Your Child’s Vision: Your Child’s Visual Milestones
At birth, the infant’s visual function is not fully developed but continues to develop in the first few years of life. It is therefore important to monitor your child’s vision as he/she grows so that any abnormalities can be detected and treated early.
The visual milestones (see Table below) are a useful guide to monitor your child’s visual development. If the child does not appear to follow the milestones or if you have any concern, do consult an eye doctor, optometrist or orthoptist for a more thorough eye examination.
Children’s Visual Milestones
|0-3 months||At birth, the vision is poor (only in the range of hand movements or count fingers). The newborn infant will initially choose to look at light sources such as a torch and only begin to develop eye contact with adults from around the age of 6-8 weeks. The infant will soon be able to follow large objects which move slowly within his/her environment.|
|3-6 months||The child will now begin to reach objects with his/her hands especially brightly coloured and larger objects. The eyes will begin to move more widely and with less head movement. The child will also be learning to grasp with his/her hands and also watch the parent’s face when being talked to.|
|6-12 months||The child is now able to see smaller objects such as ‘100s and 1000s’, bread crumbs or sweets. The child will try to pick them up and place them in his/her mouth! The child can also interact with the parents as he/she will be interested in simple pictures in books or drawn for him/her. He/she will be able to fixate and follow objects of interest such as his/her favourite toy.|
|12-18 months||The child is able to recognize people’s faces and pictures. As the child begins to crawl, he/she is able to know the way around the house. At this age, the child’s vision can be estimated by putting ‘100s and 1000s’ in your palm and watching the child reach for them.|
|18-24 months||The child now becomes interested in picture or cartoon books, and may even recognize them as representations of real objects. The child’s vision can be estimated by rolling STYCAR balls of decreasing sizes at around 3 m in front of the child and the child should be able to follow the balls movements. The vision corresponds to the smallest ball that the child is able to see moving. The child’s vision can also be assessed using Forced Preferential Teller Acuity Cards or Cardiff picture cards if the child is cooperative.|
|2 years onwards||The child’s vision is almost at its peak development but continues to improve until the age of 7-9 years old. The vision can now be tested accurately using picture recognition and matching technique with Kay or Cardiff picture cards. All children should be screened by the age of 3 years because squints and amblyopia (lazy eye) usually manifest by this age group.|
Children at risk
In most cases, the child’s vision develops without any problems. However, in some children, there may be problems during the early development of their vision and this may affect the development of the child’s other milestones such as speech (as the child cannot see words to learn) or motor development (as the child does not have the confidence to see where he/she is crawling or walking). The child may also have difficulty bonding with the mother as he/she may not be able to see the mother’s facial expressions.
Children at risk include those:
- Who have someone in the family with eye diseases such as congenital cataract, squints or high refractive errors which may be hereditary in nature
- Born to mothers who were ill during pregnancy (especially during the 1st trimester) with infections such as rubella, cytomegalovirus or herpes virus
- Born prematurely (especially less than 32 weeks gestation)
- With low birth weight (especially less than 1.5kgs)
- Who have Down’s syndrome or are educationally subnormal
Ms. Melanie Yeoh
Orthoptist (lazy eye /squint)
Dr. Tsiang Ung
Dr. Manoharan Shunmugam