The eyes of children grow just as fast as the child. Throughout infancy and adolescence the vision changes quite a bit. This is a critical period for vision. By the time the child is twelve years old, the vision has mostly completed its development. But up until this time, it's important to make sure the vision is developing appropriately. This is done by periodically getting the eyes screened by a professional.
Your child should be screened for having healthy vision and eyes at birth, between 6 months and 1 year of age, between the ages of 1 and 3 years and 3 and 5 years old, and after 5 years of age. These eye checks are important to evaluate the vision, alignment and health of the eyes.
But not all children need true “eye exams". Most of what children need are screenings of the eye. These can be done by any trained professional such as a pediatrician, primary care doctor or eye doctor. These screenings are typically done at well child visits but can also be performed at schools or other community centers. In addition, there are some additional clues at home you can use to determine whether or not your children's eyes are looking healthy.
By getting your child's eyes checked regularly, you can ensure that your child's eyes remain healthy. Here are what the official guidelines from the American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus say about eye checkups for children:
Newborns
At birth, a newborn won't have the sharpest of vision. It takes time for the eyes to develop even after birth. But the eyes of newborns should still be screened by a medical professional. During this screening, the newborns eyes are checked for signs of a cataract (a clouding of the natural lens inside our eye) or other issue that can affect vision. This is done by shining a light in the eye and evaluating whether the light completely reflects back (called the red reflex - due to the red color of the light reflecting off the retina). If anything obscures this red reflex, than the newborn must see a pediatric ophthalmology specialist for an eye exam for further evaluation. Cataracts are a prime example of something that can block this red reflex.
If the baby is born premature, the baby must have regular dilated eye exams starting right after birth. The retina in the back of the eye doesn't fully complete its development until the baby is at full term pregnancy. In a condition called retinopathy of prematurity, abnormal blood vessels can grow on the incompletely developed retina. Untreated, this can lead to blindness. Until the retina reaches its full developed, premature infants needs to be screened for this condition by a specialist.
6 months to 1 year
Before the baby turns one year old, they should have another screening exam performed on their eyes. This is typically done with the primary care or pediatrician through the well-child exams. The red reflex is once again examined to screen for any abnormalities. In addition, the movements of the eye are observed to make sure that the eyes are aligned and working together.
Misalignment of the eye, known as strabismus, can prevent the eyes from working together. If the child develops a preference for one eye, the other neglected eye can also develop poor vision or amblyopia (also commonly called lazy eye).
But even though your child can't tell you what's wrong, there are a few things you can look for at home outside of the screening:
- Does one eye of your child turn inwards or outwards? This is a sign of misalignment of the eyes and must be evaluated.
- If you cover or block one of the child’s eyes does the child get upset? This can be a sign that vision is only developing well in one of their eyes and again must be evaluated.
- The child is constantly rubbing their eyes. This can occur if the child has poor vision in both of their eyes.
Above 1 year of age
As the child gets older than one, the screening exams continue to look for signs of strabismus or amblyopia.
One Screening between 1 years and 3 years
As children are unable to read letters off the eye chart, a special device is used to measure the prescription in their eyes to check for any abnormal prescription measurements.
If the prescription of the eye is too high or if the child has lots of astigmatism, they may require glasses from a pediatric eye specialist in order to allow the vision to develop appropriately. Untreated prescription error, can lead to the development of amblyopia.
Another screening between 3 years and 5 years
This screening should be done as soon as the child is able to read the letters off the eye chart so that visual acuity (such as whether they have 20/20 vision) can be measured and compared between the two eyes.
Knowing the visual acuity can determine whether any poor vision or amblyopia is present. If the child isn’t seeing well or one eye sees better than the other, than it is important to follow-up the screening exam with a full eye exam to investigate the cause.
Above 5 years
There is no set frequency of recommended screenings in this age group. But after the age of 5, the child needs to be screened for the development of near-sightedness. The vision should be routinely screened at school or with the child's primary care doctor to determine if glasses are necessary. This is especially important if there is a family history of near-sightedness.
What to look for at home
In addition to the screenings, during all these ages there are a few things to watch out for with your children that can suggest inadequate development of vision or the development of prescription error.
- Poor attention span during tasks or during school
- Avoidance of activities requiring discrimination of details (such as puzzles or coloring)
- Needing to sit real close to see the TV
- Frequent squinting
Any suggestion that there could be vision issues should be followed-up with outside of the regular screening intervals.
Health indications for eye exams in children
There are certain times when children need to be followed more closely with eye exams outside of the general screening recommendations.
- Family history of childhood eye disease such as amblyopia, strabismus, cataracts in childhood, glaucoma or retinoblastoma
- Prematurity. While prematurity can lead to issues with the developing retina, prematurity also leads to a higher risk of developing strabismus, glaucoma or near-sightedness and these children need regular follow-up.
- Down syndrome increases the risk that the child can develop strabismus, infantile cataracts, glaucoma or require glasses to see.
- Juvenile idiopathic arthritis can cause inflammation to develop within the eyes. This inflammation can be impossible to detect without an eye exam. If left untreated, this inflammation can lead to the development of cataracts or glaucoma. It's important that an eye doctor exam these children regularly to make sure no inflammation is present.
Summary
Children need eye screenings regularly throughout their life. These screenings are there to ensure that their eyes develop healthy. Complete full eye exams for most children aren't necessary unless the child fails the screening or if something abnormal is noticed by you or the professional.
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