Pediatric Eye Care

Your baby has a whole lifetime to see and learn. But did you know your baby also has to learn to see? As a parent, there are many things that you can do to help your baby's vision develop. Being aware of the normal visual development can help you spot problems in their very early stages and get treatment started as soon as possible.

Eye care for your child should begin with an examination in the first year of life. Unless you notice a need, or your doctor advises you otherwise, your child's next examination should be around age three, and then again before he or she enters school.

Digby Eye Associates is a participant in the InfantSee program. InfantSEE™ is a public health program designed to ensure that eye and vision care becomes an integral part of infant wellness care to improve a child's quality of life. Under this program, Dr. Hall and member optometrists will provide a comprehensive infant eye assessment within the first year of life as a no cost public health service.

VISUAL DEVELOPMENT

During the first four months of life, your baby should begin to follow moving objects with the eyes and reach for things, first by chance and later more accurately, as hand-eye coordination and depth perception begin to develop.

To help, use a nightlight or other dim lamp in your baby's room; change the crib's position frequently and your child's position in it; keep reach-and-touch toys within your baby's focus, about eight to twelve inches; talk to your baby as you walk around the room; alternate right and left sides with each feeding; and hang a mobile above and outside the crib.

Between four and eight months, your baby should begin to turn from side to side and use his or her arms and legs. Eye movement and eye/body coordination skills should develop further and both eyes should focus equally.

At about age six months, you should take your baby to your doctor for his or her first thorough eye examination. Things that the doctor will test for include excessive or unequal amounts of nearsightedness, farsightedness, or astigmatism and eye movement ability as well as eye health problems. These problems are not common, but it is important to identify children who have them at this stage. Vision development and eye health problems can be more easily corrected if treatment is begun early.

Enable your baby to explore different shapes and textures with his or her fingers; give your baby the freedom to crawl and explore; hang objects across the crib; and play "patty cake" and "peek-a-boo" with your baby.

From eight to twelve months, your baby should be mobile now, crawling and pulling himself or herself up. He or she will begin to use both eyes together and judge distances and grasp and throw objects with greater precision. To support development don't encourage early walking - crawling is important in developing eye-hand-foot-body coordination; give your baby stacking and take-apart toys; and provide objects your baby can touch, hold and see at the same time.

From one to two years, your child's eye-hand coordination and depth perception will continue to develop and he or she will begin to understand abstract terms. Things you can do are encourage walking; provide building blocks, simple puzzles and balls; and provide opportunities to climb and explore indoors and out.

There are many other affectionate and loving ways in which you can aid your baby's vision development. Use your creativity and imagination. Ask your doctor to suggest other specific activities.

PRE-SCHOOL VISION

During the infant and toddler years, your child has been developing many vision skills and has been learning how to see. In the preschool years, this process continues, as your child develops visually guided eye-hand-body coordination, fine motor skills and the visual motor skills necessary to learn to read.

As a parent, you should watch for signs that may indicate a vision development problem, including a short attention span for the child's age; difficulty with eye-hand-body coordination in ball play and bike riding; avoidance of coloring and puzzles and other detailed activities.

There are activities that you can do at home to help your preschooler's vision develop, as it should. These include reading aloud to your child and letting him or her see what you are reading; providing a chalkboard, finger paints and different shaped blocks and showing your child how to use them in imaginative play; providing safe opportunities to use playground equipment like a jungle gym and balance beam; and allowing time for interacting with other children and for playing independently.

By age three, your child should have a thorough eye examination to make sure your preschooler's vision is developing properly and there is no evidence of eye disease. If needed, your doctor can prescribe treatment including glasses and/or vision therapy to correct a vision development problem.

Here are several tips to make your child's examination a positive experience:

1. Make an appointment early in the day. Allow about one hour.
2. Talk about the examination in advance and encourage your child's questions.
3. Explain the examination in your child's terms, comparing the E chart to puzzle and the instruments to tiny flashlights and a kaleidoscope.

Unless recommended otherwise, your child's next eye examination should be at age five. By comparing test results of the two examinations, your doctor can tell how well your child's vision is developing for the next major step. . .into the school years.

SCHOOL-AGE VISION

A good education for your child means good schools, good teachers and good vision. Your child's eyes are constantly in use in the classroom and at play. So when his or her vision is not functioning properly, learning and participation in recreational activities will suffer.

The basic vision skills needed for school use are:

• Near Vision. The ability to see clearly and comfortably at 10-13 inches.
• Distance Vision. The ability to see clearly and comfortably beyond arm's reach.
• Binocular coordination. The ability to use both eyes together.
• Eye movement skills. The ability to aim the eyes accurately, move them smoothly across a page and shift them quickly and accurately from one object to another.
• Focusing skills. The ability to keep both eyes accurately focused at the proper distance to see clearly and the change focus quickly.
• Peripheral awareness. The ability to be aware of things located to the side while looking straight ahead.
• Eye/hand coordination. The ability to use the eyes and hands together.

If any of these or other vision skills is lacking or does not functions properly, your child will have to work harder. This can lead to headaches, fatigue and other eyestrain problems. As a parent, be alert for symptoms that may indicate your child has a vision or visual processing problem. Be sure to tell your doctor if you child frequently:

• Loses their place while reading
• Avoids close work
• Holds reading material closer than normal
• Tends to rub their eyes
• Has headaches
• Turns or tilts head to use one eye only
• Makes frequent reversals when reading or writing
• Uses finger to maintain place when reading
• Omits or confuses small words when reading
• Consistently performs below potential

Since vision changes can occur without you or your child noticing them, your child should visit the eye doctor at least every two years, or more frequently, if specific problems or risk factors exist. If needed, the doctor can prescribe
treatment including eyeglasses or contact lenses.

Remember, a school vision or pediatrician's screening is not a substitute for a thorough eye examination.

Protective Eyewear for children

Please don't overlook the importance of safety eyewear when playing sports. Each year, hundreds of men, women, and children are injured when playing sports. To help prevent sports eye injuries, athletes should use protective athletic eyewear whether or not prescription eyewear is needed. One choice is a sports frame with prescription or non-prescription polycarbonate lenses is another choice. Baseball or softball players who are hit in or near the eye, or suffer a blow to the head, should seek immediate care at a hospital emergency room or from an eye care professional.

Children & Contact Lenses

The important thing for parents and their children who wear contact lenses to remember is that contacts are prescribed medical devices. Contact lenses are not a cosmetic accessory. While the wearer may be happy about his or her new look, it's extremely important that the lenses be properly cleaned and worn according to the instruction of the doctor. Your doctor will discuss the most appropriate lens options for your child and determine which lenses would be prescribed. Not all lenses are appropriate for all children, therefore a customized recommendation will be based on your child's needs.