Parenting Advice From Your Physicians at Kaiser Permanente

I got my first pair of glasses when I was 8. I’m not sure how my mom realized I needed them, but I do remember very clearly the first day I wore them. As we drove home from the optometrist’s office, I was captivated by the view out the window and shouted, “Mom! The trees have leaves!”

To understand more about protecting kids’ vision, I reached out to Dr. Daniel Greninger, a pediatric ophthalmologist. He explained that many parents wonder about their kids’ vision, especially when they are so young and might not even know their vision could be better and not blurry!

He explained that, fortunately, a regular part of your child’s pediatric care is vision screening: a brief eye and vision check to detect vision issues in children. It isn’t just done to see if a child needs glasses. There are also other eye problems that can cause permanent vision loss if left untreated in childhood. A vision screening will help detect and treat issues before they cause long-term damage. That’s why pediatricians physically examine your child’s eyes at each well-check and do formal vision screening tests at appropriate ages.

Some eye problems have no symptoms and will only be detected during a screening. In some cases, parents will notice concerning symptoms. Contact your pediatrician if you notice your child:

• Squints
• Blinks more than usual
• Has red eye(s)
• Has wandering, crossed, or out-turned eye(s)
• Tilts their head when they try to focus
• Has one eye that appears to have a white pupil in a photograph

What happens in a vision screening?

Vision screenings may be done differently depending on your child’s age and their pediatrician’s preference. For some screenings, your child will read or match images in an age-appropriate way. Other times, the doctor will use different technologies to measure the eye position, reflection of light off the back of the eye, or the focus of light into the eye.

What happens if my child “fails” a vision screening?

If your child fails a screening, they’ll be referred to an eye doctor, either an ophthalmologist or optometrist, experienced in evaluating and treating children. It’s important to follow up with the eye doctor, even if you aren’t noticing any vision problems. The eye doctor should perform a complete eye examination. They may dilate your child’s pupils with eye drops, and they’ll tell you if your child needs eyeglasses or another kind of treatment.

When should my child’s eyes get checked?

The American Academy of Ophthalmology and the American Academy of Pediatrics recommend that children have their eyes checked according to the following schedule:

Newborns – At birth, all babies should have their eyes checked by their pediatrician for birth abnormalities, infections, cataracts, and glaucoma. This happens in the hospital as a routine part of care for a newborn. Premature babies may require further specialized examinations by an eye doctor at this time.

Birth to 6 months – Pediatricians will ask you about any family history of childhood vision problems. They’ll check the red reflex (light reflected through the pupil from the back of the eye and assessed by using an ophthalmoscope), size and shape of the pupil, and external structures of the eye.

6 months and up – Pediatricians will continue to check the red reflex, pupils, and external eye structures. In addition, they’ll check that each eye will look at and appropriately follow a toy or face and check for strabismus (eye misalignment).

Starting at 1 to 2 years – Vision can be checked with instrument-based screening devices.

Starting at 3 years – Visual acuity screening (where the child tells the doctor what they see during the exam) is recommended at ages 4 and 5 and can also be done with cooperative 3-year-olds.

Remember to always tell your pediatrician if you have concerns about your child’s eyes and vision. Together, you and your pediatrician can help ensure a lifetime of excellent sight for your child!