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Newborns have all the eye structures necessary to see, but they haven’t learned to use them yet. Infants' vision begins to develop at birth. Babies spend much of their early weeks and months of life learning how to see--developing such skills as focusing, teaming their eye movements, recognizing depth, developing eye-hand coordination, and making spatial judgments. As the child grows, more complex skills, such as visual perception and visual motor integration, develop to meet the child’s growing need to understand and interpret his world.  

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Birth to Four Months  

When they’re born, babies see in black and white and shades of gray. Because newborns can only focus eight to twelve inches, most of their vision is blurred. Babies first start to learn to focus their eyes by looking at faces and then gradually moving out to bright objects of interest brought near them. Newborns should be able to momentarily hold their gaze on an object for a few seconds, but by 8-12 weeks they should start to follow people or moving objects with their eyes. At first, infants have to move their whole head to move their eyes, but by 2-4 months they should start to move their eyes independently with much less head movement. When infants start to follow moving objects with their eyes they begin to develop tracking and eye teaming skills. Young infants haven't learned to use their eyes together; they haven't developed enough neuromuscular control yet to keep their eyes from crossing. This alarms many parents, but by 4 or 5 months babies usually have learned to coordinate their eye movements as a team and the crossed-eyes should stop. (If you're seeing your infant's eyes cross after this time, this could indicate a problem, and you should seek the advice of your family optometrist.) By four months, babies start to reach for objects, the beginning of eye-hand coordination.  Also by four months of age, babies's visual systems have developed the ability to see in full color, and they're exposed to an exciting new world!  

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Four to Six Months  

As babies learn to push themselves up, roll over, sit, and scoot, eye-body coordination develops as they learn to control their own movements in space. Likewise, four- to six-month-old babies become quite skillful with their eye-hand coordination, able to direct a bottle into the mouth or grasp at objects freely. Their hands become their most important tool--they reach for almost everything they see!   This is also the time they start to work on remembering things they see.

By the fourth or fifth month, babies' brains have finished learning how to fuse the pictures coming in from both their right and left eyes into a single image for full binocularity, or "two-eyed" vision with  strong depth perception. Spatial and dimensional awareness continue to  improve as baby learns to aim accurately when reaching for objects of interest. Likewise, they refine their eye teaming and focusing skills as they learn to look quickly and accurately between near and far distances. Normal visual acuities, or a child's sharpness of vision, has usually developed to 20/20 by the time the child reaches six months. 

 

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Six to Eight Months  

Most babies start crawling during this time, further developing eye-body coordination. They learn to judge distances and set visual goals, seeing something and moving to get it. Their sudden freedom allows for many new experiences and the rapid development of visual perception skills as babies experience their own bodies in relation to other objects and notice differences in size, shape, and position. By the sixth month, babies acquire fairly accurate eye movement control. Some experts warn that early walkers may not learn to use their eyes together as well as babies who have crawled a lot and teamed their eyes more when looking at close-up objects.  

 

 

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Eight to Twelve Months  

Babies can now judge distances well. Eye/hand/body coordination allows them to grasp and throw objects fairly accurately. Perception skills such as visual memory and visual discrimination help babies make sense of their exciting new world. The integration of their vision and fine motor coordination allows babies to manipulate smaller objects, and many begin feeding themselves with finger foods. Once children start walking, they learn to use their eyes to direct and coordinate their bodies' large muscle groups to guide their whole body movements.  

 

 

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Toddlers and Preschoolers  

Children’s vision continues to develop throughout their preschool years. As toddlers, it is important for them to continue development of eye/hand/body coordination, eye teaming, and depth perception. Stacking building blocks, rolling a ball back and forth, coloring, drawing, cutting, or assembling lock-together toys all help improve these important skills. Also, reading to young children is also important. They develop strong visualization skills as they "picture" the story in their minds.

A child should have his first eye exam by age three (sooner if vision problems run in the family) so the optometrist can check if vision is developing normally and catch any problems early. Vision should be checked again when the child enters school.  

