Your Child's Eyes

The human ocular system is an integral part of the brain, and begins to develop at the same time: just 18 days after conception! After 7 weeks of pregnancy, the protrusion of the eyes becomes visible — they look like two little buttons. At this stage, they are wide apart and appear enormous because they do not yet have eyelids. They will gradually move closer together, and these mobile parts responsible for protecting the eyes will appear in the 3rd month of pregnancy. Initially closed, they will open in the 4th month. A miracle of nature: by the 7th month of intrauterine life, the fetus's full visual potential is ready to function. When a child comes into the world, they see incomparably better than kittens, but still in an imprecise way!

Nevertheless, scientific studies show that newborns prefer complexity to simplicity. From the first weeks of life, they seem more attracted to drawings with highly contrasted stripes or checks than to a plain surface. Mothers know this. They are also more responsive to moving, smiling faces than to expressionlessness. 

AT ONE MONTH

At one month, a baby can accommodate: they are able to see from 20 to 50 centimeters and begin to track visually. Until this point, it is not uncommon for a child to have a "wandering eye": a slight tendency to squint. Simply because, at this stage of their development, the eyes are still poorly coordinated. 

AT THREE MONTHS 

The first convergence reflexes appear before 3 months. The child then follows movements with increasing precision. Their world expands. This development of convergence — the ability of both eyes to look at the same point at the same time — continues and refines itself until the 6th month. The tendency some babies have to "cross their eyes" — this anomaly known as strabismus — should have disappeared by then. 

AT SIX MONTHS AND BEYOND 

At this age, a baby still sees imperfectly. Their visual acuity — their ability to distinguish very fine details — is only 1 to 2 tenths! They can broadly recognize a face other than their mother's and detect a smile, but not the detail of the lips. It is not until around 3 or 4 years of age — when their eyes have reached a normal size — that their acuity is, most often, around 10 tenths, which can be considered good vision. 

Some children reach 13 tenths of visual acuity by around age 6.

When the eye is not "in shape"

Good eye health encompasses several elements: good visual acuity, good coordination, and satisfactory eye motor function. 

Visual acuity is determined by the optical precision of the eyes. In the majority of cases, a child with poor vision may be nearsighted, farsighted, and/or astigmatic. The cause lies in the geometric shape of the eyes. A nearsighted eye is said to be too "long"; a farsighted eye too "short"; an astigmatic eye is said to have a curvature defect. In reality, these terms describe the relationship between the curvature of the cornea and the depth of the eyeball. 

Nearsightedness is caused by a vision anomaly whereby the image is formed in front of the retina rather than on it. Generally, a severely nearsighted child sees poorly at a distance but well up close. They tend to draw or write with their nose pressed against their notebook and decipher letters with their eyes glued to their book. However, this behavior is only indicative of a visual defect in 20% of cases.

Farsightedness causes the image to form behind the retina rather than on it. Unlike a nearsighted child, a farsighted child sees fairly well at a distance but less well up close.

They tire from looking up close to the point of having sore eyes and headaches. Mild farsightedness often goes unnoticed. However, when this defect is significant, it is detected early because it is often accompanied by convergent strabismus, which may disappear once the farsightedness is corrected.

Astigmatism is, most often, caused by an irregularity in the curvature of the cornea. Instead of being round like a soccer ball, it is closer in shape to a rugby ball. Vision is poor both up close and at a distance. Whether looking at their notebook or the blackboard, an astigmatic child confuses similar letters such as "H" and "M". They have a blurred vision of objects. Astigmatism is certainly the most widespread visual defect, as perfectly spherical corneas are extremely rare. It is also rarely found in isolation. One is often nearsighted and astigmatic, or farsighted and astigmatic. 

Eye coordination, or binocular vision, refers to the brain's ability to create a single image from the two images perceived by the two eyes. If they struggle to converge on the same point — for example, on a letter in a word — this is a sign of poor coordination.

The cause: a slight, even invisible strabismus. A child who squints sees letters in double. This situation quickly becomes intolerable, and spontaneously they use only one eye to read: their brain suppresses one of the images.

Danger: the other eye becomes lazy, ineffective, and sometimes even useless. Motor function concerns the ability of the eyes to track an object moving at the pace of a tortoise as well as that of a hare. Our eyes are capable of two types of movement: slow pursuit movements and also rapid movements called saccades by specialists.

Saccades allow the eye to move from one point of visual fixation to another at very high speed: at the speed of a supersonic aircraft flying at 20 meters. After each saccade, the eye "lands" on a point in the text.

Preventing and detecting vision problems

AMBLYOPIA: TO BE TREATED FROM 3 MONTHS 

A strange anomaly... One day, it becomes apparent that a child has poor vision in one or both eyes, yet when you observe them, they show no obvious signs of trouble. Their visual acuity is, however, very low, so that the images reaching the brain are of poor quality. The brain becomes lazy: it does not learn to see.

