The child health record book: which eye checks it lists, and what to do if a box is blank
The kad kesihatan is more than immunisation stamps. Which eye boxes the Ministry of Health's book prints, when they are filled in, and what to do when one is blank.
- The 2021 Ministry of Health child health record prints eye rows at the newborn examination, one month and 18 months, and a full eye page at four years.
- The four-year eye page records the outside of the eyes, the vision of each eye separately, and a light reflex test, with a box for referral.
- The 0 to 6 book is not where school screening is written. The school health team keeps its own record for each pupil.
- A blank box means a check was not written down. Take the book to the klinik kesihatan, point to it, and ask for the eyes to be checked and recorded.
- A white or cloudy pupil, a red eye that does not settle, or an eye that turns should be seen by an eye doctor without waiting for the next visit.
Most parents call it the kad kesihatan or the child's health book. Its printed name is the Buku Rekod Kesihatan Bayi dan Kanak-Kanak (0 hingga 6 tahun), the Ministry of Health record that comes home from the maternity ward and goes to every klinik kesihatan visit. Parents know the immunisation pages. Fewer know that it also has a few lines about the eyes, and one whole page.
This page walks through those boxes as printed in the 2021 edition (Pindaan 03/2021) on the Ministry's website. Older or other printings may differ. It also covers the question behind most searches for the kad kesihatan: what do I do if a box is blank? A blank box does not mean your child's eyes are unhealthy. It means a check was not written down, and that can be put right.
Which eye checks are written in the child health record book?
Four points in the first four years: the newborn examination, the doctor's check at one month, the doctor's check at 18 months, and a separate eye page at four years. At three to four months and at six months the book also asks whether your baby fixes on an object and follows it with the eyes.
The Ministry's visit schedule runs monthly to six months, every two months to a year, every three months to under two, every six months from two to four, and yearly at five and six. Three of those visits are marked as a medical officer's examination: one month, 18 months and four years. The four-year row also lists "pemeriksaan penglihatan", a vision check.
It is just as useful to know what is not there. This edition has no eye row between 18 months and four years, and at five and six the schedule lists growth, development and diet advice with no eye item. That is the gap school screening is meant to meet, which the fourth section below explains.
What is written at the newborn, one-month and 18-month checks?
A single row, "Eyes (including red light reflex)", with a tick under normal or abnormal and a space for notes. The newborn row is filled in by a medical officer. The one-month and 18-month pages are headed as the medical officer's examination too.
The red reflex is the orange-red glow that comes back from the retina, the light-sensing layer at the back of the eye, when a light is shone in. It is the same glow you sometimes see in a flash photograph. The NHS says a red reflection should be seen, and that a white reflection could be a sign of an eye problem. A baby's first eye check explains what the examiner does and why a dull or white glow is followed up.
What a tick does not tell you matters as much. It records that the glow and the outside of the eye looked normal on that day. It is not a measure of how well your baby sees, and it cannot show an eye that turns in or out only some of the time. If you have noticed something at home, say so at the visit and ask for it to go in the notes.
What is on the eye page at four years?
A full page headed "Pemeriksaan Mata pada Umur 4 Tahun", in three parts, signed by whoever did the examination. Part A is a look at the outside of the eyes. Part B records the visual acuity, how sharp the sight is, for the right eye and the left eye separately. Part C is a light reflex test.
Part A has eight yes-or-no lines: swelling around the eyes, watering, discharge, sunken eyes, a growth on the white of the eye, the colour of the two irises not matching, a pupil that is not round, and a white pupil. The printed note says to refer to the medical officer if the eyes are red or the pupil looks cloudy or white.
Part B has a line for each eye without glasses, with glasses, and with glasses and a pinhole. The book does not name the chart, so ask which one was used if you are curious.
Part C is the Hirschberg test: a light is held in front of the child and the examiner marks where its reflection falls on each eye, which shows whether the two eyes point the same way. At the foot of the page the examiner circles whether your child was referred, and where. The medical officer's four-year page repeats the red reflex row and has a referral box of its own.
