A child will not tell you they cannot see

What to watch for, by age

The signs change as a child grows. These are the ones worth acting on.

• Babies up to one year: no eye contact by around three months, a white reflection in the pupil in photographs, constant watering or a sticky eye, an eye that drifts
• One to five years: sitting very close to screens, rubbing the eyes often, tilting the head to look at things, avoiding close work like colouring, one eye turning in or out
• School age: headaches, holding books very close, squinting or screwing up the eyes, copying from the board becoming a problem, marks dropping without an obvious reason

Conditions treated here

Most childhood eye problems have a window in which treatment works well, and the window narrows with age. That is the whole reason for checking early.

• Squint, or strabismus: eyes that do not point together. Glasses, patching or surgery depending on the type
• Lazy eye, or amblyopia: one eye developing weaker vision. Highly treatable young, much harder after about eight
• Refractive errors: short sight, long sight and astigmatism, corrected with child appropriate glasses
• Childhood cataract: uncommon but urgent, because it blocks visual development
• Blocked tear ducts: the cause of a permanently watery, sticky eye in a baby. Often settles with massage
• ROP screening: retinopathy of prematurity screening for babies born early
• School vision problems: the everyday case, and the one most often found late

When to have eyes checked

A first check at around six months, again at about three years, and once more before the first year of school. Earlier if the baby was premature, if there is a family history of squint, lazy eye or strong glasses, or if you have noticed anything on the list above. You do not need your child to know their letters. Vision is measurable long before that.

What the visit is like

Testing is done with pictures and shapes for children too young to read, and the pace follows the child. Drops are often needed to measure the true spectacle power in children, because a child’s focusing muscle is strong enough to mask a real error. Those drops blur near vision for several hours, so plan a quiet afternoon and skip homework that day.

On screens

Screen time is not destroying your child’s eyes, but it does two real things: it triggers dry, tired eyes, and time indoors is linked with short sight progressing faster. The most useful thing you can do is send them outside in daylight every day, and put breaks into long stretches of close work.

Questions people ask about this