From the initial newborn squint to movement tracking, your baby’s vision goes through a lot of changes in their first few months. As your infant’s vision develops, it’s important to watch for normal developmental milestones and notice if anything seems unusual.
If your baby doesn’t seem to notice when they poke their eye with a finger or if one eye crosses inward or outward, there may be eye issues that need to be addressed. The sooner you treat infant eye problems, the more likely your child is to develop healthy vision.
Eye development milestones
There is a lot of change happening behind your newborn baby’s eyes. At first, they can only focus on objects eight to 10 inches away. Both eyes are learning to work together, so it’s normal for eyes to cross in or drift out a little as babies develop this coordination.
Vision development by age
As your child grows, you can follow vision milestones to see if their vision is developing appropriately. Talk with your child’s doctor if you notice any big delays or challenges:
- 0-3 Months: Your baby begins to follow (track) movement with both eyes and recognize faces. As their hand-eye coordination improves, babies also begin to reach for items they see. Milestone: A baby should start making eye contact when your faces are close.
- Four months: At this point, your baby’s eyes are working together, and eye crossing should disappear. Milestone: Check to see that your baby can track a moving object with their eyes, like a toy passing by their face.
- Six months: By now, your baby’s eyes are tracking well together. If you notice any eye crossing or drifting, tell your child’s doctor. Eye misalignment, called strabismus, can be corrected. Babies’ depth perception is also improving, which means they understand how far away an object is. Milestone: Your child should be able to reach for colorful toys and follow peek-a-boo games.
- One year: Now that your baby is crawling, their depth perception and hand-eye coordination are improving. This is a good time for your baby’s first visit with an optometrist. Milestone: A baby should be able to grasp something between their thumb and forefinger.
Advocate for healthy eyes
If your baby does not seem to reach these milestones, or if you are seeing anything unusual in their eyes, discuss this with your child’s doctor.
“Watch how your baby’s eyes track movement, or if the eyeballs or eyelids are misaligned or uneven. This is important to bring up with your child’s doctor,” said Dr. Charline Boente, a pediatric ophthalmologist at Riley Children’s Health. “If you have concerns, start with your child’s pediatrician, and they can make an appropriate referral, if needed. It’s important that parents advocate for their child and find answers when something doesn’t seem right. Even if it means getting second or third opinions.”
When your baby doesn’t seem to have feeling in their eyes
In rare conditions, a baby won’t react when they poke a finger in their eye. Or they don’t close their eyes in water.
“This might be particularly noticeable if parents have had another child because parents know how a baby typically behaves,” said Dr. Gregory Borschel, a plastic surgeon at Riley Children’s Health.
What is neurotrophic keratopathy?
These symptoms may be caused by a condition called neurotrophic keratopathy (pronounced “NOO-ro-tro-fik” “kair-uh-TOP-ah-thee.”) Neurotrophic keratopathy, or NK, describes damage to nerves in the eye’s cornea. Without sensation in these nerves, the eye can’t protect itself from damage from dust, scratches or other irritants. This can lead to ulcers, scars and even blindness.
NK is usually a congenital condition, which means babies are born with it. In other children, it’s caused by developmental issues in the nerves, a brain tumor or a head trauma.
Treating neurotrophic keratopathy
While NK is rare, Riley Children’s Health is the busiest center for treating kids with this condition. Families travel from all over the world for NK treatment with Dr. Boente and Dr. Borschel. NK is treated using a surgery called corneal neurotization. In this type of surgery, a nerve is taken from a child’s leg and grafted into the child’s cornea. The new nerve helps return sensation to the eye.
Barriers to treating neurotrophic keratopathy
While this surgery is an effective treatment, it can take a while for some children to be diagnosed with NK because it is not very common. In fact, Dr. Boente and Dr. Borschel published a study about the challenges and barriers families face in getting treatment for their children. Sometimes, there are delays in a child’s diagnosis because physicians aren’t familiar with NK, so they do not recognize it. Other times, NK symptoms look like other health problems. Plus, infants and young children often can’t communicate their symptoms.
“Some young kids are born with it, so they don’t complain about symptoms, and families may not pick up on it,” Dr. Boente said. “It can take several months or years to figure out there’s a problem. Even with established eye care, it can take a while to diagnose.”
“Our research showed it can be very difficult to get your child diagnosed and treated for neurotrophic keratopathy,” said Dr Borschel. “Some eye doctors are not trained or aware that corneal neurotization surgery is possible and that the nerves can regenerate.”
Getting care ASAP
If you are concerned about your child’s eyes, contact your child’s pediatrician or eye doctor. It’s important to treat young children’s vision problems as soon as possible.
“There’s a sweet spot for visual development,” Dr. Boente said. “If your vision did not develop appropriately from birth to age seven or eight, and you catch it too late, you’re going to have poor vision for the rest of your life no matter what treatment you receive.”
To discuss a consultation for your child, contact the plastic surgery department at Riley Children’s Health by calling 317.948.0345.
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