Seeing to Your Baby’s Vision

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Baby Vision

During those first few days after birth, you’ll marvel as your new arrival takes in her surroundings.  You’ll notice her opening her eyes, staring, even seeming to smile at new faces.  As the weeks go by, she seems to look around.  But you may wonder:  is she really seeing?  And at what point will she be able to see as well as I can?

The Eyes’ Learning Curve

Although it’s going to be a while before your baby will be reading street signs—or even an eye chart—it’s generally agreed that babies have quite a bit of vision even on that first day of life.  One estimate has a baby’s vision at 20/400 at birth.  And in those first few days, it seems clear that newborns have a visual preference for a human face.

After birth, infant vision develops at a rapid pace.  You can help that along by providing your baby with lots of face-to-face contact.  Young infants also seem to respond to having bright colors and patterns to look at.  By three months of age, it should be fairly apparent that a baby fixes (appears to look at) objects, especially bright colors and faces.  He should also be able to follow, or move his eyes to keep looking at a moving object.  And although sources differ on the age at which “normal adult” vision is achieved—somewhere between one and five years of age according to various estimates—by late infancy he should certainly see well enough to differentiate familiar from unfamiliar adults!

My Baby Doesn’t Seem to Do Any of That!  Now What?

As with anything concerning you about your little one, it’s important to contact your pediatric provider if there’s any question about her vision.  If she’s not fixing and following, the provider will focus on that first.  Usually in the right environment—not a lot of stimuli except what’s placed in front of the baby—an otherwise visually healthy baby will show some signs of vision development at the proper age.  If there’s any doubt after that examination, likely the baby will be referred to an ophthalmologist—a medical eye doctor—who sees infants.

However, one problem is that many babies—even those without any medical history—are at risk for vision problems even if they appear to see OK.  The one that pediatricians probably worry about the most is known as amblyopia, or “lazy eye.”  This is present in 1 to 4 percent of children and can happen for variety of reasons.  One of the most common is that the eyes do not move together correctly in early infancy, and one eye takes over all the vision duties.  Since both eyes need to be working to see for vision to develop further—a classic example of “use it or lose it”–one eye shuts down.

Although sometimes babies with amblyopia show symptoms—some examples are a tilting of the head or eyes that don’t seem to be lining up right most of the time—many will look normal.  And this is a condition that is more easily treated early on.

Preventing Eye Problems (ESPECIALLY Amblyopia)

One thing that parents can do to help ensure great eyesight is something that they should be doing anyway:  bring the baby in for regular checkups!  The pediatric provider will include an eye exam as part of the well-baby exam.  Usually pediatricians will start by looking for something called a “red reflex”—similar to those “red eyes” in certain photographs, the pupil area will normally have a reddish tinge when viewed through an instrument, known as an ophthalmoscope, that all pediatricians use.  It can be abnormal if the infant has a cataract or tumor in the eye—both rare, but both needing attention.

The provider will certainly make sure the baby can fix and follow at the appropriate age, and may also do something called a “cover test”:  covering one eye.  If the baby gets upset, there may be a vision problem in the uncovered eye.  (This works best with younger infants, as older ones may get upset with any exam!)  Providers will also make sure that the eyes are moving together well.

Finally, it’s now become possible for infants to have their vision screened with a special instrument in the pediatric office.  Some can be used as early as six months of age, allowing providers to diagnose vision problems at a much younger age.  Historically many insurers have not paid for this screening, but parents should really consider talking with their provider about having it done.  Chances are the cost won’t be prohibitive for most, and in a substantial number of children, it can be a vision saver!

For those who really can’t afford instrument-based screening and won’t have it covered by insurance, another option is going directly to an optometrist.  Many insurers who won’t cover instrument-based screening in a pediatric office will cover an optometry visit for infants. If not, there is a program called InfantSEE, which will provide an infant screening free of charge.

What your baby experiences in those first few days is only the beginning.  You want your child to have a lifetime of seeing all of it.  Give her that opportunity by giving her plenty to see and following your provider’s advice on preventive care!

Stan Sack
Dr. Stan Sack has 29 years’ experience as a primary care pediatrician in Massachusetts and Florida. A medical writer since 2015, he enjoys blogging on topics that are on parents’ minds but are covered less often in books and on websites. He lives in the Florida Keys with his family and enjoys healthy cooking, fitness activities and singing in his spare time.

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