What do babies see? Everything you need to know about your baby’s vision

Can babies see inside the womb?

Eyes begin developing when the fetus is about 3-4 weeks old, and they open around the 26-27th gestational week. But of-course, the womb is dark and there isn’t much visual stimulus for the sense of vision to develop in there. A baby is first exposed to light during birth, and that is when they are first exposed to this grand experience of being able to see.

What do babies see in their first few weeks of life?

During the first few weeks of life, the cells in the eye’s retina and the neural cells in our brain are not completely mature yet, and therefore babies cannot see distant images and can only see as far as 20-30cm. Visual acuity isn’t very good either at this age, so babies are mainly able to see large objects, they are unable to visualize smaller details. Their ability to see colours is also underdeveloped at this point.

Does my baby recognize my face?

I often get questioned about when babies start recognizing their caretakers’ faces. Some babies can recognize their caretakers’ faces at the age of 4-6 weeks. There is no reason for concern, however, as for some babies this starts slightly later. At around 3 months of age, babies are supposed to be able to focus their vision and to recognize the person who feeds them.

Should I place an open book near my baby’s head in the stroller/bassinet? Does it matter what side I place it on?

As mentioned earlier, babies are unable to see distant objects in their first few weeks of life and their visual acuity and ability to see colours is underdeveloped. So, stimulating them and encouraging them to develop their sense of vision with the help of open books is certainly a good idea. These books should be placed closed to the baby’s head so that they are near their eyes and will usually have large black-white-red illustrations. The idea is to produce contrast in the images and shapes so that the baby can see them.

My baby’s eyes are sometimes crossed. Is this normal? Is it dangerous? Does it require treatment?

Babies’ eyes can sometimes appear to be crossed when they are under the age of 3 months (read more about crossed eyes or strabismus in children in the following link). This is normal, as long as it resolves within a few seconds and the eyes appear to be aligned most of the time. It is a good idea to tell your pediatrician about this so that they can also take a look, but most of the time this tends to resolve spontaneously by the time the baby is 3 months old.
If your baby’s eyes appear to be crossed all the time, regardless of whether they are under or over the age of 3 months, they must be seen by a pediatric ophthalmologist.

If strabismus (crossed eyes) tends to resolve spontaneously in babies, isn’t it better to simply wait for the baby to grow out of it?

Repair of strabismus is very important for the normal development of vision and the normal function of both eyes. In infants over the age of 3 months or babies under the age of 3 months with constant strabismus, there is no reason to “wait for them to grow out of it”. On the contrary, it is important to diagnose and treat their strabismus as soon as possible, to allow adequate treatment and to maximize the possibility of ideal results in terms of eye alignment and vision. I suggest you read more about strabismus in children and about the term lazy eye on this website.

Can I tell what my baby’s eye colour is going to be right after birth?

The million dollar question…
Many babies are born with light-coloured eyes (grey or blue). With time, as the eye develops, a dark pigmentation appears on the iris and the colour of the iris slowly changes. This process may continue until the infant is 1 year old, which is around the time the child gets their permanent eye colour. If you are trying to predict your baby’s eye colours, keep in mind the colour is more likely to remain permanent at around 9 months than it is in the previous months but I’ve heard from parents whose baby’s eye colour changed after 9 months too, so there are really no guarantees!

Am I allowed to let my baby watch television or look at my phone’s screen? Is this dangerous?

The world health organization recommends children under the age of 2 years to have no screen time at all (no television, videos, or phone games, etc). Children between the age 2 and 4 years are permitted up to an hour of screen time. Studies have found an association between screen time and sleep disorders, attention deficit disorders, obesity and anxiety. When it comes to visual disturbances – there is a wide range of information in the medical literature about the effect on different aspects of vision but the evidence is not strong enough for the composition of clear guidelines.
For children over the age of 4, there is no “magic” number for screentime that you can apply to all children. Families have their individual needs and considerations. As an ophthalmologist I can tell you that studies have shown that children that play outside in daylight between 1-2 hours a day tend to develop less nearsightedness. It is not clear whether this is because they spend less time watching screens or because there is something about the daylight or looking into indefinite distances that causes this (which is not possible at home, even in a large living room the farthest you can look is a few meters away).
I would like to invite you to read the summaries of two very interesting articles: the association between screen time, development in general and autism in particular.

How can we examine a baby’s eyesight?

