Health & Nutrition - All eyes

What are the common eye problems that affect children and how can parents and carers help? Meredith Jones Russell reports

Eye conditions can adversely affect children’s learning and behaviour
Eye conditions can adversely affect children’s learning and behaviour

Good eye health supports education as well as wider well-being, but several studies indicate that young children’s needs are often going unmet. A report by the Education Endowment Foundation (EEF) found that more than one in ten (around 13 per cent) of children in the UK could have undiagnosed eye conditions that hold back their development.

Sir Kevan Collins, chief executive of the EEF, calls eye testing a ‘no-brainer’. He says, ‘Making sure all young children with possible eyesight problems are identified, and those that are given glasses or other treatments use them, is a cheap way of removing this unnecessary barrier to learning.’


The period between three and six years old isessential for detecting eye problems, says Daniel Hardiman-McCartney, clinical adviser at the College of Optometrists.

‘This is what we call the “plastic period” of development,’ he explains. ‘Most children around the age of three are long-sighted. Gradually, the eyes grow, and by six or seven most have grown out of it, and broadly they won’t have a prescription.’

However, there are several common eye conditions which can affect young children, including:

  • short-sightedness (myopia)
  • long-sightedness (hyperopia)
  • astigmatism
  • lazy eye (amblyopia)
  • squint (strabismus).

If long- or short-sighted, many children will present as asymptomatic, despite potentially having a notable prescription, because they are unaware of what they should be seeing.

Amblyopia should be detected by six or seven years old in order to strengthen the weaker eye successfully by training the brain to ‘talk’ to both eyes equally using glasses. A squint, when one eye turns in or out, can turn into amblyopia if not detected early; again, from the ages of three to six.

Children are generally asymptomatic, but Mr Hardiman-McCartney notes, ‘Parents and, even more often, grandparents, are very good at spotting that something is wrong. Squints and lazy eyes also often run in families, which can help with identification.’

These conditions can affect all children, but those from disadvantaged backgrounds are more likely to go without a diagnosis.


Meanwhile, as a society our eyesight is suffering. There has been an increase in myopia (short-sightedness) in the UK of 50 per cent in 50 years.

Mr Hardiman-McCartney explains, ‘This is not due to more testing or awareness. It is just more prevalent. The theory that screen time contributes doesn’t seem to hold true, but the idea that less time outside and more time in small rooms have led to the increase is convincing. The magic number to reduce the risk of short sight is two hours a day spent outside.’

Early years consultant Penny Tassoni agrees. ‘After getting glasses, we also often see progress in children’s physical development, and an overall increased hunger to explore the world and surrounding environment,’ she explains. ‘Parents and practitioners often report how much more children talk after being prescribed glasses, because they can see so much more to talk about.

‘Our work with the youngest children so often involves the word “look”, and while a child might look in the general direction of what you are pointing out, they may not be able to see with the optimal level of precision – and, of course, children don’t know what they’re not seeing.’

Meanwhile, a study conducted by researchers at the Mayo Clinic in the US found that children with intermittent exotropia, a form of strabismus, where the eyes deviate outwards, and convergence insufficiency, when the eyes do not work together, were significantly more likely to be diagnosed with learning disabilities and attention deficit hyperactivity disorder (ADHD) than children with normal eye alignment.

Mr Hardiman-McCartney adds, ‘We know that squints limit outcomes. Children cannot become pilots, bus drivers or other occupations. They also limit depth perception, stopping children from doing certain sports.’

Ms Tassoni says eye problems can also affect behaviour. ‘Children may struggle to create movements that are sufficiently precise, such as doing their coats up or picking up small items, and their ability to move around safely or spot small objects on a floor or surface might be impaired. This might make them feel less confident and competent than others, and outbursts of frustration are not unusual.’


The NHS funds eye examinations and glasses for all children, and the UK National Screening Committee recommends that all children aged four to five should be included in a national screening programme to prioritise children who need a further examination. However, the commissioning of these services varies by local area.

Mr Hardiman-McCartney explains, ‘The programmes are not everywhere, and they are funded by local authorities without any protected status, because free eye tests are available. A lot of parents, therefore, simply rely on them happening, so don’t take their children to get tested, which can result in children reaching the end of the “plastic period” without having their problems supported.’

Ms Tassoni says this is where practitioners have a responsibility to keep informed on possible vision problems. She says, ‘Because children are not routinely sight tested, parents and practitioners need to be constantly considering whether aspects of development that may not be joining up could be linked to sight problems.’

She warns adults can too easily explain away problems. ‘It can just become part of the child. We create their personality, and say things like “they are always like this”, or “they’ve got their head in the clouds”. It often takes a change in environment or task for any problem to become apparent, so it is important that we are always thinking about it and questioning whether everything is OK.

‘We must encourage regular trips to the opticians, and encourage children who have glasses to wear them. Glasses should not be left in a bag on the pegs, should be comfortable and should be kept clean. We should also ensure there are good role models around so that wearing glasses is cool.’

Mr Hardiman-McCartney agrees. ‘Above all, sight tests are quick, easy and free for children. The majority of children’s eyes develop normally, but just going in for one initial check-up to make sure is vital.’


There is a range of activities that can help young children continue to develop visual skills successfully. The American Optometric Association recommends that children:

  • practise throwing and catching a ball or bean bag
  • use a chalkboard or finger paints
  • engage in activities that require hand-eye co-ordination, such as building with blocks and assembling puzzles
  • play simple memory games
  • colour, cut and paste
  • are read aloud to and are able to see what is being read
  • play outdoors, including ball games, bike or tricycle riding, swinging and rolling activities
  • have lots of opportunities to interact with other children.


Eye conditions: what to look out for

From around six weeks old, babies should be able to follow something colourful or interesting with their eyes, or smile back at someone who is not using sound to get their attention. If a baby does not seem able to focus properly or respond to facial gestures, or if their eyes wander when they are looking at you, there might be a problem.

Try covering each eye in turn. If they object to having one eye covered more than the other, they may have problems with one eye. Babies may squint sometimes, which is normal, but if they always squint, this should be investigated.

Things to look out for in young children include:

  • having one eye turned in or out (easier to spot when tired)
  • rubbing their eyes a lot
  • watery eyes
  • poor hand-eye co-ordination
  • avoiding reading, writing or drawing
  • screwing up their eyes when they read or watch TV
  • sitting very close to the TV, or holding objects close to their face
  • having behaviour or concentration problems
  • blurred or double vision, or unexplained headaches.

Adapted from advice by the College of Optometrists


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