Your Baby Wants To See You!

By: Ben Franklin

Vision contributes a great deal to an infant's perception of the world. Many parents naturally are concerned about their child's vision. In infants, however, serious eye conditions and blindness are rare. Babies can, however have eye problems, so an eye checkup is still an important part of well-baby care. Here are a few eye conditions that can occur in babies.

Two weeks after conception, the eyes begin to develop. Over the next four weeks all of the major eye structures form. During this time the eye is particularly vulnerable to injury. If the mother takes drugs or becomes infected with German measles, for example, the eye can be malformed or damaged. During the last seven months of pregnancy the eye continues to grow and mature, and the nerve that connects the eye to the brain (the optic nerve) is formed.

At birth a baby's eye is about 75 percent of the size of an adult eye. The next few years of life are very important to the development of the eye. During the first two years of life, the optic nerve, visual function and internal eye structures continue to develop.

Whereas an adult with perfect vision is said to have 20/20 vision, the newborn's visual acuity (sharpness of vision) is approximately 20/400. This is equivalent to seeing only the big letter "E" on an eye chart. By the age of two, their vision has slowly improved to that of 20/20. Color vision is present at birth, unless a child is born colorblind.

Newborns at first don't pay much attention to the visual world but normally will blink when light shines in their eye. The will also focus on a caregiver's (such as a mother or father) face, especially when eating. At that point, they are close enough to see it clearly. By 6 to 8 weeks of age, infants will fix their gaze on an object and follow its movement.
A baby's eyes should be well aligned (working as a team) by 4 months of age. As the eyes become aligned, three-dimensional vision develops. This also helps with their depth perception.

The first eye exam takes place in the newborn nursery. The pediatrician performs a screening eye exam to check for infections or structural problems with the eyes: malformed eyelids, cataracts, glaucoma or other abnormalities. When the baby is 6 months old, the pediatrician should check the baby's eye alignment and visual fixation, or how it focuses its gaze, and follows an object.

Pediatricians can treat simple eye problems such as pinkeye. If you or your pediatrician believes your baby has a more serious eye problem, which may require medical or surgical treatment, the infant should be referred to an ophthalmologist. No child is too young for a complete eye exam.

An eye doctor's examination of a baby is similar to that performed on adults. The doctor evaluates the baby's medical history, vision, eye muscles and eye structures. Obviously, the baby can't talk yet, to say how well it sees. Therefore, the doctor must rely on the baby's reaction to different things.

The doctor assesses the baby's vision by observing the following. Does the infant react to light shone in the eyes? Will the baby look at a face or follow a moving toy? Other, more sophisticated vision tests may be used if needed.

Eye drops are used to temporarily enlarge the pupils for closer examination of the eyes. The drops may take 30 to 90 minutes to work. The eye doctor then uses an instrument to test the baby's eye for nearsightedness (better at seeing things close up), farsightedness (better at seeing things far away) or astigmatism (where the rays in the eye don't align, resulting in blurred vision). Most children are farsighted at birth but usually not to a degree requiring glasses. However, a baby -even a newborn- can wear glasses if needed.

Finally, the eye doctor uses a lighted instrument with a magnifying glass to look inside the eye.

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