Early Signs of Vision Impairment in Infants and Toddlers
It’s probably one of the most common things we take for granted. Like hearing and the ability to walk, many of us go through life without thinking about what it would be like if we couldn’t see. Many of us don’t even think to have our babies’ vision tested. And how many of us would really know what to look for in terms of what kind of vision our babies are supposed to have by a certain age, and what kinds of things we should actually be concerned about?
Believe it or not, “[v]ision disorders are the fourth most common disability in the United States and the most prevalent handicapping condition during childhood” while only about 14 percent of young children (younger than 6 years of age) have had their eyes and vision examined (American Optometric Association). In light of this and other statistics (read the “Statement of the Problem” in this document published by the AOA to read more statistics), the American Public Health Association has “adopted a resolution that…encourages regular eye examinations at the ages of 6 months, 2 years, and 4 years….” (AOA).
Parents shouldn’t rely solely on their pediatricians and eye care professionals, however, when it comes to first noticing the signs of a possible vision impairment in their child, parents need to know what is normal for baby’s vision, and what is not.
What is normal vision development for infants (0-3 months)?
Just moments after birth, your doctor will examine your baby’s eyes. While eye problems such congenital cataracts and other neonatal eye problems are rare, it is important they are detected, diagnosed, and treated early to prevent negative repercussions from long-term non-treatment. Your doctor will also put antibiotic ointment in your baby’s eyes to prevent any eye infection that might develop due to bacteria in the birth canal.
For the first week or two, your baby will see only black, white, and gray, and won’t be able to focus. By the end of the first month, your baby will be able to see some colors.
It is normal at this age for your baby’s eyes not to always work together. For example, one eye may drift inward or outward from “normal” visual alignment. If you observe a really significant or constant misalignment, you should contact your eye care practitioner immediately.
Through months 2 and 3, your baby’s eyes begin to move and focus better allowing them to reach for objects and shift their gaze to follow the sound of your voice or other objects placed within their visual range – without moving their head. This is called “tracking”.
What are Signs of Vision Impairment in infants (older than 3 months)?
Because there is so much growing and developing happening during the first three months, it isn’t usually until babies are into their fourth or fifth month that vision problems start becoming more obvious.
As stated above, it is normal for your baby’s eyes to look slightly, occasionally misaligned before three months, but “after 4 months of age inward crossing or outward drifting that occurs regularly is usually abnormal” (AAP) and you need to let your doctor know.
Your child should also be able to “fixate on an object, maintain fixation, and then follow the object into various gaze positions [track an object]. Failure to perform these maneuvers indicates significant visual impairment” (AAP). You should observe how your baby’s eyes perform this task together (binocularly,) and one at a time, (monocularly). When you engage your baby in these activities, make sure he/she is awake and alert. Since babies’ attention spans are very short, disinterest or lack of cooperation can make it look like they are not responding the way they should. “If poor fix and following is noted binocularly after 3 months of age, a significant bilateral eye or brain abnormality is suspected, and referral for more formal vision assessment is advisable.” (AAP)
Darlene Oakley is a freelance writer for Empowher.com
Optometric Clinical Practice Guideline: Pediatric Eye and Vision Examination. American Optometric Association. Web. Aug 17, 2012.
Your Infant’s Vision Development. Heiting, Gary OD. All About Vision. Web. Aug 17, 2012.
Developmental Signs of Eye Problems in Babies. Smith, Barbara M.S. OTR. Web. Aug 17, 2012.
Warning signs of Vision Problems in Children. American Academy of Pediatrics. Web. Aug 17, 2012.
Eye Examination in Infants, Children, and Young Adult by Pediatricians. American Academy of Pediatrics Committee on Practice and Ambulatory Medicine and Section on Ophthamology et. al. Policy Statement. PEDIATRICS Vol. 111 No. 4 April 2003. Web. Aug 17, 2012.
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