Parent's Checklist

The human visual system is our most dynamic sense.  At birth, many of the components of the visual system are in place, such as the eyes, optic nerve and brain, but it is after birth that growth, development, co-ordination and fine tuning of the system occur.

Some of the changes that occur in the first 6 months of life are:

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Structure

The newborn eye is remarkably close to its full adult size. At birth the length of the eye is around 17mm, growing to full adult size of 23mm.  The power of the cornea is around 50 dioptres at birth, reducing to 43 dioptres as an adult.

Vision

The visual acuity of an infant develops rapidly from birth.  At 1 month, the child has a visual acuity of 6/180, improving to 6/30 at 2 months and to adult levels of 6/6 (20/20) by 4-6 months.

Focusing

Focusing, like visual acuity appears to develop to full adult levels by around 4-6 months.  At 1 month the infant has a fixed focus at around 20 cm, which is the perfect distance to see the mother’s face while feeding.  At 2 months there is some flexibility, while at 4 months there is adult capacity to vary focus and to fixate on objects at different distances.

Visual Guidance

At birth, a primitive reflex called the tonic neck reflex exists.  This reflex has the head and eyes pointing at the outstretched hand when the head is turned to the side. At 4 months, the child exhibits "swiping" behaviour, where it sees an object and tries to grasp it, but doesn't have the required coordination. At 6 months, the child is able to grasp an object they see.

Eye movement

At birth, the child's eyes generally point in the same direction, but they do not work together as a team.  This is why it is common for it to appear that there is a turned eye. The eyes generally move together, but only one eye fixates a target.  By 8 weeks, the child is generally able to use both eyes as a team.

Important Developmental Milestones

Parents6 LGThis checklist has been developed by Behavioural Optometrists and educators to give parents an approximate indication of what to expect in their child’s visual capabilities at a particular age.  Any significant delay should be referred for immediate assessment by a Behavioural Optometrist.

Birth To 6 Weeks:

  • Stares at surroundings when awake
  • Momentarily holds gaze on bright light or bright object
  • Blinks at camera flash
  • Eyes and head move together
  • One eye may seem turned in or out at times

8 Weeks To 24 Weeks:

  • Eyes begin to move more widely with less head movement
  • Eyes begin to follow moving objects or people (8-12 wks)
  • Watches parent's face when being talked to (10-12 wks)
  • Begins to watch own hands (12-16 wks)
  • Eyes move in active inspection of surroundings (18-20 wks)
  • While sitting, looks at hands, food, bottle (18-24 wks)
  • Now looking for, and watching more distant objects (20-28 wks)


30 Weeks To 48 Weeks:

  • May turn eyes inward while inspecting hands or toy (28-32 wks)
  • Eyes more mobile and move with little head movement (30-36 wks)
  • Watches activities around him for longer periods of time (30-36 wks)
  • Looks for toy he drops (32-38 wks)
  • Visually inspects toys he can hold (38-40 wks)
  • Crawls after favourite toy when seen (40-44 wks)
  • Sweeps eyes around room to see what's happening (44-48 wks)
  • Visually responds to smiles and voices of others (40-48 wks)
  • More and more visual inspection of objects and persons (46-52 wks)

12 Months To 18 Months:

  • Now using both hands and visually steering hand activity (12-14 mths)
  • Visually interested in simple pictures (14-16 mths)
  • Often holds objects very close to eyes to inspect (14-18 mths)
  • Points to objects or people using words "look" or "see" (14-18 mths)
  • Looks for and identifies pictures in books (16-18 mths)

24 Months To 36 Months:

  • Occasionally visually inspects without needing to touch (20-24 mths)
  • Smiles, face brightens when viewing favourite objects and people (20-24 mths)
  • Likes to watch movement of wheels, egg beater, etc (24-28 mths)
  • Watches own hand while scribbling (26-30 mths)
  • Visually explores and steers own walking and climbing (30-36 mths)
  • Watches and imitates other children (30-36 mths)
  • Can now begin to keep colouring on the paper (34-38 mths)
  • "Reads" pictures in books (34-38 mths)

40 Months To 48 Months:

  • Brings head and eyes close to page of book while inspecting (40-44 mths)
  • Draws and names circle and cross on paper (40-44 mths)
  • Can close eyes on request, and may be able to wink one eye (46-50 mths)

4 Years To 5 Years:

  • Uses eyes and hands together well and with increasing skill
  • Moves and rolls eyes in an expressive way
  • Draws and names pictures
  • Colours within lines
  • Cuts and pastes quite well on simple pictures
  • Copies simple forms and some letters
  • Can place small objects in small openings
  • Passes all the tests described on preceding pages
  • Visually alert and observant of surroundings
  • Tells about places, objects, or people seen elsewhere
  • Shows increasing visual interest in new objects and places

Signs of Problems

Appearance Of Eyes:

  • Unusual redness of eyes or eyelids
  • Crusted eyelids
  • Styes or sores on lids
  • Excessive tearing
  • Unusual droopiness
  • One eye turns in or out with fatigue

Evidence Of Discomfort:

  • Excessive rubbing of eyes
  • Avoids bright light
  • Keeps eyes closed too often

Clinical Testing & Care

If your child shows any difficulty in achieving these visual skills on the developmental milestones checklist, you should have them assessed by a Behavioural Optometrist.  It is important to deal with any issues as soon as possible.

Your child should have a comprehensive examination several times before entering school.  The first of these should take place at age 6 months.  The vision screening that most children receive at school does not replace a thorough examination by a Behavioural Optometrist.

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