In young children, amblyopia is — in more than 50% of cases — secondary to strabismus that is sometimes so slight as to be undetectable: the eye becomes amblyopic because it is not being used. Conversely, amblyopia can be the cause of strabismus. Other causes of amblyopia include severe nearsightedness, farsightedness, and astigmatism.

Whatever its origin, amblyopia must be detected and treated very early. If treated before the age of 2, success is almost complete. Between 2 and 6 years of age, only 50% of vision can be recovered. Beyond that, at the age when reading is being learned, recovery is far more unpredictable, slower, and also more demanding. When should you have your child screened for amblyopia?

if a white glow appears in their pupil,

if there are cases of strabismus in the family,

if the child always uses the same eye, if they are indifferent when the other is covered but cry when a hand is placed over their "good" eye. Today, it is possible to correct amblyopia caused by vision disorders from as early as 2 or 3 months of age, thanks to glasses or contact lenses that are very well tolerated by infants.

With the deficient eye being treated, the brain learns to see and to receive the correct images. When amblyopia is caused by a disease — glaucoma, congenital cataract... — It is most often treated surgically by the ophthalmologist.

Between 0 and 4 years, children's vision continues to improve. A newborn focuses their gaze and tracks with their eyes from birth. At 3 or 4 weeks, they fix their gaze on their mother's face when she talks to them or feeds them. At 6 weeks, they follow people moving around the room with their eyes. At 8 weeks, they track an object moved through more than 90°, and at 12 weeks, they follow it from one side to the other. This goes to show how unnecessary it is to wait until a child starts school to determine whether their vision is good. Certain vision problems manifest very early and respond all the better to treatment when addressed promptly. 

This is why two mandatory examinations are scheduled at the 9th and 24th months of the child's life.

Certain defects can even be diagnosed at birth, during the hospital stay. This is the case with some forms of strabismus.

In the meantime, parents must be attentive to a host of details, even if they appear — on the surface — to have no connection to vision. A young child who refuses to scribble, who loses interest in all visual activities (puzzles or otherwise), or who seems clumsy may have a vision problem. The same applies to a child who vaguely complains of headaches, "stinging" eyes, red eyes, or rubs their eyes...

It is — most often — a mild condition, considered common and easy to correct. As you know, very few individuals possess "eagle eyes" — vision without any defect. Attention must be even more heightened if the child was born prematurely, if their birth weight was below 2.5 kg, if the father or mother is nearsighted, or if one of them suffers or has suffered from strabismus. When one parent is affected by this type of defect, the child has a one-in-two chance of being affected as well. 

In all cases, it is recommended that an eye examination be carried out — at least once a year — between the ages of 3 and 6. Preferably with an ophthalmologist experienced with children, who knows how to approach and test them using equipment adapted to young children who cannot yet read.

Solutions for seeing and reading well

The ophthalmologist has detected a minor visual defect in your child — don't panic! In the vast majority of cases, it is a mild anomaly that is easy to correct. In early childhood, the most common defects are farsightedness and astigmatism. At this stage of life, nearsightedness is rare.

It generally appears later: around the ages of 6 to 8. It then progresses with growth, becoming truly bothersome between the ages of 8 and 13, before stabilizing around age 20. Important to know: the earlier nearsightedness manifests, the more severe it risks becoming in adulthood. Farsightedness, astigmatism, nearsightedness... There is absolutely no need to make a drama out of it. These defects are very well corrected as soon as the child agrees to wear their glasses. 

GLASSES: A FASHION STATEMENT AND A PLEASURE 

Today, glasses have become a fashion accessory, and most children see wearing them as a reward! The frames opticians offer them are no longer miniature versions of adult models. New children's frames take into account the particular morphology of young faces: the absence of a nasal bridge, chubby cheeks, and delicate ears.

Manufacturers also take into account the rough treatment that some "rough-and-tumble" children put their glasses through. Nowadays, the temples feature flexible hinges. Children can play at putting them on and taking them off without fear of breaking them.

Finally, lenses offer great resistance to impact and friction when handled carelessly. Made from so-called "organic" glass, they are virtually unbreakable. One last advantage: eyeglasses for children — frames and lenses alike — are now better reimbursed than in the past! 

AND CONTACT LENSES? 

Worldwide, 30 million people wear contact lenses, including a number of children and even infants! In the latter case, it is of course up to the mother to learn how to handle them. Contact lenses are therefore often a better means than glasses for correcting amblyopia or strabismus.

Except in special cases, it is generally better to wait until a child is old enough to manage on their own before introducing contact lenses. They need to know how to place them on the eye, remove them for sleep, and care for them...

