Parents often ask me, “What can my baby see?” or “Is my baby meeting visual milestones?” These are good questions, and if you have any concerns, please do discuss them with your doctor. In general, a child is referred to a pediatric ophthalmologist if there are questions regarding visual development.

Normal visual development in babies

Remember that preemies will usually need more time to develop and reach milestones, and that’s okay.

  • Newborns can only see about 20/400, which is the “big E” on the eye chart. At birth, the part of the eye responsible for central vision is still developing. Over the first year of life, this continues, allowing for approximately 20/20 vision by age one.
  • Infants will blink in response to light. This is the first visual response we see in development.
  • During the first month of life, a newborn is most responsive to a human face and light. They see objects best when they’re held 30 centimeters, or about a foot, in front of their face. High contrast colors like black and white are helpful.
  • A six-week-old can usually track up and down but not yet side-to-side.
  • Tracking side-to-side is usually achieved by three to four months of age.
  • Eye contact normally begins at six weeks of age, although up to eight weeks is still considered normal.
  • By 12 weeks, infants begin to focus on their hands, which helps them learn hand-eye coordination. As they start to grab at visualized objects, they begin to recognize distances. These skills help them build an understanding of three-dimensional space and orientation.
  • Around five to seven months of age, an infant can distinguish a caretaker or familiar relative by sight.
  • Between seven and 10 months, infants develop a finer focus and can see small objects and detailed facial features.
  • At one year, most children have 20/20 vision, even though they can’t communicate that on a vision screening.

Abnormal visual development and warning signs of vision problems

  • Healthy newborns may have temporary misalignment of their eyes during initial development. But if their eyes still seem to cross or wander out by three to four months of age, seek an evaluation from an ophthalmologist.
  • If a child seems to consistently turn his or her head to look at things, ask an ophthalmologist to evaluate for eye problems.
  • Nystagmus, sometimes described as fluttering, rhythmic jerking, or wandering movements of the eyeballs, should immediately be brought to a doctor’s attention. These movements aren’t present at birth but can develop as early as two months of age.
  • Alert your doctor if you also notice forceful or constant eye rubbing, droopy eyelids, a white pupil, or constant tearing when the baby isn’t upset or crying.

Does my baby need glasses?

Since we can’t ask such a young child to read a chart, it’s common for parents to ask how to know if a baby needs glasses. Many pediatricians will screen pre-verbal and pre-reading children at a routine check-up to catch an early need for glasses with devices that look like cameras. While these devices are very good at sensing changes in the eyeballs that suggest a child might need glasses, they can also have a lot of false positives, when there isn’t a true problem. If a baby doesn’t pass this screening test, the pediatrician will refer the child to an ophthalmologist for a complete evaluation.

If your pediatrician doesn’t have this device, don’t worry! There are other ways that your doctor can check your baby’s eyes. Classically, an ophthalmoscope red reflex test can be performed by shining a light in the baby’s eyes. The reflection gives the doctor information about eye development and will indicate if anything needs to be examined by an ophthalmologist. If you still have questions, ask your doctor to refer your child to an ophthalmologist for a complete dilated exam.

Advice for parents of babies 

Try your best not to Google any serious health concerns, including vision issues. Information online isn’t tailored for your child’s specific circumstances and medical care is never one-size-fits-all. Discuss your questions with your doctor or an experienced eyecare specialist.

We’re here to help! Visit our website for more information or call us at 401-444-6551 to schedule an appointment.

Melissa A. Simon, MD

Melissa Ann Simon, MD is a board-certified ophthalmologist, specializing in pediatric ophthalmology and adult strabismus, with the Lifespan Physician Group Ophthalmology.