So, last week, I had a nice little seven year old come into the office and we were talking about all kinds of things—Christmas, playing baseball, his annoying little sister—you know, typical seven year old stuff. Well the conversation came back to his school performance and a sudden drop-off in his grades. For a few months, he had been doing well, but was having more and more difficulty. He was also having some headaches after school and had requested to move to the front of the classroom himself so he could “hear better.” I asked him if he could see clearly and he said “Yeah, why?” So I asked him to read a passage in a magazine, and he did, but was squinting the whole time. I asked him why he was squinting and he said, “I’m not!” So, we tested his vision, and of course, he was blind as a bat. After thinking about our experience, it was amazing to me that he was able to deal with his vision problems and at the same time didn’t even know he was doing it! Today, we will talk about common vision issues with infants and kids, what to look for, and how to address it.
Most parents think that childhood vision issues are only limited to glasses when kids get older, but in fact, there are lots of different eye issues that can arise, even on the first day of life! In the nursery, your child’s doctor will examine his or her eyes to with a special tool called an ophthalmoscope to see if there is a red reflection in the back of their eyes. This screens for major newborn eye issues and is an important first step. In addition, at birth and throughout the first few months of life, the doctor will look for any alignment abnormalities. Now, almost all babies in the first few months of life will have temporary eye crossing or lazy eyes. As long as it’s temporary, it’s OK. Basically, the eye muscles are a little weak at birth and the infants don’t have great control over them all the time. Sometimes, the infants will have a prolonged period of eye weakness that is followed closely by the physician and if not improving, are referred to a pediatric ophthalmologist. This is a specialty eye doctor who can help assess eye function and improve eye control with medicine or even a patch. Sometimes, if the eye cannot be aligned, for vision and cosmetic issues, the infant might need surgery. As the child gets around three years old, other screening tests are used to measure acuity and around five, they start formal eye tests.
So, what can you as a parent look for to make sure your child‘s eyes are doing ok? As an infant, the first things to look for around 6-8 weeks of life are when your child looks at you and smiles! Next, be sure that they track you or objects equally with both eyes across the room. As they get older, look out for chronic eye redness and/or eye rubbing and itching. Look for eyelid drooping, chronic tearing, or eye drainage. When the kids hit school age, watch for signs like frequent eye squinting while reading, headaches after school, light sensitivity, and/or sudden decline in grades.
One of the more common issues that arises in newborns is a goopy eye. Despite what every daycare says, it’s most likely not pink eye! Eye drainage in the newborn period is usually from an obstructed tear duct. Basically, since most newborns don’t make tears, the duct isn’t flushed out very well and can get some dried gunk in it. So then, the tear duct tries to flush out the gunk by making eye snot—that’s right, eye snot to flush out the dried gunk. The move is to help flush out the gunk by taking a baby washcloth and running it under warm water and then rubbing the tear duct area. That area is a little hump on the lower eyelid near the corner. You can do this three or four times a day until it’s resolved. Sometimes, the obstruction can lead to infection, so if it doesn’t resolve within a day or two, or gets red and worse, then contact your healthcare provider. Talk to your doctor and check out the resources at aap.org about your child’s vision. And remember, if your child needs glasses, let them pick out the frame themselves. They will be much more likely to wear them!