Who We Serve
Eye Care for Infants and Toddlers
First eye exam at around six months. We examine babies using objective techniques that need no response at all from the child.
Parents almost never book an eye exam for a six-month-old, and it is not because they are careless. Nobody tells them to. Paediatric checks look at the eyes briefly, the baby seems to see fine, and the assumption is that vision is something you test once a child can read a chart.
The problem with waiting is that the visual system develops on a schedule that does not wait for the child to be old enough to describe a problem. The first few years set the wiring, and conditions caught during that window are treatable in a way they simply are not later.
How you examine a baby who cannot talk
This is the first question every parent asks, and the answer is that we do not need the child to tell us anything. Almost everything we need is measurable objectively.
We use retinoscopy, which involves shining a light into the eye and observing how the reflection moves, to determine the refractive error without a single answer from the child. We watch how each eye fixates on and follows a target to assess visual attention and tracking. We check the red reflex, which reveals clouding of the lens or abnormalities inside the eye. We examine alignment using light reflexes and cover testing, and we assess the health of the eye itself including the retina and optic nerve.
Drops are usually used, and for a specific reason that has nothing to do with viewing the retina. Infants have extremely strong focusing ability, and that focusing effort masks their true refractive state. Relaxing it is the only way to measure accurately rather than measuring their effort.
What we are actually looking for
- Significant refractive error
- Large amounts of farsightedness, nearsightedness or astigmatism, particularly when the two eyes differ substantially. Uncorrected, this is the most common route into amblyopia.
- Amblyopia risk
- Where one eye sends a poorer image and the brain begins to suppress it. Found and treated early, vision in the affected eye can develop normally. The window closes at around age eight.
- Strabismus
- An eye that turns in or out. Some misalignment is normal in the first few months and should have resolved by around four months. Persistent turning needs assessment.
- Structural abnormalities
- Congenital cataract, ptosis and other conditions where the physical structure of the eye or lid interferes with visual development. Rare, and time-critical when present.
- Retinal conditions
- Including retinoblastoma, which is uncommon but is exactly the kind of thing an eye examination exists to rule out. An abnormal red reflex is the classic sign.
What parents notice at home
You are with your child constantly and you will see things we cannot see in a twenty-minute appointment. These are worth reporting rather than waiting for the next scheduled visit.
- An eye that turns in or out, even occasionally or only when the baby is tired, after around four months of age
- A white or unusual reflection in one pupil in photographs, particularly with flash
- Persistent watering or discharge from one eye
- A drooping eyelid, especially if it covers part of the pupil
- Not following faces or objects with the eyes by around three months
- Excessive sensitivity to light
- Constant eye rubbing beyond ordinary tiredness
- Unusual head tilting or turning to look at something
Children who should be examined earlier
- Premature birth, particularly with low birth weight or a history of oxygen therapy
- A family history of amblyopia, strabismus, congenital cataract or high prescriptions in childhood
- Developmental delay or a neurological condition
- Down syndrome or another genetic condition associated with eye involvement
- Any concern raised by your paediatrician or health visitor
- Anything on the list above that you have noticed yourself
What the appointment is like
It is shorter and considerably less formal than an adult exam. Your baby stays on your lap for most of it. We work around a wriggling child because that is what every infant appointment involves, so please do not arrive worried about whether your baby will cooperate.
Two practical things help. Book at a time your child is normally alert rather than close to a nap, and bring a familiar toy. Beyond that, we handle it.
If drops are used, expect light sensitivity and blurred near vision for a few hours afterward. Bring a hat or a pram cover and plan a quiet rest of the day.
What we check at this stage
Every exam is adapted to who is in the chair. For this group, these are the things that actually change the plan.
- Refractive error measured objectively with retinoscopy
- Eye alignment and the red reflex in both eyes
- Fixation, following and visual attention
- Pupil responses
- Health of the front of the eye, the lens, the retina and the optic nerve
- Any asymmetry between the two eyes, which matters more at this age than the absolute numbers
Related
- Eye Care for Preschool ChildrenThe exam before school starts. Picture-based testing, amblyopia detection while it is still treatable, and the focusing skills reading will demand.
- Eye Care for School-Age ChildrenThe years when myopia appears and progresses fastest. What a school screening misses, and why a reading problem is sometimes a vision problem.
This page is general educational information, not medical advice or a diagnosis. If you are experiencing sudden vision loss, eye pain or an eye injury, contact us immediately or go to an emergency room.
Infants and Toddlers: common questions
My baby is six months old and seems to see fine. Do they still need an exam?
Yes. A baby cannot tell you what they are not seeing, and an infant with a significant prescription in one eye will still track your face, reach for toys and seem entirely normal. The whole point of examining at this age is to find what is invisible from outside.
How can you get a prescription from a baby?
With retinoscopy, which measures how light reflects out of the eye and requires no response at all. It is objective. We use it on adults who cannot respond reliably too.
Will my baby need drops?
Usually yes, and for a specific reason. Infants have very strong focusing ability that masks their true prescription, so relaxing it is the only way to measure accurately. Expect a few hours of light sensitivity afterward.
What if you find something?
It depends on what. Refractive error may mean glasses, which infants tolerate far better than parents expect. Amblyopia risk means a treatment plan started while it works best. Structural conditions are referred promptly to a paediatric ophthalmologist, and we stay involved.
How often after the first exam?
Again at around age three, before starting school, and then annually. Sooner if we find something that needs monitoring or if you notice anything from the list above.
Book an appointment with a doctor who has time for you
We schedule 2 patients an hour, so your exam is unhurried and your questions get answered. Most patients are seen within a few days.