Detecting Vision Problems in Toddlers

"It first became evident to me and my husband that our child Ryan may have problems with his eye sight two months into his first grade year," recalled Janet Benson (real name withheld for privacy reasons), mother of six-year-old Ryan Benson. "We noticed that he was struggling in school, especially in comprehension skills," Janet observed.

But it was when Ryan's teacher mentioned that he rarely participated in class that Janet really started to pay attention to Ryan's behavior.

"At home, Ryan always has something to say and is very outspoken, so it just seemed odd to us that he was acting so reserved in school," Janet said.

In Ryan's case, it was only after his first school eye exam that the root of his struggles was resolved.

Ryan was diagnosed with myopia, or being near-sighted, and needed prescription glasses.

Detecting when your child is having trouble with his or her eyesight is not always clear from the onset. It can take months--as it did Janet Benson--to figure out why your child is not thriving in school or behaving differently than normal. Because most young children under the age of six cannot pinpoint the root of the issue themselves, it is really up to parents and teachers to initially become aware of the symptoms and then take the next step of setting up an eye examination with their pediatrician.

So when should your child get their first eye examination, and do you have to wait until it becomes an obvious issue?

"The eye check starts as soon as the child is brought in for their initial well baby check-up, which is approximately two weeks after birth," said Joan Stroud M.D., family medicine physician and associate medical director of CABS Health Center in Brooklyn, N.Y.

According to Dr. Stroud, during these early examinations a child is checked for early signs of congenital cataracts, blocked tear ducts and bacterial conjunctivitis. But it is not until the child's annual checkups at four years old that further vision tests and exams are performed.

According to Arnold Scherz, M.D. F.A.A.P., partner in pediatric and adolescent medicine of Holbrook, N.Y., the first eye exam is differentiated between screening exams and an exam for an eye complaint.

"Pediatricians and family practitioners can do visual acuity testing for a cooperative four year old and then annually," Dr. Scherz added. "There is also a screening test for unsuspected 'lazy eye' called VEP (visual evoked potential). It is done beginning at six months old and then annually through eight years old."

Dr. Scherz advises that parents should bring their children in to see their pediatric ophthalmologist for some obvious and not so obvious reasons.

"Of course," Dr. Scherz states, "complaints of altered vision, eye pain, eye turning and eye trauma are cause for quick referral."

However, most children experience more subtle symptoms that indicate a consideration for glasses.

Dr. Scherz recommended that parents and teachers keep a sharp eye out for these symptoms:


--Complaints of blurred vision

--Difficulty seeing the black board

--Eye turning (caused by poor vision)

--Family history of early visual acquit problems

According to the American Association of Certified Orthoptists, children may need glasses for many reasons, some of which are different from adults.

Because a child's vision system is growing and developing, especially during the first 5-6 years of life, glasses may play an important role in ensuring normal vision development. As outlined on the AACO's website at, the main reasons a child may need glasses include:

--To provide better vision, so that a child may function better in his/her environment

--To help straighten the eyes when they are crossed or misaligned (strabismus)

--To help strengthen the vision of a weak eye (amblyopia or "lazy eye"). This may occur when there is a difference in prescription between the two eyes (anisometropia). For example, one eye may be normal, while the other eye may have a significant need for glasses caused by near-sightedness, far-sightedness or astigmatism.

--To provide protection for one eye if the other eye has poor vision

The issue of whether or not glasses make a child's eyes deteriorate, or more dependent on them, is often raised once the doctor makes his or her diagnosis. According to the AACO, the very opposite may be true.

"In fact, if a child does not wear the glasses prescribed, normal vision development can be adversely affected," the AACO states.

In some cases, children need glasses when they are young and "grow out of them" a year or two later and may never need glasses again as adults.

But is there anything parents can do to lessen the chances their child will need glasses? According to Dr. Scherz, preventative measures of good vision are few but significant.

He recommends:

--Using appropriate eye protection for certain sports or other potentially eye injuring activity

-- Alerting the doctor when any eye symptoms occur

--Nursing infants, or alternatively feeding them one of the newer supplemented formulas. (Similac Advance or Enfamil Lipil) have been shown to improve early visual development.

--Good nutrition that is high in foods that contain vitamins A, C, E and Beta-carotene. (For a complete list of specific foods please refer to

"Since Ryan got his glasses, he has excelled tremendously in school and is one of the most inquisitive students in class," says his mother Janet.

Ryan's success story is just one of many that proves having good vision starting from a young age is key to getting the most out of life. Taking the necessary steps to ensure your child is not struggling but excelling in school can be as simple as eating more carrots, paying attention to any vision complaints, and most importantly, being diligent about scheduling your child's annual eye exam.

Reviewed by Health Managing Editor Dr. Manny Alvarez

For more great information on living healthy through every decade of life, click here to check out Dr. Manny's book The Check List (Harper Collins, 2007).

Dr. Manny Alvarez is the managing editor of health news at, and is a regular medical contributor on the FOX News Channel. He is chairman of the Department of Obstetrics and Gynecology and Reproductive Science at Hackensack University Medical Center in New Jersey. Additionally, Alvarez is Adjunct Professor of Obstetrics and Gynecology at New York University School of Medicine in New York City.