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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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. 

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.  

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.  

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.

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.