When kids hit school age, they might start complaining about not being able to see the board. But you can spot vision problems long before pre-K. According to pediatric ophthalmologist and surgeon Caroline DeBenedictis, MD, of Wills Eye Hospital in Philadelphia and Eye Physicians in Voorhees and Washington Twp., parents and pediatricians must work together to ensure good vision from the time baby’s born.

“Part of the reason pediatricians see babies at birth is to start looking at their eyes,” says pediatrician Puthenmadam Radhakrishnan, MD (“Dr. Rad”), of Bellevue Pediatrics in Ewing. In newborns, they’re looking for congenital problems 

like cataracts. When infants are 2 months old, pediatricians look for lazy eye so the child can get early treatment like glasses, patches and exercises (lazy eye is normal in a 4- to 6-week-old but by 2 months, she should be able to start focusing). During baby’s first six months, the doctor looks for problems like cataracts, cardiac issues and even tumors.

As children get older, pediatricians assess their visual acuity (the ability to see clearly) at every well-visit. “In the past, we relied on ophthalmologists to pick up these problems in children ages 1 to 4,” says Radhakrishnan, “but now most pediatricians have the specialized equipment to detect poor vision right in their office.” If a problem is detected, the pediatrician will refer a pediatric ophthalmologist (they handle abnormalities and diseases of the eye in children) or optometrist (they prescribe corrective eyeglasses). If referred to an optometrist, ask your doctor to recommend one with experience and training with children.

As DeBenedictis says, “Kids eyes are not small adult eyes.” But there are clues you can look for between doctor visits at home.

  • Asymmetry: Is there a significant difference in appearance between her two eyes? Is one eye larger than the other? Are her pupils different sizes? Is one eye bulging?
  • Drifting: Does her eye drift up, down, in or out? Do her eyes cross frequently?
  • Eye movement: Do both eyes move at the same rate when looking from one object to another? Is one eye used more than the other?
  • Tracking: Can her eyes follow the movement of an object? Do her eyes jump or wiggle from side to side? Are her eyelids droopy? Do her eyes appear cloudy? Is she sensitive to light? In photos, does her eye have a white or abnormally dark red reflex instead of common red-eye? Does she not see from a distance that other people can see from? Is she squinting when trying to see things? Does she consistently tilt her head when looking at things?

If she does need glasses, or a specialist, vision care can be costly. In an effort to ensure that children receive eye and vision care, Give Kids Sight Day at Wills Eye Hospital in Philadelphia annually offers kids up to age 18 a free eye screening. If needed, they receive two pairs of free eyeglasses or an eye exam by a pediatric ophthalmologist. Visit willseye.org/give-kids-sight-day for more information. InfantSEE is another service program sponsored by the American Optometric Association, and participating optometrists provide infants ages 6 to 12 months with a free comprehensive eye assessment. Visit infantsee.org to locate a doctor in your area.

And what if they do need glasses? Ask your doctor for the names of a few licensed opticians trained and experienced in fitting children for glasses. That’s important because kid faces are not small adult faces, says Renee Dyer, optician with Wills Eye Physicians in Voorhees. The bridge of the nose, distance between the eyes and distance between the ears and face all need to be considered when selecting a child’s frames.

Also, frames should be lightweight, flexible, BPA free, hypoallergenic and should stay on your child’s face. Spare your little one the aggravation of always having to push her glasses back in place. Ask your optician about security straps that fit behind the head, or cable temples that fit in a curve behind the ears, which are lifesavers when you have a toddler. Finally, involve your child in the selection process. She’s more likely to wear glasses she helped pick.

For more information on children’s vision, visit healthychildren.org, AAPOS.org and AAO.org.

Karen Gibbs is a freelance lifestyle writer based in Louisiana.