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How do I know if my child’s development is normal?

The eye movements of newborns are very inaccurate.  They have fast and jerky movements, without the smooth coordination of normal visual fixation.  During the first several weeks after birth, infants develop accurate, smooth pursuant eye movements and central fixation.  A key developmental milestone for normal infants is the ability to fixate and accurately follow small objects by 2 to 3 months of age.  Normal infants may occasionally show delayed visual maturation; however, poor fixation past 6 months of age is usually pathologic, and should be fully investigated with a complete ophthalmologic examination.

Visual acuity is just one accept of eye development.  The alignment of the eyes also changes after birth.  Eye alignment at birth is variable with approximately 70% of infants showing a small variable exotropia, 30% having essentially straight eyes, and esotropia is considered rare.  Majority of normally developing infants have established proper alignment by 2-3 months of age.  Therefore, the persistence of a strabismus after 2 months of age may indicate ocular pathology, and these patients should be referred for ophthalmologic evaluation.

Summarized below are the key visual developmental milestones for young children:

Visual Developmental Milestones

Birth to 2 months

Pupillary response

Jerky eye movements in response to visual stimuli

Poor sporadic fix and follow

Variable alignment:  XT 70%, Straight 30%, ET rare

2-6 months

Blink and responds to visual threat

Accurate fixation on visual target

Central fix and follow

Precise smooth eye movements

Properly aligned eyes (straight)

Accommodation, binocular fusion and stereopsis

6 months – 2 years

Central fixation, accurate & smooth pursuit eye movements

3-4 years

VA 20/40 & not more than 2 line difference between the 2 eyes

5-6 years

VA 20/30 & not more than 2 line difference between the 2 eyes

7-9 years

VA 20/25 to 20/20 & not more than 2 line difference between the 2 eyes

Any deviation from the above mentioned eye developmental milestones warrant an ophthalmologic evaluation.

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