 

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School-Aged Children  

It is important for children to have a complete eye examination before starting school. The optometrist needs to determine if a child’s vision system is adequately prepared to handle reading, writing and other close work. The demands of schoolwork can put too much stress on a child’s visual system, causing problems even if none existed before. Whereas toddlers use their eyes mostly for looking at distance, school requires children's eyes to focus on very close, small work for hours every day. This can cause vision problems to arise. Children don’t often realize that their eyes are under too much strain, and they rarely report vision problems. Because their vision is "normal" to them, they think everyone sees the way they do.  

School vision screenings provide a valuable service, but children can pass a school eye chart test and still have undetected vision problems which are affecting their school work. The eye chart just checks a child’s sharpness of vision, but reading requires many other visual skills. The eye chart test can’t tell is a child’s eyes are healthy, or if he can track a line of print without losing his place, focus his eyes comfortably, or use his two eyes together for long periods of time. School vision screenings are no substitute for a complete eye examination by your family optometrist.  

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Choosing an Eye Doctor for Learning-Related Vision Problems

In order to check if your child has developed adequate visual skills for success in school, your choice of an eye doctor is very important.  Routine exams will check to see if your child's eyes are healthy and if he/she needs glasses to see clearly, and all eye doctors can do this.  However, children who struggle in school need additional tests beyond a routine eye exam.  Here are some helps in choosing an eye doctor:

Ophthalmologists are eye doctors who specialize in surgery and eye disease, and generally ophthalmologists do not have training in this specialized area of care. You will need to schedule an appointment with an optometrist, an eye doctor trained with an extensive background in dealing with visual systems under stress, such as the demanding close work and small print required for school performance.  However, many optometrists do not incorporate this specialized area of children's vision care within their practice, so you're going to have to make additional inquiries.  When making the appointment, ask if the doctor can run eye teaming, focusing, and tracking tests such as cover tests, vergence ranges, and the Developmental Eye Movement test.  If the doctor does not, then ask if he or she can refer you to a colleague or specialist who does.

Ideally, you need a pediatric optometrist who specializes in learning-related vision problems.  These optometrists are called "developmental" optometrists, or sometimes "behavioral" optometrists, who have received the professional credentialing of Fellow in the College of Optometrists in Vision Development (FCOVD).  Click here for more information about developmental optometrists, or visit the website of the national certifying board for pediatric optometrists at covd.org

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Free Vision Screenings for Infants and Three-Year-Olds

The early years of life from birth until age five are crucial for a child’s visual development and eye health.  The American Optometric Association  recognizes how important it is to get your baby's vision off to a good start.  InfantSEE™ is a free public health program for children during their first year of life; participating AOA optometrists provide a comprehensive infant eye assessment at no cost to the parents. Visit www.infantsee.org for more information.

The Kansas Optometric Association also sponsors the "See to Learn" program. In order to identify vision problems in pre-school children, all three-year-olds in Kansas are eligible for free vision screenings by participating KOA optometrists. Contact your local Kansas optometrist for more information, or visit the See-To-Learn web site at www.seetolearn.com.  

If you live in Wichita, Child and Family Optometry participates in both the InfantSEE™ and See to Learn™ programs.  We invite you to call (316) 721-8877 to schedule an appointment.

 

Free Screenings for School-Aged Children who Struggle 

The Wichita Vision Development Center invites parents of school-aged children in Wichita and south-central Kansas to schedule a free vision screening when they suspect their child may be struggling with poor vision or inadequate visual skills.  The screenings are offered at no cost or obligation as part of our community service commitment to help identify at-risk children who are struggling needlessly because of poor vision.  Click here for more information or call (316) 722-3740 to schedule an appointment.   

 

 
 

The Children's Vision Information Network was created to raise public awareness about potential vision problems in children.  This site is not intended as a substitute for a complete eye exam and professional advice from your family optometrist.  Parents, teachers, occupational therapists, psychologists, and related professionals have permission to copy and distribute information contained in the site for educational purposes only with the condition that each page is copied in its entirety with the URL included (www.ChildrensVision.com).  All publishing rights are reserved. Direct specific inquiries to Mary Barton, Director of Vision Therapy, at (316) 722-3740 or email VTDirector@ChildrensVision.com.