All of these gestures risk being experienced as a constraint by a child, particularly if they did not choose this method of correction themselves. Success with contact lens wear depends greatly on individual motivation. This is why some young athletes around ten years of age adapt to them very well, while others give them up. 

VISION THERAPY AND SURGERY 

Certain visual defects attract more parental attention. Strabismus is one such case. From a slight "wandering eye" corresponding to the deviation of one eye to a more pronounced "squint", one child in 20 is affected. Strabismus can be caused by an eye that becomes lazy because it does not see well, or more rarely by a defect in one of the muscles that control the eye.

In the first case, wearing special glasses — from as early as 3 or 4 months of age — and subsequently, vision therapy carried out with an orthoptist may be sufficient to correct the affected eye.

Mothers do not always readily accept glasses on the little nose of their baby. Children, for their part, do not seem bothered at all. They adapt very quickly. In the second case, surgical intervention designed to realign the eyes on the correct axis is necessary.

Specialists recommend this procedure at around age 5, before starting "big school". Sometimes earlier: around age 2 and a half. Aesthetically, the result is 98% successful. In terms of vision quality, success depends on associated conditions: farsightedness, astigmatism, less commonly nearsightedness at this age, and amblyopia. Each case of strabismus is unique and requires tailored management.

When to consult at reading age? Warning signs

Introduction to writing (the child plays at tracing loops, arches, sticks, their name) and reading (they learn to read their name and recognize certain letters...) — it is in the final year of preschool or at the start of first grade (CP) that certain visual defects that went unnoticed in early childhood begin to reveal themselves.

Teachers play a crucial observational role, but it is also up to parents to be attentive to certain signs:

very frequent blinking,

frowning,

red eyes that water or "sting",

fatigue or headaches after returning from school,

neck pain,

the child draws, writes, or reads with their nose pressed against their notebook or book,

when reading, they sometimes lose their line, re-read the same line or the same word twice,

they confuse certain letters,

they dislike reading or do not read for long,

by the end of first grade, they do not retain what they read,

they occasionally squint,

they are excessively sensitive to bright light...

If your child displays one of these characteristics, it may be a minor issue or a discomfort not necessarily linked to a visual defect. To be safe, seek the advice of a specialist.

Reading: a pleasure to help them discover

Just like toys, books belong to a child's world at an increasingly early age. Fabric or "tear-proof" cardboard books, books to handle or chew on at the age of first teeth... Babies adore these objects filled with bears, rabbits, hens, or crocodiles. 

Then comes the time for stories. Reading is the opportunity for a special moment between a child and an adult, provided the right moment is chosen. Children are very early sensitive to colors, to the expressions of characters, and even to typography. They can tell when the monkey has done something naughty, when mama bear is angry, or when the chick is sad. They sense, through the difference in letter size, when something is happening in the story. And, in time, reading images fosters the reading of written text.

Around 18 months, a child becomes interested in picture books, those books where a word is paired with an illustration. You can already enroll them in a specialized library, teach them a taste for, the handling of, and respect for real books, and the pleasure of beautiful illustrations. Your own personal affinity for books motivates them.

Around age 2 and a half, a child is able to recognize their first name written in block letters. They are beginning to associate an animal, a tree, a flower, a toy... With a word. They will soon enjoy deciphering and "reading" the packaging of familiar products: flour, chocolate...

Around age 3 or 4, children enjoy copying: mom, dad, cat, dog... Unconsciously, they understand that reading goes hand in hand with writing and vice versa. That said, there is no need to play the role of the nursery school teacher and "redo class" in the evening — simply being attentive to your child's interests is enough.

Around age 4 or 5, they enjoy collections of nursery rhymes where they can find words learned by heart. If they have a passion for whales, cars, or dinosaurs, this is the time to give them their first encyclopedia: the ideal book for teaching them more without being too instructive, without boring them too much, while giving them a taste for learning to read.

This is how a young child's inclination toward reading is nurtured: through specialist or general interest magazines, board games whose instructions need to be read, or even simplified cooking recipes. 

Reading with a child in everyday life means teaching them to observe, to develop their vocabulary, and to enrich their knowledge.

NEW DEVELOPMENTS IN DYSLEXIA 

At the age when reading and writing are being learned, 8 to 10% of schoolchildren suffer from dyslexia: a disorder characterized by difficulty reading and comprehending without frequent pauses. Contrary to what some believed, this phenomenon may not be due to a language processing dysfunction but rather, perhaps, to a failure of the visual system.

The significance of this discovery — made by a team of neurologists at Harvard — would be to ultimately enable early screening for dyslexia, followed by rehabilitation of affected children from the youngest possible age. A story to follow...