Infants Vision - Development through Early Months
Just like the ability to crawl, walk, talk or use the bathroom, your baby’s vision needs to be honed over time. Your baby is born with visual acuity of about 20/400 and only sees in black, white and shades of gray for awhile before distinguishing colours and shapes and recognizing faces becomes possible. As a parent, it’s your responsibility to stimulate your child’s visual development in addition to watching closely for signs of eye disease or problems. Understanding what is typical and what is cause for alarm is important and will help you gain peace of mind, in addition to helping you catch any potential issues before vision is impacted.
Your Baby’s Eyes at Birth
When your baby is first born, assuming he or she is full-term, their eyes are already 65 percent the size of an adult’s. This can give them a large-eyed, even startled, expression you may find concerning or amusing. Antibacterial gel is applied to almost every baby’s eyes as a matter of procedure immediately after birth, to prevent an infection from bacteria in the birth canal. Your baby doesn’t yet know what you look like and is only seeing the world in shades of contrast, often making bright lights the most interesting thing in the room.
The First Month
Once you bring your newborn home, you may notice his or her eyes are drawn to your hairline the most. This is because of the contrast in shade between your hair and your skin. To help your baby bond with you, keep your hairstyle the same and avoid wearing a kerchief when interacting with your baby. Speak in soothing tones as you move around the nursery to encourage your child to follow the sound with their eyes as well as their ears. At this age, your baby cannot distinguish low levels of light, meaning you don’t need to keep the nursery dark to help your baby sleep.
Your baby’s best visual acuity at this age is eight to ten inches from their face, so you will want to hold them close or lean down to their level to catch their attention. Visual acuity will improve very quickly, and you’ll likely note that your baby begins to shift their eyes back and forth between targets within the first eight weeks of life. He or she should also start focusing more on your face while being held, perhaps switching back and forth from your eyes to your hairline.
You may note that your child’s eyes have a tendency to wander or even cross at this age. This is not usually a cause for concern unless it’s always the same eye that isn’t following its partner and focusing. If you note any disturbing signals, feel free to make an appointment with a pediatric ophthalmologist. Your child was likely assessed in the hospital before coming home, but there’s no harm in taking a second look.
Two to Four Months
As your baby grows, so does their ability to use their visual acuity, track targets and process the stimuli they are seeing. You will note your baby is started to track moving objects and should start to reach for them around the three-month mark. Whether it’s the flash of your earrings or the movement of the family cat during floor time, your baby now notices movement and instinctively wants to touch. It’s never too early to talk to your baby, so feel free to describe the objects he reaches for throughout the day.
At this age, feel free to change the location and orientation of the crib in the nursery and to keep brightly coloured, crib-safe toys within his or her visual range and grasp. If you’re offering a bottle, offer it from the left and the right, switching now and again, to encourage eye movement and focus. Hang a bright mobile over the crib, and consider swapping out the soft, hanging objects occasionally. Leave a lamp or nightlight illuminated to encourage your child to use their vision, as they are still not old enough to be bothered by sleeping in a lighted room.
Five to Eight Months
At this stage, your baby’s colour vision is nearing adult acuity. He or she is also developing depth perception, meaning you will likely note less reaching and grabbing failures. When your baby reaches for a nearby object now, it’s likely he or she will grasp it properly. To encourage this and help foster better colour vision and depth perception, consider a baby gym to give your baby plenty of things to kick, touch and interact with. He or she should get plenty of floor play time to explore toys, their blanket and their own body’s capabilities. While crawling usually won’t start until eight or nine months, make sure family pets keep a respectful distance while the baby is on the floor to avoid accidents.
At six months, your baby will need his or her first eye exam. This exam can diagnose nearsightedness (myopia), farsightedness (hyperopia) and astigmatism, which can delay a child’s development if left untreated. Your optometrist or ophthalmologist will also look or signs of disease and assess your baby’s tracking and focusing abilities to check for developmental delays or other issues. Don’t put this off, as this exam is just as important as vaccines and wellness visits.
Nine Months to a Year
At this stage, your baby is likely mobile, crawling around the room and successfully reaching for objects. You may also notice that your baby now has the visual acuity to discern between colours with ease and even throw objects at an intended target. You can help foster these milestones by sitting and playing on the floor with him, identifying objects and encouraging hand-eye coordination.
You may also note around this age that your child’s eyes are changing colour. This is completely normal, but it can be alarming to first-time parents. Many babies are born with blue eyes, only to have them darken to gray, brown or hazel at this age. As long as the colour change is happening to both eyes and your baby shows no signs of distress, this is a perfectly natural process as the cells of the iris mature.
Symptoms of Possible Trouble
The timeline established here varies from child to child, so it’s not unusual if your baby deviates a bit from the schedule. With that said, there are some alarming signs and signals of which you need to be aware.
- Refusal to make eye contact. If your child is a year old and is still avoiding your gaze, this could be an early sign of autism.
- Tearing or streaming eyes. This could point to an infection, a problem with the tear ducts or the presence of a foreign body. If your baby has watery eyes, make an appointment to see your eye care professional right away and try to keep your child from rubbing their eyes in the meantime.
- An involuntary jerking of the eyes, either horizontally, diagonally or vertically. This condition is called nystagmus and treatment is available. If you notice this eye movement, make an appointment for an exam as soon as possible.
- Crusty or irritated eyelids. This can be a sign of infection, like conjunctivitis or blepharitis or a foreign body in the eye.
- Sensitivity to light. It’s quite normal for a child to turn their head away when transitioning from indoors to bright sunlight or wincing when the overhead light is turned on in a dark room. Even adults do this. What is not normal is an overt sensitivity, which can be a symptom of high pressure inside the eye or a painful eye, possibly due to a corneal abrasion.
- Cloudiness or white spots. The cornea is the rounded, clear section on the front of the eye. If it is cloudy or you notice any spots in it or in the black pupil of the eye, see an eye care professional right away. These signs can point to cancer or congenital cataracts.
- Lack of consistent red eye in photography. When you use a flash for photography, your child’s eyes may show up red in the picture. This is normal and some cameras even correct it automatically. Should you note that one eye is red while the other shines white or slightly blue, however, you need to have your child examined. While very rare, this is a sign of ocular cancer called retinoblastoma.
A Word About Prematurity and Vision
If your child was born premature, meaning he or she arrived before 37 weeks of gestation, it’s possible he or she will be behind on this schedule of expectations. Prematurity also carries with it a risk of retinopathy of prematurity (ROP), which needs to be addressed by an ophthalmologist or pediatric doctor as soon as it’s diagnosed. Speak to your pediatrician or pediatric ophthalmologist about your child’s visual expectations, as premature babies are often about to ‘catch up’ to their full-term counterparts within the first few years of life if properly stimulated.
Your child’s vision develops over time, much like other skills. You can help your child develop their visual acuity and hand-eye coordination, in addition to watching for signs of disease or infection. If your baby needs an eye exam or you would like a second opinion about something that’s troubling you regarding your child’s sight, contact your optician today.
Author: John Dreyer Optometrist Bsc(Hons), MCOPTOM, DipCLP
Created: 20 Mar 2017, Last modified: 4 Mar 2020