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Parents'
Center
Cooing, sitting up, and crawling are signs that your baby is
growing. Your baby’s vision has stages of development too, but
the signs marking progress are not so obvious.
For many months to come, those little eyes will be the windows
she uses to learn almost everything about her new world.
It’s up to you to help her develop properly, and ensure that
she sees her new world clearly and accurately.
Many eye conditions have no symptoms that can be identified by
a parent or in a well baby check-up. Early detection is the
best way to ensure your child has healthy eyes and appropriate
development of vision- now and in the future.
We can help.
InfantSEE®, developed by the American Optometric Association
and The Vision Care Institute of Johnson & Johnson Vision Care
Inc., is a public health program designed to ensure that eye
and vision care becomes an integral part of infant wellness
care to improve a child’s quality of life. We feel so strongly
about the importance of healthy vision that participating
member optometrists will provide a no-cost comprehensive
infant eye and vision assessment within the first year of
life.
Your baby's
developing eyes
Prenatal care: A bright start
When you are expecting, proper prenatal care and nutrition are
very important to the development of healthy eyes and the
related nervous system. Researchers are continually
discovering more about the link between nutrition and
eyesight.
At birth: Opening to a new world
It might take a moment or two for your baby’s eyes to open.
His eyes should be examined for signs of congenital eye
problems. These are rare, but early diagnosis and treatment
are important to your child’s development. Health
professionals typically administer an antibiotic ointment,
such as erythromycin, to prevent infection. Within a short
period of time, he will begin to focus on objects less than a
foot away, such as mom’s face when nursing.
The latest research shows that complex shapes and high
contrast targets best stimulate the interest of infants. When
setting up baby’s room, include décor that is bright,
contrasting and varied. Babies’ eyes are drawn to new objects,
so be prepared to change the location of items. Also have a
nightlight, to provide visual stimulation when the baby is
awake in bed. While children should be put down to sleep on
their backs to reduce the chance of SIDS, they should have
supervised time on their stomach. This provides important
visual and motor experiences.
Two months: Learning to look
For the first six to eight weeks of life, it is normal for a
child’s eyes to not always track together. This should not be
a concern unless the child’s eyes are never aligned or their
alignment does not gradually improve. Tears are normal for
many children because the tear drainage ducts may not have
fully opened. They usually open on their own, but the doctor
should be informed and he or she will suggest what to do to
stimulate the opening of the ducts if it continues or seems
excessive.
Activity: Stimulating both sides of the body by moving a
child’s arms or legs simultaneously, as parents tend to do
naturally, is helpful in fostering appropriate bilateral and
binocular development.
Four months: Eyes, brains, hands
During the first four months of life, your baby should begin
to follow moving objects with the eyes and reach for things.
At first, this will be inconsistent, and later more accurate,
as eye-hand coordination and depth perception begin to
develop. During the next few months, your baby should begin to
use his/her arms and legs. Eye movement and eye/body
coordination skills continue to develop as vision
progressively stimulates and guides movement.
Activity: Use a nightlight in your baby’s room.
Change the crib’s position frequently and your child’s
position in it.
Keep reach-and-touch toys within your baby’s focus, about
eight to twelve inches.
Talk to your baby as you walk around the room.
Alternate right and left sides with each feeding.
Hang a mobile above and outside the crib.
Six months: A trip to the optometrist
Your baby’s first visit to your doctor of optometry for a
comprehensive eye assessment should be scheduled at six months
of age. The optometrist will test for visual acuity, excessive
or unequal amounts of nearsightedness, farsightedness, or
astigmatism, evaluate eye alignment, and examine eye teaming
ability. The health of your baby’s eyes will be assessed as
well. Although problems are not common, it is important to
identify children who have specific risk factors at this
stage. Vision development and eye health problems can be more
easily corrected if treatment is begun early.
Exercise: Let your baby explore different shapes and textures
with his or her fingers.
Give your baby the freedom to crawl and explore.
Play “patty cake” and “peek-a-boo” with your baby.
Eight to twelve months: Getting mobile
Your baby is mobile now, being attracted to objects in their
visual environment. He is using both eyes together to judge
distances, and is grasping and throwing objects with greater
precision. Crawling is important for developing
eye-hand-foot-body coordination.
