When you are born, the majority of your organs are fully operational. The eyes however, are a bit different. It takes months for a baby’s vision to be comparable to an adults.
All babies are born with vision deficiencies and this is normal. Clear vision, color perception, light tolerance, and more all develop over the first 1-2 years of life.
It can be difficult to track vision milestones and know if your baby needs an eye exam or if they are developing at a normal pace.
Here is everything you need to know about your infant’s eyesight.
A Newborn’s Vision
The first weeks of a baby’s life are hazy (literally). They rely on smell and sound to help navigate the new world around them.
Blurry Vision
Newborns are naturally nearsighted. Their vision beyond one foot in front of them is anywhere from 20/200 to 20/400, which is considered legally blind if you aren’t an infant.
The sweet spot for a newborn baby’s vision is 8 to 12 inches in front of their face. This puts your face at the perfect gazing distance as you hold them in your arms.
Limited Color Perception
Much of what a newborn sees is black and white blobs. Their vision is not only blurry, it isn’t very colorful either.
For the first few weeks of life, babies don’t perceive colors off the grayscale. At about two weeks old babies will start to see red. This will be the only new color for at least another month.
Preference For High-Contrast Patterns
New infants enjoy looking at high-contrast patterns. This brings variety to their world. Because they can’t see color or very far in front of themselves, high-contrast images are very exciting!
Not only do newborns enjoy fun black-and-white images, but it is good for them too. Studies show that looking at high-contrast pictures improves vision and the brain’s interpretation and response to the signals the eyes send.
Sensitivity to Light
After spending months inside a dark womb, infants are sensitive to bright lights. This is because their pupils are small and can’t take in much light. It is normal for babies to keep their eyes closed in bright environments for a few weeks while their pupils naturally widen.
Baby Vision Milestones
Babies undergo a rapid transformation in their first year of life. Their vision is no exception.
Tracking objects
One of the earliest baby vision milestones is the ability to track objects. Following moving objects is difficult for babies for a few months as their eyes learn to work together. Once their eyes start to work as a team your baby will be able to focus on and follow things that move.
Smooth Pursuit Movements and Hand-Eye Coordination
Smooth pursuit movements are voluntary eye movements we all make. They are slow eye movements used when following a moving object.
Babies will be able to track moving things at about two months of age. Between two and three months babies will get so good at following moving objects that their hand-eye coordination will start to manifest. It is exciting when your infant can start to bat at toys and pat objects!
Smooth pursuit movements and hand-eye coordination aren’t perfect at this age. They’ll continue to develop throughout the first year.
Color Vision
As was mentioned above, a baby will start to see red a few weeks after they are born. More colors and shades will become visible to your baby between two and four months of age. At four months most babies will have nearly perfect full-color vision and will be able to differentiate between many hues.
Depth Perception
A month after your infant can see in color they will have early depth perception. At five months most babies can see things three-dimensionally.
Depth perception improves as babies practice grabbing objects, learn to crawl, and continue to conceptualize the space around them. By nine to ten months babies have pretty good depth perception and understand what is close and what is far away.
Sharp Vision
Infants continue to develop better vision throughout their first few years of life. By four months a baby has clear nearsighted vision and can see across a small room.
A baby will never see as sharply as an older child. It takes two years for most babies’ eyes to fully develop. After development is done it still takes another one to five years for a child to have 20/20 vision like an adult.
Babies and young children function so well without 20/20 vision that people often don’t realize that their vision is not as sharp as an adults.
Baby Eye Color
Iris Color
It is common for a baby’s eye color to change in the first couple months of life. By six to twelve months of age, a baby is typically set with their eye color.
Genetics play a large role in eye color. A baby’s eye color often reflects one or both of their parents’ eye shades. Occasionally a grandparent’s eye color might be passed down.
Temporary Problems
The iris color is not the only part of the eye that can change. Some babies are born with discolored whites of the eyes. This is often due to an illness or injury and will resolve with medication or time.
