Glasses

How to tell if your child needs glasses: the signs from baby to 12, and what the eye check involves

Children rarely say they cannot see. These are the signs by age, from baby to 12, the children who show none at all, and what the eye check involves, so you know when to book.

by Dr Chan Li Yen · MBBS, MOphth (UM), Fellowship in Paediatric Ophthalmology & Strabismus

Dr Chan Li Yen, consultant paediatric ophthalmologist, MMC 43128, NSR 132980 · Eagle Eye Centre Kuala Lumpur, Petaling Jaya

12 min read · 2,206 words

Key takeaways

Children often do not complain of blurred vision, especially when only one eye is affected, so the signs are indirect and some children show none at all.
In a baby the clues are an eye that turns, a white pupil in a flash photo or extreme sensitivity to light. In a preschooler they are sitting close, squinting, tilting the head, covering one eye and rubbing the eyes.
In school-age children short-sightedness is the usual cause: trouble with the board, sitting close, rubbing the eyes and losing the place when reading. It typically starts between 6 and 13.
A headache alone is a weak sign: in one clinic study, frequent headaches had no significant link with needing glasses. A headache together with other signs is worth a check.
The check is a vision test suited to the age, a look at alignment and usually drops to relax focusing. A child does not need to read. Guidance runs from every one to two years after age five to every year.

Children rarely say "I can't see". They sit closer, narrow their eyes, lose their place on the page, or say nothing at all. This page is for the parent trying to work out whether a child needs glasses before anyone has said so: the signs from baby to 12, why some children show none, and what the eye check involves.

Will my child tell me if they cannot see properly?

Usually not. AAPOS says kids often do not complain about blurry vision, especially if only one eye is affected, and the American Optometric Association says a child may think the way they see is the way everyone sees. So the signs are indirect, and for some children there are none.

The one-eye case is the hardest to spot. When the two eyes need different prescriptions, a condition called anisometropia, AAPOS explains that the brain uses the eye that sees better, so a parent notices nothing at home. The blurrier eye is the one that can turn into a lazy eye, which squint and lazy eye in children explains, and the hidden lazy eye covers this straight-eyed kind in full. That is why I would book a check rather than rely on a checklist.

What are the signs a baby might need glasses?

A baby cannot show it. What a parent can see is an eye that turns in or out, a white pupil in a flash photo, or extreme sensitivity to light. The American Optometric Association lists all three among the signs to act on, and the checks around the baby do the rest.

The NHS checks eyes within 72 hours of birth and again at 6 to 8 weeks. The AAO and AAPOS joint statement asks for alignment, the light reflex and following behaviour to be assessed at each routine well-child visit from one month, and says photoscreening or handheld autorefraction may be used from 12 months. An eye doctor can measure a baby's glasses power with an instrument called a retinoscope, without the baby saying a word, and how we test children's eyes describes it. If an eye turns, cross eyed baby: what is normal sets out the timetable, and when a baby should have a first eye check covers the first visit.

What are the signs in a toddler or preschooler?

Sitting very close to the TV or holding a book too close, squinting, tilting the head, covering one eye, rubbing the eyes, and an eye that turns in or out, says the American Optometric Association. The NHS adds clumsiness and poor hand-eye coordination. Children this age generally do not voice complaints.

Two of these are often mixed up. Squinting means narrowing the eyes to see. A squint is an eye that turns, and its causes and treatment are different. A child who shuts one eye in bright sun may have an intermittent exotropia, which AAPOS lists, rather than a glasses problem. The squint that comes and goes has the detail.

Long-sightedness is the one that surprises parents. The AAO and AAPOS joint statement says mild to moderate long-sightedness is normal in preschoolers and usually needs no glasses, but high or uneven amounts can cause blur, a lazy eye or a squint unless treated. So a child who sees fine can still need them, as long-sightedness: glasses for a child who sees fine explains. Sitting close to the screen has its own page, why does my child sit so close to the screen. The same statement asks for formal vision testing as soon as a child can do it, generally at three and a half to four years, and by five at the latest. When your child's eyes are actually checked in Malaysia sets out what is offered here.

