What is it about ?
The sight of young children is systematically evaluated during each examination, whether at the pediatrician or during the ONE consultation. Good eyesight is of paramount importance both for the learning process of the child and for the development of contacts with those around him. This is the reason why any anomalies must be detected as soon as possible and, if possible, corrected.
The most common eye abnormalities in children are:
- squinting eyes (squint): the two eyes are not looking in the same direction
- a lazy eye (amblyopia): the child always looks with the same eye because his vision is poorer or distorted when looking with both eyes, due to an abnormality in one eye. The eye which is less used, or which is not used at all, then goes see less well.
The eyes of children at increased risk of eye abnormalities should be examined regularly to detect any developmental abnormalities early on. Children at risk are
- children who have close relatives with strabismus or amblyopia
- infants and children with another disorder, delayed physical or mental development, weakness in muscles, hearing impairment or a condition often associated with visual impairment, as the Down syndrome.
What is their frequency?
Lazy eye is the number one cause of visual impairment in children.
In western countries, the condition affects 2 to 5 in every 100 young children. The anomaly usually affects only one eye, but in rare cases both eyes may be affected.
How is eye disease diagnosed in young children?
By the age of 4-6 weeks, the child normally makes eye contact and the eye movements are symmetrical. During the pediatric consultation, the doctor will assess the shape and reaction of the pupils to light. He will also look for the red reflection using an ophthalmoscope: when the doctor looks into the child’s eye with a light, a beam of light rays will produce a red reflection. In photos taken with a flash, the pupils are sometimes red too. The absence of a red reflection always indicates a serious anomaly. The child is referred to an ophthalmologist when there is no interaction between the parents and the child, when the child constantly has a squinty eye, when there is no red reflection, when other abnormalities are visible or when he suffers from Down syndrome.
At the age of 4 months, a child smiles in response to parents or the examiner. The child stares at a small picture (5 cm), such as a toy, and his eyes move smoothly. In addition to looking for the red reflection, the doctor will perform the Hirschberg test. This test aims to detect strabismus. The doctor holds a penlight about 50 cm from the child’s eyes. If the child does not have strabismus, the light is reflected by the cornea in the center of the pupil. An asymmetry of the reflections indicates a strabismus. If the child’s eyes do not move smoothly, if there is pronounced or recurrent strabismus, or if there is a difference in the size of the eyes, the child will be referred to an ophthalmologist.
At the age of 9 and 12 months, the doctor performs the same tests as at the age of 4 months (red reflection and Hirschberg test). He checks if the child recognizes the members of his family before they say a word. The doctor then also performs the bite test: while the child fixes a 5 cm target at a distance of 30 cm, the doctor moves his hand down in front of the child’s left eye and observes whether the right eye moves and, if so, in what direction. He then covers the right eye and makes the same observations. In addition, the doctor performs the grip test: he checks whether the child can recognize a very small object and grasp it between the thumb and forefinger (forming a forceps). The doctor scatters some dark-colored ball-shaped candies on an examination table behind the child in a seated position. The child is then turned over and lying on his stomach, leaning on the arms. The doctor checks whether the child is observing the candies and how he takes them (gripping): he checks whether the child is tweezing with his thumb and forefinger, or if he uses the whole palm to grasp the candies. While examining the grip, the doctor also observes the coordination of the eyes and hands when the child wants to take the candy. The way in which the child puts his weight on the supporting arm is also studied (balance). The doctor may refer the child to a specialist if, for example, he does not recognize faces but rather voices, if the use of vision is not age-appropriate, or if the child looks at things very close.
At the age of 12 or 15 months and at the age of 24 or 30 months, the ONE performs an eye test to detect a lazy eye. For this exam, the child sits on the parent’s lap and the nurse draws his or her attention with a camera in hand. To perform the test, the child must look straight into the camera for a short time. If the result is abnormal, the child is referred to an ophthalmologist.
At the age of 4, the doctor tests the visual acuity of both eyes and each eye separately using, for example, LEA vision tests (near vision and 10-line grid). He will refer the child to a specialist in the event of anomalies.
What can you do ?
Go to the pediatric clinic at the agreed times to have your child’s eyes and eyesight tested. Consult the general practitioner if your child is cross-eyed or if you suspect an abnormality.
What can your doctor do?
If the doctor notices an anomaly during the pediatric consultation, he will refer the child to a specialist (ophthalmologist, pediatrician) to correct the anomaly as quickly as possible and prevent it from becoming chronic. Sometimes the healthy eye is covered with a mask to stimulate the lazy eye. In other cases, wearing eyeglasses imposes itself quickly.
The eyes and sight of children with developmental disabilities, such as Down syndrome or a hearing impairment, presenting several anomalies or born prematurely are examined carefully. Indeed, these children often have eye problems without having symptoms, but they still need to be treated. Follow-up by a specialist is necessary.
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