Jaundice
Jaundice is a fairly common discoloration tied to elevated liver levels. The whites of the eyes turn yellow in babies with jaundice. Sunlight, artificial blue light, eating, and regular bowel movements will remove bilirubin from the bloodstream and fix jaundice.
In rare cases, a larger issue can cause jaundice. Other treatment options or surgery might be needed to address the underlying liver issues causing the jaundice.
Bruising
Birth isn’t just hard on mothers. Babies can experience injuries or trauma during delivery. Bruising around the eyes and on the whites of the eyes can occur as a result of a rough delivery.
Common Vision Issues in Infants
Infants are no strangers to eye abnormalities. Physical differences, infections, and developmental delays are all common issues babies might face.
Infection After Delivery
Babies can contract eye infections during delivery or shortly after. The whites of the eyes will usually turn pink or red if they’re infected.
Neonatal conjunctivitis is the most common delivery-related eye infection. Infants can also develop an eye infection from coming into contact with an active STI during delivery. Antibiotics are typically used to treat the infection.
Crossed Eyes
Crossed eyes, also known as Strabismus, are common in many babies until four months of age. Eye muscles need to strengthen just like other muscles of the body. While the muscles develop and strengthen it is common for eyes to cross.
Early Detection and Treatment is Important
If your baby is older than four months and still has crossed eyes occasionally or regularly, it is important to take them to an eye doctor. The earlier crossed eyes are taken care of the sooner vision can return to normal.
Early treatment can also prevent surgery. Glasses or an eye patch for a few hours a day can fix crossed eyes in most babies. Waiting until a child is older can cause the muscles to be set incorrectly. Surgery can still solve the issue, but is more invasive than physical therapy options.
Lazy Eye
Amblyopia is the scientific term for a lazy eye. A lazy eye is labeled as such because the brain doesn’t rely on it to see much. The vision in a lazy eye becomes weaker as the stronger eye is relied upon.
Causes and Risk Factors of Lazy Eye
A lazy eye occurs when one eye doesn’t communicate with the brain correctly. The eye labeled as lazy will often wander, shake, or squint shut. Vision is worse in the weaker eye as well.
Unresolved crossed eyes can lead to a lazy eye. However, not all lazy eyes are caused by crossed eyes. Problems due to prematurity, underdevelopment, or physical obstructions (such as a cataract, droopy eyelid, or cornea scratch) can cause one eye to be dominant.
If left untreated, a lazy eye can be permanently “lazy”. Lifelong vision problems will occur if appropriate action is not taken.
Treatment Options for Lazy Eye
If there is an obstruction causing the amblyopia then that will need to be resolved before other treatments will be permanently effective.
Surgery is often necessary for cataracts or drooping eyelids causing a lazy eye. A scratched cornea can be healed with an ointment or rest.
If there isn’t a physical cause of your child’s lazy eye then an eye patch or eye drop will help your brain focus on strengthening the pathway with the weaker eye. The eye patch is used to cover the strong eye so the brain has to rely on the weaker eye. The eye drops have a similar purpose. They temporarily weaken the strong eye so the brain starts to rely on the lazy eye.
In most physical therapy treatments, corrective lenses will also be used to help improve vision.
Eye Infections
Babies can easily contract an eye infection. They come into contact with many viruses and bacteria as they explore the world around them. They also rub their eyes often, putting the viruses and bacteria right into their eyes.
Common Infections and Symptoms
Pink eye is common in children. It’s highly contagious and often makes the rounds between daycares and schools. Older siblings are also common transmitters.
Red eyes, excessive mucus, itchiness, and watery eyes are the symptoms to watch for. Bacterial pink eye typically resolves within 3 days, while viral pink eye takes much longer. See your pediatrician or eye doctor if your baby has these symptoms for longer than 3 days.
Styes are blocked tear ducts that can lead to infections. Children with a stye will usually have similar symptoms to conjunctivitis, but will also have a bump on their eyelid where the tear duct is clogged.
