Learn more about the signs of vision impairment in babies and toddlers, professionals that support babies and toddlers with vision impairment and how to get Early Intervention supports whether you’re a parent or professional.

A child’s visual system is one of the last sensory systems to develop fully but plays a role in ensuring the proper development of many other sensory systems. 

Think about how much harder it is to maintain your balance while standing when your eyes are closed vs. when they are open.
As adults, we have already mastered learning to walk, talk, and many other self-care skills such as eating, dressing, toileting.  

But what about young children with visual impairments that are just learning these skills for the first time?

When our visual system is impaired, gross motor, fine motor, balance, and self care skills often take longer to master and other sensory systems need to be relied on.  

According to the CDC, Approximately 6.8% of children younger than 18 years in the United States have a diagnosed eye and vision condition. 

Early detection of vision impairments in young children is critical since vision and hearing are responsible for 80-90% of learning during a child’s first year of life. 

What is a vision impairment?

Visual impairment including blindness…

…means an impairment in vision that, even with correction, adversely affects a child’s ability to learn and develop. The term includes both partial sight and blindness. 

What are some visual impairments diagnosed in young children?

Coloboma : a congenital defect in the structure of either the eyelid or the eye.

Microphthalmia : a condition in which one or both eyes are unusually small.  An individual with microphthalmia may have accompanying birth defects, as microphthalmia is a genetic mutation. 

Retinopathy of prematurity (ROP) is a potentially blinding disease caused by abnormal development of retinal blood vessels in premature infants. 

Optic Nerve Hypoplasia is a congenital condition in which the optic nerve is underdeveloped. 

Amblyopia is the condition where one eye has not developed vision as fast or as completely as the fellow eye. The eye with the poorer vision is called the amblyopic eye; it is commonly referred to as "lazy eye." Usually only one eye is affected by amblyopia.

Strabismus is characterized by unequal action of the six extraocular eye muscles, causing a misalignment of the eyes. The imbalance may be of the horizontal or vertical axis and results in difficulties with functional vision.  

Congenital cataracts: where the lens of the eye is cloudy

Retinitis Pigmentosa: a rare inherited disease that slowly destroys the retina

Cortical Visual Impairment (CVI): caused by damage to the part of the brain related to vision, not to the eyes themselves.

How might a vision impairment affect child development?

A visual impairment may cause:

• delayed gross motor skills such as rolling, sitting, walking and reaching out for objects.

• delayed fine motor skills, for example picking objects up and manipulating objects with fingers and hands.

• a “head down” posture and cause poor body awareness.

• poor confidence to move in the environment.

• difficulties with balance.

• Hypotonia and poor posture.

• other sensory issues such as tactile defensiveness (eg. your child might be afraid to touch certain textures or explore areas they can’t see ).

• acute sensitivity to noise.

What are some signs that your child may have a vision impairment?

Babies and toddlers can’t be assessed for a vision impairment the same way an adult can since they are not able to read an eye chart or report their symptoms.

Optometrists and Opthalmologists have other ways to detect vision impairments in young children but being aware of some signs of a visual impairment is necessary for any professional or caregiver working with young children. 

Generally speaking, some crossing of the eyes is normal up to 4 months of age. After 4 months old, babies should be able to fix and follow an object using both eyes that move smoothly in all planes to follow the object.

Read here about other warning signs of vision problems in children.

Which professionals work with children with vision impairments?

• Ophthalmologist: a medical doctor (MD will follow the person’s name) who has gone through college, followed by four years of medical school and completed an internship and residency. Ophthalmologists diagnose and treat eye diseases and can perform surgery. 

• Optometrist: will have the initials OD after his or her name. Optometrists have completed college and three to four years of optometry school. They do not perform surgery. Instead, they focus on helping patients maximize the use of their vision. They do this by prescribing eyeglasses or contact lenses and, if appropriate, low vision devices such as magnifiers, monoculars, or video magnifiers, which are also referred to as closed-circuit televisions (CCTVs). Optometrists or their assistants may teach children how to use low vision devices. In some states, optometrists are allowed to prescribe medications and diagnose eye diseases; in other states, they are not.

• Certified low vision therapist (CLVT)/TVI: has completed an internship and passed an exam to demonstrate knowledge of low vision. The CLVT conducts a functional vision assessment (FVA) to determine how a child is using his or her vision for education, recreation, and daily living tasks. The low vision therapist may also be a teacher of students with visual impairments (TVI) or an orientation and mobility (O&M) specialist.

• Occupational Therapist: a health care professional that specializes in helping families and children with the things they want and need to do in everyday life. An Occupational Therapist may help children with vision impairments:

  • develop gross motor skills

  • develop fine motor skills

  • develop body and spatial awareness

  • assist with developing balance

  • assist with proprioception and sensory issues

  • develop movement and language through co-active demonstration and play

  • work with a mobility instructor to help develop independence in walking

  • assist your child to find ways to get involved in games and sports with peers

  • develop some strength-building activities into daily life

  • advise on toys and equipment necessary for the home, school and other important environments.

Other Early Intervention professionals: This may include physical therapy, speech therapy, social work, and other developmental specialists.

What is Early Intervention?

Early Intervention is a state funded program that provides services and supports to babies and young children (typically birth to 3 years old) with developmental delays and disabilities and their families.

How do I find an Early Intervention program?

To contact your local Early Intervention agency, speak with your pediatrician about a referral or contact your local state Human Services division.  

You can also find a list of programs and contacts for each state by clicking HERE.

Trust your instincts!

There are many resources available to help children with visual impairment.  Early detection and treatment is key to successful development for young children. 

Trust your gut if you suspect your child is having any vision difficulties and speak with your medical professionals.

Are you an Occupational Therapist wanting to learn more about supporting babies and toddlers with vision impairments?

Join The Therapy Village today where we will be inviting Paula Landry, EI-TVI from A Shared Vision to speak with us to learn how to perform vision screenings for young children, intervention strategies to use when coaching families and to answer our burning questions about vision as well as troubleshoot our challenging cases. 

Find out more about becoming a member of The Therapy Village here.