Children’s Eye Tests Before School: Why Little Eyes Deserve an Early Look

Stand at any school gate in September and you will spot them. Four year olds in bright blue frames. Toddlers in soft, bendy glasses with a strap round the back. Babies in pushchairs wearing tiny specs that somehow make them look even more pleased with themselves.

A generation ago this was unusual. Now it is just part of the picture, and we think that is one of the best things to happen to children’s eyesight in years.

If your little one is starting school soon, a children’s eye test is one of the simplest things to tick off the list before term begins.

And if you have a baby and are quietly wondering whether their eyes are developing as they should, this post is for you too.

No scare stories. Just what we see every week at Coleman Opticians in Norwich: what is normal, what is worth a closer look, and why spotting things early makes everything so much simpler.

 Why so many children wear glasses before school now, and why that is good news that children’s eye tests are easy to book.

It is easy to assume that more children in glasses means more children with problems. We see it the other way round. Children’s eyes have always needed help from time to time. What has changed is that we are far better at finding out early, and far more relaxed about doing something about it.

We still hear the old worries, though, and they deserve an honest answer.

• “Surely they are too young for glasses?” Babies can be prescribed glasses in their first year if they need them. The frames are designed for small faces, soft and flexible, and most little ones forget they are wearing them within a few days.
• “Won’t glasses make their eyes lazy or dependent?” No. For a young child the opposite is true. Glasses give the eyes a clear picture to work with, which is exactly what the developing visual system needs. Wearing them is what helps vision grow properly.
• “They will grow out of it, won’t they?” Sometimes a mild prescription does ease as a child grows, and we will tell you if that is likely. But a child cannot grow out of a problem that is quietly stopping one eye from developing. That one needs a helping hand, and the earlier the better.
• “I am worried they will get teased.” Walk into any Reception class and count the glasses. Children barely notice them any more, and the frames available now are ones they actually want to wear. Our children’s area has a wall of them, and choosing is usually the best bit of the visit.

And one more, which parents rarely say out loud: “How did I not notice?” Please do not be hard on yourself.

The most common childhood eye problems have no outward signs at all. That is not a failing on your part. It is simply why a children’s eye test exists.

Why the early years matter so much for your child’s vision

Children are not born seeing the way adults do. The eyes are there, but the connection between the eyes and the brain is still being wired up, and it carries on developing until a child is around seven or eight years old.

During those years the brain is learning how to see.

If one eye is sending a blurry picture, or the eyes are not working together, the brain quietly starts to favour the better eye and the other one gets left behind.

That is what a lazy eye (the medical name is amblyopia) actually is.

It is not a problem with the eye itself so much as a problem with the brain learning to ignore it.

Here is the positive part. While a child is still in that window, the brain is wonderfully adaptable.

Give it a clear picture from both eyes, nudge it to use the weaker one, and vision can develop almost as if nothing had happened.

Leave it until later and the same treatment has far less to work with. That is the whole reason the pre-school years are such a gift.

It is the time when small fixes make the biggest difference, and why an eye test before starting school is worth so much more than one a few years after.

Squint in babies: what is normal, and what is worth a check

New parents study their baby’s face more closely than anyone ever will, so you are well placed to notice things. A few pointers to help you know what you are looking at.

Wandering eyes in the first few months are usually fine. Newborns have not yet learned to hold both eyes steady together, so it is common to see one eye drift, especially when they are tired. By around four months the eyes should be straight and steady almost all of the time.

A turn that stays, or appears later, is worth a look. If one eye is turned in or out constantly at any age, or if any turn is still showing after about four months, book a baby eye test. This is not an emergency, and many squints respond beautifully to glasses alone, but it is one of the clearest early signs that an eye needs some help.

No turn does not mean no problem. This is the one we most want parents to hear. A child can have a lazy eye with perfectly straight eyes and nothing at all to see from the outside. Because they have never known anything different, they will not complain either. Straight eyes are reassuring, but they are not the whole story, which is why we recommend a children’s eye test for every child rather than only the ones who look as though something is up.

A couple of simple checks you can do at home. From about six weeks, your baby should start following your face as you move slowly from side to side. A little later, try gently covering one eye at a time with your hand while they look at a toy. If they are quite happy with one eye covered but get upset when you cover the other, it may be that the uncovered eye is the one they rely on, and the other is seeing less well. Neither of these is a diagnosis, but if anything feels off, trust your instinct and bring them in.

Watery, sticky eyes in babies are very often a tear duct that has not fully opened yet. It usually sorts itself out in the first year, and your health visitor or GP can show you a gentle massage that helps it along.

One thing to act on promptly: if you ever notice a white or cloudy look in the centre of your baby’s eye, or a white reflection in one pupil in a flash photo where the other is red, have it checked without delay. It is rare, which is exactly why it should never be put off.

Signs of eye problems in toddlers and pre-schoolers

Children this age cannot tell you the world looks blurry, because as far as they are concerned, this is how the world looks. So we watch what they do instead. The signs of eye problems in children are usually in their habits rather than their words.

• Sitting very close to the television, or holding books and tablets close to their face
• Tilting or turning their head to look at things, or watching with one eye closed
• Covering one eye, or being upset when one particular eye is covered
• Screwing up their eyes or frowning to see things in the distance
• Rubbing their eyes a lot when they are not tired
• Losing interest quickly in picture books, drawing or jigsaws, or avoiding anything close up
• Being clumsier than their friends, bumping into things or misjudging steps and kerbs
• One eye looking slightly different in photos, or an eye that drifts when they are tired or daydreaming
• Complaints of headaches or sore eyes after nursery, drawing or screen time
• A family history of squint, lazy eye or glasses in early childhood

Any one of these on its own may mean nothing. But if you have found yourself nodding along to two or three, that is reason enough to book a test.