Activity: Give your baby stacking and take-apart toys
Provide objects your baby can touch, hold, and manipulate.
Guide to good vision
Vision is a dominant process in the growth, development and
daily performance of children. Good vision includes healthy
eyes, age appropriate visual acuity, visual integration and
visual skills such as eye teaming, eye focusing and eye
motility. Optometrists can evaluate these components and help
ensure your child reaches his or her potential.
Visual acuity: Visual acuity is the ability to see objects
appropriate for your child’s age. It can be measured by your
optometrist long before your child can read or recognize
letters.
Eye health: Eye disease can impair vision or lead to vision
loss if not diagnosed and treated. Most conditions can be
treated best if caught early.
Visual integration: The ability to process and integrate
visual information, which includes and coordinates input from
our other senses and previous experiences so that we can
understand what we see. The eye-hand coordination involved in
tossing a ball, or a game of patty-cake, requires a great deal
of teamwork between the senses.
Visual skills your baby is learning:
Eye teaming: The ability of the eyes to work together.
Eye focusing: The ability of the eyes to focus clearly at
different distances quickly, accurately, and for sustained
periods of time.
Eye motility or tracking: The ability of the eyes to smoothly
follow moving objects and to move accurately from one object
to another.
Common terms about eye health
Amblyopia:
Also known as “lazy eye,” amblyopia is reduced vision in a
healthy eye. Vision must develop, and development is impaired
when eyes do not focus equally or maintain proper alignment.
The brain ignores the information from the less favored eye.
In either case, if this condition persists, the weaker eye
will not develop normally. In babies, who are learning to use
their eyes as a team, it’s easier for an eye doctor to
distinguish between appropriate development and delays that
could signal the need for intervention. Early detection of
amblyopia is important because treatments such as patching and
eye drops are most effective the earlier they are started.
Astigmatism:
Astigmatism blurs vision at all distances because the optical
parts of the eye (cornea and lens) do not focus light onto the
retina clearly. This condition is quite common, and results
from an unequal curve of the cornea when comparing the
horizontal and vertical planes. For descriptive purposes,
imagine half of a tennis ball, squeezed at the top and bottom;
the ball is now curved unequally. In the eye, this results in
inaccurate focus on the retina. Lenses are often used to help
focus the light to eliminate blurriness from astigmatism.
Hyperopia:
Often called farsightedness, hyperopia is when the eyeball is
too short for the normal focusing power of the eye. Depending
on severity, it can cause blurred vision, eye fatigue and
sometimes amblyopia or crossed eyes.
Myopia:
Often called nearsightedness, myopia causes distant objects to
appear blurred. The eyeball is too long for the normal
focusing power of the eye.
Strabismus:
Strabismus occurs when one eye does not aim at the same object
being viewed as the other eye. The “eye turn” may be present
continuously or only occasionally, and the turn may be inward
toward the nose (esotropia) or outward (exotropia), up or
down. There is a common misconception that a child will
outgrow crossed-eyes. This is not true. Untreated, this
condition can lead to amblyopia.
Optometrist:
American Optometric Association doctors of optometry are
highly qualified, trained doctors, on the frontline of eye
health and vision care, who examine, diagnose, treat, and
manage diseases and disorders of the eye. In addition to
providing eye and vision care, optometrists play a major role
in an individual's overall health and well-being by
appropriately detecting systemic diseases. Doctors of
optometry provide more than two-thirds of all primary eye care
in the United States. The American Optometric Association
represents more than 33,000 doctors of optometry, optometry
students and paraoptometric assistants and technicians in
nearly 6,500 communities across the country. For more
information, visit www.aoa.org.
Why should I take my baby to
an InfantSEE® provider?
An InfantSEE® assessment between six and 12 months of age is
recommended to determine if an infant is at risk for eye or
vision disorders. Since many eye problems arise from
conditions that can be identified by an eye doctor in the
infant’s first year of life, a parent can give an infant a
great gift by seeking an InfantSEE® assessment in addition to
the wellness evaluation of the eyes that is done by a
pediatrician or family practice doctor.