Some styes will remedy themselves. A warm compress multiple times a day can help decrease the swelling and flush the blocked tear duct. If the swelling continues to get worse or things don’t resolve after a day or two then a prescription eye drop will be needed to help relieve the infection.
When to Take Your Baby to the Eye Doctor
Because a baby’s vision isn’t perfect at birth it can be hard to know if they’re experiencing a developmental delay or just experiencing normal imperfect infant vision.
If your baby has any of the following it is best to make an appointment with an optometrist to rule out any delays or issues:
- Eye misalignment after four months
- Constant itchiness, redness, or watery eyes
- Light sensitivity past a few months old
- Inability to focus on an object at four months or later
- Can’t track an object by four months
- Drooping eyelids
- Discolored whites of the eyes
Stimulating Your Baby’s Vision
Babies benefit greatly from stimulating activities. There are a lot of games or activities you can play that your baby will enjoy that also strengthen their developing eyes.
Entertainment
Toys
High-contrast toys and patterns are the most common eye-friendly newborn toys. Placing a baby under a black-and-white photo or next to a high-contrast toy lets them practice focusing on something fun for them to see. These toys also help an infant’s brain strengthen its relationship with the eyes.
Bright toys and moving objects (such as a mobile) are great toys after a few months when babies can see color. They do the same things high-contrast toys do, but are more exciting now that color has entered a baby’s world.
Toys that have different textures or make crinkling noises are also positive for visual development. They interest more than one sense for your baby, which makes them intriguing. This will lead them to focus on the toy and explore it, which will improve their focus and overall vision.
Games and Movement
As your infant grows, games such as peek-a-boo and block stacking will help them practice focusing and will strengthen their depth perception and hand-eye coordination.
Many of these toys can also be used during tummy time. Tummy time will not only strengthen a baby’s back and core but will help their vision development as they look at objects from different angles.
You don’t have to spend a lot of money on visually stimulating toys for your baby. Many household items you already own can be used.
Creating a Vision-Friendly Environment
A vision-friendly environment will help your infant’s eyesight develop appropriately. Small changes can positively impact their development. The following are easy things to do:
- Have proper lighting in the nursery
- Move the play area often so it remains visually interesting
- Put a mobile above or wallpaper near the crib
- Reduce or eliminate screen time
Premature Newborn Vision
Premature babies frequently have eyesight problems or delayed vision development. This is typical and often fixed with time or physical therapy.
Many premature babies will still meet visual milestones based on their adjusted ages. Patience alone can be the best treatment.
Common Challenges
Much of a human’s eye development happens in the last trimester of pregnancy. Because of this, premature babies can have unique vision challenges. Their eyes will usually continue to develop outside of the womb but can hit roadblocks that aren’t as common in utero.
Fused Eyelids
Micro preemies who are born before 25 weeks will have eyelids that are fused close. Sometime between 25 and 26 weeks of gestation is when a fetus’ eyes can open. An infant born before then will not gain the ability until they reach what would have been 25 to 26 weeks gestation.
Retinopathy of Prematurity
Children who are born before 31 weeks or who weigh less than three pounds at birth are at high risk of having Retinopathy of Prematurity (ROP). A little more than half of premature babies who meet this criteria will develop it.
ROP is when the blood vessels in the retina develop abnormally and cause vision problems. Many babies will outgrow issues related to ROP. Some however, will have lifelong problems, as there is an increased risk of nearsightedness, crossed eyes, glaucoma, a lazy eye, or blindness.
Babies at risk of developing ROP need to have an eye exam between four and nine weeks of life. This can diagnose or rule out ROP. Early treatment can be life-changing for a premature baby.
Pediatric Eye Exams
Knowing what to expect during your child’s first year of life can help you support positive vision development. The right environment, toys, and attention to warning signs will ensure your baby’s vision develops appropriately.
If you suspect your baby’s eyes are not developing correctly do not hesitate to schedule an exam. Early detection is important for many infant eye problems.
