Your Infant's Visual Development

Infants are born with an underdeveloped visual system. Throughout the first year of life, your child's vision will grow and develop with him. Before your child is born, see your health-care practitioner regularly for prenatal visits and eat a nutritionally balanced diet for your child's eyes to properly develop.

Your baby's eyes will be checked at birth and during well-baby visits throughout the first year. If your baby is premature, make sure his eyes were thoroughly checked at the hospital or birthing center before you brought him home. If not, make an appointment to see your eyecare practitioner.

Babies usually see movement before anything else, as their vision is still evolving. Full-term babies should be able to see their mother's facial expression within a week of birth.

Color vision is not yet fully developed at this time. Depth perception will also mature during the first year of life, as long as both of the child's eyes are working as a team.

Eye muscle coordination in a newborn, as well as a small child, is also very immature. Babies often exhibit eyes turned in, turned out or not working as a team, called strabismus. This happens when the muscles of one side of the eye pull more than the muscles on the other side. If this problem doesn't resolve itself by the age of three or four months, consult your pediatrician or eye care practitioner.

Sometimes you need to ask for help earlier, such as if your child's eyes are grossly turned in or out, don't move normally before age three months, if the eye is crossed far into the nasal area, one eye moves while the other remains still or if one eye appears radically different from the other. Large-scale eye movement problems can be remedied with surgery if necessary. Seeing your pediatrician early also helps.

Catching strabismus early is important, because a visual condition called amblyopia may result if strabismus is left untreated. If your child doesn't see well out of one eye due to strabismus, the eyes aren't working as a team to see. If your child's brain doesn't receive visual images from that eye, eventually the brain will "shut off" that eye and vision could be permanently lost.

Premature babies take a bit longer than their full-term counterparts to develop vision. A baby born before 40 weeks gestation is considered premature. A preemie born a month early usually develops normal vision, but children born before 35 weeks have a 30 percent greater chance of developing strabismus or amblyopia. The odds increase the earlier a child is born.

Your infant should pay close attention to his mobile, or bright lights in the room. If your child cannot follow a toy passed in front of him from side to side by the age of three months, see your pediatrician. In some cases, children develop their visual reflex later than average. This is called visual maturation delay.

A vision condition called nystagmus can develop in infancy. Eyes that jump, dance, wiggle or oscillate back and forth is called nystagmus.

This condition may be caused by poor vision, defects in the nerve pathway from the eye to the brain or albinism (light-sensitive retinas in albinos contain too little pigment for the eyes to function properly). Nystagmus may also be inherited. Babies with nystagmus may have normal vision or poor vision. If your child's nystagmus persists past age three months, consult your pediatrician.

You're right if you notice that three to four months of age is an important time for vision development in your child. Take the opportunity during well-baby visits with your pediatrician to ensure that your child is visually on track.
 

Between ages four and six months, your child should start to reach or bat at the mobile or toys you hold in front of him. Swatting a toy will happen by chance at first, then become deliberate as your child's vision, depth perception and understanding grows.

From six to eight months, your child will roll over and may learn to crawl. Entice him visually with a toy to gain by rolling over or moving a few inches.

From eight to 12 months, your child may be crawling and walking. Encourage crawling rather than early walking to help your child develop eye-hand coordination. These newly mobile infants will encounter bumps and bruises as they explore more of their world with developing vision.

Closely supervise your crawler or early walker, especially while on the couch, near steps or on the bed. Remember that depth perception is still maturing, so tumbles on uneven surfaces are common. Children won't visually understand that the steps lead down, or the edge of the bed leads off into empty space.

Many toys, from mobiles to stacking cups to blocks, can help your child develop vision and have fun at the same time. Talk to your pediatrician about age-appropriate developmental toys.

In June 2005 a program called InfantSEE was launched; it provides a no-cost comprehensive eye assessment to infants in their first year of life. The program is supported by the American Optometric Association, the Vision Care Institute of Johnson & Johnson Vision Care, and former President Jimmy Carter. InfantSEE was created to encourage parents to have their babies' eyes checked early on, to prevent vision problems from interfering with their development. President Carter's granddaughter was diagnosed and treated as a toddler for amblyopia (lazy eye), a leading cause of vision loss in people under 45. His grandson's amblopia wasn't diagnosed until he was in grade school, and it may never be fully corrected.

If you would like to find an optometrist who participates in the InfantSEE program, please click here.