tell parents, a young child’s eyes are still developing, so we like to catch eye issues early, before they get baked in. Most signs show up in everyday play, reading and screen time.
Babies (0-12 months)
Newborns see mostly blurry shapes and strong contrast, and their vision develops quickly over the first year. It’s normal for a young baby’s eyes to wander or cross now and then in the first few months while they learn to work together.
Mention it to your GP, maternal and child health nurse or an optometrist if you notice:
- Eyes that still turn in, out, up or down regularly after around 4 months of age
- Your baby doesn’t follow your face or a moving toy by around 3 months
- Little or no eye contact, or not reacting to your smile
- Eyes that seem to flicker, wobble or move constantly
- Unusual sensitivity to light, or frequent watering or redness
- One eye that looks different in size or shape, or a droopy eyelid
Some babies look cross-eyed when their eyes are actually straight. A wide, flat bridge of the nose or a small fold of skin at the inner corner of the eye can create the illusion of a turn, and the look often fades as the face develops. This is called pseudostrabismus. An optometrist can assess whether a real eye turn is present.
It’s also worth having your baby’s eyes checked earlier if they were born prematurely or at a low birth weight, or if there’s a family history of a turned eye, lazy eye or glasses in childhood.
Toddlers (1-3 years)
In toddlers, vision problems usually show up in how they play and move.
Signs to watch for:
- Tilting or turning their head to look at things
- Covering or closing one eye, especially when looking at something closely
- Holding books or toys very close to their face
- Squinting or frowning to see
- Frequent eye rubbing when they’re not tired
- Seeming clumsier than other toddlers their age, or often bumping into things
- An eye that turns in or out, even only when tired or unwell
Many toddlers show none of these signs. Lazy eye (amblyopia) affects around 2 in every 100 Australian children and often has no visible clues. A child who sees well with one eye gets around fine, so the weaker eye can go unnoticed until each eye is tested on its own.
Preschoolers (3-5 years)
Preschoolers start building the visual skills they’ll need for school, like focusing up close, tracking along a line and using both eyes together. Problems with these skills don’t usually cause blurry vision.
Signs to watch for:
- Sitting very close to the TV or holding a tablet close to their face
- Avoiding or losing interest quickly in drawing, puzzles, colouring or books
- Losing their place when looking at pictures in a book, or using a finger to keep track
- Complaining of headaches, tired eyes or sore eyes after close-up activities
- Difficulty with catching a ball or judging distances
- Trouble recognising familiar people or objects from across a room
Visual processing is how the brain makes sense of what the eyes see, like recognising shapes, telling similar shapes apart and judging where things sit in space. These abilities play a part in puzzles, drawing and early literacy. A standard eye test doesn’t usually cover them, so if you have concerns, ask an optometrist which assessments are appropriate.
Even if you haven’t noticed any signs, the year before school is a good time for a full eye test. Reading and writing put new demands on the eyes, and problems are easier to address before school starts.
Signs that need prompt attention
Most of the signs above mean booking an eye test soon, not an emergency. These are the exceptions.
Get medical help the same day, from your GP or a hospital emergency department, if you notice:
- A white, grey or cloudy pupil, or a white reflection in one eye in flash photos instead of the usual red-eye
- An eye injury, or a red, painful or swollen eye
- Sudden loss of vision, or your child suddenly complaining that things look double
Book an appointment within a few days if an eye turn appears suddenly, or an existing turn gets noticeably worse.
What to do if you notice something
Book an eye test with an optometrist who regularly sees young children. You don’t need a referral in Australia, and your child doesn’t need to know their letters. Optometrists use pictures, shapes, lights and simple games instead.
A comprehensive children’s eye test checks how clearly each eye sees, the health of the eyes, and how well the eyes line up, focus and work together. Some optometrists also offer a more detailed assessment of visual skills and visual processing when there are concerns about development or early learning, so it’s worth asking what’s included when you book.
A few tips to make the appointment easier:
- Book a time when your child is usually well rested and fed
- Bring along notes on anything you’ve noticed, plus any family history of eye problems
- Explain the visit simply beforehand, for example that the optometrist will look at their eyes with lights and pictures
- Ask if a young or nervous child can sit on your lap during testing
About the author
Marvin Janet (Dip Optom SA, FOA, MCOptom) is a senior optometrist with more than 20 years of experience in paediatric and behavioural optometry. He runs Eye Care for Kids in Narre Warren and Caulfield, Melbourne, and is regularly referred families by GPs, paediatricians and maternal and child health nurses.
