A Blog from Your Kaiser Permanente Pediatricians in Northern California

Understanding Infant Vision

One summer afternoon I was sitting at the foot of my bed, holding my 2-month-old firstborn. We were enjoying one of those peaceful moments of bonding that new parents get after their baby wakes up from a nap, alert and happy. It was magical – until I noticed his eyes were looking in opposite directions. Were they supposed to do that? He looked a bit possessed! I called my pediatrician and it turned out that at his age, he was allowed to have crazy eyes!

As a new mom I temporarily forgot what I knew as a pediatrician: In the beginning babies’ eyes don’t work well together and can appear to wander out or turn in. This is normal in a young baby, but shouldn’t be seen after 4 months old.

New parents often have many questions about their baby’s eyes – I certainly wasn’t alone. Here are some questions I have frequently answered as a pediatrician/mother.

Eye color

Parents often want to know what color eyes their baby will have, but it’s hard to predict!

  • Eye color is determined by the melanin in the iris, the colored area around the pupil. Cells called melanocytes make melanin. At birth, a baby’s eyes often look grey or blue. As the melanocytes make melanin you can see the eye color develop. If not much melanin is made, the eyes will stay blue; if more is made they’ll turn green, hazel or brown. This process won’t finish until your baby is about 1 year old, but you can usually make a good prediction about eye color at about 6 months old.
  • Eye color is also determined by more than one gene. Because of this, it’s difficult to predict the eye color a baby will have, based on their parents’ eye color. Two brown-eyed parents can have a blue-eyed child and two blue-eyed parents can have a brown-eyed child. Or green-eyed. Or hazel-eyed.

Watery eyes

Parents are also concerned about watery eyes or eyes that appear to have frequent discharge. Usually this is caused by a blocked tear duct.

  • The tube or duct that drains fluid from the eye is tiny in babies. If it has a narrow portion, the tears and mucus normally produced by the eye can back up into the duct and overflow. This looks messy but isn’t a problem unless the white of the eye gets red or the lids are swollen.
  • Most babies outgrow this on their own without any treatment.

How your infant’s vision develops

  • Birth to 1 month: Newborns can see shapes but not details and have vision about 20/400-600 (think a shape larger than the big E on eye charts). They can see across a room but are more interested in what is close to them – like the gaze at a parent’s face while being fed. They prefer to look at objects with high contrast.Their focus improves over the first month.
  • 3 to 4 months: Over the first few months, babies start being able to focus on increasingly smaller objects. When they are 2 to 3 months old, they can see moving objects, so we say that they have developed the ability to “fix and follow.”
  • 4 to 5 months: Now your baby’s eyes should be working in a coordinated fashion to create stereo vision. That’s why babies start to be able to grab toys by about 4 months of age. Their depth perception develops at 5 months, and their color vision is developing, too – first with red and green.
  • 5 to 8 months: Your baby’s eye-hand coordination is improving. Tummy time, which will lead to crawling, helps develop this.
  • 9 to 12 months: Your child will have better distance perception, and even have the ability to throw toys!
  • 3 to 5 years: Your child will finally have 20/20 vision.

How parents can help babies’ vision develop

  • Hang mobiles over their crib until they’re about 5 months old. Take the mobiles down when your baby can sit up and pull, in order to avoid strangling injuries. Besides, they eventually get bored of mobiles.
  • Display pictures with high contrast.
  • Change pictures and decorations in their room often.
  • Talk to your baby as you move around the house.
  • Provide supervised tummy time to enhance your baby’s coordination skills.

When to call your pediatrician about potential problems

While I review all of these common vision issues with parents, I also like to make sure they know when to be concerned. Call your pediatrician if you notice:

  • Eyes crossed or turned out, if your child is over 4 months old
  • Eyes do not fix on and watch a moving object, if your child is over 3 months old
  • Eyes flutter repeatedly in any direction
  • An eye bulges, or an eye lid droops
  • Redness that does not go away in a few days
  • Eye pain
  • Eyes that are always watery
  • Eyes that are always sensitive to light
  • Your child often rubs or squints their eyes
  • Any change in your child’s eyes from how they usually look

Having questions about your baby’s eyes is normal – there’s a lot to wonder and worry about. There’s one time when your baby is allowed to have devilish eyes: in photographs. Those red eyes we don’t like in photos? They show light reflecting off of the retina and are medically just fine. You do however, need to call a doctor if you notice a photo with one eye red and one eye with a white appearance in the pupil, because that can be a serious condition.

If you do think your baby’s eyes look a bit crazy just call your pediatrician – the way I did!

More resources for Parents

Blocked Tear Ducts – My Doctor Online
Eyelid Problems – HealthyChildren.org
Tummy Time – American Academy of Pediatrics
Baby’s Vision Development: What to Expect the First Year – American Academy of Ophthalmology

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