Pediatric Frequently Asked Questions
Children may not always know how to express what is bothering them about their eyes and vision. These are some of the many frequently asked questions we receive regarding basic children’s eye care and pediatric ophthalmology:
Q: What are school screening exams and why are they done before kindergarten?
A: Now that summer is almost over, many of us are getting our children ready for school. Did you know that in the state of Minnesota, all children must have a vision screening exam before entering kindergarten? Unfortunately, school budgets are limited. Many districts screen infrequently after the required exam. Myopia (poor distance vision) and other vision problems often develop gradually. Young children rarely complain about poor vision, and may be completely unaware that they don’t see well. For all of these reasons, you will want to make sure that your pediatrician or family doctor checks your children's vision before their fourth birthday. The American Academy of Ophthalmology recommends a child’s vision should then be re-tested every two years.
Signs of vision problems that you may detect at home include squinting, crossed or wandering eyes, turning and tilting the head while watching television, or lack of interest in reading. If your family has a history of poor vision or crossed eyes, your child may be at increased risk for a similar eye problem. These children need to be tested at a very young age.
Q: How can you test a very young child’s vision?
A: The school screening program or your family doctor will use a special chart with pictures or symbols. These charts help to assess vision in preschool-age children even if they do not know the alphabet. Toddlers and infants can also be evaluated for vision and eye health by using behavioral tests such as observing how your child looks at special objects, or how they move their eyes.
Q: What do I do if the school or pediatrician thinks there is a vision problem?
A: If vision problems are detected, you should have a more complete exam with an Eye M.D. An Eye M.D., also known as a pediatric ophthalmologist, is a medical doctor who specializes in total eye care. A general ophthalmologist will be able to determine if your child needs glasses to correct his or her vision, or if a more serious problem exists. From there, you may be referred to a pediatric ophthalmologist for further treatment.
Q: What if my child needs glasses?
A: Children and infants can successfully and comfortably wear glasses. In fact, if they recognize that they see better, they may insist on wearing them. Children who are too young to talk show their obvious preference for wearing glasses by growing fussy or crying when the glasses are taken away!
Your child is more likely to wear the glasses if they are comfortable and fit well. If your child needs glasses, you should have the prescription filled at an optical shop that carries children's frames and impact resistant lenses. Associated Eye Care’s optical shops now carry frames that are designed specifically for children’s faces. These frames give a superior fit to the alternative "small adult glasses," which tend to fall down the nose, or fit poorly behind the ears. Because most children are tough on their glasses, ask your optical shop about their breakage or replacement policy.
Finally, make the experience a positive one. Over half of all Americans wear glasses or contacts to see well. Glasses are now considered a fashion accessory. Have fun selecting them; your child’s first impression will be a lasting one!
Q: Can my child wear these glasses during school sports?
A: The answer depends on the sport. In 1997, over 44,000 eye injuries occurred in sports related activities. A large percentage of these were in young athletes. Protective eyewear may decrease these injuries by 90%.
In certain high-risk sports, such as hockey, baseball and lacrosse, all players should wear a helmet with a wire shield or polycarbonate mask. In hockey, players are required to wear facemasks approved by the Hockey Equipment Certification Council (HECC) or Canadian Standards Association (CSA). Players may wear their own glasses under the facemask.
In other sports such as basketball, racquetball, tennis and soccer, goggles should be worn to protect the eyes from the ball or from other players’ elbows, knees or feet. If your child wears glasses, you may purchase protective goggles with the prescription already built in. Be sure to choose goggles that have been approved by the American Society of Testing and Materials (ASTM) or which pass the Canadian Standards Association (CSA) racquet sport standard. Associated Eye Care Optical offers several options.
In low risk sports, such as track and field, street wear frames with polycarbonate or plastic (CR-39) lenses should be adequate. A sports head strap that secures the frames also increases safety by helping to keep the glasses from falling off.
Q: The school says my child is myopic. What is that?
A: People who are nearsighted, or myopic, have difficulty seeing in the distance without glasses. Children with myopia may squint to see distant objects, or complain of being unable to see the board. Infrequently, they may complain of headaches. Headaches are actually more often a sign of other eye problems.
There is no set age for the onset of myopia. Parents who never needed glasses may have a child who starts to wear them in 1st or 2nd grade. Parents who had glasses in grade school may have a son or daughter who does not need them until later if ever. If children exhibit signs of poor vision, such as squinting, closing one eye or wandering eyes, or if a school screening test has detected a problem, you should arrange an exam with an Eye M.D.
During that exam, the Eye M.D. will conduct a variety of tests to determine the overall health of your child’s eyes. They can also determine the correct prescription for glasses, if necessary. Even children too young to know the alphabet can be accurately examined.
Q: My pediatrician thinks my child has amblyopia. The word strabismus was also used. What does that mean?
A: Amblyopia, also known as "lazy eye" is poor vision due to lack of normal development of sight. It is a very common condition, affecting 2-3 of every 100 people. Normally, children’s eyes continue to develop from birth until age 9 or 10. Amblyopia is caused by conditions that interfere with that normal development. There are three major causes of amblyopia:
- Unequal focus. In the healthy eye, equal focusing problems can be corrected with glasses. If there is unequal focus because one eye is more nearsighted, farsighted, or has astigmatism, amblyopia may occur. In these cases, the out of focus or blurry eye "turns off" and becomes amblyopic. The brain ignores that blurry eye, and it develops poor vision. This type of amblyopia is very difficult to detect, because the eyes look normal.