One in every 10 children is at risk from undiagnosed eye and
vision problems, yet only 13 percent of mothers with children
younger than 2 years of age said they had taken their babies
to see an eye and vision care professional for a regular
check-up or well-care visit. Moreover, many children at risk
for eye and vision problems are not being identified at an
early age, when many of those problems might be prevented or
more easily corrected. Some 4.02 million children were born in
2004, according to the U.S. Census Bureau. In approximately 4
percent, strabismus will develop, and amblyopia will develop
in 3 percent–this equates to as many as 100,000 infants born
each year who are at risk for serious eye and vision problems.
Early intervention is critical to successful and
cost-effective treatment. Despite the nation’s present system
of preschool vision screening, there exists a lack of
understanding by the public of the importance of periodic
professional eye and vision assessments. Unfortunately, during
the course of their young lives, most children probably never
see an eye care practitioner who can provide the kind of
professional eye assessment necessary to identify critical eye
and vision problems at an early stage, explain those
conditions to parents, and provide the care necessary to
correct those problems.
Optometry has stepped forward to accept its public health role
and make a significant contribution to our society in the area
of infants’ eye and vision health. To that end, the American
Optometric Association, with The Vision Care Institute of
Johnson & Johnson Vision Care, Inc. as a working partner, is
launching InfantSEE®, a first-of-its-kind national program to
provide children professional eye and vision care earlier in
life. The program will address the early childhood segment of
the pre-school population, providing no-cost infant eye and
vision assessments before the age of one year.
With Former President Jimmy Carter and Former First Lady
Rosalynn Carter as honorary spokespersons for the program, and
The Vision Care Institute of Johnson & Johnson Vision Care,
Inc. promising multi-year support, InfantSEE® has the
potential to change the nation’s concept of early childhood
wellness care to include a professional eye and vision
assessment as a necessary step in assuring an infant’s overall
health and wellness.
Eye problems that 'the
system' is missing now
Are children with eye and vision problems ‘falling through the
cracks’?
In a word, yes.
Fact: Vision disorders are the fourth most common
disability in the United States and the most prevalent
handicapping condition during childhood.
Fact: Below the age of 6, only about 14 percent are
likely to have had an eye and vision examination.
Fact: Pediatricians provide an important base-level eye
screening that is designed to detect gross eye abnormalities.
A comprehensive eye assessment by an optometrist is designed
to detect much more and is an important part of your well baby
care.
Fact: The American Public Health Association adopted a
resolution that recognizes the shortcomings of vision
screenings, encourages regular eye examinations at the ages of
6 months, 2 years, and 4 years, and urges pediatricians to
recommend that all children receive eye examinations at these
intervals.
Fact: Healthy People 2010, a national disease
prevention initiative of the U.S. Department of Health and
Human Services, also recognizes the importance of preventive
vision care. One of its goals is “to improve the visual health
of the Nation through prevention, early detection, treatment,
and rehabilitation.” These national efforts to inform the
public about the importance of early eye care and the current
limitations of vision screening are issues that all
optometrists need to discuss within every community until all
children receive professional eye examinations on a regular
basis throughout childhood.
For these reasons, members of the American Optometric
Association and The Vision Care Institute of Johnson & Johnson
Vision Care, Inc. have joined forces to create InfantSEE®, a
public health program to ensure that every infant in America
has the opportunity for a professional eye and vision
assessment during the first year of life at no charge.
Former President Jimmy Carter and First Lady Rosalynn Carter
have pledged their support for the program for a very
important, personal reason: They have two grandchildren with
amblyopia. For one grandchild, the condition went undetected
until he was well into grade school, when classroom
difficulties made the condition apparent. Had a program like
InfantSEE® been in place then, he may have been treated with
far less effort and would have found academic success sooner.
Why do you suggest getting
the eyes tested at 6 months?
Clinical experience and research have shown that at 6 months,
the average child has reached a number of critical
developmental milestones, making this an appropriate age for
the first eye and vision assessment. Many visual abilities are
fully functioning by the age of 6 months. Interference with
development during this very critical phase may lead to
serious lifelong effects on vision. Successful treatment can
be obtained more quickly with early intervention.
The good news about a trip to the optometrist is that there
are no shots or cold stethoscopes. While the doctor will be
shining a light in the baby’s eyes, and may spray a mist on
eyelids or use eye drops to dilate the baby’s pupils, many
infants seem to enjoy the “games” they play as part of the
professional assessment.
