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pediatric eye exam guide

As a new parent, do you know when you need to have your infant or toddler's eyes examined? It used to be that a child's first exam was done at school, and only if a problem were detected would a parent be referred for follow-up care. Today, however, parents know early intervention and ongoing eye examinations are extremely important to a child's visual health.

According to the American Optometric Association (AOA), a child's first comprehensive eye exam should take place at six months of age. The doctor will test for any eye health problems, ability to move the eyes and any nearsightedness, farsightedness or astigmatism.

How the eye exam is done will depend on the age of your child, but generally it will involve gathering a case history, including the family history, eye health and vision testing, eye alignment testing, determination of the need for corrective lenses, and the scheduling of any necessary therapy or surgery.

testing for eye health problems

Signs of Vision Problems

Experts estimate that 10% of preschoolers experience eyesight problems. Early detection is critical because, if left unchecked, some childhood eye issues can result in irreversible vision loss. Additionally, corrective measures are generally more effective when started at an early age. Discovering problems can be difficult in toddlers because they may not mention any issues or even realize they have a vision problem.

preschoolers eyesight problems

Here are some signs to watch for that may indicate your child has a problem with their vision. If these signs are present, it's time to schedule a pediatric eye exam for your baby or toddler:

  • Squinting
  • Frequent eye rubbing
  • Holding books close to their face
  • Sitting too close to the television
  • Lack of age-appropriate attention
  • Poor hand-eye coordination
  • Eye frequently turning in or out
  • Light sensitivity
  • Excessive tearing or watering eyes
  • Red or crusted eyelids

Early eye exams also are important because children need the basic visual skills, including near and distance vision, hand/eye coordination, peripheral vision and eye movement and teaming skills, to learn about their world. Because of this need, some states require an eye exam for all children entering school.

signs of vision problems in kids

What Do Pediatric Eye Exams Include?

What can you expect at a pediatric eye appointment for your infant? The Vision Screening Committee of the American Association of Pediatric Ophthalmology and Strabismus provides the following guidance:

Ages six to 12 months, tests include:

  • Ocular history
  • Vision assessment
  • Examination of the eyes and lids
  • Pupil responses
  • Fixate and follow testing
  • Red reflex

Be sure to share concerns about any warning signs you have noticed, any motor coordination issues the child displays, or any health issues the child is experiencing. In the case where the first exam is conducted by the child's pediatrician, infants who do not track well after 3-6 months of age, have an abnormal red reflex or have a history of retinoblastoma in a parent or sibling should be referred to a pediatric optometrist for further assessment.

If no issues are detected during the first exam, children don't need to have any additional eye exams until they are three years of age. The next exam should be right before they enter school at about age five or six. After that, the AOA recommends that school-aged children receive an eye exam every two years. If vision correction is required, annual exams are recommended.

At three years of age, testing will include all of the previous tests, plus:

  • Visual acuity testing or photo screening using LEA symbols, a chart using pictures and symbols that preschoolers can easily identify, instead of letters. This way a child who is unable to read can still be accurately assessed.
  • Ophthalmoscopy or retinoscopy, a technique that involves shining a light into the eye to observe how it reflects from the retina. This is a quick, easy and reliable test that helps to determine the child's prescription, if they need one.
  • Random Dot Stereopsis, a test designed to test how well the child's eyes work together.

At five years of age:

Testing includes all previous tests. The only difference is that the passing line of the vision screening chart is now 20/30. After six years of age, if no corrective treatment is warranted, eye exams are recommended every two years.

Screening vs. Examination

A vision screening done by your child's pediatrician or preschool nurse, while important, is not the same as a comprehensive eye and vision exam done by a pediatric optometrist. A screening cannot be used to diagnose eye or vision issues, but it can be used to determine any further need for evaluation. It may only assess one or two areas of vision and may not uncover issues like color blindness, problems with focusing or more serious issues.

A comprehensive eye and vision exam to determine if your child's vision is developing appropriately is warranted by age three. An optometrist can also determine if there is any eye disease and prescribe corrective treatment if necessary.

Scheduling Your Child's Appointment

Comprehensive eye exams are possible, even in infants and small children who cannot read or understand letters or numbers, thanks to today's diagnostic equipment and tests. To make your child more comfortable, schedule the appointment when they will be well rested, happy and alert. Also allow plenty of time so your child is not rushed.

For older children, explain what is involved in an eye exam in simple terms and make sure your child's questions are answered. Eye exams are conducted differently, depending on your child's age, but generally the exams will include the following steps:

  • Parents will be required to provide a case history
  • The doctor will conduct vision testing
  • An eye health evaluation will be performed
  • Eye alignment will be tested

Based on the results of the vision testing, the doctor will determine if your child needs corrective lenses and prescribe eyewear.

Sharing Your Child's Health and Family History

After you've made the appointment, you will need to provide a case history that includes information about your child's perinatal history, such as birth weight, any complications during pregnancy or delivery and whether or not the child was full-term. You will also need to provide information about your child's medical, as well as any previous ocular diagnoses or treatments. Finally, it is important to share any family history of eye problems requiring corrective treatment including therapy or surgery.