- Strabismus or misaligned eyes can cause amblyopia when the brain ignores the crossed eye to avoid seeing double. The straight eye usually retains normal vision. Some children may have a large amount of crossing, which is easy to detect. Others have a very tiny amount, which can be difficult to see at home, but can still cause amblyopia.
- Cloudiness of the normally clear parts of the eye can prevent a sharp image from reaching the inside of the eye. One example of this is a cataract, or cloudiness of the lens of the eye. Although far less common in children than in the elderly, cataracts can occur in young children.
Amblyopia is diagnosed by finding a difference in the vision of the two eyes. A vision screening exam will help detect this, though further diagnosis and treatment will need to take place with an Eye M.D. (ophthalmologist). An Eye M.D. will help determine which of the three causes of amblyopia are occurring in your child. Sometimes, more than one can exist at the same time. During that visit, the entire eye will be carefully examined to check for other causes of poor vision.
Treatment of amblyopia involves using the weak eye. Covering or patching the stronger eye accomplishes this by making the weaker eye work alone. Glasses may also be prescribed to correct the unequal focus, or to attempt to straighten misaligned (strabismic) eyes. Patching often needs to be done while wearing glasses full time in order to completely treat amblyopia. If surgery is required for straightening the misaligned eyes, patching or glasses may continue afterward. Surgery, if necessary, may correct the strabismus, but only patching or using the weak eye can correct amblyopia. All forms of treatment need to be started as soon as possible. Amblyopia in particular can become permanent if not treated at an early age.
Q: My child has red, itchy eyes each autumn (or spring). Could this be allergies?
A: Many children have sneezing, eyelid swelling, tearing, itching and a clear discharge in springtime or early fall, indicating seasonal allergies or hay fever. If your child has some or all of these symptoms, your primary care doctor may have you try some simple treatments at home.
Cold compresses can be effective for short-term relief of itching. There are many eye drops that are also effective, but you should check with your primary physician before using any over-the-counter eye drops in children. Prescription eye drops are available to provide relief. Your primary care physician may refer you to an Eye M.D. (ophthalmologist) if your symptoms are particularly troublesome or persistent.
A red eye may also occur with a viral infection (commonly referred to as pink eye). Although it is sometimes difficult to initially determine whether a red eye is due to a virus versus seasonal allergies, a few key features can help. A viral infection is more likely if there is a history of a recent cold or exposure to another person with a red eye. Unlike seasonal allergies, viral infections usually begin in one eye first, and may or may not spread to the other eye. They typically last 8-10 days, and go away on their own. Cold compresses will also help relieve itching in viral infections, but antibiotics are not effective. Careful hand washing can prevent the spread of this infection to others. Your primary care doctor can help determine if other intervention is necessary.
Finally, red eyes that persist or are accompanied by pain or decreased vision, can be a sign of a more serious problem. Your family doctor will direct you to an Eye M.D. for immediate treatment of more serious "red eye" problems.
Q: Could my child’s headaches be caused by eye problems?
A: What do you do if your child is coming home from school with frequent headaches? Ophthalmologists are frequently asked to examine children with this problem. Fortunately, in most cases, headaches are not a symptom of something serious. Tension headaches, which are common, often occur at the end of the day, and are not associated with other symptoms. Occasionally, the need for glasses is the cause of the headache. An exam with an Eye M.D. (ophthalmologist) can uncover that. Children who have already passed a school screening exam, whose headaches are infrequent or not related to a particular activity, probably do not need an eye exam. You should discuss this with your primary care doctor to be sure. On the other hand, headaches that occur after periods of reading, or in someone who squints frequently or closes one eye to see, may indicate a need for corrective glasses. Finally, headaches accompanied by vomiting, persistent fever or lethargy should be taken seriously. In these cases, contact your primary care physician immediately.
Q: My child has a learning disability. Can glasses cure this?
A: The topic of learning disabilities is a very large one. To briefly answer this question, however, learning disabilities are not due to a problem with the eye or visual system. You may have been told that special exercises, tinted lenses, or other types of visual training will be beneficial to your child. There are no scientifically proven studies that support these costly treatments. The Association for Pediatric Ophthalmology and Strabismus, the American Academy of Pediatrics and the American Academy of Ophthalmology all agree that children with learning disabilities should have a multidisciplinary approach, involving the pediatrician and school teacher. These two primary sources will help determine what other specialists might be helpful in working with your child. From the ocular standpoint, your pediatrician can help to determine if a learning disabled child also has one of the common childhood eye problems: near sightedness, lazy eye or strabismus. If this is the case, an Eye M.D. will examine your child, to diagnose those eye problems. The treatment they prescribe will help your child’s overall visual acuity, but will not change the underlying learning disorder. Again, for that, your pediatrician and child’s teacher are the best sources of information on helping to identify and treat learning disabilities.