Preparing for a trip to the
optometrist
Everyone understands that the young patient may be cooperative
for only a limited period of time. The optometrist may send
you the patient history and information forms prior to the
visit, or they may even have the forms on his or her Web site,
so that you can complete the paperwork at your convenience.
When setting an appointment time, let the practitioner know if
you have any special concerns or conditions. Set an
appointment time that is most agreeable to the baby’s
schedule, avoiding nap time.
On the day of the visit, change the infant’s diaper just
before the assessment. Children in this age group generally
perform best if the assessment takes place when they are
alert. Because infants tend to be more cooperative and alert
when feeding, it is also helpful to bring a bottle to feed the
child. Bring a security toy or object for the infant, but also
toys or games that will hold older siblings’ interest if they
are coming too. If possible, arrange for only the infant and
the parent to be in the exam room during the assessment.
During the assessment, most likely you will be asked to hold
the baby on your lap, or on a lap pillow. Parents should be
present for the assessment to help the baby focus on the
doctor, so avoid talking to the baby or adults during the
assessment. You may be recruited to hold targets or be a
puppet master to hold the baby’s attention during certain
procedures. The optometrist may encourage the child to touch
and explore the instrument. Be ready to play each “game” first
to show the baby that it is safe and fun.
What the optometrist is
looking for during the assessment
Babies can’t speak. How do
you test their vision?
Optometrists have the clinical background and expertise
necessary to provide eye and vision assessments for any
non-verbal patients, including infants. The optometrist is
looking for answers to the same questions you are:
Patient History:
Some eye conditions are strongly linked to family history, so
the first step for the optometrist is to compile a history on
the child. A comprehensive patient history for infants may
include any problems you have noticed, visual and ocular
history, general health history, family eye and medical
history, developmental history and demographic data.
Factors placing an infant, toddler, or child at significant
risk for visual impairment include:
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Prematurity,
low birth weight, oxygen at birth
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Family history
of eye diseases such as retinoblastoma, congenital
cataracts, or metabolic or genetic disease
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Infection of
mother during pregnancy (e.g., rubella, toxoplasmosis) or
drug/alcohol use during pregnancy
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Sexually
transmitted diseases, cytomegalovirus, or HIV
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Difficult or
assisted labor, which may be associated with fetal distress
or low Apgar scores
Visual
Acuity:
Because traditional eye chart testing requires identification
of letters or symbols and demands sustained attention, this
test cannot be used with infants and toddlers. Assessment of
visual acuity for infants and toddlers may include tests to
assess that the infant can fix his eyes on an object and
follow the object, or at which objects the baby prefers to
look, and at what distances.
Refractive Status:
The doctor may use lenses and light from a small hand-held
instrument to assess how the eye responds to particular
targets. The doctor may also repeat this test after using eye
drops to enlarge the pupil and stabilize the baby’s focusing.
As an alternative, some doctors use photographic testing to
then analyze the pupil reflex in the photo.
The typical infant may have some degree of nearsightedness,
farsightedness, and astigmatism not requiring correction.
Studies show that 30 to 50 percent of infants under 12 months
have significant astigmatism, which declines over the first
few years of life, becoming stable between approximately 2½ to
5 years of age. Low amounts of anisometropia (where the
refraction is not the same in both eyes) are common and
variable in infants.
Eye movement:
Using her hands, a light, or a toy, the optometrist catches
the baby’s attention and observes how the baby follows the
movements of the object.
Eye Alignment/Binocular Potential:
By covering one eye at a time, the optometrist gathers
information about the eye muscles and acuity. While
identifying strabismus is important in itself, the presence of
strabismus may indicate any number of disease entities.
Eye Health:
The optometrist will examine the eye’s structure as well as
eyelids, tear ducts, and other parts of the eye. Pupil
function will be checked, and a hand-held biomicroscope may be
used for evaluation of the front of the eye. A test to assess
visual field will be completed and an examination of the inner
eye through a dilated pupil will be done. An ideal time for
evaluation of the posterior segment is when the infant is in a
calm, relaxed, condition (i.e., being bottle fed or sound
asleep).
The assessment:
In addition to sharing her findings with you, you may request
the optometrist to send summary letters to the infant’s
pediatrician, family physician, or other appropriate
practitioner, reporting and explaining any significant
condition diagnosed in the course of the assessment.
Contents taken from the
InfantSee website Infantsee.org
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