Seeing

What is typical?

Birth to 6 Weeks:

• Stares at surroundings when awake
• Momentarily holds gaze on bright light or bright object
• Eyes and head move together
• One eye may seem turned in or out at times

8 to 24 Weeks:

• Eyes begin to move more widely with less head movement
• Eyes begin to follow moving objects or people
• Watches parent’s face when being talked to
• Begins to watch own hands
• Eyes move in active inspection of surroundings
• While sitting, looks at hands, food and bottle
• Now looking for, and watching, more distant objects

30 to 48 Weeks:

• May turn eyes inward while inspecting hands or toy
• Eyes more mobile and move with little head movement
• Watches activities around them for longer periods of time
• Visually inspects toys they can hold
• Crawls after favourite toy when seen
• Sweeps eyes around room to see what’s happening
• Visually responds to smiles and voices of others
• More and more visual inspection of objects and persons

12 to 18 Months:

• Now using both hands and visually steering hand activity
• Visually interested in simple pictures
• Often holds objects very close to eyes to inspect
• Points to objects or people using words “look” or “see”
• Looks for and identifies pictures in books

24 to 36 Months:

• Occasionally visually inspects without needing to touch
• Smiles, face brightens when viewing favourite objects and people
• Likes to watch movement of wheels, egg beater, etc
• Watches own hand while scribbling
• Visually explores and steers own walking and climbing
• Watches and imitates other children
• Can now begin to keep colouring on the paper
• “Reads” pictures in books

40 to 48 Months:

• Brings head and eyes close to page of book while inspecting
• Draws and names circles and crosses on paper
• Can close eyes on request, and may be able to wink one eye

4 to 5 Years:

• Uses eyes and hands together well and with increasing skill
• Moves and rolls eyes in an expressive way
• Draws and names pictures
• Colours within lines
• Cuts and pastes quite well on simple pictures
• Copies simple forms and some letters
• Can place small objects in small openings
• Passes all the tests described on preceding pages
• Visually alert and observant of surroundings
• Tells about places, objects, or people seen elsewhere
• Shows increasing visual interest in new objects and places

What are the common concerns?

The most common vision disorders in children are refractive errors, which occur when light is not focused on the retina causing blurred vision. Myopia, or near-sightedness, is defined as a condition in which the visual images come to a focus in front of the retina of the eye resulting especially in defective vision of distant objects. Hyperopia, or farsightedness, is defined as a condition in which the visual images come to a focus beyond the retina of the eye resulting especially in defective vision of near objects (nearby objects appear blurry). Hyperopia prevalence varies by age and race/ethnicity. Astigmatism, is an irregularity in the shape of the cornea or lens that causes blurry vision at all distances if not corrected. Children who have myopia or hyperopia are more likely to have astigmatism.

What are warning signs of a vision problem?

Babies up to 1 year of age:

• Babies older than 3 months should be able to follow or track an object, like a toy or ball, with their eyes as it moves across their field of vision. If your baby can’t make steady eye contact by this time or seems unable to see, let your child’s doctor know.
• Before 4 months, most babies’ eyes occasionally look misaligned (strabismus). However, after 4 months, inward crossing or outward drifting that occurs regularly is usually abnormal. If one of these is present, let your child’s doctor know.
• Toddlers and preschool children may squint, tilt their head, hold books close to their face, have crossed or turned eyes, watery eyes, or be clumsy falling over excessively.

What can I do?

Low vision has a significant impact on the amount and quality of information that a child receives. Your child’s development, education and ability to socialise with others may be impacted. The following strategies can be used in your home and school environment:

• Provide maximum contrast between objects and backgrounds using bright plain colours.
• Reduce glare with curtains and blinds and ensure that the child’s back is to the window.
• Reduce clutter and pattern. It may be difficult to locate people and objects if the background is busy.
• Greet a child by name and say your name. Remember to bring your face close to their level to make identification easier.
• Provide time for children to look closely at objects and people, and to touch and explore to make sense of the world around them.

Who can I speak to?

If you have concerns about your child’s vision you can speak to your family general practitioner (GP), paediatrician or make an appointment with an optometrist.