Babies and toddlers do not need to know their letters—or even be able to speak—to have a meaningful eye examination.
In young children, vision is assessed very differently from an adult eye test. Rather than relying on answers such as “which is clearer, one or two?”, we use objective measurements, visual behaviour and age-appropriate responses to understand how the eyes and visual system are developing.
At Westmead Eyes, we see babies, toddlers and preschool-aged children using techniques adapted to their age, attention and level of development.
What Are We Looking For in a Baby’s Vision?
A baby’s eye examination is about much more than whether they can “see”.
We may assess:
- whether they notice and maintain attention on a face or target
- whether both eyes appear to see similarly
- how well they follow moving objects
- whether the eyes are straight and working together
- whether one eye is preferred over the other
- whether there is a significant glasses prescription
- eye health
- whether visual behaviour appears appropriate for their developmental stage
Because a baby cannot describe blur, double vision or a difference between the two eyes, these observations can provide valuable information.
Fixation: Can Your Baby Find and Hold a Target?
One of the first things we look at is fixation.
We may observe whether your child can notice a face, light or visually interesting target and maintain their gaze on it.
We can also compare the behaviour of the two eyes. For example, does your child appear equally comfortable looking with either eye, or do they strongly object when one particular eye is covered?
A significant fixation preference can sometimes indicate that one eye is providing clearer or more useful visual information than the other.
Tracking and Eye Movements
Parents often notice visual concerns when their baby does not seem to follow faces or toys in the way they expect.
During an eye examination, we may assess how your child follows a target horizontally, vertically and through different positions of gaze.
We look at things such as:
- whether both eyes move together
- whether fixation is maintained during tracking
- whether the movements appear symmetrical
- whether the child frequently loses the target
- how the eyes and head work together during visual tracking
Visual tracking develops over time, so findings need to be interpreted in the context of the child’s age and overall development.
What Is OKN?
Optokinetic nystagmus, or OKN, is another visual response that can be useful when examining a child who cannot tell us what they see.
When someone looks at a repeated pattern moving across their field of vision, such as black and white stripes, the eyes normally follow the moving pattern and then rapidly reset.
This produces a characteristic eye movement response.
Observing an OKN response can give us information about whether the visual system is detecting and responding to the moving pattern.
It is not a replacement for a full eye examination or a precise measurement of visual acuity, but it can be useful when conventional vision testing is not possible.
Preferential Looking: Babies Often Show Us What They Can See
Young babies naturally tend to look towards something visually interesting rather than an area with little or no pattern.
This behaviour can be used in preferential-looking tests.
A patterned target may be presented alongside a blank area while the examiner watches where the baby chooses to look.
As patterns become finer and more difficult to detect, the child’s responses can help us estimate their level of visual function.
This allows us to gain useful information well before a child is able to identify pictures or letters on a conventional eye chart.
Can You Measure a Baby’s Glasses Prescription?
Yes.
A baby does not need to answer “better one or better two?” for us to detect significant:
- long-sightedness
- short-sightedness
- astigmatism
- differences in prescription between the two eyes
Using techniques such as retinoscopy, we can objectively assess how light focuses through the eye.
This is particularly important in young children because a significant difference between the two eyes may not be obvious to parents.
A child with one stronger eye can sometimes function quite normally while relying predominantly on that eye.
Eye Alignment and Binocular Vision
We also assess whether the eyes appear to be aligned and whether they are developing the ability to work together.
This may include looking for:
- an eye turning in or out
- intermittent eye turns
- fixation preference
- unusual head turns or tilts
- asymmetrical visual behaviour
Early childhood is an important period for visual development.
If one eye consistently provides poorer visual information, or if the eyes are not aligned, this can affect how the brain learns to use the two eyes.
Visual Development
Vision develops alongside a child’s broader neurological and motor development.
During an assessment, we consider whether visual behaviours such as fixation, tracking, visual attention and reaching towards visually interesting targets appear appropriate for the child’s age and developmental stage.
There is a wide range of normal development, so one isolated behaviour does not necessarily indicate a problem.
The overall pattern of visual responses is more important.
When Should a Baby or Toddler Have an Eye Examination?
You may consider an eye examination if you notice:
- one eye regularly turning in or out
- one eye appearing to behave differently from the other
- difficulty following faces or toys
- poor or inconsistent visual attention
- frequent closing or covering of one eye
- an unusual head turn or tilt
- concerns about reaching towards visual targets
- unusual sensitivity to light
- a family history of significant childhood eye problems
- developmental concerns
- a history of premature birth
You do not need to wait until your child can speak or read an eye chart before arranging an assessment.
Baby and Toddler Eye Tests at Westmead Eyes
At Westmead Eyes, we provide eye examinations for babies, toddlers, preschoolers and school-aged children.
Our assessments are adapted to the child’s age and ability and may include evaluation of:
- fixation
- visual attention
- tracking and eye movements
- OKN responses where appropriate
- preferential looking
- eye alignment
- refractive error
- binocular vision
- ocular health
- age-appropriate visual development
A child does not need to know their letters—or even be able to speak—for us to obtain useful information about how their visual system is developing.
Concerned About Your Child’s Vision?
If you have noticed an eye turn, poor tracking, unusual visual behaviour or have concerns about your child’s visual development, you can arrange a specialised children’s eye assessment at Westmead Eyes.