Although serious vision problems during childhood are rare, routine eye checks are offered to newborn babies and young children to identify any problems early on.
Free NHS sight tests are also available at opticians for children under 16 and for young people under 19 in full-time education.
Why eye checks are important
The sooner any eye problem is found, the sooner you and your child will be able to get any treatment and support needed.
Children may not realise they have a vision problem so, without routine tests, there’s a risk a problem may not be spotted. This may affect their development and education.
If you have any concerns about your child’s vision see a GP or go to an opticians.
When will my child’s eyes be checked?
Your child’s eyes may be checked a number of times throughout the first hours, weeks and years of their life.
Within 72 hours of birth
Your child’s eyes will be checked for any obvious physical problems as part of the newborn physical examination.
Between 6 and 8 weeks old
This is a follow-up physical examination to check for any obvious problems that were not picked up soon after birth.
Around 1 year, or between 2 and 2-and-a-half years
You may be asked if you have any concerns about your child’s eyesight as part of your child’s health and development reviews. Eye tests can be arranged if necessary.
Around 4 or 5 years old
Your child’s eyes may be examined soon after they start school. This is called vision screening and it checks for reduced vision in one or both eyes. The aim is to detect any problems early so that treatment can be given if needed.
Vision screening is usually carried out in your child’s school. However, this does not happen in all areas. If your child’s vision is not checked at school, take them to your local opticians for an eye examination.
Read more about vision screening for 4 to 5 year olds (PDF, 1.09Mb).
Speak to a GP or go to an opticians if you have any concerns about your child’s vision at any stage (see spotting signs of a vision problem).
What tests may be carried out?
A number of tests may be carried out to check for vision or eye problems in babies and children.
The red reflex test
The red reflex test is usually carried out alongside a general examination of your baby’s eyes, as part of newborn checks.
It involves using an instrument called an ophthalmoscope that magnifies the eyes and uses a light so they can be examined clearly.
When light is shone into your baby’s eyes, a red reflection should be seen as it’s reflected back. If a white reflection is seen, it could be a sign of an eye problem.
The pupil reflex test
The pupil reflex test involves shining a light into each of your baby’s eyes to check how their pupils (black dots at the centre of the eyes) react to light.
Your baby’s pupils should automatically shrink in response to the light. If they don’t, it could be a sign of a problem.
Attention to visual objects
This is a simple test to check whether a newborn baby pays attention to visual objects.
A midwife or doctor will try to attract your baby’s attention with an interesting object. They then move it to see if the child’s eyes follow.
These sorts of tests can also be used to check the eyesight of older babies and young children who are not yet able to speak.
If your child can speak but is not yet able to recognise letters, pictures may be used instead of objects.
Snellen and LogMAR charts
When your child can recognise or match letters, their vision is tested using charts that have rows of letters and numbers of decreasing sizes.
Your child will be asked to read out or match the letters they can see from a specific distance. These charts are called Snellen or LogMAR charts.
For younger children, a similar test using pictures or symbols may be carried out instead.
Range of movement tests
To test the range of movement of each eye, a child’s attention will be drawn to an interesting object, which is then moved to 8 different positions: up, down, left, right, and halfway between each of these points.
This tests how well the eye muscles work.
A refraction test is carried out by an optometrist at a high-street opticians and is used to check if your child needs glasses and, if so, what prescription they need.
Before the test, your child may be given special eyedrops that widen their pupils so the back of their eyes can be examined more clearly.
Your child will be asked to look at a light, or read letters on a chart if they’re old enough, while different lenses are placed in front of their eyes.
Colour vision deficiency test
Colour vision deficiency tests, also known as colour blindness tests, are usually carried out in older children if a problem is suspected.
One of the tests used to check for colour blindness is the Ishihara test. This involves looking at images made up of dots in 2 different colours. If a child’s colour vision is normal, they’ll be able to recognise a letter or number within the image.
A child who can’t tell the difference between 2 colours won’t be able to see the number or letter, which means they may have a colour vision problem.
Read more about diagnosing colour vision deficiency.
Causes of eye problems in babies and children
There are a number of different eye problems that can be detected during eye tests, including:
- childhood cataracts – cloudy patches in the lens of the eye that are present from birth
- lazy eye (amblyopia) – where the vision in one eye does not develop properly
- squint (strabismus) – where the eyes look in different directions
- short-sightedness (myopia) – where distant objects appear blurred, while close objects can be seen clearly
- long-sightedness (hyperopia) – where you can see distant objects clearly but nearby objects are out of focus
- astigmatism – where the transparent layer at the front of the eye (cornea) is not perfectly curved
- colour vision deficiency (colour blindness) – difficulty seeing colours or distinguishing between different colours; this is more common in boys than girls
Spotting signs of an eye problem
Although your child should have regular eye tests as they grow up, it’s still important to look out for signs of any problems and get advice if you have any concerns.
For babies, the checklist in your baby’s personal child health record (red book) can be used to help you check if your child’s vision is developing normally.
In older children, signs of a possible eye problem can include:
- the eyes not pointing in the same direction
- complaining of headaches or eye strain
- problems reading – for example, they may need to hold books close to their face and they may lose their place regularly
- problems with hand-eye co-ordination – for example, they may struggle to play ball games
- being unusually clumsy
- regularly rubbing their eyes
- sitting too close to the TV
Speak to a GP or go to an opticians if you have any concerns about your child’s eyes or vision. The earlier a problem is picked up the better.
Children can have an eyesight test at any age. They do not need to be able to read, or even speak. An eyesight test is particularly important if there’s a history of childhood eye problems, such as squint or lazy eye, in your family.