What are the signs in a school-age child, from 5 to 12?

Usually short-sightedness. The NHS says it typically starts between 6 and 13, and the signs are trouble reading the board, sitting close to the TV or computer, headaches and rubbing the eyes. The AAO adds losing the place while reading, avoiding close work, a short attention span and turning the head to one side.

In a 2003 survey of school children in Gombak District, Selangor, myopia was found in 9.8% of 7 year olds and 34.4% of 15 year olds. Teachers can notice the board problem before parents do, and what your child's teacher notices and the homework headache cover it. The AAO says a head turned to the side can be a sign of astigmatism, and AAPOS says astigmatism blurs vision at all distances. Astigmatism in children, explained goes through it.

Headaches need care. The AAO reports a clinic study in which frequent headaches had no significant link with needing glasses, and headaches improved in 75% of children whether or not they got a new prescription. A headache alone is a weak sign. A headache together with squinting, sitting close or trouble with the board is worth a check. If the school has sent a letter, the school vision letter explains the tick, and myopia control in Malaysia is the guide for what comes after a short-sighted result.

Can my child need glasses even if they see fine and say nothing?

Yes. A child can need glasses with no signs at all. When one eye is much blurrier the better eye covers for it. Long-sightedness can be hidden by focusing effort, so the child sees well while high or uneven amounts still do harm. And astigmatism blurs near and far alike, in a child who has never seen another way. The answer is a test, not a checklist.

Malaysian surveys show how often this goes unseen, though they are local samples. In Segamat, Johor, 12.5% of 1,287 kindergarten children aged 4 to 6 had reduced vision, and glasses-type errors made up 95% of the eye problems diagnosed. In the same Gombak survey of 4,634 children aged 7 to 15, more than half of those who needed glasses did not have them.

The reverse also holds: not every sign means glasses. A headache may not be the eyes, an eye that looks crossed in photos may only be the nose bridge, as my baby looks cross-eyed in photos explains, and small amounts of long-sightedness need nothing. That is why guessing helps less than looking.

What does an eye check for glasses involve?

A vision test suited to your child's age, a look at how the eyes line up, usually drops that relax focusing so the glasses power is measured accurately, and a look inside the eye. A child does not need to read letters.

The NHS describes picture-based tests for younger children and letter charts for older ones, and the American Optometric Association notes that a child does not have to know the alphabet to be examined. AAPOS says drops that relax the focusing muscles let the eye doctor check properly whether a child needs glasses. They sting briefly, near vision stays blurred and light feels bright for some hours, and about those eye drops at the clinic and getting eye drops into a small human cover the practical side. Who can check my child's eyes in Malaysia sorts out the optometrist from the eye doctor.

How often? Guidance differs. The AAO and AAPOS joint statement suggests screening every one to two years after age five, and the American Optometric Association says every year, or more often when there are problems or risk factors. A child who already wears glasses is seen at the interval the eye doctor sets. Your six-year-old has never had an eye test is for the child who has never been checked.

What happens if the check says yes, and where do I start in Malaysia?

Your child gets a prescription, and the work is wearing it as advised. AAPOS says to ask whether glasses should be worn all the time or only for some activities, that they will not weaken a child's eyes or make a child more dependent on them, and that most children adjust within about two weeks.

What the first weeks in glasses look like covers that fortnight, why a toddler pulls off glasses covers the small ones, and reading your child's myopia prescription explains the numbers. For cost, free and subsidised glasses for school children in Malaysia lists what exists. If the check finds a turn or a lazy eye, the squint and lazy eye guide is the next page, and finding a children's eye specialist in KL and Selangor helps with where to go.

Some things should not wait for any of this. An eye that turns and stays turned, or a white glow in a flash photo, means booking now. For everything else, a child who squints at the TV does not need to wait for a letter from school to be seen.

