Toddler Through Age 5

After the first year, children's eyes and vision continue to develop. Their eye muscles gain strength, and the connections between nerves multiply. This development is aided by providing visual stimulation. Activities such as stacking building blocks, coloring, and cutting all assist in improving eye/hand/body coordination, eye teaming, and depth perception. By age three, most children have developed the necessary language and motor skills that allow them to participate in some traditional vision tests.

Preschool

During the preschool years, a child's vision keeps developing. The child develops visually guided eye/hand/body coordination, the fine motor skills and visual motor skills required for reading. The following can facilitate a preschooler's visual development:

• reading aloud to the child and letting him or her see what is being read
• providing a chalkboard or finger paints and demonstrating   how to use them in play
• allowing time for interacting with other children and for playing alone

School Age

It is important that children have a complete eye examination before beginning school. The optometrist or ophthalmologist needs to determine if a child's vision is prepared to handle reading, writing, and other close-up activities. While toddlers use their eyes primarily for distance sight, school requires that the child's eyes focus on very close work for hours every day. This activity occasionally causes eye problems to arise. It is important to note that children rarely report vision problems. They believe their vision is normal and believe others see the way they do.

The basic vision skills needed for school work are:

• near vision (the ability to see clearly at 10–13 inches [25-32 cm])
• distance vision (the ability to see clearly beyond arm's reach)
• binocular vision (using both eyes together for depth perception)
• focusing skills (the ability to keep both eyes accurately focused at the proper distance)
• eye movement skills (the ability to aim the eyes accurately)
• peripheral awareness (the awareness of objects located to the side while looking straight ahead)
• eye-hand coordination

Common Problems

Infants born prematurely have more difficulty integrating and interpreting visual information even when their acuity is normal. In some cases, children develop their visual reflex later than normal. This is called visual maturation delay. A condition, nystagmus, which sometimes develops in infancy, causes the eyes to jump, dance, wiggle, or oscillate. Babies with this problem may or may not have normal vision.

Parental Concerns

Parents need to assess their child frequently for any signs that the child's visual development is not progressing as expected. Some vision disorders are untreatable at later ages, so it is important to have the child seen by an optometrist or ophthalmologist no later than the age of three.

When to Call The Doctor

At the first signs of eye and vision problems, parents should consult their pediatrician, optometrist, or ophthalmologist. Some of these signs are:

• an eye that is crossed far into the nasal area
• eyes turned grossly in or out or which do not move normally before the age of three months
• an eye that moves while the other remains still
• an eye that appears considerably different from the other
• the inability at three months of age of an infant to follow a toy passed in front of him from side to side

During the preschool years, parents should continue looking for signs that a vision development problem exists. These signs may include a short attention span for the child's age; difficulty with eye/hand/body coordination; or the avoidance of coloring, puzzles, and other activities.

A child should have his first eye exam by the age of three (or sooner if vision problems run in the family), so the practitioner can assess if vision is developing normally. Vision should be checked again when the child enters school.

Some of the signs of visual problems in the school age child are:

• frequently losing his or her place while reading
• frequently avoiding close work
• holding reading material closer than usual
• frequently rubbing the eyes
• complaining of headaches
• turning or tilting the head to use one eye only

Since vision changes may occur without the parents or the child noticing them, a child should visit an eye doctor at least every two years, more frequently if specific problems or risk factors exist.