Vision tests in babies include examinations performed by pediatricians at birth and at follow ups (the ability to follow objects and the red light reflex) and examinations performed by ophthalmologists.

What is the red light reflex?

All babies undergo the red light reflex test before they are discharged from the hospital for the first time – this is an exam in which the pediatrician looks into the baby’s pupils. The purpose of the exam is to make sure the baby’s lens are clear and that the inner parts of the eye have developed properly. Note that it is important to repeat this examination at the pediatrician’s office at the age of 2 months, 9 months, 18 months and 24 months.

How is vision examined at the pediatrician’s office?

At the age of 2 months, the physician will check whether the baby is able to follow an object (or a smiling face) from a 20-30cm distance. The baby is supposed to be able to move their head and eyes slowly from right to left and back, at an angle of 45 degrees in each direction. A baby’s first social smile (as a reaction to voice, stimulus or a human face) usually appears around age 1.5 months.
At the 4 months follow up visit, the baby is much more interactive with their surroundings. The baby will be able to make noises, respond to people and make fun interactions with their voice and will be able to laugh. The baby will also be able to follow an object (or a smiling face) vertically as it moves up and down.
Moving on to 7 months up to 1 year of age, we will find that the baby’s vision has improved drastically compared to when they were younger but is still not as good as adult vision. Their ability to see from far is much better, their ability to estimate distances improves, their ability to distinguish between different colours improves. Together with the different exciting changes that occur in terms of motoric development, more changes occur that are related to sense of vision. This is the stage at which a baby (and possibly his/her parents even more so!) starts enjoying peek-a-boo games, where the parents hide their face, or an object, and the baby rediscovers them and responds with excitement.
The sense of vision continues developing over the years and reaches its adult capacity only between ages 6-9 (!).

When is it recommended for a baby or child to visit an ophthalmologist for routine examinations?

According to the American Academy of Ophthalmology, vision screening is recommended at the following ages:
Newborn – red reflex, blink and pupil response
6-12 months – a second screening to repeat the tests mentioned above, inspect the eyes and check for eye alignment and movement
12-36 months – screening to make sure there are no risk factors for development of lazy eye
3-5 years – eye alignment is checked, visual acuity is checked as soon as child is old enough to read an eye chart
5 years and older – child is screened for visual acuity and eye alignment.

Who should be advised to see a pediatric ophthalmologist?

Some children need to see a pediatric ophthalmologist in addition to the above mentioned screening tests (often performed by pediatricians). These include:
Children who have a family history of eye disorders (parents/uncles/cousins with prescription lenses from a young age, lazy eye to strabismus, or a different eye disease known to have first appeared at a young age)
Children with motoric developmental delay
Children with speech problems
Children who tend to fall a lot or get caught up in objects
Children with nystagmus (a type of non-stop vibration in the eye)
Children with crossed eye or eyes that do not line up
If different reflexes appear in each of the child’s eyes when photos are taken
If a child has excessive tearing (find out more about the tear ducts in babies here)
If a child has to tilt or turn their head to see properly and is not able to look straight
If one eye is more shut than the other
If a child always shuts the same eye every time they are in the sun
And generally, if there is anything that is of concern to the parents, it is recommended to see a pediatric ophthalmologist. It is better to identify problems earlier than later, because the chances of repairing a problem and improving vision increases the younger the child is.
Keep in mind that children who are born prematurely are more prone to developing eye problems and for them the routine examinations are even more important.

What is the difference between a general ophthalmologist and a pediatric ophthalmologist?

A general ophthalmologist is one that has completed residency in ophthalmology and cares for many different eye diseases in different age groups.
A pediatric ophthalmologist will have completed a general ophthalmology residency as well as a sub-speciality (1 or 2 years) in pediatrics (working with premature babies, term babies, and children). Pediatric ophthalmologists have more experience with the approach needed to treat children in different ages (which is crucial for the proper diagnosis and treatment of children), hold special equipment at their offices for the examination of children and have more experience with recognizing and managing eye problems in children. Just like any other doctor who has a sub-speciality in pediatrics.

In summary, the development of vision during our childhood plays a vital role in our general development. It is important to make sure your child undergoes the recommended routine examinations at the pediatrician’s office and at the ophthalmologist’s. It is also very important to be aware of the red flags that require a special visit to the ophthalmologist’s office, for early diagnosis and management of problems that can affect vision, especially since early treatment can bring about better results.