Is vision screening at preschool and school written in the same book?
No. The school health team keeps its own record for each pupil, and the 0 to 6 book is not where school results go. The Ministry's portal lists vision among the basic checks for preschool pupils, and "saringan penglihatan" under Tahun 1. The Ministry's school procedure uses a Snellen letter chart, one eye at a time, and a referral letter when a child falls short.
The sources do not say which preschools are visited. A child in a private tadika may be left out, so ask the tadika whether the school health team comes, and read what a tadika can and cannot require. When your child's eyes are actually checked in Malaysia sets the clinic and school checks side by side, and the school vision letter explains what a referral tick means.
A box is blank or we missed a visit. What do I do?
Take the book to the klinik kesihatan, point to the blank line, and ask whether the eye check can be done and written in now. Say plainly that you want the eyes looked at, not only weight and immunisation. Missing a visit is common, and nobody needs to be blamed for it.
Do not wait for the next stamped visit if the missing check is the four-year eye page and your child is already past four. The book does not say whether every clinic will complete that page late, so ask, and if the answer is no or you are unsure, a first eye test by an eye doctor does not need a clinic's permission. The first eye test before school describes how it works for a child who cannot read letters yet.
If you need a government hospital eye clinic, the usual route is a referral letter from the klinik kesihatan, which asking for a referral walks through. Ask the clinic to write what they saw in the notes column, so the next doctor can read it.
When should I see an eye doctor instead of waiting for the next visit?
When you see a white or cloudy pupil, a red eye that does not settle, an eye that turns in or out, or a baby who does not follow your face or a toy by about three to six months. The book's own note for the four-year page says the same about red eyes and white or cloudy pupils. The next scheduled slot is for routine checks, not for a worry you have now.
A white glow in one eye in a flash photograph needs an eye doctor this week, and the page on white glow in photos explains why. The AAO also lists a vision complaint or odd visual behaviour, prematurity, Down syndrome, juvenile arthritis, and a family history of squint, lazy eye, cataract, glaucoma or eye cancer as reasons for a full eye examination without waiting for a routine check.
For anything else, the NHS puts it simply: speak to a doctor if you have any concern about your child's vision at any stage. Bring the book, because it shows what has already been checked and saves the next doctor from starting from nothing.
- A white or cloudy pupil, or a white glow in one eye in a flash photograph.
- An eye that turns in or out, or a baby who does not follow your face or a toy by three to six months.
- A red eye that does not settle, or swelling around the eye.
- Your child is past four and the four-year eye page is blank.
Common questions
What is the kad kesihatan kanak-kanak, and is it the same as the Buku Rekod Kesihatan?
Which eye checks does the child health record book list?
What is the red reflex row in the book?
What happens at the four-year eye check in the book?
The eye box in my child's book is blank. What should I do?
Is school vision screening recorded in the same book?
When should I see an eye doctor instead of waiting for the next clinic visit?
- Kementerian Kesihatan Malaysia · Rekod Kesihatan Bayi dan Kanak-kanak (0-6 tahun), Pindaan 03/2021 · hq.moh.gov.my
- Kementerian Kesihatan Malaysia, Bahagian Pembangunan Kesihatan Keluarga · Jadual lawatan ke Klinik · hq.moh.gov.my
- MyGovernment (malaysia.gov.my) · Kesihatan Sekolah untuk Murid Pra-Sekolah · www.malaysia.gov.my
- MyGovernment (malaysia.gov.my) · Kesihatan Sekolah bagi Murid Sekolah Rendah · www.malaysia.gov.my
- Kementerian Kesihatan Malaysia · Prosedur Operasi Piawai Perkhidmatan Kesihatan Sekolah (2013) · hq.moh.gov.my
- NHS · Eye tests for children · www.nhs.uk
- American Academy of Ophthalmology · Eye screening for children · www.aao.org