Pediatric Eye Exams

Key Takeaways

  • Children who do not have regular pediatric eye exams may not develop to their full potential.
  • Children should have eye exams at 6 months, 3 years and 5 years of age.
  • Certain risk factors may require a child to have exams more frequently.
  • Vision tests are instrumental in ruling out or diagnosing learning disabilities.


As parents, we know that supporting our kids through a healthy childhood will include many trips to the pediatrician for immunizations, check-ups and probably a fever or two.

What may come as a surprise is that your child’s regular medical appointments should include visits to the eye doctor, even when your little one is at a tender age.

Eye Exam Timeline for Children

Exams by an ophthalmologist or optometrist may seem like another appointment to fit into your busy schedule, but they are critical to your child’s development.

In fact, healthy eyes are essential to hitting a host of cognitive, social and physical developmental milestones. In the long run, good sight can help children meet their full aptitude in academics, social situations, sports and other hobbies.

Why Regular Pediatric Eye Exams?

The American Optometric Association (AOA) states that an estimated 10% of preschoolers have a vision problem. The problem becomes worse as kids get older. An astonishing 25% of school-aged children suffer from vision issues, according to the National Commission on Vision and Health. More often than not, children are not aware they have a visual problem and therefore do not voice complaints, making regular eye exams critical in childhood.

Children with Vision Problems

It is not uncommon for sight impairments in schoolchildren to have roots in a younger age, even in infancy. As your child grows, their brain learns to use their eyes to see, just as they learn to use their legs to stand or their hands to refine motor skills.

Vision irregularities during early eye and brain development can be a trigger for a lifetime of poor eyesight and vision-related learning difficulties. As with most ailments, eyesight issues can best be prevented and corrected when detected early.

To ensure your child’s eyes mature and function properly, the AOA recommends that your child receive eye exams at ages 6 months, 3 years, and 5 years. Thereafter, children should receive eye exams every two years, or more often for kids with vision problems.

6-Months Exam

Taking your infant to the eye doctor when they are only a half year into their life may seem a little early, but there is an excellent reason for it: your baby’s visual acuity begins to dramatically sharpen at 6 months.

Until this age, infants can only see objects in high contrast and within about a foot of their face. An examination at 6 months with an eye doctor will ensure that your child’s eyes are developing normally and working in tandem.

Hot tip for the 6-months exam

Your family doctor or pediatrician may perform this eye exam, but they are not as well trained as eye specialists. An ophthalmologist or optometrist are best equipped to give the thorough evaluation your child deserves and to identify potential problems.

Your eye doctor will typically evaluate the following visual skills in your 6 month old:

  • Fixation – by 6 months of age, your child should be able to visually lock on an object and follow it. Soon after birth, an infant should be able to fixate on an object, and by 3 months old, a baby should have the ability to visually follow an object.
  • Pupil responsiveness – your doctor will determine whether your baby’s pupils open and close in the absence or presence of light.
  • Detection acuity – this test may involve cards that have stripes on one side to attract the gaze of your infant.

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Preschool & Pre-Kindergarten Exams

Preschoolers are little sponges, taking in the world and growing by leaps and bounds every day. Their multitude of learning experiences will largely be guided by their vision.

During those pre-kindergarten years (ages 2 to 5), a child will hone the visual abilities gained during infancy, while developing new ones too. An eye exam at about 3 years old, and again a couple of years later just before kindergarten, is key to keeping your child on the path towards optimal eye health.

These pre-K exams are designed to detect if your child has difficulty seeing, whether due to nearsightedness, farsightedness or astigmatism. Your child will also be evaluated for other common visual problems like:

  • Eye misalignment – also known as strabismus, crossed or misaligned eyes can be caused by underlying problems such as improper muscle control. Strabismus is a common cause of lazy eye (amblyopia), and should be treated as early as possible to facilitate eye teaming skills.
  • Lazy eye – this is when one eye does not have the same visual acuity as the other eye. Amblyopia is best treated at a young age and cannot always be overcome with eyeglasses or contact lenses. Eye drops or a patch may be needed to improve the health of the weaker eye.
  • Convergence insufficiency – your eye doctor will assess the ability of your child’s eyes to converge and focus on a nearby object for a length of time. This skill is particularly important for reading.
  • Anterior eye health – your doctor will examine your child’s iris, cornea and lens to check for structural irregularities or cloudiness. At this time, your child’s eyelids will be looked over for abnormalities like eyelash follicles, bumps, inflammation and discharge.

What If My Child Doesn’t Know the Alphabet Yet?

It’s not a problem if your little one doesn’t have the alphabet under their belt. There are ways to test for visual acuity that don’t involve the alphabetized vision test that most of us adults take.

LEA symbols swap out letters for easily identifiable symbols like a house, apple, triangle or circle, and are often used on young children, making it easy for them to explain what it is they see.

Eye Charts for Young Children

In addition to taking a visual acuity test, your child may have the following tests performed:

  • Random dot stereopsis – your kid will probably love this one. They get to wear 3D glasses and stare at a pattern of dots. For them it’s a fun game, while we measure how well your child’s eyes work together.
  • Retinoscopy – this test involves shining a light into the eye to observe the reflection from the retina and if there is a refractive error. It is used in determining a corrective lens prescription.

Exams for School-Aged Children

The AOA recommends an eye exam for school kids every two years, if no vision correction is required. Children who wear eyeglasses or contact lenses should plan on being examined annually, or as recommended by their optometrist or ophthalmologist.

When your child is busy in elementary school learning arithmetic and expanding their vocabulary, vision tests are as needed as ever. Vision acuity can change relatively quickly and solid visual skills are paramount to your child performing well academically.

For example, a child who cannot view a blackboard or see print easily can become frustrated, think they are not smart enough to perform reading or mathematical tasks, and experience stagnation in learning and a decline in school performance.

Vision Tests & Learning Disabilities

As this paper from the American Academy of Pediatrics notes, reading disabilities like dyslexia “stem from altered brain function and… such difficulties are not caused by altered visual function.”

In other words, vision exams by your trusted eye doctor are integral to determining if a child’s problems with learning are due to vision dysfunctions or learning disabilities. Only with the right set of tests can your child get an accurate diagnosis, and therefore effective treatment, for their learning problems.

When You May Need to Be Seen More Often

Children considered at risk for developing eye and vision problems may require additional testing, or evaluation on a more frequent basis. Factors that put a child at higher risk for visual impairments include:

  • Prematurity or low birth weight
  • Difficult labor or fetal distress
  • A mother with a prenatal infection
  • A family history of certain eye, genetic or metabolic diseases
  • Certain eye diseases, like strabismus
  • Developmental delays, seizures, cerebral palsy, or other central nervous system conditions

Scheduling Eye Exams for Your Child

When scheduling an eye exam for your child, it’s a good idea to choose a time of day when they are typically attentive and in good spirits. It’ll make it easier on you while there, and more likely that your kid will want to come back to our office next time.

Parents should be prepared to discuss certain aspects of their family medical history – especially relating to sight. Also, be sure to tell your doctor about any problems you have noticed with your child’s vision or related behaviors, such as if your child has:

  • Excessive blinking
  • Frequent eye rubbing
  • Difficulty maintaining eye contact
  • Poor eye tracking abilities
  • Inability to maintain a gaze on objects
  • Delayed motor development

Working with the right doctor, you can dramatically improve the chances that your little one will have quality sight throughout childhood, and all the benefits relating to learning, growing and socializing that seeing well entails.

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