Vision Problems of
Preschool Children

By Gretchyn Bailey

During the preschool years from ages 3 to 6, your child will be fine-tuning the vision he has already developed during the infant and toddler years. Young preschoolers are learning to ride tricycles and master the complex hand-eye coordination needed to pedal, steer and watch where they're going at the same time.

Older preschoolers are learning how to use more sophisticated sports equipment such as baseball bats and baseballs (keep your eye on the ball!), and working on the fine motor skills needed to write their names.

Warning Signs

At this stage, most children have passed that crucial time during infancy where many childhood visual problems develop. Parents need to look for refractive errors in their preschoolers by watching for these warning signs:

• Consistently sitting too close to the TV or holding a book too close
• Squinting
• Tilting the head to see better
• Frequent eye rubbing when your child is not sleepy
• Sensitivity to light
• Excessive tearing
• Closing one eye to read, watch TV or see better
• Avoiding activities which require near vision, such as coloring or reading, or distance vision, such as playing ball or tag
• Complaining of headaches or tired eyes

Schedule an appointment with your eye care practitioner if your preschooler exhibits any of these possible refractive error signs.

Farsightedness is very common in young children. Excessive farsightedness can lead to strabismus, which is also still very common in children this age. Sometimes the excessive farsightedness can simply be corrected with glasses, and the crossed eye resolves. A severely crossed eye may require surgery. Untreated strabismus can lead to amblyopia. If not treated, eventually the amblyopic eye "shuts off" and vision may be permanently lost.

Nearsightedness, on the other hand, requires immediate correction with glasses. A child's eye can't compensate for the blurry distance vision like it can for the blurry near vision.

Astigmatism will also lead to blurry, distorted vision if your child has a moderate amount, and requires correction with glasses.

The First Eye Exam

If your child exhibits no symptoms of a refractive error or other visual problems, he should have an eye exam by the age of 6 months, then again at age 3, according to the American Optometric Association (AOA). Having a complete eye exam before the child enters school allows enough time to catch and correct any problems while the visual system retains flexibility and elasticity. Children without symptoms should receive an eye exam again right before beginning school, says the AOA.

Should your child require correction for any visual problem, be it nearsightedness, farsightedness or strabismus, the AOA recommends an exam every year. A yearly exam allows your eye care practitioner to stay on top of your child's visual needs, as well as ensure that your child's prescription for eyeglasses or contact lenses is still correct. The visual system is developing along with your child, so annual prescription changes are common. Read more about children's eye exams and how often they're needed.

Make sure your child receives a comprehensive eye exam from an eye care practitioner, not just screenings from school nurses or pediatricians. Screenings may help spot problems, but they can easily miss them, too, because they are not complete tests. And screenings are typically administered by people who don't have enough eye-specific training in order to catch all vision and eye health problems. Read more about why you can't rely on vision screenings alone.

Motivation to Wear Eyeglasses

If your child needs to wear eyeglasses, get him involved in the frame purchase — if he's the one who picks out the frame, he will be more motivated to wear the glasses. Explain that he needs them to see clearer, and give specific examples that he can understand. He'll be able to see the words in his books better, or will be able to play catch with his brother because he can now see the ball.

Schedule the eye exam and glasses selection at a time that's good for your child. Some kids are more focused early in the day, while others come to life after lunch or an afternoon nap. Don't visit the eye doctor when your child is tired, cranky or hungry.

First select a few frame styles yourself, then give your child the final choice on the glasses he'll wear. Make the outing a positive event, discussing how lots of people he knows wear glasses, and how they see much better. Make sure the frames you choose are comfortable to wear, and fitted properly for your child. No one, especially a child, will wear uncomfortable glasses.

Read tips on choosing children's eyeglasses that last.

[Page updated December 2007]