Vision Issues in Children

In addition to refractive errors such as farsightedness, astigmatism and nearsightedness, the following vision issues may be found in children:

  • Amblyopia - Commonly known as "lazy eye," children suffering from amblyopia have diminished vision in one or both eyes. One eye turns inward or outward involuntarily, in spite of the fact that no damage or eye problem exists. Strabismus, in which eyes are incorrectly aligned, is a common cause of amblyopia in children. Another cause may be a dissimilarity in the vision problems between the child's eyes. Your child may require patching of the dominant eye to resolve the issue. Patching will strengthen the weaker eye and is usually successful in correcting amblyopia.


  • Strabismus - A congenital defect affecting the eye muscles is generally the cause of strabismus. The child's eyes are misaligned when the eye muscles are incorrectly positioned or too weak to correctly control the movement and positioning of your child's eyes. If left untreated, amblyopia can occur. When patching the dominant eye doesn't work or if the amblyopia is severe, your child may need surgery to help treat strabismus.


  • Convergence insufficiency. This is the inability to maintain eye alignment comfortably, making reading and other near tasks difficult. Vision therapy, involving a specific regimen of eye exercises, is often successful in treating convergence insufficiency.


  • Focusing problems, depth perception and color blindness. Children with focusing problems may find it difficult to change focus from near to far and back again, or they may be unable to maintain near focus for any length of time, making reading difficult. Vision therapy can successfully treat this issue.


  • Color blindness is also a potential issue among children that must be addressed.


  • Eye teaming problems. Eye teaming (binocularity) problems can hinder a child's ability to gauge distances between objects (depth perception), as well as hand/eye coordination.


  • General eye and eyelid health. Any abnormal eyelash follicles, discharge, bumps or swelling could be a sign of a bigger problem. Your doctor should also examine the entire eye including the cornea, iris and pupil for general health.

Supporting Visual Development

Good visual health is important in children of all ages, but it plays a crucial role in a child's early development, including strengthen motor skills, bonding and even balance. Poor visual health can negatively impact development.

Surprisingly, good vision doesn't just happen. Just as a child's brain learns to use their mouth to talk and their legs to walk, a child's brain must learn how to see. Undiagnosed and untreated vision problems can cause long-term issues.

Not only is a comprehensive pediatric eye examination important for your child, but so is a parent's interaction in stimulating a child's visual development. By following these guidelines, parents can help their child's vision development with these age-appropriate activities:

child development activities

Birth to Four Months

  • Install a nightlight or lamp into your baby's room for dim lighting.
  • Change the location of the crib at frequent intervals.
  • Put reach-and-touch toys about eight to twelve inches away from your baby, so he or she can focus on them.
  • Talk out loud to your baby when you're in the room.
  • Switch between the right and left sides when you're feeding.

Five to Eight Months

  • Hang a mobile on the crib, so your baby has the ability to grab, pull or kick.
  • Let your baby play on the floor and explore.
  • Give your baby building blocks or other toys to help improve fine motor skills and increase small muscle development.
  • Play games like patty cake and guide your baby's hands along with the motions while you say the words.

Nine to Twelve Months

  • Help your baby develop his or her visual memory by playing games like hide and seek.
  • Allow your baby to crawl and examine things around the house.
  • Start naming objects while you talk to spark word association and heightened vocabulary.

One to Two Years

  • Give your child a chance to track objects with their eyes by rolling balls back and forth.
  • Find balls or building blocks to play with your child that help increase fine motor skills and small muscle development.
  • Read stories to your children, which helps them learn how to visualize and may give them a head start on developing reading and learning skills.

Preschool-Age Children

Throw a ball or beanbag and practice catching.

  • Read out loud to your child, and hold the book in front of them so they can see what you're reading.
  • Allow your child to draw on a chalkboard or paint with finger paints.
  • Plan block-building activities or help your child complete a puzzle to encourage hand-eye coordination.
  • Encourage your child to play outdoors with balls, bikes, swings or roller skates.
  • Set up times for your child to play with other children.

For preschoolers, games and playtime activities can be an active way to promote their vision development. However, your child may miss a step in vision development no matter how many activities you plan. Scheduling vision exams when your child is three and five years old is a proactive way to detect and treat any potential vision problems before your child enrolls in school.

Enhance Your Child's Life with Strong Eye Health

Your child's academic, social, and athletic success is enhanced by good vision and eye health. For long-term vision health, it is important to have infants and toddlers examined by a pediatric optometrist or ophthalmologist on a regular basis.

Just like you take your child to the pediatrician for checkups, you should also make sure you care for your child's vision. Regular care ensures any issues or deficiencies of the visual system are treated promptly so permanent damage can be avoided. It is especially important since corrective treatments such as patching, corrective lenses and therapy become less effective with age.

For more information or to schedule an appointment for your child at Prince William Eye, call us at 703-361-6151 or contact us online today.

 
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Prince William Eye Associates