Don't wait for a check-up if…

An eye turns in or out and stays turned, at any age.
A flash photo shows a white or golden glow in a pupil.
A baby is extremely sensitive to light.
Your child says they see double.

Common questions

How do I know if my child needs glasses?

You often cannot tell from home, because children rarely say they cannot see. Signs include sitting close to screens, squinting, tilting the head, covering one eye, rubbing the eyes, trouble with the board and losing the place when reading, but some children show none. An eye check is what settles it.

What are the signs of short-sightedness in a child?

The NHS lists difficulty reading words from a distance, such as the whiteboard, sitting close to the TV or computer, headaches and rubbing the eyes. It usually starts between 6 and 13. Near vision usually stays clear, which is why a short-sighted child can read a book comfortably and still miss the board.

Can a child need glasses and not complain?

Yes. AAPOS says kids often do not complain about blurry vision, especially if only one eye is affected, and when the two eyes need different prescriptions the brain uses the better eye. The American Optometric Association notes a child may think the way they see is the way everyone sees.

My child squints at the TV. Does that mean glasses?

It can, and it is worth a check. AAPOS says that if you notice your child squinting, holding things too close or struggling to see, you should talk to an eye doctor. Squinting means narrowing the eyes. It is different from a squint, an eye that turns, and a child who closes one eye in bright light may have an intermittent exotropia.

Do headaches mean my child needs glasses?

Not on their own. The AAO reports a clinic study in which frequent headaches in children had no significant link with needing glasses, and headaches improved in 75% of children whether or not they got a new prescription. A headache together with squinting, sitting close or trouble with the board is worth an eye check.

At what age can my child have an eye check for glasses?

At any age. A baby needs no words, because an eye doctor can use a retinoscope to find the prescription, and a child does not need to know the alphabet to be examined. The AAO and AAPOS joint statement asks for formal vision testing as soon as a child can do it, generally at three and a half to four years, and by five.

Does a school or klinik kesihatan screening replace an eye check?

No. A screening is a quick check for reduced vision, and the AAO and AAPOS joint statement says a child who does not pass should be referred for a fuller assessment. The American Optometric Association separates it from a full eye examination. A child who passes but keeps squinting or sitting close should still be examined.

How often should my child's eyes be checked?

Guidance differs. The AAO and AAPOS joint statement suggests screening every one to two years after age five, and the American Optometric Association says every year, or more often when there are problems or risk factors. A child who wears glasses is seen at the interval the eye doctor sets.

Will wearing glasses make my child's eyes weaker?

No. AAPOS says wearing glasses will not worsen a child's eyesight or make a child more dependent on glasses. Most children adjust within about two weeks, and the eye doctor will say whether the glasses are for all the time or only for some activities.

References

AAPOS · Refractive errors in children · aapos.org
AAPOS · Anisometropia · aapos.org
AAPOS · Glasses for children · aapos.org
AAPOS · Dilating eye drops · aapos.org
AAPOS · Exotropia · aapos.org
AAO and AAPOS · Vision screening for infants and children, joint policy statement 2022 · www.aao.org
American Academy of Ophthalmology · Four hidden signs of vision problems in kids · www.aao.org
American Academy of Ophthalmology · Headaches and eye problems · www.aao.org
American Optometric Association · Infant vision: birth to 24 months of age · www.aoa.org
American Optometric Association · Preschool vision: 2 to 5 years of age · www.aoa.org
American Optometric Association · School-aged vision: 6 to 18 years of age · www.aoa.org
NHS · Short-sightedness (myopia) · www.nhs.uk
NHS · Eye tests for children · www.nhs.uk
Goh et al. · Refractive error and visual impairment in school-age children in Gombak District, Malaysia, Ophthalmology 2005 · pubmed.ncbi.nlm.nih.gov
Chew et al. · Visual impairment and amblyopia in Malaysian pre-school children, the SEGPAEDS study, Med J Malaysia 2018 · pubmed.ncbi.nlm.nih.gov

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.