And if your child shows none of them, book one anyway. Most of the children we help came in with no symptoms at all.

Common eye conditions in pre-school children, and how easily they are treated.

Here is what we actually find at a children’s eye test, and what tends to happen next. You will notice how often the answer is simply a pair of glasses.

Long-sightedness (hypermetropia). Almost all young children are a little long-sighted, and that is perfectly normal. Their eyes are small and their focusing muscles are strong enough to cope. The ones we help are the children with a lot of it. They can see, but only by focusing hard all the time, which is tiring and can pull one eye inwards. The fix is glasses, and the difference in a child who has been straining without knowing it can be lovely to watch.

Astigmatism. This simply means the front of the eye is shaped slightly more like a rugby ball than a football, so the picture is a little stretched or smeared at all distances. Very common, very easy to correct with the right lenses, and no cause for concern at all.

Short-sightedness (myopia). Less common in the very young, and more likely to appear in the primary school years, but we do see it in pre-schoolers. Glasses sort the blur straight away, and we can talk you through the options for keeping an eye on it as they grow.

Squint (strabismus). An eye that turns in, out, up or down. Many squints in young children are caused by long-sightedness and settle with glasses alone. Some need a patch for the stronger eye to encourage the weaker one, and a small number are helped by a simple operation at the hospital. We will always explain what we are seeing and what we recommend, and we refer on when that is the right thing to do.

Lazy eye in children (amblyopia). This is the big one, thought to affect around one in fifty children, and the main reason early testing matters. It usually happens because one eye has a stronger prescription than the other, or because of a squint, and the brain has quietly learned to switch the weaker eye off. Treatment is gentle and effective in young children: the right glasses first, then if needed a patch over the good eye for part of each day, or eye drops that do the same job for children who will not keep a patch on. Caught early, most children end up with good vision in both eyes. Caught late, that is much harder, and this is the one condition where the calendar really does count.

Different prescriptions in each eye (anisometropia). Often the hidden cause behind a lazy eye. The child sees fine with the better eye, so nobody notices. Glasses balance the two eyes up so the brain starts using both.

Across all of these, the pattern is the same. Found early, the treatment is simple, inexpensive, and often just a pair of glasses the child will happily wear. That is why we are so keen to see children before they start school, not after.

Does school check children’s eyes?

In England, the NHS recommends a vision screening for children in Reception, at age four to five. Where it happens, it is a useful safety net and well worth saying yes to. But two things are worth knowing. It is not offered in every area, and it is not a full eye examination. Screening checks how well each eye sees on the day. It does not measure a child’s prescription, look at the health of the eye, or check how the eyes work together. So please do not wait for a letter from school. Treat screening as a bonus, not a substitute for a proper children’s eye test.

What happens during children’s eye tests?

Children cope with it far better than most parents expect. Children’s eye tests are built around play. Your child does not need to know their letters, because we use pictures, shapes and matching games instead. We check how each eye sees, whether the eyes work together, and the health of the inside of the eye, and there is plenty we can tell from watching how a child looks at things, without needing any answers from them at all.

For some younger children we use eye drops that relax the focusing muscles for a few hours. This lets us measure the prescription accurately, because little eyes are so good at focusing that they can hide a lot of long-sightedness.

The drops sting for a moment and leave things a bit blurry and bright for the afternoon, so we will explain beforehand and let you plan a quiet rest of the day.

Our practice on St Augustine’s Street is child friendly and we have a proper selection of frames made for small faces, including soft, flexible frames for babies and toddlers and sturdier ones for the school playground.

We even stock the Indii Kids Flexible Memory Plastic Eyewear range

Our team see children every day, and there is no such thing as a child who is too young, too shy or too wriggly for us.

Free NHS eye tests for children under 16

Every child under 16 is entitled to a free NHS eye test, and young people aged 16 to 18 in full-time education are too. If your child needs glasses, the NHS also provides a voucher towards the cost, which means many children’s glasses cost nothing at all. There is help towards repairs and replacements as well, and anyone who has lived with a three year old will appreciate why that matters.

Children’s eyes change as they grow, so once they are being seen we will tell you how often to come back. For most it is every year or two, and sooner if anything changes.

You can read more about eye tests in children on the NHS website, and about Reception vision screening on GOV.UK.

Children’s eye test questions parents ask us

At what age should my child have their first eye test? Any age at all if you have a concern. Otherwise we like to see children by the time they are three or four, and certainly before they start school.

Does my child need to know their letters? No. We use pictures, shapes and matching games, and for babies and toddlers we can check a great deal simply by watching how they look at things.

Is a children’s eye test free? Yes. The NHS pays for eye tests for all children under 16, and provides a voucher towards glasses if they are needed.

What if my child will not sit still? That is most children. We work at their pace, take breaks when we need to, and if we do not get everything done in one go we simply pick it up another day.

How to book a children’s eye test in Norwich

Paediatric eyecare is a specialism we care deeply about, and we have shaped the practice around it, from the way we test to the frames on the wall.

If your little one is starting school soon, or you simply want the reassurance of knowing their eyes are developing well, we would love to see them.

• Book a children’s eye test online, any time of day or night
• Call us on 01603 624564 and the team will find a time that fits around naps and nursery
• Or call in to see us at Coleman Opticians on St Augustine’s Street, Norwich, just outside the ring road, with up to 2 hours free parking very close to Coleman Opticians

Most children we see have healthy eyes and leave with nothing more than a sticker and a clean bill of health.

For the ones who need a little help, finding out now, while their vision is still growing, is the kindest thing you can do for them.

See you soon.